tag:theconversation.com,2011:/id/topics/plastic-surgery-1094/articlesPlastic surgery – The Conversation2023-10-03T15:17:34Ztag:theconversation.com,2011:article/2145172023-10-03T15:17:34Z2023-10-03T15:17:34ZCosmetic surgery boosts some people’s mental health – but for others it makes problems worse<figure><img src="https://images.theconversation.com/files/551682/original/file-20231003-17-eqmv5e.jpg?ixlib=rb-1.1.0&rect=49%2C16%2C5550%2C3672&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many hope having cosmetic surgery will bring real mental health improvements.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-beautiful-female-customer-mirror-getting-2282971349">Oleksandr Berezko/ Shutterstock</a></span></figcaption></figure><p>Demand for cosmetic procedures is <a href="https://baaps.org.uk/about/news/1872/cosmetic_surgery_boom/">higher than ever</a>. From breast augmentations to “tweakments” such as lip fillers and Botox, <a href="https://www.isaps.org/discover/about-isaps/global-statistics/reports-and-press-releases/global-survey-2021-full-report-and-press-releases">more and more people</a> around the world each year are undergoing procedures to change how they look.</p>
<p>There are <a href="https://www.healthline.com/health-news/more-people-getting-plastic-surgery#Advice-for-the-cosmetically-inclined">many reasons</a> why cosmetic procedures may be on the rise, from falling costs and lower stigma to <a href="https://www.itv.com/news/2023-07-24/the-rise-of-tweakments-what-to-look-out-for-when-getting-cosmetic-injectables">social media</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6604085/">Instagram filters</a>.</p>
<p>But a major reason behind the decision to undergo cosmetic procedures remains a desire to <a href="https://journals.lww.com/plasreconsurg/abstract/2006/01000/psychosocial_factors_predicting_the_motivation_to.9.aspx">improve body image</a> – the way we think and feel about our bodies. Research also shows that people who have <a href="https://journals.sagepub.com/doi/abs/10.1177/1049732310362984?casa_token=vfB7mol5VPUAAAAA:qcppwO8j1lK4CgRIf1Tz1z_Z_7QEbVh3ANG62a4cFyfXCWIPkV-RRxIpIVL6Fj3c-P4vYMQBQVs">low self-esteem</a> or who have been teased about their appearance are more likely to have cosmetic surgery.</p>
<p>Many people who have cosmetic surgery expect it will bring <a href="https://journals.sagepub.com/doi/abs/10.1177/1049732310362984?casa_token=vfB7mol5VPUAAAAA:qcppwO8j1lK4CgRIf1Tz1z_Z_7QEbVh3ANG62a4cFyfXCWIPkV-RRxIpIVL6Fj3c-P4vYMQBQVs">mental health improvements</a>. But does it actually? Unfortunately, the answer to this question <a href="https://journals.lww.com/jonmd/Fulltext/2022/07000/The_Psychological_Benefits_of_Cosmetic_Surgery.2.aspx?casa_token=Gzt5XaiXGtgAAAAA:ejoze7iHaIadH-nv1l3_Hq6deFgjtgg2PE7ERAh4Al1pRJ_dqxd5xHSQnUaHQBFEDWW_DUJEfzFyR5oHEGYX-Wx0_XAn">isn’t clear-cut</a> – and the outcome depends on many factors, including some that are outside our control.</p>
<hr>
<figure class="align-right ">
<img alt="Quarter life, a series by The Conversation" src="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em><strong><a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">This article is part of Quarter Life</a></strong>, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/body-dysmorphic-disorder-what-to-know-about-this-mental-health-condition-206243?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Body dysmorphic disorder: what to know about this mental health condition</a></em></p>
<p><em><a href="https://theconversation.com/three-steps-for-getting-over-social-media-envy-advice-from-a-psychologist-214446?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Three steps for getting over social media envy – advice from a psychologist</a></em></p>
<p><em><a href="https://theconversation.com/social-media-how-to-protect-your-mental-health-187935?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Social media: how to protect your mental health</a></em></p>
<hr>
<h2>Body image improvements</h2>
<p>A number of studies have found that cosmetic surgery patients do experience <a href="https://academic.oup.com/asj/article/28/3/245/268521">improvements in their body image</a> following a cosmetic procedure.</p>
<p>For example, <a href="https://journals.lww.com/dermatologicsurgery/abstract/2010/12004/a_double_blind,_randomized,_placebo_controlled.3.aspx">one study</a> showed that participants who’d had Botox felt they were more attractive, were less self-conscious and felt more satisfied with their appearance up to three months later.</p>
<p>Cosmetic surgery may also improve feelings about the specific feature that was altered. One study of women who’d undergone breast augmentation found they generally reported <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4879787/">greater satisfaction</a> with breast appearance up to four years post-surgery. </p>
<p>Another study of people who’d had rhinoplasty (what’s often called “a nose job”) found they were <a href="https://www.liebertpub.com/abs/doi/10.1001/jamafacial.2015.1445">generally satisfied</a> with the appearance of their nose several months afterwards – and were more satisfied with their face’s overall appearance, too.</p>
<p>These body image improvements aren’t short lived either, with some studies showing improvements enduring even <a href="https://journals.lww.com/plasreconsurg/Fulltext/2011/09000/Psychosocial_Changes_after_Cosmetic_Surgery__A.26.aspx">five years</a> post-surgery. </p>
<h2>Other mental health outcomes</h2>
<p>The effect that cosmetic surgery has on other psychological outcomes is less clear, however.</p>
<p>Some studies looking at the impact of <a href="https://journals.lww.com/jonmd/Fulltext/2022/07000/The_Psychological_Benefits_of_Cosmetic_Surgery.2.aspx?casa_token=Gzt5XaiXGtgAAAAA:ejoze7iHaIadH-nv1l3_Hq6deFgjtgg2PE7ERAh4Al1pRJ_dqxd5xHSQnUaHQBFEDWW_DUJEfzFyR5oHEGYX-Wx0_XAn">cosmetic surgery on self-esteem</a> – our overall sense of worth or value – have shown cosmetic procedures only improve it in the short term. </p>
<p>But other studies have found cosmetic surgery <a href="https://academic.oup.com/asj/article/28/3/245/268521">doesn’t improve self-esteem</a> at all. This is particularly true when researchers look at things in the long-term, finding that any improvements in self-esteem immediately after a procedure have had faded after <a href="https://journals.lww.com/annalsplasticsurgery/abstract/2009/02000/a_prospective,_multi_center_study_of_psychosocial.5.aspx">several years</a>.</p>
<p>Researchers have also looked at the relationship between cosmetic surgery and <a href="https://journals.lww.com/jonmd/Fulltext/2022/07000/The_Psychological_Benefits_of_Cosmetic_Surgery.2.aspx?casa_token=Gzt5XaiXGtgAAAAA:ejoze7iHaIadH-nv1l3_Hq6deFgjtgg2PE7ERAh4Al1pRJ_dqxd5xHSQnUaHQBFEDWW_DUJEfzFyR5oHEGYX-Wx0_XAn">symptoms of depression</a>. For example, a study of people who’d had rhinoplasty found that while some reported <a href="https://journals.sagepub.com/doi/abs/10.2500/ajra.2011.25.3649?casa_token=jFySfrD42p0AAAAA:3CCwVTBbnrccJCB3ZwQCCOrvyUV8f5vS8xgyCrUgWKLWb6nsNP5k17IBNQr7mg29HA11e8k5URs">lower symptoms of depression</a> post-surgery, most showed no change – or even a worsening of symptoms. </p>
<figure class="align-center ">
<img alt="A male plastic surgeon looks at a young woman's nose." src="https://images.theconversation.com/files/551684/original/file-20231003-25-586dxa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/551684/original/file-20231003-25-586dxa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/551684/original/file-20231003-25-586dxa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/551684/original/file-20231003-25-586dxa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/551684/original/file-20231003-25-586dxa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/551684/original/file-20231003-25-586dxa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/551684/original/file-20231003-25-586dxa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Cosmetic surgery could worsen symptoms of depression in some cases.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/rhinoplasty-reshaping-nose-surgery-change-appearance-2249751279">Rabizo Anatolii/ Shutterstock</a></span>
</figcaption>
</figure>
<p>A separate study of Norwegian adolescents also found that symptoms of depression and eating problems worsened in those who’d had <a href="https://www.cambridge.org/core/journals/psychological-medicine/article/abs/predictors-of-cosmetic-surgery-and-its-effects-on-psychological-factors-and-mental-health-a-populationbased-followup-study-among-norwegian-females/F4ED8C49C2245BCCEF98FCECBB5DD9C3">cosmetic surgery</a> compared to those who hadn’t. Even patients with little to no depressive symptoms don’t report experiencing a boost in their <a href="https://academic.oup.com/asj/article/28/3/245/268521">psychological wellbeing</a> after cosmetic surgery.</p>
<p>In other words, there’s a risk cosmetic surgery may worsen existing mental health problems for some people. This is especially concerning as <a href="https://journals.lww.com/plasreconsurg/abstract/2003/07000/body_image_concerns_of_breast_augmentation.11.aspx">some research shows</a> people who seek out cosmetic surgeries are more likely to have experienced mental health problems compared to the general population. </p>
<h2>What affects the outcome</h2>
<p>Many factors can determine what outcome you might experience after having a cosmetic procedure.</p>
<p>One of these is the degree of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/">post-operative complications</a>. A study of women who’d undergone breast augmentation found that those who’d experienced post-operative complications – such as leaking implants and infections – had smaller improvements in body image following surgery. <a href="https://www.tandfonline.com/doi/abs/10.1080/13548500903112374">Healing time</a> may also be important, with studies finding patients who took a long time to heal often show only small improvements in wellbeing.</p>
<p>Research has also found that people with symptoms of <a href="https://theconversation.com/body-dysmorphic-disorder-what-to-know-about-this-mental-health-condition-206243">body dysmorphic disorder</a> – a preoccupation or obsession with some aspect of appearance – don’t see improvements to psychological wellbeing after surgery. Likewise, patients who are experiencing high levels of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/">psychological distress</a> – including severe symptoms of depression and anxiety – may not experience any benefit from cosmetic surgery.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/">Relationship factors</a> can also affect whether cosmetic surgery is beneficial to your wellbeing. For example, people who are motivated to have a procedure because they think it will save their relationship often report poorer psychological outcomes. The same may also be true when <a href="https://journals.lww.com/annalsplasticsurgery/Citation/1984/10000/Augmentation_Mammaplasty__The_Surgical_and.3.aspx">partners disagree</a> on the need to have a procedure.</p>
<p>The decision to undergo cosmetic surgery is not to be taken lightly. Any procedure – even minimally invasive ones – can come with a risk of complications. If you’re considering one, it’s important not to rush into anything. </p>
<p>The NHS has some very <a href="https://www.nhs.uk/conditions/cosmetic-procedures/advice/cosmetic-procedure-right-for-me/">good questions</a> to ask yourself before having a cosmetic procedure, such as why you want to have a procedure and whether you want the procedure for yourself or to please someone else. </p>
<p>It’s also important to do your research, thinking not only about the costs, but also the impact any procedure might have on those around you. Find out as much as you can about the procedure you want, talk to experts, and – if you do decide do go ahead – make sure you choose a qualified practitioner.</p><img src="https://counter.theconversation.com/content/214517/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Viren Swami does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many people have cosmetic procedures to improve how they feel about themselves – but the evidence is mixed on whether they actually do.Viren Swami, Professor of Social Psychology, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2071712023-06-08T15:16:05Z2023-06-08T15:16:05ZBeauty procedures from manicures to cosmetic surgery carry risk — and the reward of a better life — podcast<figure><img src="https://images.theconversation.com/files/530387/original/file-20230606-27-d4x6su.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6000%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">UV lights in nail salons may be associated with the risk of skin cancer.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Making yourself more beautiful can result in tangible, material rewards. <a href="https://thewalrus.ca/pretty-privilege-at-work/">Pretty privilege</a>, as it is called, can lead to greater access to money and social capital, resulting in a better quality of life.</p>
<p>In Brazil, this understanding that beauty is important to one’s social status and mental and emotional well-being has prompted the state to subsidize cosmetic surgery. But this pursuit of beauty has a dark side and can often mean exposure to harm. </p>
<p>And this isn’t limited to extreme beautification practices, like extensive cosmetic surgery. People are also willing to endure potential risks in more mundane and everyday beauty treatments — like manicures.</p>
<p>In this episode of <em>The Conversation Weekly</em>, we speak to an anthropologist and a cancer researcher about the potential harm inherent in seeking beauty treatments.</p>
<iframe src="https://embed.acast.com/60087127b9687759d637bade/6481c321a0ac590011369fbb" frameborder="0" width="100%" height="190px"></iframe>
<p><iframe id="tc-infographic-561" class="tc-infographic" height="100" src="https://cdn.theconversation.com/infographics/561/4fbbd099d631750693d02bac632430b71b37cd5f/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>The illusion of choice</h2>
<p>Carmen Alvaro Jarrín is an associate professor of anthropology at the College of the Holy Cross in Worcester, in the U.S. They research cosmetic surgery in Brazil and looked at how the state came to support access to cosmetic procedures as part of the delivery of health care. The plastic surgeon Ivo Pitanguy had campaigned for access to cosmetic surgery, arguing that everyone had the right to be beautiful.</p>
<p>“It surprised me how many of them get plastic surgery, and spend a lot of money on beauty because they see it as a way to attain upward mobility,” Jarrín said. Their book, <a href="https://www.ucpress.edu/book/9780520293885/the-biopolitics-of-beauty"><em>The Biopolitics of Beauty: Cosmetic Citizenship and Affective Capital in Brazil</em></a>, examined how beauty became a health right. </p>
<p>Many of those who access state-subsidized clinics cannot afford cosmetic procedures privately. And these clinics come with a risk — often they are used as training centres and many patients have experimental procedures tested on them, sometimes with drastic effects.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/in-brazil-patients-risk-everything-for-the-right-to-beauty-94159">In Brazil, patients risk everything for the 'right to beauty'</a>
</strong>
</em>
</p>
<hr>
<p>“People believe that beauty gives you wealth. If you’re born poor and you’re beautiful, people think that it will give you upward mobility. Everybody was convinced that they would gain upper mobility,” Jarrín explains. “Anthropologists have noticed that the more unequal a society is, and the less upward mobility there is, the more that people will take to these magical means. In Brazil, beauty has that kind of magical quality to it.”</p>
<p>Access to cosmetic surgery promises better job opportunities and social mobility. In that context, seeking medical intervention to become more beautiful can be a rational choice.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/lNt4S40RwoY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">‘Unreported World’ looks at access to cosmetic surgery for lower income women in Brazil.</span></figcaption>
</figure>
<h2>The risk of exposure</h2>
<p>It’s not just plastic surgery, or in Brazil, where the pursuit of beauty can carry an extreme price. The growing popularity of gel manicures, with their employ of UV lights, can also place people at risk.</p>
<p>In 2016, Karolina Jasko — the 2018 Miss Illinois — was diagnosed with a rare form of melanoma on her thumb nail. Her cancer had been triggered by exposure to UV lights in nail parlours from getting regular manicures.</p>
<p>Maria Zhivagui is a postdoctoral researcher in environmental toxicology and cancer genomics at the University of California, in the U.S. She recently co-authored a study on <a href="https://doi.org/10.1038/s41467-023-35876-8">the impacts of using UV light to cure nail polish</a>.</p>
<p>“We started hearing about a lot of cancer cases that developed from artificial UV lamp exposure,” Zhivagui said. “We found this UV nail machine that is used in nail salons and that has been linked to cancer in females, that occurs on the dorsum of the hand or on the nail and the finger. And that was a very rare cancer, we usually don’t observe it.”</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1625125501772627968"}"></div></p>
<p>Her team found that UV nail lamps can cause mutations in human and mice cells. Once she saw the effects, Zhivagui — who would often get manicures and would even do them herself at home — stopped using the UV lights.</p>
<p>“After seeing the effects on the mitochondria, on the DNA and cell death, I was like, no, this is very alarming,” she said. “And I stopped immediately getting exposed to these UV radiations in nail salons.”</p>
<p>While UV lights are widely used in nail salons, the devices are easy to acquire for home use. And as they become more widely accessible, it’s likely more people are exposing themselves to risk.</p>
<hr>
<p>This episode was written and produced by Nehal El-Hadi and Mend Mariwany, who is also the executive producer of The Conversation Weekly. Eloise Stevens does our sound design, and our theme music is by Neeta Sarl.</p>
<p>You can find us on Twitter <a href="https://twitter.com/TC_Audio">@TC_Audio</a>, on Instagram at <a href="https://www.instagram.com/theconversationdotcom/">theconversationdotcom</a> or <a href="mailto:podcast@theconversation.com">via email</a>. You can also subscribe to The Conversation’s <a href="https://theconversation.com/newsletter">free daily email here</a>. </p>
<p>Listen to <em>The Conversation Weekly</em> via any of the apps listed above, download it directly via our <a href="https://feeds.acast.com/public/shows/60087127b9687759d637bade">RSS feed</a> or find out <a href="https://theconversation.com/how-to-listen-to-the-conversations-podcasts-154131">how else to listen here</a>.</p><img src="https://counter.theconversation.com/content/207171/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carmen Alvaro Jarrín received a Wenner-Gren Foundation Dissertation Fieldwork Grant and Mellon/ACLS Dissertation Completion funding.</span></em></p><p class="fine-print"><em><span>Maria Zhivagui does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Being beautiful can improve a person’s quality of life and emotional wellbeing. But sometimes, there is a risk of harm — from exposure to cancer-causing UV light, to cheap cosmetic procedures.Nehal El-Hadi, Science + Technology Editor & Co-Host of The Conversation Weekly Podcast, The ConversationDaniel Merino, Associate Science Editor & Co-Host of The Conversation Weekly Podcast, The ConversationLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2037512023-04-28T14:46:54Z2023-04-28T14:46:54ZBeauty ideals were as tough in the middle ages as they are now<p>After turning up at this year’s Grammys, Madonna was subjected to a <a href="https://www.independent.co.uk/arts-entertainment/music/news/madonna-now-grammys-facelift-recent-b2279848.html">vitriolic online attack</a> over her appearance, particularly what was deemed her excessive use of plastic surgery. The irrepressible 64-year-old instantly hit back, saying:</p>
<blockquote>
<p>Once again I am caught in the glare of ageism and misogyny that permeates the world we live in. I look forward to many more years of subversive behaviour pushing boundaries.</p>
</blockquote>
<p>It’s a familiar story. Standards of beauty have been embedded in different cultures, in varying forms, from time immemorial. The standards that women and, increasingly, all people are expected to meet to embody a certain level of beauty, are often based on binary notions of idealised forms of femininity or masculinity, or both. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1627713003238965248"}"></div></p>
<p>Women’s bodies have been pathologised throughout history, from Plato’s notion of the “<a href="https://www.rcn.org.uk/library-exhibitions/Womens-health-wandering-womb">wandering womb</a>” which was used to account for every female physical and emotional ailment. In medieval <a href="https://juliamartins.co.uk/what-is-the-humoral-theory">humoral theory</a>, women were considered <a href="https://www.medievalists.net/2011/08/the-female-body-in-medieval-europe-theories-of-physicality-versus-practical-gynecology/">cold and wet in constitution</a>, and more prone to certain afflictions.</p>
<p>The association of beauty with health, and ugliness with disease, has been taken up in more recent feminist debate over the modern cultural obsession with women’s appearance as an <a href="https://www.waterstones.com/book/beauty-sick/renee-engeln/9780062469786">epidemic</a>. It’s no wonder that instances of anxiety, depression, eating disorders and dysmorphia can all be connected to modern – and indeed, pre-modern – people’s experience of beauty standards.</p>
<p>In her 1991 book <a href="https://www.theguardian.com/books/2005/oct/18/classics.shopping">The Beauty Myth</a>, Naomi Wolf argued that the standards of western female beauty were used as a weapon to stagnate the progress of women. But in medieval culture, such pressures were doubly weighted, since beauty was closely aligned with morality: beauty was associated with goodness and ugliness with evil.</p>
<p>Such cultural associations are addressed by Eleanor Janega in her book <a href="https://www.waterstones.com/events/the-once-and-future-sex-eleanor-janega-in-conversation-with-cat-jarman/london-gower-street">The Once and Future Sex: Going Medieval on Women’s Roles in Society</a>. In her lively exploration of medieval women’s social roles, Janega shows how beauty “was a key to power”, crucially connected to wealth, privilege, youth and maidenhood – to create “a ‘perfect’ sort of femininity”. </p>
<p>Janega explores medieval gender norms to consider the ways that women’s roles have – and haven’t – changed. Focusing on female beauty standards and contradictions, sex and female sexuality, and women’s roles as workers, wives and mothers, Janega reflects on what this study of women in the middle ages means now:</p>
<blockquote>
<p>Turns out that the way we think about and treat women is socially malleable, and while some of our constructs have changed, we continue to treat women as inferior to men. </p>
</blockquote>
<h2>Weaponising beauty</h2>
<p>I’ve recently been examining a type of weaponised beauty that some religious women in the middle ages appeared to practise to emphasise the more superior beauty of their inner selves. In BBC Radio Wales’s <a href="https://www.bbc.co.uk/programmes/m001l1rl">The Idea</a>, I explored how some medieval saints subverted standards of “traditional” female beauty to avoid living lives that would hinder their chastity and spiritual goals: in other words, taint the beauty of their souls.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/520863/original/file-20230413-14-ozhcz7.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An ancient pen and ink drawing of a female saint mutilating herself in front of vikings." src="https://images.theconversation.com/files/520863/original/file-20230413-14-ozhcz7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/520863/original/file-20230413-14-ozhcz7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=798&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520863/original/file-20230413-14-ozhcz7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=798&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520863/original/file-20230413-14-ozhcz7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=798&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520863/original/file-20230413-14-ozhcz7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1003&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520863/original/file-20230413-14-ozhcz7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1003&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520863/original/file-20230413-14-ozhcz7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1003&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">St Æbbe and her nuns mutilate their faces in front of the Vikings.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Ecclesiae_Anglicanae_Trophae_-_Plate_18.jpg">Giovanni Battista de'Cavalieri / Venerable English College, Rome / WIkipedia</a></span>
</figcaption>
</figure>
<p>Some of their tactics were extreme. In a female monastery in the Scottish borders, the abbess was a woman known as Æbbe the Younger, daughter of Æthelred, King of Northumbria. As marauding Vikings attacked the monastery, and terrified of being defiled, Æbbe attempted to repel them by disfiguring her face:</p>
<blockquote>
<p>The abbess, with an heroic spirit… took a razor, and with it cut off her nose, together with her upper lip unto the teeth, presenting herself a horrible spectacle to those who stood by. Filled with admiration at this admirable deed, the whole assembly followed her maternal example. </p>
</blockquote>
<p><em><strong>From Roger of Wendover’s Flowers of History, Comprising the History of England</strong></em></p>
<p>Though the nuns’ mutilated faces did cause the Vikings to flee, they later returned to set fire to the monastery, burning the women alive. But in their martyrdom, the nuns’ souls remained beautiful and untainted, which was what they had desired.</p>
<p>In 15th-century legend, <a href="https://en.wikipedia.org/wiki/Wilgefortis">Wilgefortis</a>, a young Christian Portuguese princess determined to live in perpetual virginity, was commanded by her parents to marry a pagan Sicilian king. At her refusal, her father had her imprisoned and tortured. Wilgefortis starved herself in penance and prayed to God that she should be disfigured.</p>
<p>Her prayers were answered and she miraculously grew a moustache and a beard. Horrified at the loss of her beauty the suitor rejected her, and her furious father ordered that she be crucified. As she died on the cross, Wilgefortis beseeched other women to pray through her to be delivered from vanity and erotic desire. </p>
<p>Wilgefortis’s metamorphosis from female-coded standards of medieval beauty to a type of <a href="https://www.health.com/mind-body/transmasculine">transmasculinity</a> offered by her beard and moustache, is, like Æbbe’s self-mutilation, an act of physiological resistance. Wilgefortis prays for deformity and God bestows her with the facial hair that repulses her suitor and secures the beauty of her soul.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/520861/original/file-20230413-16-4lx37a.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman with a beard wearing a dress being crucified on a cross." src="https://images.theconversation.com/files/520861/original/file-20230413-16-4lx37a.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/520861/original/file-20230413-16-4lx37a.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=901&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520861/original/file-20230413-16-4lx37a.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=901&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520861/original/file-20230413-16-4lx37a.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=901&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520861/original/file-20230413-16-4lx37a.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1132&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520861/original/file-20230413-16-4lx37a.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1132&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520861/original/file-20230413-16-4lx37a.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1132&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The bearded Wilgefortis was crucified by her own father for wishing away her beauty so she didn’t have to marry a pagan king.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/8/86/Hl_kuemmernis_museum_neunkirchen.jpg">Städtisches Museum Neunkirchen / Wikipedia</a></span>
</figcaption>
</figure>
<h2>Eternal beauty?</h2>
<p>Today’s cosmetic surgeons, in supplying women like Madonna with surgical answers to their supposed aesthetic problems, might also serve as God-like figures in the continuing quest to adhere more closely to the standards of beauty that medieval saints like Æbbe and Wilgefortis harnessed in order to subvert.</p>
<p>In fact, the “gods” of cosmetic surgery, like the God of medieval Christianity, somehow enable their worshippers to match their outward appearance with their inner feelings – the states of their souls – allowing them to make peace with the variants of beauty that they desire.</p>
<p>As in the medieval past, women today negotiate the parameters of beauty in which they have been historically confined, embracing change and letting their souls spill out as they decide what beauty means for them and their bodies.</p>
<p>The pursuit of youth and beauty – and beauty within – is rarely without pain, but as we know, that makes for a powerful weapon.</p><img src="https://counter.theconversation.com/content/203751/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laura Kalas does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Standards of beauty have been embedded in different cultures, in varying forms, from time immemorial. What endures is that women are still regarded as inferior to men.Laura Kalas, Senior Lecturer in Medieval English Literature, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2021362023-03-21T19:11:55Z2023-03-21T19:11:55ZDoctors may soon get official ‘endorsements’ to practise cosmetic surgery – but will that protect patients?<figure><img src="https://images.theconversation.com/files/516551/original/file-20230321-16-ypoa6u.jpg?ixlib=rb-1.1.0&rect=15%2C117%2C3537%2C3186&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://images.unsplash.com/photo-1551601651-09492b5468b6?ixlib=rb-4.0.3&ixid=MnwxMjA3fDB8MHxwaG90by1wYWdlfHx8fGVufDB8fHx8&auto=format&fit=crop&w=1213&q=80">Unsplash/Olga Guryanova</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Disturbing reports about botched cosmetic surgeries and injuries in Australia – from breast augmentations causing chronic pain to liposuction leaving patients with lifelong injuries – have <a href="https://pubmed.ncbi.nlm.nih.gov/35338692/">sparked concerns in recent years</a>. Several high-profile cosmetic surgeons alleged to have fallen short of expected professional standards have been <a href="https://www.medicalboard.gov.au/News/2022-09-01-Ahpra-MBA-CSR-reply.aspx">disciplined</a>. </p>
<p>Last year, <a href="https://www.supremecourt.vic.gov.au/sites/default/files/2022-08/Group%20Proceeding%20Summary%20Statement%20%289%20March%202022%29.pdf">a class action</a> was commenced against one clinic in the Victorian Supreme Court.</p>
<p>People who are interested in exploring whether cosmetic surgery is appropriate for them are right to feel wary and confused. Now, the introduction of a scheme to officially endorse doctors who practise in the area of cosmetic surgery promises to allay patients’ doubts. But the idea <a href="https://www.smh.com.au/politics/federal/legitimises-the-activities-of-unscrupulous-operators-cosmetic-surgery-safety-fears-20230313-p5crnq.html">remains contentious</a> for those in the field.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/thinking-about-cosmetic-surgery-at-last-some-clarity-on-who-can-call-themselves-a-surgeon-196947">Thinking about cosmetic surgery? At last, some clarity on who can call themselves a surgeon</a>
</strong>
</em>
</p>
<hr>
<h2>The story so far</h2>
<p>In the wake of cosmetic surgery controversies, two significant but separate responses have been adopted by medical regulators. First, the country’s health ministers began a <a href="https://pubmed.ncbi.nlm.nih.gov/35338692/">consultation</a> to decide whether to stop doctors promoting themselves as “surgeons”.</p>
<p>The consultation acknowledged a gap or “loophole” that allows any registered medical practitioner to call themselves a surgeon in Australia, even with <a href="https://www.sydney.edu.au/news-opinion/news/2016/05/12/call-yourself-a-cosmetic-surgeon--new-guidelines-fix-only-half-t.html">no specialist training</a> beyond their medical degree.</p>
<p>The second response was initiated in December 2021, by AHPRA, which accredits and registers doctors, and the Medical Board of Australia, which regulates the practices of registered medical practitioners. Together, they commissioned an <a href="https://www.ahpra.gov.au/Resources/Cosmetic-surgery-hub/Cosmetic-surgery-review.aspx">independent review</a> into the regulation of medical practitioners who perform cosmetic surgery in Australia. </p>
<p>Although informed by each other, these separate initiatives wrought distinct solutions. While one has been embraced, the other remains controversial.</p>
<h2>Ministerial reforms</h2>
<p>After nearly two years of consultation, the health ministers decided <a href="https://www.health.gov.au/sites/default/files/2022-12/health-ministers-meeting-communique-14-december-2022_0.pdf">last December</a> to restrict the use of the title “surgeon”. Soon, only medical practitioners holding a specialist registration, such as ophthalmology, will be permitted to use the title.</p>
<p>In a meeting late last month, health ministers approved <a href="https://www.health.gov.au/sites/default/files/2023-02/health-ministers-meeting-communique-24-february-2023.pdf">a draft bill</a> to give effect to this decision. While the draft remains unpublished, no stakeholders in the health sector appear to have criticised the change. </p>
<p>But the health ministers approved another, more controversial, reform as well. They welcomed a new model of accrediting cosmetic surgery practitioners known as an “endorsement of registration”. This proposal came from the AHPRA and Medical Board review.</p>
<h2>AHPRA and the Medical Board’s ‘endorsement model’</h2>
<p>Among its 16 recommendations (all of them accepted by AHPRA and the Medical Board), <a href="https://theabic.org.au/storage/app/media/BLOG/Ahpra---Report---Cosmetic-surgery-independent-review---Final-report---August-2022.pdf">the independent review’s</a> first and most significant reform proposal was to establish an “area of practice endorsement” for cosmetic surgery. </p>
<p>The technical language of “<a href="https://www.legislation.qld.gov.au/view/html/inforce/current/act-2009-hprnlq#sec.98">endorsement</a>” comes from <a href="https://www.ahpra.gov.au/About-Ahpra/What-We-Do/Legislation.aspx">consistent national laws</a> enacted, with minor variations, in each state and territory.</p>
<p>In a nutshell, “area of practice endorsement” would introduce new minimum standards for the education, training and qualification of Australian medical practitioners seeking to practise as cosmetic surgeons. </p>
<p>Currently, the Medical Board uses <a href="https://www.medicalboard.gov.au/codes-guidelines-policies/code-of-conduct.aspx">codes of conduct</a> and <a href="https://www.medicalboard.gov.au/Codes-Guidelines-Policies/Advertising-a-regulated-health-service/Guidelines-for-advertising-regulated-health-services.aspx">guidelines</a> to regulate most doctors’ practices. </p>
<p>But these “soft law” instruments permit doctors to decide for themselves whether they are competent enough to perform procedures like brow lifts or tummy tucks.</p>
<p>The new endorsement model would require doctors to apply to the Medical Board to qualify to practice in the area of cosmetic surgery. To be approved, the doctor-applicant would need to furnish evidence of their qualifications. Such an endorsement arrangement already exists for <a href="https://legislation.nsw.gov.au/view/whole/html/inforce/current/act-2009-86a#pt.7-div.8-sdiv.4">acupuncture</a>.</p>
<p>Together with restricting the title “surgeon” and some other reforms (such as improved information campaigns), it is now hoped the endorsement model would manage risky cosmetic surgeries by requiring practitioners to be endorsed by the Medical Board. But not everyone thinks it’s the way to go. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whos-the-best-doctor-for-a-tummy-tuck-or-eyelid-surgery-the-latest-review-doesnt-actually-say-189700">Who's the best doctor for a tummy tuck or eyelid surgery? The latest review doesn't actually say</a>
</strong>
</em>
</p>
<hr>
<h2>What’s the problem with endorsement?</h2>
<p>Fresh forms of old tensions have arisen, based on how endorsement will be designed. At the core of these tensions is a debate about how the Australian Medical Council, which is responsible for setting the accreditation, training and education standards for the medical profession, will determine the curriculum and assessment regimes for cosmetic surgery study programs. </p>
<p>What was once a debate about an unregulated area of practice is now about what kind of training cosmetic surgeons should have before wielding their instruments.</p>
<p>Some experts suggest <a href="https://researchnow-admin.flinders.edu.au/ws/portalfiles/portal/21121551/Dean_Defining_P2018.pdf">defining cosmetic surgery</a> could help regulation and safety discussions. Meanwhile, the Royal Australasian College of Surgeons says it will <a href="https://www.surgeons.org/-/media/Project/RACS/surgeons-org/files/advocacy/20221212-Consultation-cosmetic-surgery-registration-standards.pdf?rev=a997d89161cf4abc8c7b405f1e7a5ccb&hash=F4DFEE1BC200732360B2976ACE6E1D4F">oppose</a> any study program of a lesser standard than that required of specialist surgeons. </p>
<p>Although the Australian Medical Council has not yet published its education standards for cosmetic surgery, it has proposed <a href="https://www.amc.org.au/wp-content/uploads/2023/01/Attachment-B-Draft-Accreditation-standards-for-cosmetic-surgery-programs.pdf">six draft qualification standards</a> and is consulting with the profession. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1442755873177104386"}"></div></p>
<h2>What this could mean for patient safety</h2>
<p>On the one hand, the proposed changes are a continuation of a long-running turf war. On one side are the surgeons with special accreditation, approved by the Royal Australasian College of Surgeons and typically engaged in reconstructive plastic surgeries. On the other, stand the so-called “non-surgeons” or “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8795651/">wannabees</a>”.</p>
<p>The debate is also about protecting patients and <a href="https://www.legislation.qld.gov.au/view/html/asmade/act-2022-022#ch.3-pt.2">legislative reform</a>. </p>
<p>It is too early to determine whether the Australian Medical Council’s endorsement standards will improve patient safety. But the slow process of reforming the cosmetic surgery “industry” – in the face of explosive increases in demand, fuelled in part by <a href="https://doi.org/10.1177/07488068221105360">seductive social media claims</a> – illustrates how complex medical regulation is in Australia. With so many regulatory actors involved in our <a href="https://eprints.qut.edu.au/127800/">polycentric system</a>, feuds over governance are unsurprising. </p>
<p>Today, the cosmetic surgery industry is estimated to be worth <a href="https://www.afr.com/life-and-luxury/health-and-wellness/cosmetic-surgery-boom-is-new-face-of-covid-19-20200821-p55o0u">more than one billion dollars a year</a>. It is crucial regulators ensure the public is protected from unscrupulous – or unqualified – operators.</p><img src="https://counter.theconversation.com/content/202136/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher Rudge was previously a researcher at the Medical Council of New South Wales. He is a chief invstigator on a project concerning patient decision-making about stem cell treatments funded by the Australian government's Medical Research Future Fund.</span></em></p>A new proposal is reigniting an old debate about cosmetic surgery. Now it’s focused on what kind of training cosmetic surgeons should have before wielding their instruments.Christopher Rudge, Law lecturer, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1897002022-09-01T06:19:35Z2022-09-01T06:19:35ZWho’s the best doctor for a tummy tuck or eyelid surgery? The latest review doesn’t actually say<figure><img src="https://images.theconversation.com/files/482000/original/file-20220831-24-cmfgn7.jpg?ixlib=rb-1.1.0&rect=8%2C638%2C1908%2C1793&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/a-surgeon-marking-a-patient-s-eyelid-7585312/">cottonbro/Pexels</a></span></figcaption></figure><p>If you’re thinking about a tummy tuck, breast implants or eyelid surgery, you might be looking for reassurance your chosen doctor is qualified and has the right skills for the job.</p>
<p><a href="https://www.ahpra.gov.au/News/Cosmetic-surgery-independent-review-of-patient-safety.aspx">Today’s release</a> of the much anticipated review of how cosmetic surgery is regulated in Australia goes partway to achieving that.</p>
<p>The review makes several sensible suggestions about how to protect consumers, following allegations around cosmetic surgery practices aired in the media (which prompted the review in the first place).</p>
<p>There’s much to commend. The review is comprehensive, sober, realistic and the product of considerable consultation.</p>
<p>It recommends tightening up how cosmetic surgery is advertised, streamlining how to complain when things go wrong, and improving how complaints are managed.</p>
<p>However, these recommendations and others, which the health professionals’ <a href="https://www.ahpra.gov.au/News/Cosmetic-surgery-independent-review-of-patient-safety/Medical-Board-and-Ahpra-response-to-the-cosmetic-surgery-review.aspx">regulator</a> <a href="https://www.abc.net.au/news/2022-09-01/ahpra-accepts-16-recommendations-on-cosmetic-surgeons/101387624">accepts</a>, are unlikely to be implemented right away. Such reforms take time.</p>
<p>Recommendations to identify who has the appropriate education and skills to perform cosmetic surgery – a GP with or without extra surgical qualifications, a specialist plastic surgeon, or doctors with other titles – may take time to finalise and determine.</p>
<p>That’s because plans to identify certain doctors as “endorsed” practitioners – effectively validating their ability to competently perform cosmetic surgery – hinge on the medical board identifying and approving what skills and education will be needed.</p>
<p>Any relevant course or training program would also need to be accepted by the Australian Medical Council (which looks after doctors’ education, training and assessment).</p>
<p>Here’s what needs to happen next to protect health consumers.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/linda-evangelista-says-fat-freezing-made-her-a-recluse-cryolipolysis-can-do-the-opposite-to-whats-promised-168657">Linda Evangelista says fat freezing made her a recluse. Cryolipolysis can do the opposite to what's promised</a>
</strong>
</em>
</p>
<hr>
<h2>Remind me, what’s the review about?</h2>
<p>Over the past few years, the media has reported on allegations people had undergone inappropriate or unsafe cosmetic surgeries and were turning up to hospitals for remedial surgery.</p>
<p>Critics said people had been enticed by deceptive social media advertising and had trusted “<a href="https://www.smh.com.au/healthcare/worse-than-wild-west-cosmetic-cowboys-must-be-reined-in-20220511-p5akil.html">inadequately trained</a>” cosmetic surgeons to care for them. But they were never adequately warned of the risks.</p>
<p>Facing what threatened to become a crisis of regulatory confidence, the Australian Health Practitioner Regulation Agency or AHPRA (and its medical board) was bound to act. It commissioned an independent review of doctors who perform cosmetic surgery in Australia.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/who-is-our-health-regulator-ahpra-and-does-it-operate-effectively-101966">Who is our health regulator, AHPRA, and does it operate effectively?</a>
</strong>
</em>
</p>
<hr>
<h2>What did the review recommend?</h2>
<p>The review examined “cosmetic surgeries” in which the skin is cut, such as breast implants and <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/abdominoplasty-tummy-tuck">abdominoplasties</a> (tummy tucks). It didn’t cover injections (such as Botox or dermal fillers) or laser skin treatments.</p>
<p>It makes several significant recommendations.</p>
<p><strong>1. Cosmetic surgeons need to be “endorsed”</strong></p>
<p>A new system would see doctors “endorsed” as a cosmetic surgeon with AHPRA. This “blue tick” style of endorsement would only be given to those who had met a yet-to-be determined minimum educational standard.</p>
<p>Once rolled out, however, consumers would be educated to look for this endorsement on the publicly available register of health professionals. </p>
<p><strong>2. Making complaints will be simpler</strong></p>
<p>There are currently several avenues for making complaints about cosmetic surgeons, including to AHPRA itself, to the medical board (within AHPRA), as well as to state-based health-care complaints agencies.</p>
<p>The review recommends new educational materials be produced to show consumers exactly how and when to complain about cosmetic surgeons. It also recommends a special consumer hotline be created to provide further information. </p>
<p><strong>2. Stricter rules on advertising</strong></p>
<p>The review recommends tightening up existing <a href="https://www.ahpra.gov.au/Resources/Advertising-hub/Advertising-guidelines-and-other-guidance/Advertising-guidelines.aspx">advertising guidelines</a> to strictly control those who promote cosmetic surgery health services, particularly advertising that might:</p>
<ul>
<li><p>glamourise or trivialise risky procedures</p></li>
<li><p>use models who have not had cosmetic surgery to sell a cosmetic procedure</p></li>
<li><p>use social media influencers</p></li>
<li><p>suggest cosmetic surgery be used to obtain an “acceptable” or “ideal body type”.</p></li>
</ul>
<p><strong>4. More scrutiny, more policing</strong></p>
<p>Finally, the review recommends sharpening policies about how health professionals obtain informed consent for procedures, the importance of postoperative care, and the expected training and education of cosmetic surgeons. </p>
<p>The review also recommends AHPRA create a specific cosmetic surgery <a href="https://www.theguardian.com/australia-news/2022/sep/01/cosmetic-surgery-in-australia-to-be-monitored-by-enforcement-unit-to-improve-patient-safety">enforcement unit</a> to regulate doctors providing these services.</p>
<p>Such an enforcement unit might refer problematic doctors to the medical board, which could then determine whether immediate disciplinary action was necessary. This might mean the immediate suspension of their registration (“medical licence”).</p>
<h2>Will these reforms work?</h2>
<p>The Royal Australasian College of Surgeons and the Australasian Society of Aesthetic Plastic Surgeons have <a href="https://www.watoday.com.au/politics/federal/regulator-announces-cosmetic-surgery-crackdown-but-won-t-hit-pause-on-1-4bn-industry-20220831-p5be4t.html?ref=rss&utm_medium=rss&utm_source=rss_feed">said</a> the suggested reforms are inadequate and may even lead to some doctors being endorsed when they lack appropriate training. </p>
<p>Another possible reform rejected by the review was to make the title “surgeon” a protected title. This could then only be used by those who have done years of specialist training. </p>
<p>Indeed, Australian health ministers are currently examining <a href="https://www.abc.net.au/news/2022-09-01/ahpra-accepts-16-recommendations-on-cosmetic-surgeons/101387624">this very issue</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/482196/original/file-20220901-24-x7euw1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Female surgeon operating" src="https://images.theconversation.com/files/482196/original/file-20220901-24-x7euw1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/482196/original/file-20220901-24-x7euw1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/482196/original/file-20220901-24-x7euw1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/482196/original/file-20220901-24-x7euw1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/482196/original/file-20220901-24-x7euw1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/482196/original/file-20220901-24-x7euw1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/482196/original/file-20220901-24-x7euw1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A cosmetic surgeon doesn’t need specialist qualifications. But a plastic surgeon does.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/qLzWvcQq-V8">Artur Tumasjan/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Currently, any doctor can call themselves a “cosmetic surgeon”. But since “plastic surgeon” is a protected title, only those with specialist training can use it.</p>
<p>Others doubt whether the enhanced regulation of titles will in fact <a href="https://www.spaandclinic.com.au/medi/ahpra-cosmetic-surgery-review">improve safety</a>. After all, a title is no guarantee of safety, and there may be unintended consequences too, such as the inadvertent creation of a market monopoly.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/call-yourself-a-cosmetic-surgeon-new-guidelines-fix-only-half-the-problem-59078">Call yourself a cosmetic surgeon? New guidelines fix only half the problem</a>
</strong>
</em>
</p>
<hr>
<h2>This has been a long time coming</h2>
<p>Today’s review is the latest in a long line of reviews of medical practice involving cosmetic procedures <a href="https://theconversation.com/call-yourself-a-cosmetic-surgeon-new-guidelines-fix-only-half-the-problem-59078">over the past 20 years</a>. Until now, no reforms have been able to sustain long-lasting improvements in outcomes or reduce numbers of complaints. </p>
<p>These recurrent scandals and the regulatory stagnation reflects the fractured nature of Australia’s cosmetic surgery industry – with its <a href="https://www.smh.com.au/national/patients-at-risk-in-ugly-cosmetic-surgery-wars-20061022-gdoni4.html">longstanding turf wars</a> between plastic surgeons and cosmetic surgeons.</p>
<p>But this is also a <a href="https://www.smh.com.au/politics/federal/regulator-announces-cosmetic-surgery-crackdown-but-won-t-hit-pause-on-1-4bn-industry-20220831-p5be4t.html">multimillion-dollar industry</a> that has historically been unable to agree on a set of standards for education and training. </p>
<p>In the end, for this review to catalyse meaningful reform, the next task will be for AHPRA to reach professional consensus about the standards to be set for cosmetic surgery. With some luck, the endorsement model may have the required impact.</p>
<p>It’s a huge challenge, but an important one. After all, regulators who try to impose standards from above without the support of professional consensus face an incredibly difficult task.</p><img src="https://counter.theconversation.com/content/189700/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher Rudge was formerly a legal research associate at the Medical Council of New South Wales.</span></em></p><p class="fine-print"><em><span>Cameron Stewart is a member of the Medical Council of New South Wales but the views expressed here are his own.</span></em></p>The latest plan is comprehensive, sober, realistic and the product of considerable consultation. But it’s missing a few key issues if we are to adequately protect consumers.Christopher Rudge, Law lecturer, University of SydneyCameron Stewart, Professor at Sydney Law School, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1853412022-07-01T15:38:42Z2022-07-01T15:38:42ZGood historical fiction is not just about factual accuracy, but the details of human experience too<p>How do you begin the process of researching a novel? In the case of my latest book, <a href="https://www.flyonthewallpress.co.uk/product-page/man-at-sea-by-liam-bell#:%7E:text=MALTA%201941.,Victor%2C%20that%20will%20shatter%20everything.">Man at Sea</a>, the task seemed straightforward if a little daunting.</p>
<p>The novel is partly set during the second world war, so I spent a lot of time combing the <a href="https://www.iwm.org.uk/research/research-facilities">Imperial War Museum archives</a>. It also examines Malta’s transition from <a href="https://historiansatbristol.blogs.bristol.ac.uk/archives/408">British colony to independence</a> in the 1960s, so I was fortunate enough to undertake several research trips to the island.</p>
<p>As a writer, the key is not so much assembling reams and reams of material, but finding the details that make a period or situation vivid for you and, eventually, for the reader – those few facts which make a sprawling and multi-faceted topic specific enough to relate to and empathise with. The novelist <a href="https://www.sarahwaters.com/#:%7E:text=Sarah%20Waters%20OBE%2C%20was%20born,in%20the%20UK%20and%20US.">Sarah Waters</a> once memorably described those nuggets of information as the “poignant trivia” that provides the canvas for historical fiction.</p>
<p>As a creative writing lecturer, I teach students to not judge their historical fiction purely on historical accuracy, but on its ability to evoke an emotional response. This is what academic Melissa Addey describes in her <a href="https://www.tandfonline.com/doi/full/10.1080/14790726.2021.1876095">research</a> as a “playful exploration set within the frame of the historical record”, which allows for incorporation of smaller, more idiosyncratic details. </p>
<p>Other <a href="https://www.tandfonline.com/doi/full/10.1080/13642529.2020.1727189?src=recsys">research</a> points to the useful distinction between accuracy and authenticity, with the latter allowing for the character-based detail that a reader will connect with.</p>
<p>For me, the initial wartime narrative clicked with the discovery of <a href="https://www.rafbf.org/guinea-pig-club/about-the-guinea-pig-club">the Guinea Pig Club</a>. This was the moniker adopted by a group of airmen badly burned in action who were operated on by the pioneering plastic surgeon, <a href="https://www.eastgrinsteadmuseum.org.uk/guinea-pig-club/">Archibald McIndoe</a>, in East Grinstead in Sussex.</p>
<p>At that point, I knew that one of the protagonists of the novel, Stuart, had been injured in the war, but the Guinea Pig Club provided a wealth of detail and characteristics that really brought him to life. In July 2017, I made my first visit to the “<a href="https://www.eastgrinsteadmuseum.org.uk/guinea-pig-club/town-didnt-stare/">town that didn’t stare</a>”, where the club’s honorary secretary, Bob Marchant, showed me around the Queen Victoria Hospital.</p>
<p>Here were the cedarwood huts which I’d seen in the background of photographs showing men with bandaged faces and long trunk-like skin grafts as they waited for their next surgery. And the balconies over the operating theatre from which fellow patients used to watch procedures undertaken by McIndoe. Back at the East Grinstead Museum, Bob showed me the archive of club magazines.</p>
<p>In those pages I found the camaraderie which my character would pine for in those long post-war years, the sense of support and belonging which could sustain him in navigating civilian life.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/Rsn95_qJFmo?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>And I was genuinely moved to find the Christmas 1960 issue with a memorial to McIndoe who had died that year. At the end was the simple statement: “There are no words.” The Guinea Pig Club, and the debt of gratitude the members owed to their surgeon, became the core of Stuart’s character.</p>
<p>But the emotional link to Malta itself, though, came from much closer to home. </p>
<h2>A family story</h2>
<p>Back in 1956, my grandparents lived in Malta while my grandfather was stationed with the Mediterranean fleet. My late grandmother, Marian Scrimgeour, kept a diary which was ideal for providing distinctive detail.</p>
<p>She didn’t experience the fierce air raids of the <a href="https://www.iwm.org.uk/history/how-malta-survived-the-second-world-war">siege of Malta</a>, but she did navigate the <a href="https://www.iwm.org.uk/history/why-was-the-suez-crisis-so-important">Suez Crisis</a> with two young children in tow. So, her account of daily life includes notes such as: “Watched review of Nato ships whilst hanging out washing on roof. Cook. Dinner. A and J to sleep”. That steadfast continuation of the everyday domestic tasks while tensions escalated provided valuable insight for imagining life on the island during the war. </p>
<p>I also found an entry in which she is passing notes with a friend via the “ice man”, and there is a mention, in late April, of the milk going sour overnight. In the novel, I used those small allusions as a way of the characters noting the arrival of the hot Maltese summer. </p>
<p>These real experiences had the benefit of feeling period-specific and would have been nigh-on impossible to gain from my own trips, some 60 years later. I was also fortunate in being able to speak with my grandfather, Murray Scrimgeour, about his memories before he passed away.</p>
<p>I have scrawled notes about his ship, the <a href="https://www.iwm.org.uk/collections/item/object/205163252">HMS Duchess</a>, and the position of the admiralty in Malta. But the most valuable elements I gleaned from him were the specific naval references, such as <a href="https://www.lordmountbattenofburma.com/return-to-the-royal-navy">Lord Mountbatten</a>, second in command of the Mediterranean fleet, being disparagingly referred to as the “straw-boss”; and the “two-tier” wardroom, or officer’s mess, with the Maltese taken on mostly as stewards for the British officers.</p>
<p>My grandfather told me what it was like to be moved to a “war footing” and having to evacuate his young family from the island by way of a flight on a decommissioned WWII bomber with a faulty fourth engine.</p>
<p>He also related just how dangerous driving his hired Morris Minor had felt, and it is as a nod to him that the character of Stuart observes that the locals all “drove like ricocheting bullets”.</p>
<h2>The historical and the personal</h2>
<p>Reading back over the finished novel now, it is lines like these which make me smile. It is easy to search out a newspaper article or an official report for the facts, but finding that kind of detail which sharply evokes the experience of living in that historical moment is so much more important for the novelist.</p>
<figure class="align-left ">
<img alt="A statue of a surgeon with a burns patient." src="https://images.theconversation.com/files/471875/original/file-20220630-12-ydiymv.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/471875/original/file-20220630-12-ydiymv.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=758&fit=crop&dpr=1 600w, https://images.theconversation.com/files/471875/original/file-20220630-12-ydiymv.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=758&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/471875/original/file-20220630-12-ydiymv.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=758&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/471875/original/file-20220630-12-ydiymv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=953&fit=crop&dpr=1 754w, https://images.theconversation.com/files/471875/original/file-20220630-12-ydiymv.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=953&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/471875/original/file-20220630-12-ydiymv.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=953&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A statue of pioneering plastic surgeon Archibald McIndoe with a patient, East Grinstead.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Archibald_McIndoe#/media/File:McIndoe_monument.jpg">Martin Jennings/WIkipedia</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>As Man at Sea is released into the world, then, my hope is that the “poignant trivia” Waters speaks of provides a sense of connection and immediacy. My bookshelves are filled with authoritative accounts of the second world war and detailed analyses of Malta’s journey to independence, but the passages in the narrative which readers will hopefully relate to are those provided by the Guinea Pig Club and especially by my late grandparents.</p>
<p>I’ve learned that the key to writing historical fiction is not providing all of the facts and figures, but combing through your research and pinpointing the one detail in ten which the reader can emotionally connect with. It is the human experience that truly resonates.</p><img src="https://counter.theconversation.com/content/185341/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Liam Murray Bell receives funding from the Society of Authors.</span></em></p>When it comes to writing historical fiction, one author finds that it’s the very human details that resonate with the reader.Liam Bell, Senior Lecturer in Creative Writing, University of StirlingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1750602022-02-07T01:25:51Z2022-02-07T01:25:51ZDissatisfied plastic surgery clients show the downsides of online research<figure><img src="https://images.theconversation.com/files/444451/original/file-20220203-19-1l2ss1y.jpg?ixlib=rb-1.1.0&rect=0%2C321%2C6720%2C3430&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>A woman walks into a plastic surgeon’s office with an image she has found online. She wants her body to look like the same, and thinks she knows how to get it. She tells the consulting surgeon exactly what she wants: round, 350cc implants, with full projection. She believes this will get her to a full D-cup shape. </p>
<p>But after the operation, once the physical pain subsides and the scars heal, she’s dissatisfied with the decidedly unnatural-looking result. It’s nothing like the image she hoped to emulate. Because that body was not hers. </p>
<p>This woman wasn’t stupid. In spending many hours online pondering her options and making decisions she was doing exactly what expert services from plastic surgeons to financial advisers encourage clients to do. </p>
<p>Yet, as our research shows, this trend has also shifted responsibility and risks onto customers. </p>
<p>Charged with “doing their own research”, drawing on anecdotal information online to inform their decision making, consumers can become overconfident about their level of understanding. The result is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4728899/">an increasing number</a> of bad outcomes.</p>
<h2>How we did our research</h2>
<p>To understand more about the paradox of “informed” customers, we conducted a <a href="https://journals.sagepub.com/doi/abs/10.1177/10946705211047983">qualitative study</a> of women seeking breast augmentation surgery.</p>
<p>Our research involved a deep immersion into plastic surgery forums over two years. This included an analysis of YouTubers who documented their breast augmentation in online videos, and participation in a private Instagram group designed for women seeking breast augmentation surgery. From this Instagram group, we then formally interviewed 20 women aged between 18 and 34 who had breast augmentation surgery. </p>
<figure class="align-center ">
<img alt="Many women only see their cosmetic surgeon once before their surgery." src="https://images.theconversation.com/files/444466/original/file-20220204-25-i773jv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/444466/original/file-20220204-25-i773jv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/444466/original/file-20220204-25-i773jv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/444466/original/file-20220204-25-i773jv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/444466/original/file-20220204-25-i773jv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/444466/original/file-20220204-25-i773jv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/444466/original/file-20220204-25-i773jv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many women only see their cosmetic surgeon once before their surgery.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-five-most-surprising-cosmetic-surgery-trends-around-the-globe-59408">The five most surprising cosmetic surgery trends around the globe</a>
</strong>
</em>
</p>
<hr>
<h2>Turning to the internet</h2>
<p>The results of our research suggest many women turn to the internet because consulting a plastic surgeon is expensive. An appointment costs, on average, about US$500 (A$700), with the cost of breast augmentation in the US generally ranging from US$4,000 to US$15,000 (A$ 5,600 to $A21,000). </p>
<p>Many women only see their surgeon once, for 30 to 40 minutes, before their surgery. In this consultation everything must be decided – from aesthetic decisions to discussing any medical conditions that may complicate the surgery. </p>
<p>For this reason, customers often spend weeks and months online to prepare and educate themselves before they meet their surgeon. They learn about terminology and techniques, find pictures they like, and talk to others who have gone through the procedure. </p>
<p>They even conduct DIY experiments, such as the “rice-test”, which involves filling two bags with rice and placing them inside their bra as a way of understanding breast implant sizes. </p>
<p>Many women go to these efforts to build some form of expertise for their doctor consultations, to communicate what they want to a professional and get their money’s worth. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/441233/original/file-20220118-13-1mdt3qd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/441233/original/file-20220118-13-1mdt3qd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=382&fit=crop&dpr=1 600w, https://images.theconversation.com/files/441233/original/file-20220118-13-1mdt3qd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=382&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/441233/original/file-20220118-13-1mdt3qd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=382&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/441233/original/file-20220118-13-1mdt3qd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=480&fit=crop&dpr=1 754w, https://images.theconversation.com/files/441233/original/file-20220118-13-1mdt3qd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=480&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/441233/original/file-20220118-13-1mdt3qd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=480&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The ‘rice-test’ involves filling two bags with rice as a way of understanding breast implant sizes.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>The limits of individual expertise</h2>
<p>Our study suggests the more women solely relied on lay expertise to dictate how their breast surgery should go, the more likely they were to be disappointed with the outcome. Better results occurred when they carefully selected their doctors and were open to working with them.</p>
<p>Creating aesthetically beautiful breasts must consider myriad factors. But online forums for breast augmentation mostly focus on size and often ignore risks.</p>
<p>Those who reported trying to control the decision making, by asking for very specific products or techniques – as the woman in our introduction did – were more likely to be disappointed by the result. They described feeling their breasts were too small, too large, too perky, too fake-looking or not fake-looking enough.</p>
<p>When asked about why these bad outcomes occurred, they blamed themselves for being bad decision makers. “I should have asked more questions,” one said. “I should have researched more,” said another. “I should have communicated what I wanted better,” said yet another. </p>
<p>But more questions and research were not the solution. What they needed to question was the premise that a medical service provider should simply do what a customer asks.</p>
<h2>Research and ‘responsibilisation’</h2>
<p>This is part of a wider trend, in which access to unfettered information online has emboldened many people to believe they can work things out for themselves. </p>
<p>It is also reflects a trend in expert services that require deep technical knowledge, termed “responsibilisation”, in which customers are encouraged to do their own research and take responsibility for “<a href="https://journals.sagepub.com/doi/10.1177/10946705211012474">coproducing</a>” those services. </p>
<p>While being prepared is superficially good advice, such encouragement also shifts risks to individual customers, who invest a lot of time and effort to become educated through the internet because it is easily accessible and free. But all this “research” does not necessarily lead to better outcomes. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/distrust-of-experts-happens-when-we-forget-they-are-human-beings-76219">Distrust of experts happens when we forget they are human beings</a>
</strong>
</em>
</p>
<hr>
<p>Our research also highlights the downside problem when people lose faith in medical expertise. </p>
<p>Women in our study reported happier outcomes when they listened to the doctor. </p>
<p>One woman we interviewed related telling her surgeon what she wanted and being told no. “You will never have that shape,” he said, referring to an image she had shown him. The doctor then discussed with her what was possible. She credits her satisfaction with the outcome to this process of working with her surgeon.</p>
<p>Our research offers a cautionary tale of the limits of lay expertise in online forums. The best outcomes occurred when consumers’ preferences were respected within the limits of medical possibilities. </p>
<p>So it pays to listen to experts. There is certainly a space for online research, but not to the extent that it makes us think we always know better.</p><img src="https://counter.theconversation.com/content/175060/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aphrodite Vlahos received funding from the Australian Government Research Training Program (RTP) Scholarship.</span></em></p><p class="fine-print"><em><span>Anna E Hartman receives financial support provided by the Australian Government Research Training Program Scholarship.</span></em></p><p class="fine-print"><em><span>Julie Ozanne does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Our study found encouraging people to do their own research comes with risks – including shifting too much responsibility onto the individual.Aphrodite Vlahos, Adjunct Lecturer, The University of MelbourneAnna E. Hartman, PhD Candidate (Marketing), The University of MelbourneJulie Ozanne, Professor of marketing, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1641822021-07-08T15:13:51Z2021-07-08T15:13:51ZLove Island: how women with ‘fake’ faces have been belittled throughout history<p>After a recent episode of the British dating reality show <a href="https://www.itv.com/loveisland">Love Island</a>, Twitter buzzed with the word “fake”. In a challenge designed to test the couples’ knowledge of each other, the islanders were quizzed on everything from their partner’s favourite sex positions and turn-ons and turn-offs to which cosmetic procedures they had undergone.</p>
<p>Contestant Hugo Hammond’s repeated disparagement of women who were “fake” was read as a slight against women who chose plastic surgery. This offended several of the women, with fellow participants Faye Winter and Sharon Gaffka calling Hammond “ignorant” for not understanding why women undergo aesthetic procedures.</p>
<p>The game’s neglect of the <a href="https://www.theguardian.com/fashion/2021/mar/03/zoom-ready-male-demand-for-cosmetic-procedures-rising#:%7E:text=Amid%20news%20that%20comic%20Jimmy,for%20video%20consultations%20over%202020.&text=A%202019%20report%20from%20the,%E2%80%9D%20rather%20than%20%E2%80%9Ctucked%E2%80%9D.">growing market in men’s plastic surgery</a> (only the women were quizzed on their procedures) and the association of aesthetic surgeries with “fake” bodies and personalities isn’t surprising. Issues of gender, identity and authenticity have been relevant throughout the long history of plastic surgery.</p>
<h2>Reconstructive surgery</h2>
<p>The earliest operations akin to today’s plastic surgery focused on restoring the face and body to “normal”. This stretched from the <a href="http://journal.sciencemuseum.ac.uk/browse/issue-11/treating-facial-wounds/">neat suturing of wounds</a>, to reattachment and then full recreation of a cut-off nose. Such procedures were uncommon, and mainly used by men who had been wounded in duelling or warfare.</p>
<p>The earliest accounts of a nose being recreated from a skin flap <a href="https://ispub.com/IJPS/3/2/7839">date back to 600BC India</a>. European operations to build a new nose from a flap of skin from the forehead or cheek began in 16th-century Italy. Bolognese surgeon Gaspare Tagliacozzi published the first major <a href="https://wellcomecollection.org/works/r5e3unwm">Latin guide</a> to reconstructing the nose, lip or ear using skin from the arm in 1597, claiming the credit and biggest space in the history books.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/this-400-year-old-botched-nose-job-shows-how-little-our-feelings-about-transplants-have-changed-156774">This 400-year-old botched nose job shows how little our feelings about transplants have changed</a>
</strong>
</em>
</p>
<hr>
<figure class="align-center ">
<img alt="Illustration of 16th-century plastic surgery on the nose." src="https://images.theconversation.com/files/410340/original/file-20210708-27-15hjlk7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/410340/original/file-20210708-27-15hjlk7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=922&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410340/original/file-20210708-27-15hjlk7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=922&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410340/original/file-20210708-27-15hjlk7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=922&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410340/original/file-20210708-27-15hjlk7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1159&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410340/original/file-20210708-27-15hjlk7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1159&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410340/original/file-20210708-27-15hjlk7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1159&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Illustration of 16th-century plastic surgery on the nose.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:16th_century_plastic_surgery_on_the_nose_Wellcome_M0013854.jpg#/media/File:Plastic_surgery_on_the_nose_-_16th_century._Wellcome_M0013856.jpg">Wellcome Collection.</a></span>
</figcaption>
</figure>
<p>In 17th- and 18th-century Britain, this operation was associated with another kind of damaged nose: the collapsed nasal bridge of caused by syphilis. Bodily changes and augmentations that were seen as intended to hide disease were especially associated with “loose women”, out to deceive men into marrying poorly or paying for the pox (syphilis). </p>
<p>The 17th century English Poet <a href="https://poets.org/poet/robert-herrick">Robert Herrick</a> was one of many writers to describe women using padding, cosmetics, transplants and other tricks to “cheat” men. These women were “False in legs, and false in thighs; / False in breast, teeth, hair, and eyes.” </p>
<h2>The conundrum of ‘effortless’ beauty</h2>
<p>Perhaps Love Islander Aaron Francis should have landed in hotter water for naming women’s arm hair as his biggest turnoff. But between him and Hugo we see the classic women’s conundrum: change your body too much and you’re fake, but don’t show yourself too naturally either. Herrick’s contemporary, English poet <a href="https://www.poetryfoundation.org/poems/44452/still-to-be-neat-still-to-be-dressed">Ben Jonson</a> put it bluntly. In the poem “Still to be neat, still to be dressed”, he praised women for a style of effortless “sweet neglect” that required them “still to be powdered, still perfumed” but with the “art” and labour of it carefully hidden away.</p>
<p>Rare and disparaged through these centuries, the use of skin flaps for reconstructive procedures like rhinoplasty was <a href="https://oldoperatingtheatre.com/joseph-constantine-carpue-and-the-revival-of-rhinoplasty/">revived</a> at the very end of the 18th century, as new information arrived from India. Patients included men and women whose noses had been damaged by accidents and fights, but also diseases like cancer and lupus. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/-wyXGl55hMk?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>Male surgeons began to compete and brag about the speed and success of operations, including the beauty of the resulting noses. Major facial procedures remained restorative up to the huge improvements made by <a href="https://collection.sciencemuseumgroup.org.uk/people/cp121917/harold-delf-gillies">Sir Harold Delf Gillies</a>, who is considered the father of modern plastic surgery, and his teams in the first world war. But aesthetic options were also increasing, with the <a href="https://www.researchgate.net/publication/342080522_History_of_Dermal_and_Subdermal_Injectable_Fillers_Before_Collagen_The_Early_Years">first facial fillers</a>— made of ingredients like fat and paraffin — appearing in the late 19th-century.</p>
<p>People make strong distinctions today between reconstructive and “normalising” surgeries, and those seen as merely “aesthetic”. These divisions carry serious implications, such as whether something is covered by the NHS. This is the case even if the operation is very similar, or even identical: breast reduction for aesthetics is usually not NHS eligible, but <a href="https://www.nhs.uk/conditions/cosmetic-procedures/breast-reduction-female/">breast reduction to help with mental health or back pain</a> often is. </p>
<p>There are also continuing levels of stigma and accusations of deception or “fakeness”, as we saw on Love Island. On the other hand, feminists, disability activists and other ethicists have raised important concerns about the normalisation of cosmetic surgeries and the <a href="https://www.bbc.co.uk/news/magazine-35380469">pressure to achieve “perfect” looks</a>. “Sweet neglect” remains a difficult line to tread.</p><img src="https://counter.theconversation.com/content/164182/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily Cock previously received postdoctoral funding from the Leverhulme Trust for for ‘Fragile Faces: Disfigurement in Britain and its Colonies (1600–1850).’. </span></em></p><p class="fine-print"><em><span>Catherine Han does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A woman’s right to use fillers and have plastic surgery was a topic of discussion on the show after a male contestant alluded that he found women who used such enhancements ‘fake’.Emily Cock, Lecturer in Early Modern History, Cardiff UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1637292021-07-02T02:20:31Z2021-07-02T02:20:31ZNo, you can’t identify as ‘transracial’. But you can affirm your gender<figure><img src="https://images.theconversation.com/files/409408/original/file-20210702-15-12w3w72.png?ixlib=rb-1.1.0&rect=7%2C2%2C1582%2C1426&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.instagram.com/p/CQfzCQbt3Z9/">Instagram</a></span></figcaption></figure><p>Earlier this week, online influencer Oli London <a href="https://nypost.com/2021/06/30/oli-london-getting-death-threats-after-identifying-as-korean/">responded to criticism</a> after saying they identify as Korean. Having undergone surgeries to change their appearance, they equated being “transracial” with the experiences of transgender people who affirm their gender. </p>
<p>The same reasoning behind London’s Korean identity (they have asked to be called Jimin after <a href="http://kpopherald.koreaherald.com/view.php?ud=201902171029283781683_2">a K-Pop star</a>) can be compared to that of <a href="https://theconversation.com/the-contradiction-at-the-heart-of-rachel-dolezals-transracialism-75820">Rachel Dolezal</a>, a white woman who identifies as Black and made headlines in 2015. Debates about “<a href="https://www.nytimes.com/2017/05/18/opinion/the-uproar-over-transracialism.html">transracialism</a>” followed. Unfortunately, it seems we haven’t learned much in this space. </p>
<p>At their core, London’s words and actions are a prime example of racism, cultural appropriation, and transphobia, enacted from a perspective of considerable privilege. Trans and gender diverse experiences don’t equate with someone deciding to change their appearance to be part of a group whose experiences, community and struggles they can’t fully understand. </p>
<h2>Race and gender are not built the same</h2>
<p>Gender is our internal sense of self, whether that be man, woman, neither or both. </p>
<p>Most people have an idea about their gender at <a href="https://raisingchildren.net.au/pre-teens/development/pre-teens-gender-diversity-and-gender-dysphoria/gender-identity">two to three years old</a> — this may not align with the sex assigned to them at birth. </p>
<p>Unlike gender, race presents as categorised (often physical) traits that are socially constructed and understood. You can’t inherit your gender, this is internal and something individual to you — but you do inherit the social construct of race. There is also much more to one’s racial identity than physical appearance — it’s also about culture, community, connection and even trauma. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/409411/original/file-20210702-25-1fey6l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman with black curly hair" src="https://images.theconversation.com/files/409411/original/file-20210702-25-1fey6l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/409411/original/file-20210702-25-1fey6l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=462&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409411/original/file-20210702-25-1fey6l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=462&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409411/original/file-20210702-25-1fey6l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=462&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409411/original/file-20210702-25-1fey6l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=581&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409411/original/file-20210702-25-1fey6l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=581&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409411/original/file-20210702-25-1fey6l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=581&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In 2015, activist Rachel Dolezal faced questions about whether she lied about her racial identity, with her family saying she is white but has portrayed herself as Black.</span>
<span class="attribution"><a class="source" href="https://photos.aap.com.au/search/rachel%20dolezal">Colin Mulvany/The Spokesman-Review via AP</a></span>
</figcaption>
</figure>
<p>While multicultural communities and LGBTQ+ experiences of discrimination are sometimes compared, it is important to understand these experiences are different and complex. This is particularly the case, for example, in considering trans people of colour and their experiences of both racism and transphobia. </p>
<p>People who face discrimination based on their race or cultural background can usually go home to members of their family who understand them. This is often not the case for trans and gender diverse people. </p>
<p>Race and gender have very different histories, understandings, experiences, and implications in the face of discrimination. The very idea of being able to transition to a difference race discredits trans and gender diverse people’s experiences of gender affirmation. It also undermines the importance of cultural connections for many communities. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-does-it-mean-to-be-cisgender-103159">Explainer: what does it mean to be 'cisgender'?</a>
</strong>
</em>
</p>
<hr>
<h2>Picking and choosing</h2>
<p>London, who is non-binary and uses they/them pronouns, has actively chosen a “transracial” identity. But trans and gender diverse people’s decision to transition (whether that be <a href="https://www.transhub.org.au/social">social</a>, <a href="https://www.transhub.org.au/medical">medical</a> and/or <a href="https://www.transhub.org.au/legal">legal</a>) is almost always involuntary and out of necessity to live their lives authentically. </p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CPvbOPnA2Ro","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p><a href="https://www.telethonkids.org.au/projects/trans-pathways/">Almost 50% of trans young people</a> in Australia have attempted suicide at least once in their lives. Trans and gender diverse young people experience <a href="https://www.latrobe.edu.au/__data/assets/pdf_file/0010/1198945/Writing-Themselves-In-4-National-report.pdf">higher levels of psychological distress</a> than their cisgender peers. </p>
<p>This is not because there is anything inherently wrong with trans people, but because of how trans people are treated by others. Conflating racial identity with gender identity implies that being trans is a choice, and therefore so is race. The reality is that transitioning as a trans person is a difficult and taxing process, one that can be dangerous but also lifesaving and celebrated. </p>
<p>It is racist to think someone can <a href="http://bostonreview.net/race-philosophy-religion-gender-sexuality/robin-dembroff-dee-payton-why-we-shouldnt-compare">pick and choose parts of a race or culture they like</a>, then distance themselves from that culture when it suits them. They avoid the burden of discrimination while reaping the rewards of white privilege, taking the necessary resources and voices from the communities who need it. </p>
<p>There is a difference between affirming your gender as a trans person, which doesn’t harm anyone else, and choosing to live and <a href="https://theconversation.com/indigenous-cultural-appropriation-what-not-to-do-86679">appropriate another culture</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-genes-and-evolution-shape-gender-and-transgender-identity-108911">How genes and evolution shape gender – and transgender – identity</a>
</strong>
</em>
</p>
<hr>
<p>What’s more, the word “transracial” is already in use, usually referring to <a href="https://journals.sagepub.com/doi/10.1177/030857591203600304">adoption practices</a> in which white parents adopt children of colour. So it’s misleading when used to talk about someone changing their appearance. </p>
<p>Gender understandings can also be different based on their cultural context. </p>
<p>The gender binary we’ve come to think of as usual — male and female — has previously been enforced upon people, cultures and countries through colonisation. Rigid understandings of gender are imposed upon cultures where gender fluidity was previously more accepted. </p>
<p>Trans and gender diverse experiences have existed in many Indigenous cultures around the world for thousands of years, <a href="https://junkee.com/brotherboy-sistergirl-decolonise-gender/262222">including in Australia</a>.</p>
<figure class="align-center ">
<img alt="Six people laying on the ground in a circle with tie dyed t-shirts that say 'I stand with the trans community.'" src="https://images.theconversation.com/files/409302/original/file-20210701-15-1x6bza.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/409302/original/file-20210701-15-1x6bza.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409302/original/file-20210701-15-1x6bza.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409302/original/file-20210701-15-1x6bza.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409302/original/file-20210701-15-1x6bza.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409302/original/file-20210701-15-1x6bza.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409302/original/file-20210701-15-1x6bza.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Members of TransFolk of WA, a peer support service for trans and gender diverse people and their loved ones in Western Australia.</span>
<span class="attribution"><span class="source">TransFolk of WA</span></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-research-shows-how-indigenous-lgbtiq-people-dont-feel-fully-accepted-by-either-community-161096">New research shows how Indigenous LGBTIQ+ people don't feel fully accepted by either community</a>
</strong>
</em>
</p>
<hr>
<h2>Amplifying diversity</h2>
<p>It’s important for us to acknowledge that talking about “transracial” identities as something you can be <a href="https://thehill.com/blogs/pundits-blog/civil-rights/332246-if-progressives-believe-gender-is-fluid-then-why-not-race">for or against</a> only further marginalises and harms people of colour and trans and gender diverse people. This marginalisation is compounded for trans people of colour. </p>
<p>Instead of the pursuit of fame and followers, we need to prioritise amplifying the experiences of diverse peoples in ways that not only focus on discrimination and abuse, but also celebrate people being their authentic selves.</p>
<figure class="align-center ">
<img alt="ECU staff and students hold up the pansexual flag, rainbow flag, trans flag, bisexual flag and progress pride flag with their hands waving in the air and smiling." src="https://images.theconversation.com/files/409305/original/file-20210701-27-pp6gm0.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/409305/original/file-20210701-27-pp6gm0.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409305/original/file-20210701-27-pp6gm0.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409305/original/file-20210701-27-pp6gm0.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409305/original/file-20210701-27-pp6gm0.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409305/original/file-20210701-27-pp6gm0.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409305/original/file-20210701-27-pp6gm0.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">ECU Staff and students hold up LGBTIQA+ pride flags, including the trans flag, and the progress pride flag which acknowledges POC and trans communities.</span>
<span class="attribution"><span class="source">ECU</span></span>
</figcaption>
</figure><img src="https://counter.theconversation.com/content/163729/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stevie Lane was previously a board member with TransFolk of WA and still sometimes volunteers with this organisation at events and through community initiatives, though not often.</span></em></p><p class="fine-print"><em><span>Braden Hill does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>An online influencer’s desire to identify as ‘transracial’ reveals their own racism, transphobia and privileged perspective.Braden Hill, Pro-Vice Chancellor, Edith Cowan UniversityStevie Lane, Equity Projects Officer, Edith Cowan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1541642021-02-03T13:11:59Z2021-02-03T13:11:59ZWhat The Weeknd’s changing face says about our sick celebrity culture<figure><img src="https://images.theconversation.com/files/381792/original/file-20210201-17-1r6aoeu.jpg?ixlib=rb-1.1.0&rect=103%2C1%2C1101%2C716&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Weeknd performs at the 2020 American Music Awards on Nov. 22 in Los Angeles.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/in-this-screengrab-released-on-november-22-the-weeknd-news-photo/1287129877?adppopup=true">AMA2020 via Getty Images</a></span></figcaption></figure><p>You might have seen The Weeknd’s altered face on the internet lately – either bloodied and covered in bandages or transformed by faux plastic surgery. With the 30-year-old singer <a href="https://www.nfl.com/super-bowl/halftime-show">set to perform at the Super Bowl LV halftime show</a> on Feb. 7, it’ll be interesting to see whether he continues the act before hundreds of millions of viewers.</p>
<p>The changes to The Weeknd’s face didn’t simply appear overnight. </p>
<p>Rather, they surfaced as a slow crescendo, as notes in a larger arrangement.</p>
<p>Initially, there were facial bruises at the end of his “<a href="https://www.youtube.com/watch?v=4NRXx6U8ABQ">Blinding Lights</a>” music video, in which an all-night bender ends in a car accident. He sported a bandaged nose for performances on “<a href="https://www.youtube.com/watch?v=VJYpyC1SNPc">Jimmy Kimmel Live</a>” in January 2020 and “<a href="https://www.youtube.com/watch?v=17GxpgE-Fwo">Saturday Night Live</a>” in March 2020. Later that March, the bloodied nose and lips appeared <a href="https://upload.wikimedia.org/wikipedia/en/c/c1/The_Weeknd_-_After_Hours.png">on the cover</a> of “After Hours,” his most recent album.</p>
<p>He took the performance a step further at the <a href="https://www.youtube.com/watch?v=f-g_SHNv5NI">2020 American Music Awards</a>, showing up with his whole head covered in bandages, which <a href="https://www.the-sun.com/entertainment/1843099/the-weeknd-face-mask-bandages-amas-2020/">worried some fans</a> who assumed the they were real. When those bandages came off for the “Save Your Tears” <a href="https://www.youtube.com/watch?v=XXYlFuWEuKI">music video</a>, a face disfigured by excessive plastic surgery was revealed – a carefully constructed visage created using makeup and prostheses that made him nearly unrecognizable.</p>
<p>As an anthropologist who has been analyzing <a href="https://www.ucpress.edu/book/9780520293885/the-biopolitics-of-beauty">the societal implications of plastic surgery</a> for over 15 years, I was struck by The Weeknd’s use of this medical practice.</p>
<p>What, I wondered, was he trying to say?</p>
<p>Initially, I’d assumed the bruises and bandages were a metaphor for The Weeknd’s struggle with drug addiction, <a href="https://www.billboard.com/articles/columns/pop-shop/6663161/weeknd-lana-del-rey-songs-about-drugs-pop-radio-analysis">a topic he has long explored in his music</a>. He’s noted that, when scripting his music videos for “After Hours,” <a href="https://www.crfashionbook.com/mens/a34877992/the-weeknd-change-outfit/">he was inspired</a> by the film “Fear and Loathing in Las Vegas,” in which writer Hunter S. Thompson, played by Johnny Depp, often hallucinates or spirals out of control. </p>
<p>However, another key emerges in the videos from the “After Hours” album. In all the videos, people are constantly watching him, whether it’s the crowd of stiff, masked fans in the “<a href="https://www.youtube.com/watch?v=XXYlFuWEuKI">Save Your Tears</a>” music video or the frantic crowd reaching out to grab him as he tries to escape at the end of “<a href="https://www.youtube.com/watch?v=i58MNnk6BhY">Until I Bleed Out</a>.” </p>
<p>In both cases, he seems to be comparing fandom to an unsettling loss of privacy, one where his very safety is at stake. It’s not that he fears his fans will hurt him. It’s more a commentary on how his celebrity status makes him vulnerable to a prying gaze at all times.</p>
<p>In his most violent music video to date – for the song “<a href="https://www.youtube.com/watch?v=Wh8DT09QCHI">Too Late</a>” – the themes of plastic surgery and fandom collide. Two wealthy white women with bandaged heads find his severed head and swoon over it, before deciding to murder a Black male stripper so they can attach The Weeknd’s head onto that muscular body. </p>
<p>The racial dynamics of the video are hard to miss: The women seem to exoticize Blackness and reduce the body parts of two Black men to objects that give them pleasure.</p>
<p>People love musical performances – or art, more generally – because it’s pleasurable to soak in the talented work of other people. </p>
<p>In the celebrity culture of <a href="https://www.theatlantic.com/business/archive/2017/05/late-capitalism/524943/">late capitalism</a>, however, artists are finding it more and more difficult to separate themselves from their art: The show continues after the work has been published or the performance has concluded. Fans feel entitled to access all aspects of their personal lives – even their bodies.</p>
<p>Communication scholar P. David Marshall <a href="https://www.upress.umn.edu/book-division/books/celebrity-and-power">has written about</a> the ways in which the public assumes celebrities are automatically open to – or deserving of – scrutiny thanks to their fame. When their privacy is invaded, it’s simply shrugged off as coming with the territory.</p>
<p>Some celebrities, like the Kardashians, <a href="https://www.instyle.com/celebrity/kim-kardashian-makes-more-money-on-instagram-than-kuwtk">lean into it</a>. They’re willing to expose themselves in increasingly invasive ways – whether it’s through social media or reality television – because they want to exploit the symbiotic relationship between media exposure, wealth and power. </p>
<p>But other celebrities, like <a href="https://www.vanityfair.com/hollywood/2020/09/lady-gaga-hated-being-famous">Lady Gaga</a>, have been forthright about the ways in which fame has harmed their mental health. Musicians like <a href="https://www.npr.org/2014/07/08/329500971/a-reluctant-star-sia-deals-with-fame-on-her-own-terms">Sia</a> and <a href="https://www.rollingstone.com/music/music-news/why-daft-punk-wear-helmets-182716/">Daft Punk</a> have gone to great lengths to hide their faces and protect their privacy, making it part of their act. </p>
<p>By using bandages and prostheses to hide his face, perhaps The Weeknd is also telling us that parts of his life are off limits – and should stay that way.</p>
<p>The Weeknd also seems to be acknowledging the immense pressures that celebrities feel to conform to unrealistic beauty standards. Celebrity journalism can be particularly cruel when famous people fail to measure up, with the <a href="https://www.theatlantic.com/magazine/archive/2008/04/shooting-britney/306735/">paparazzi making a fortune off pictures that demonstrate celebrities as vulnerable or imperfect</a>.</p>
<p>[<em>Insight, in your inbox each day.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=insight">Get The Conversation’s newsletter</a>.]</p>
<p>Feminist and literary scholar Virginia Blum <a href="https://www.ucpress.edu/book/9780520244733/flesh-wounds">has written about</a> how celebrities are admired for their ability to transform and beautify themselves, and yet they also become canvases for harsh critique when it seems they’ve gone too far with plastic surgery or have aged ungracefully. </p>
<p>For celebrities, it can sometimes seem that there’s no pleasing anyone. By making those concerns with superficial beauty part of his art, The Weeknd seems to throw that mirror back at his listeners, asking them to reflect on the irrelevance of his appearance to his craft.</p><img src="https://counter.theconversation.com/content/154164/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alvaro Jarrin's research on plastic surgery was funded by the Wenner-Gren Foundation and the American Council of Learned Societies.</span></em></p>Over the past year, the singer has carefully constructed a visage that has made him nearly unrecognizable.Carmen Alvaro Jarrin, Assistant Professor of Anthropology, College of the Holy CrossLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1272692020-01-02T09:31:47Z2020-01-02T09:31:47ZNew year, new you? Why we think a better body will be a better self<figure><img src="https://images.theconversation.com/files/302968/original/file-20191121-483-4e81yr.jpg?ixlib=rb-1.1.0&rect=126%2C95%2C10440%2C5465&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There has been a global rise in demand for plastic surgery, which represents the simultaneously growing believe that fixing the outside will fix the inside</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/horizontal-shot-woman-under-going-face-1179413374">Jacob Lund/Shutterstock</a></span></figcaption></figure><p>Is a better body a better self? Is a perfect body our best self? In the visual culture we inhabit we increasingly believe that a better body will lead to a better life, one where we are happier, have a better job, a better partner, and things go well for us.</p>
<p>Think about the New Year’s resolutions we make, the majority of them are about the body – to exercise more, to change our diet, or straightforwardly to lose weight. While exercise might be undertaken <a href="https://theconversation.com/if-weight-loss-is-your-only-goal-for-exercise-its-time-to-rethink-your-priorities-120083">under the guise of health</a>, it’s often for beauty, and as beauty becomes the dominant value we, at times, risk our health for it. </p>
<p>Thinking that we are our bodies is transformative, it overturns how we understand human beings. We used to think that to be better we had to change what was on the inside – to have a better character, be kinder, be a better mother or friend. In <a href="https://press.princeton.edu/books/hardcover/9780691160078/perfect-me*">my research</a>, I’ve found that we now increasingly judge ourselves and others on looks. We think that the inside will follow the outside.</p>
<p>In the social media world, what matters is looking like the perfect mother rather than being the perfect mother. In a visual and virtual culture to succeed we have to look like we succeed, and make the grade when it comes to our appearance: to be thin, firm, smooth and young enough. And then, miraculously, all the rest will come to us. This is a dramatic change in what we value and what matters to us. </p>
<h2>Surgical fixes</h2>
<p>As our bodies have become ourselves, we are also then under pressure to “fix” them in order to fix ourselves. It’s no surprise in this context that we think changing our bodies is something we have a duty to do. Bodywork, from hair removal and constant diet and exercise to cosmetic surgery, is something we obsess about and focus our lives around. </p>
<p>Many of us want to change our bodies because we feel like we are not good enough as we are. While cosmetic surgery is still a minority activity it is growing. More and more of us are going under the knife, as well as engaging in very many more beauty practices.</p>
<p>This is a global trend. In 2018, more than <a href="https://baaps.org.uk/about/news/1708/cosmetic_surgery_stats_number_of_surgeries_remains_stable_amid_calls_for_greater_regulation_of_quick_fix_solutions">28,000 procedures</a> took place in the UK. In the US, the number was close to <a href="https://www.medicalnewstoday.com/articles/324693.php#1">18 million</a>. While in South Korea, which boasts the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005311/">highest number of procedures per capita</a> worldwide, there were a million. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/in-a-virtual-universe-of-perfect-bodies-instagrams-new-policy-offers-important-protection-for-young-users-123912">In a virtual universe of 'perfect' bodies, Instagram's new policy offers important protection for young users</a>
</strong>
</em>
</p>
<hr>
<h2>Televised ‘routine’ procedures</h2>
<p>That cosmetic surgery is becoming normal is reflected in the TV shows we watch. Increasingly, they present cosmetic surgery not as unusual or an “extreme makeover” but routine and aspirational. <a href="https://www.channel4.com/press/news/caroline-flack-present-surjury-wt-channel-4#:%7E:targetText=Caroline%20Flack%20is%20to%20present,they've%20always%20dreamed%20of.">Channel 4’s Surjury</a> clearly buys the claim that our bodies are ourselves, and that if we fix our body we’ll fix ourselves.</p>
<p>In attracting participants, the show promises to “make your surgical dreams come true”. The format involves contestants pitching their stories to a jury of strangers (and you can apply to be on the jury too) who decide which lucky contestant will have the surgery they desire.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/VZnAetkE4Sw?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>The <a href="https://www.bbc.co.uk/iplayer/episodes/p07sltv0/plastic-surgery-undressed">BBC’s Plastic Surgery Undressed</a> is less sensationalist and doesn’t pay for surgery. Instead, it takes four people considering a procedure and gives them the opportunity to learn as much about the surgery as possible, including watching one being performed by a leading surgeon. </p>
<p>The show is pitched as a response <a href="https://aestheticsjournal.com/news/almost-half-of-millennials-compare-aesthetic-treatment-to-a-haircut">to a poll the BBC conducted</a> of 1,033 UK women aged between 18 and 30. The results found that 48% of respondents believed that having a cosmetic procedure is like having a haircut and that 66% indicated that they had either had a cosmetic procedure, or would consider one. </p>
<p>While the show strives to educate it also normalises procedures that can raise real risks. For example, bum enhancement surgery, also known as “Brazilian butt lifts”, have seen an increase in demand but are wildly dangerous. The British Association of Aesthetic Plastic Surgeons has warned surgeons <a href="https://baaps.org.uk/media/press_releases/1630/the_bottom_line">against performing the surgery</a> until more is known and the American Society of Plastic Surgeons has dubbed it the <a href="https://theconversation.com/brazilian-butt-lifts-are-the-deadliest-of-all-aesthetic-procedures-the-risks-explained-101559">most dangerous</a> form of plastic surgery – with a <a href="https://www.newsweek.com/woman-who-died-during-butt-enhancement-surgery-allegedly-rushed-hospital-staff-inquest-told-1473386">mortality</a> rate of <a href="https://eu.usatoday.com/story/opinion/voices/2019/01/31/plastic-surgery-brazilian-butt-lifts-florida-death-column/2374585002/">1 in 3,000</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/brazilian-butt-lifts-are-the-deadliest-of-all-aesthetic-procedures-the-risks-explained-101559">Brazilian butt lifts are the deadliest of all aesthetic procedures – the risks explained</a>
</strong>
</em>
</p>
<hr>
<h2>The modified norm</h2>
<p>As more people have surgery, the more normal it is, and the more people opt for it, in turn, the more normal it becomes, and so on. It might not be very long in the future when it will be normal to have surgery and abnormal not to. We can see this in other beauty practices. Body hair, for example. We have reached the stage where we now believe that a normal, and even natural, body is one that is hairless. In 2018, there was an increase in hair removal with 70% of adults removing hair from their bodies compared with 64% in 2016, according to <a href="https://store.mintel.com/uk-shaving-and-hair-removal-market-report?_ga=2.239483395.1630422344.1574349413-1107517240.1572104721">research by Mintel</a>.</p>
<p>As the modified body becomes the normal body, we will spend more and more time trying to fix them - shaping, cutting, moulding and toning ourselves into our “perfect” body. A body that doesn’t and cannot exist. We all age, sag, wrinkle and die, and even those who fit the ideal will still feel they don’t measure up. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/body-dysmorphic-disorder-and-cosmetic-surgery-are-surgeons-too-quick-to-nip-and-tuck-74234">Body dysmorphic disorder and cosmetic surgery: are surgeons too quick to nip and tuck?</a>
</strong>
</em>
</p>
<hr>
<p>As the practice of surgery becomes more prevalent, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986110/">more surgeons are being confronted</a> with patients who suffer from body dysmorphic disorder (BDD). It is believed that <a href="https://www.priorygroup.com/blog/the-risks-of-cosmetic-surgery-for-body-dysmorphic-disorder-patients">15% of people</a> seeking plastic surgery have it and fewer than 10% of BDD patients will be satisfied with the results. Instead, it is likely that their anxieties will focus upon another aspect of their appearance. </p>
<p>The type of beauty ideals we aspire to cannot be achieved. No one can have perfectly smooth, pore-free, blemish-free, wrinkle-free skin. This only exists in the virtual world of make up, filters, apps and airbrushing. We all know that even celebs and influencers don’t look like their enhanced and modified images.</p>
<p>While we know this, it does little to turn the rising tide of body image anxiety, shame and feelings of failure. To change this we need to focus less on what individual women do and don’t do, and instead focus on changing the culture. One way of doing this is to take the pressures to be perfect seriously and recognise how much our bodies matter in a visual and virtual culture. If our bodies are ourselves then body shaming is never OK. To begin to end this we can call out <a href="https://everydaylookism.bham.ac.uk/">lookism</a>, prejudice or discrimination based on a person’s appearance, and push back.</p><img src="https://counter.theconversation.com/content/127269/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Heather Widdows has received funding to research on beauty in the form of an AHRC Networking Grant and a Leverhulme Trust Major Research Fellowship with supported the writing of Perfect Me. </span></em></p>A growing interest in plastic surgery reflects growing ideas that ‘fixing’ your body will fix your life.Heather Widdows, John Ferguson Professor of Global Ethics, University of BirminghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1061912018-11-06T17:19:01Z2018-11-06T17:19:01ZWorld War I: the birth of plastic surgery and modern anaesthesia<figure><img src="https://images.theconversation.com/files/244092/original/file-20181106-74763-t94fws.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Reconstructive surgery carried out between 1916 and 1918.</span> <span class="attribution"><span class="source">Wellcome Images</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span></figcaption></figure><p>The metrics from World War I are horrific. In all, there were <a href="https://files.nc.gov/ncdcr/wwi%20lesson.pdf">37m military and civilian casualties</a> – 16m dead and 21m wounded. Never before had a conflict brought such devastation in terms of death and injury. In response, during the four years of the war, military surgeons developed new techniques on the battlefield and in supporting hospitals which, in the war’s final two years, resulted in more survivors of injuries that would have proved mortal in the first two.</p>
<p>On the Western Front, 1.6m British soldiers were successfully treated and returned to the trenches. By the end of the war, 735,487 British troops <a href="http://www.greatwar.co.uk/research/books/british-official-history-volumes.htm">had been discharged</a> following major injuries. The majority of the injuries were caused by <a href="https://www.smithsonianmag.com/history/the-shock-of-war-55376701/">shell blasts and shrapnel</a>. </p>
<p>Many of the injured (16%) had injuries affecting the face, over a third of which were categorised as “severe”. Historically, this was an area where very little had been attempted, and survivors with major facial injuries were left with major deformities that made it difficult to see, breathe easily, or eat and drink – as well as looking horrific. </p>
<p>A young ENT (ear, nose and throat) surgeon from New Zealand, <a href="http://broughttolife.sciencemuseum.org.uk/broughttolife/people/haroldgillies">Harold Gillies</a>, working on the Western Front saw attempts to repair the ravages of facial injuries and realised that there was a need for specialised work. The timing was right, because the military medical leadership was recognising the benefit of establishing specialist centres for dealing with specific injuries and wounds, such as neurosurgical and orthopaedic injuries or victims of gassing. </p>
<p>Gillies was given the go ahead, and by January 1916 was setting up Britain’s first plastic surgery unit at the <a href="https://www.forces-war-records.co.uk/units/3680/cambridge-military-hospital">Cambridge Military Hospital in Aldershot</a>.
Gillies toured base hospitals in France to seek suitable patients to be sent to his unit. He returned expecting about 200 patients – but the opening of the unit coincided with the opening of the <a href="https://theconversation.com/why-the-battle-of-the-somme-marks-a-turning-point-of-world-war-i-60741">Somme offensive</a> in 1916, and more than 2,000 patients with facial injuries were sent to Aldershot. Treatment was also needed for sailors and airmen suffering from facial burns.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-the-battle-of-the-somme-marks-a-turning-point-of-world-war-i-60741">Why the Battle of the Somme marks a turning point of World War I</a>
</strong>
</em>
</p>
<hr>
<h2>A strange new art</h2>
<p>Gillies described the development of plastic surgery as a “<a href="https://blog.sciencemuseum.org.uk/exposing-the-face-of-war/">strange new art</a>”. Many techniques were developed by trial and error, although some mirrored <a href="https://tzmvirginia.files.wordpress.com/2013/12/zizsser-rats-lice-and-history.pdf">work</a> that had been done <a href="https://www.ncbi.nlm.nih.gov/pubmed/18286429">centuries previously in India</a>. One of the main techniques Gillies developed was <a href="http://news.bbc.co.uk/1/shared/spl/hi/picture_gallery/07/magazine_faces_of_battle/html/6.stm">tube pedicle skin-grafting</a>. </p>
<p>A flap of skin was separated but not detached from a healthy part of the soldier’s body, stitched into a tube, and then sutured to the injured area. A period of time was needed to allow a new blood supply to form at the site of implantation. It was then detached, the tube opened and the flat skin stitched over the area that needed cover.</p>
<p>One of the first patients to be treated was Walter Yeo, gunnery warrant officer on HMS Warspite. Yeo sustained facial injuries during the Battle of Jutland in 1916, including the loss of his upper and lower eyelids. The tube pedicle produced a “mask” of skin grafted across his face and eyes, producing new eyelids. The results, although far from perfect, meant that he had a face once again. Gillies went on to repeat the same sort of procedure on thousands of others.</p>
<p>There was need for larger facilities for surgical and postoperative treatment and also rehabilitation of the patients, together with the different specialities involved in their care. Gillies played a large part in the design of a specialist unit at <a href="http://qmh.oxleas.nhs.uk/news/pioneer-gillies-and-queen-marys-featured-britains-/">Queen Mary’s Hospital in Sidcup</a>, southeast London. It opened with 320 beds – and by the end of the war, there were more 600 beds and 11,752 operations had been carried out. But reconstructive surgery continued long after hostilities ceased and, by the time the unit finally closed in 1929, some 8,000 military personnel had been treated between 1920 and 1925.</p>
<p>The details of the injuries, the operations to correct them and the final outcome were all recorded in detail, both by early clinical photography and also by detailed drawings and paintings created by Henry Tonks, who although trained as a doctor, had given up medicine for painting. Tonks became a war artist on the Western Front but then joined Gillies to help not only in the recording of the new plastic procedures, but also with their planning.</p>
<h2>The only real advances</h2>
<p>The complex facial and head surgery necessitated new ways of delivering anaesthetics. Anaesthesia generally had advanced as a speciality during the war years – both in the way it was administered, and also how doctors were trained (previously, anaesthetics had often been given by a junior member of the surgical team).</p>
<p>The survival from operations requiring anaesthesia was improving, although techniques were still based on chloroform and ether. The Queen Mary’s anaesthetic team developed a method of passing a rubber tube from the nose to the trachea (windpipe), as well as working on the endotracheal tube (mouth to trachea) whch was made from commercial rubber tubing. Many of their techniques remain in use today. As an <a href="http://homepage.eircom.net/%7Eodyssey/Quotes/History/Keegan_Soldiers.html">Austrian doctor wrote in 1935</a>: </p>
<blockquote>
<p>Nobody won the last war but the medical services. The increase in knowledge was the sole determinable gain for mankind in a devastating catastrophe.</p>
</blockquote>
<hr>
<p><em>The author would like to acknowledge the assistance of Norman G Kirby, Major General (Retired), Director of Army Surgery 1978-82.</em></p><img src="https://counter.theconversation.com/content/106191/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Robert Kirby does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Medical advances were the only positive things to come out of the Great War.Robert Kirby, Professor of Clinical Education and Surgery, Keele UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1037352018-09-25T15:13:46Z2018-09-25T15:13:46ZWhy older skin heals with less scarring<figure><img src="https://images.theconversation.com/files/237662/original/file-20180924-117383-olicyb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Large scar after surgery on the abdomen young woman.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/scars-removal-concept-large-scar-after-740292784?src=p2QH5MZ6U88TTDQ4BHbDzg-1-30">OneSideProFoto/SHutterstock.com</a></span></figcaption></figure><p>When it comes to your skin, getting older isn’t all bad news. Older people heal skin wounds with thinner scars. </p>
<p>As a practicing dermatologist, my physician colleagues and I make this somewhat counterintuitive observation routinely. But how this occurs is not well understood. Mailyn Nishiguchi, a graduate student, Casey Spencer, a research technician, and I worked together to <a href="https://www.cell.com/cell-reports/fulltext/S2211-1247(18)31340-8">discover how aging normally modulates how our skin heals and the thickness of our scars</a>. </p>
<p><a href="https://www.thomasleunglab.org">My laboratory</a> at the University of Pennsylvania studies how to heal human tissues without a scar. Organisms heal skin wounds using two different processes: scar formation and tissue regeneration. Tissue regeneration results in the return of the original tissue architecture and absence of scars. Scar formation results in fibrous tissue deposition that obliterates the tissue architecture, and generates a thick line of raised red skin. Mammals generally repair injured tissue with scar formation. </p>
<p>In experiments we observed that when young mice were injured, they healed with a scar. However, when elderly mice were injured, their skin wounds regenerated and repaired without a scar. These results reflected what we have observed in our clinic patients. We concluded that aging improves tissue regeneration in both mice and humans, and we set out to understand how this works. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/237560/original/file-20180922-7728-5mjgbh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/237560/original/file-20180922-7728-5mjgbh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=385&fit=crop&dpr=1 600w, https://images.theconversation.com/files/237560/original/file-20180922-7728-5mjgbh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=385&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/237560/original/file-20180922-7728-5mjgbh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=385&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/237560/original/file-20180922-7728-5mjgbh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=483&fit=crop&dpr=1 754w, https://images.theconversation.com/files/237560/original/file-20180922-7728-5mjgbh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=483&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/237560/original/file-20180922-7728-5mjgbh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=483&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Older mice heal skin injuries without a scar.</span>
<span class="attribution"><span class="source">Thomas Leung</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>First, we wanted to see if this change was due to a circulating factor in the blood. We exchanged blood between young and old mice through a technique called parabiosis. When elderly mice were exposed to young blood, their skin no longer regenerated as well. Thus, young blood contained a circulating chemical that promotes scar formation and prevents tissue regeneration from occurring.</p>
<p>To identify this factor, we compared gene activity between injured young and elderly human skin. We focused only on the genes of proteins circulating in the blood and found 13 different proteins in old versus young skin. One of them, SDF1, had previously been shown to regulate tissue regeneration in the <a href="https://doi.org/10.1101/gad.267724.115">skin</a>, <a href="https://doi.org/10.1371/journal.pone.0079768">lung</a> and <a href="https://doi.org/10.1038/nature12681">liver</a>.</p>
<p>To prove that SDF1 may be the mysterious factor responsible for scarring in the young animals, we engineered a mouse that lacked the SDF1 protein in the skin. When SDF1 was eliminated, young mice regenerated their skin with no scarring, just as in elderly mice. Therefore, we concluded that SDF1 promotes scar formation in young mice.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/237757/original/file-20180924-85755-1gdnvey.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/237757/original/file-20180924-85755-1gdnvey.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=249&fit=crop&dpr=1 600w, https://images.theconversation.com/files/237757/original/file-20180924-85755-1gdnvey.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=249&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/237757/original/file-20180924-85755-1gdnvey.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=249&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/237757/original/file-20180924-85755-1gdnvey.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=312&fit=crop&dpr=1 754w, https://images.theconversation.com/files/237757/original/file-20180924-85755-1gdnvey.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=312&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/237757/original/file-20180924-85755-1gdnvey.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=312&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A factor in young blood promotes scar formation.</span>
<span class="attribution"><span class="source">Thomas Leung</span></span>
</figcaption>
</figure>
<p>How does getting older shut off SDF1 production? We discovered that a different protein, called EZH2, turns off the SDF1 gene, and as mice aged, the amount of EZH2 rose. To take this one step further, we used a drug to block EZH2 function in elderly mice. In the absence of EZH2, elderly mice reactivated SDF1 and lost their ability to regenerate their skin.</p>
<p>We wanted to see if these findings also held true in human skin. Similar to mice, skin injury in young people triggered SDF1 production, and this induction was diminished in elderly human skin. We also showed that EZH2 is the reason behind this change. In this case, mouse and human skin behaved in the same way.</p>
<p>Why do mice and humans form more scars when they are young? We speculate that this is a trade-off between speed and quality. Tissue regeneration is a slow process – it takes a month for our skin injuries to regenerate. Meanwhile, a scar can form in little as three to five days. As a young animal, one would want an injury to heal as quickly as possible to live to fight another day. You will tolerate imperfect healing for a faster response. Whereas, older animals that have passed their reproductive prime may not need to heal as fast.</p>
<p>Taken together, we identified a rare example where aging improves tissue function, specifically the tissue repair process. We are planning a clinical trial with the drug, plerixafor, an existing FDA-approved SDF1 inhibitor which is currently used to mobilize stem cells for bone marrow transplant patients, to test its efficacy in preventing scar formation in humans. </p>
<p>Currently, there are no effective treatments on the market to prevent scar formation. In addition to scars from acne and incidental trauma, we hope this approach may be beneficial for many types of human tissue injuries, including the genetic disease epidermolysis bullosa, an extremely debilitating blistering skin disease, in burn patients, or patients with keloid scars.</p><img src="https://counter.theconversation.com/content/103735/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Thomas Leung receives funding from National Institutes of Health, U.S. Department of Veterans Affairs, and the Moseley Foundation. </span></em></p>When kids get injured their skin heals fast, but usually with nasty-looking scars. Now scientists studying the genes of old mice have figured out how they regenerate skin and block scars.Thomas Leung, Assistant Professor of Dermatology, University of PennsylvaniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1015592018-08-24T09:24:57Z2018-08-24T09:24:57ZBrazilian butt lifts are the deadliest of all aesthetic procedures – the risks explained<figure><img src="https://images.theconversation.com/files/232651/original/file-20180820-30587-5ao2gq.jpg?ixlib=rb-1.1.0&rect=245%2C779%2C4437%2C2337&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/598816265?src=tA-X5nY4VFmHdObzy7zJIg-3-96&size=huge_jpg">MaximP/Shutterstock</a></span></figcaption></figure><p>The desire for a larger bottom is becoming more popular, with the number of so-called Brazilian butt lifts <a href="https://www.plasticsurgery.org/documents/News/Statistics/2017/cosmetic-procedure-trends-2017.pdf">more than doubling</a> in the last five years. </p>
<p>However, a recent high-profile case involving a doctor in Miami who was <a href="https://www.miamiherald.com/latest-news/article216245690.html">banned</a> from operating after the death of a patient during surgery, highlights the risks associated with having this procedure. According to the American Society of Plastic Surgeons, the Brazilian butt lift (BBL) has the <a href="https://www.plasticsurgery.org/news/press-releases/plastic-surgery-societies-issue-urgent-warning-about-the-risks-associated-with-brazilian-butt-lifts">highest rate of death</a> of all aesthetic procedures. </p>
<h2>What is a Brazilian butt lift?</h2>
<p>Some people have a BBL for aesthetic reasons, but many have it after losing lots of weight, serious disfigurement after pelvic trauma or practical problems, such as holding up trousers. </p>
<p>The procedure involves taking fat from areas of the body where it’s not wanted and transplanting it into the glutes to enlarge them.</p>
<p>To be successful, a fat graft needs nutrition and so has to be injected into tissue that has a blood supply. Fat <a href="https://www.sciencedirect.com/science/article/pii/S2049080117302406#bib75">can survive</a> if injected into other fat, but up to 90% of it can be absorbed if it is. Fat has more chance of staying in place if it is inserted into muscle – but this is where the risk lies.</p>
<p>Injecting fat into the buttock can easily lead to serious problems if done incorrectly. These include a fat embolism, when fat enters the bloodstream and blocks a blood vessel. In the lungs, for example, it blocks oxygen from entering the bloodstream, while in the brain it can cause a stroke – both can be fatal.</p>
<p>The volume of fat is also important. Most surgeons consider 300ml – slightly less than a can of soda – to be a safe amount. However, some more experienced surgeons use a much larger volume of fat that may be measured in litres. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/232330/original/file-20180816-2897-5uztcv.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2598%2C1730&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/232330/original/file-20180816-2897-5uztcv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/232330/original/file-20180816-2897-5uztcv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/232330/original/file-20180816-2897-5uztcv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/232330/original/file-20180816-2897-5uztcv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/232330/original/file-20180816-2897-5uztcv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/232330/original/file-20180816-2897-5uztcv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">More people are risking surgery to get a bigger bum.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/371181623?src=sCIAWMxSfrQ9iPLhTtiHYw-1-90&size=huge_jpg">Satyrenko/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Why is the mortality rate so high?</h2>
<p>A <a href="https://academic.oup.com/asj/article/37/7/796/3075249">2017 survey</a> of 692 surgeons from across the world investigated the rate of mortality among patients undergoing BBL. Throughout their careers, the surgeons reported 32 cases of death from a fat embolism and 103 non-fatal cases, but there are probably many more that remain unreported.</p>
<p>Fat embolism was recently identified as the leading cause of death in aesthetic surgery. The estimated death rate from fat embolism may be as high as <a href="https://www.plasticsurgery.org/news/press-releases/plastic-surgery-societies-issue-urgent-warning-about-the-risks-associated-with-brazilian-butt-lifts">one in 3,000</a> for BBLs. A <a href="https://www.ncbi.nlm.nih.gov/pubmed/26111314">2015 study</a> of deaths from BBL surgery concluded that they probably occur as a result of gluteal blood vessels becoming damaged during the procedure, allowing fat to enter the bloodstream. The authors recommended that “buttocks lipoinjection should be performed very carefully, avoiding injections into deep muscle planes”.</p>
<p>Deaths in the US <a href="https://www.nbcmiami.com/news/local/NBC-6-Investigation-Prompts-Worldwide-Warning-About-Popular-Cosmetic-Procedure-398954221.html">have caused concern</a>. In one recently <a href="http://www.dailymail.co.uk/news/article-3594781/Death-mother-two-29-following-liposuction-buttocks-augmentation-surgery-caused-fat-clots-lungs-heart.html">reported</a> case in the US that led to death from a fat embolism, surgeons believed injections had been made into superficial fat, but at post-mortem fat was found in the heart and lungs. There was also some evidence of damage to gluteal blood vessels. </p>
<p>However, it should be noted that fat is also injected into muscle for some breast enhancement surgery, with no reported deaths. This suggests that there are other factors involved in the high mortality rate among BBL patients.</p>
<p>Most of these deaths <a href="https://academic.oup.com/asj/article/37/7/811/3868431">appear to have been caused</a> by inappropriately qualified practitioners working in non-approved facilities, including homes and garages. </p>
<p>Other post-surgery problems, such as gangrene and <a href="https://www.thesun.co.uk/news/3899372/youngest-euromillions-winner-jane-park-is-fighting-for-her-life-with-sepsis-after-brazilian-bum-lift-went-wrong/">sepsis</a>, can also be fatal.</p>
<h2>Is it worth the risk?</h2>
<p>The potential risk of death from a fat embolism has to be weighed against the benefits, especially in cases where there are physical and functional benefits to having the surgery. In the case of the Brazilian butt lift, perhaps the risks outweigh the benefits. </p>
<p>Nevertheless, in a celebrity and beauty obsessed society, the procedure remains popular, despite the risks. So it is important that surgeons make the risks of the procedure very clear to anyone considering it. Patient safety should always be the top priority. And surgeons need to do more to increase the safety of the procedure and lower the unnecessarily high mortality rate.</p><img src="https://counter.theconversation.com/content/101559/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jim Frame does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The number of people going under the knife for a big bum is increasing – but it carries the highest risk of death in any cosmetic surgery.Jim Frame, Professor of Aesthetic Plastic Surgery, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/992622018-07-12T10:24:53Z2018-07-12T10:24:53ZDoes thinking you look fat affect how much money you earn?<figure><img src="https://images.theconversation.com/files/227240/original/file-20180711-27027-9hsswi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Is the scale telling the truth?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cropped-image-woman-feet-standing-on-604196501?src=sFopdWh9s_6XEvAb68uQrA-1-71">VGstockstudio/Shutterstock.com</a></span></figcaption></figure><p>Two things people often think about are <a href="https://www.nbcnews.com/better/money/americans-think-about-money-work-more-sex-survey-finds-n424261">money</a> and <a href="https://www.allure.com/story/national-judgement-survey-statistics">their appearance</a>. Past research has shown that there is a correlation between the two: <a href="https://www.uni-muenster.de/imperia/md/content/psyifp/aeechterhoff/wintersemester2011-12/vorlesungkommperskonflikt/hamermesh_beautylabormarket_amereconrev1994.pdf">People subjectively considered attractive earn more</a>.</p>
<p>And body weight plays a major role in attractiveness. A person’s body mass index – which adjusts a person’s weight for their height – and their success in the workplace <a href="https://wol.iza.org/articles/obesity-and-labor-market-outcomes/long">are linked</a>. Put simply, thin people, especially women, are rewarded more than their larger colleagues. But those studies only considered how other people perceive you. </p>
<p>In <a href="http://www.sciencedirect.com/science/article/pii/S1570677X17302617">our research</a>, we looked at the flip side: Does our own perception of our bodies, even when incorrect, make a difference? In other words, does thinking you look fat or skinny affect your wages? </p>
<p>Knowing if a worker’s own perception of his or her weight makes a difference – rather than only the employer’s – could help determine the best way to mitigate the impact of weight discrimination on earnings. In addition, a better understanding of gender differences in weight perception might help explain the persistent <a href="https://theconversation.com/us/topics/gender-wage-gap-11006">gender wage gap</a>. </p>
<h2>Pressure to ‘look good’</h2>
<p>Americans spend billions of dollars each year on making minor changes to their appearance with <a href="http://www.npd.com/wps/portal/npd/us/news/press-releases/2017/us-prestige-beauty-industry-adds-1-billion-in-sales-grows-6-percent-in-2016/">makeup, hair dye and other cosmetics</a>. We also spend billions trying to change our weight with diets, <a href="http://www.clubindustry.com/studies/ihrsa-reports-57-million-health-club-members-276-billion-industry-revenue-2016">gym memberships</a> and <a href="http://www.plasticsurgery.org/documents/News/Statistics/2016/cosmetic-procedures-average-cost-2016.pdf">plastic surgery</a>.</p>
<p>Trying to live up to the pervasive images of “perfect” models and movie heroes has a dark side: body-shaming, anxiety and depression, as well as unhealthy strategies for weight loss or muscle gain. For example, anorexia nervosa involves the extreme over-perception of weight and <a href="http://www.nationaleatingdisorders.org/statistics-research-eating-disorders">claims the lives of roughly 10 percent of its victims</a>. It also has a financial cost. Having an eating disorder boosts annual health care costs <a href="http://www.sciencedirect.com/science/article/pii/S2211335514000230">by nearly US$2,000</a> per person.</p>
<p>Why is there both external and internal pressure to look “perfect”? One reason is that society rewards people who are thin and healthy looking. Researchers have shown that body mass index is related to wages and income. Especially for <a href="https://wol.iza.org/articles/obesity-and-labor-market-outcomes/long">women</a>, there is a clear penalty at work for being overweight or obese. Some studies have also found an <a href="https://www.forbes.com/sites/freekvermeulen/2011/03/22/the-price-of-obesity-how-your-salary-depends-on-your-weight/#431b14393d9a">impact for men</a>, though a less noticeable one.</p>
<h2>Does weight perception matter?</h2>
<p>While the research literature is clear that labor market success is partly based on how employers and customers perceive your body image, no one had explored the other side of question. Does a person’s own perception of body image matter to earnings and other indicators of success in the workplace?</p>
<p>In simple terms, does it change your wages if you think of yourself as overweight when you are not? Or if you think of yourself as skinny, when in reality you are not, does this misperception affect your ability to find and keep a job?</p>
<p>We were interested in answering these questions because it is often easier to fix your own view of yourself than to fix the entire world’s.</p>
<p><a href="http://www.sciencedirect.com/science/article/pii/S1570677X17302617">Our study</a> answered this question by tracking a large national random sample of the first wave of U.S. millennials, born in the early 1980s. We followed about 9,000 of them starting in 1997 when they were teenagers and ending 15 years later when the oldest was 31. Our research followed these respondents over a critical time period when bodies change from teenage shape into adult form and when people build their identities.</p>
<p>The survey asked respondents to report their actual weight and height. It also asked each to classify themselves each year as “very overweight,” “overweight,” “about the right weight,” “slightly underweight” or “very underweight.” This enabled us to compare each person’s clinically defined BMI category, such as being underweight, with his or her perception. </p>
<p>As in other research, women in our sample tend to over-perceive weight – they think they’re heavier than they are – while men tend to under-perceive theirs.</p>
<h2>What other people think matters more</h2>
<p>While self-perceived weight, especially when incorrect, can influence <a href="http://www.ncbi.nlm.nih.gov/pubmed/20919592">self-esteem</a>, <a href="http://www.emeraldinsight.com/doi/abs/10.1108/JPMH-11-2013-0071">mental health</a> and health behaviors, we found no relationship between the average person’s self-perception of weight and labor market outcomes like wages, weeks worked and the number of jobs.</p>
<p>In other words, it’s not what you think about your appearance that matters in the workplace, it’s just what other people think. Worrying if eating another cookie will make you look fat may harm your self-esteem, but thinking you’re overweight likely will not affect your earnings.</p>
<p>Because we find that women earn lower wages than men do even when accounting for weight perception differences, it appears the well-known gender pay gap is not due to differences in self-perceived weight.</p>
<p>While the continued gender penalty in the labor market is frustrating, <a href="https://www.sciencedirect.com/science/article/pii/S1570677X17302617">our finding</a> that misperceived weight does not harm workers is more heartening. Weight misperception is common, but thinking you’re heavier or lighter than you are doesn’t dampen earnings.</p>
<p>At the same time, it’s important to remember that although self-perceived weight doesn’t appear to affect wages, it still takes a toll on mental and physical health.</p>
<p>Passing over heavier workers to hire or promote less productive but thinner workers is inefficient and unfair. Our results indicate that expanding efforts to reduce discrimination on the basis of body weight in the workplace is important. </p>
<p>Since employers’ perception of weight is what matters in the labor market, policies to reduce the social stigmatization of body weight, such as curbing <a href="https://www.cnn.com/2016/04/15/health/fat-shaming-feat/index.html">body-shaming</a>, make sense. Changing discrimination laws to include body type as a category would also help. For example, <a href="http://time.com/4883176/weight-discrimination-workplace-laws/">Michigan is the only state</a> that prohibits discrimination on the basis of weight and height. </p>
<p>We believe expanding such protections would make the labor market more efficient and fair.</p><img src="https://counter.theconversation.com/content/99262/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A new study explores whether how we perceive our body weight affects our prospects in the job market and at work.Patricia Smith, Professor of Economics, University of MichiganJay L. Zagorsky, Senior lecturer, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/957192018-05-14T09:52:03Z2018-05-14T09:52:03ZThis is what really happens when you go under the knife<figure><img src="https://images.theconversation.com/files/218472/original/file-20180510-34038-y5mmtc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/medical-team-performing-surgical-operation-bright-741433855?src=-3BA1ZyV3GGvLHsWUU-S5A-1-28">shutterstock</a></span></figcaption></figure><p>We’ve all seen the TV dramas – <a href="http://abc.go.com/shows/greys-anatomy">Grey’s Anatomy</a>, <a href="https://www.imdb.com/title/tt0108757/">ER</a>, <a href="https://www.bbc.co.uk/programmes/b006m8wd">Casualty</a>, <a href="https://www.bbc.co.uk/programmes/b006mhd6">Holby City</a> – and most of us like to think we have a pretty good idea of what happens in an operating theatre. The doctors and nurses will be clad in blue scrubs, <a href="https://www.huffingtonpost.co.uk/entry/music-surgery_n_6310842">operatic music will be playing</a>, with intermittent calls of “scalpel” or “swabs”, right?</p>
<p>For those readers, who’ve ever had an operation – whether it was <a href="https://theconversation.com/seven-body-organs-you-can-live-without-84984">planned or an emergency</a> – things in the real world probably felt very different to those familiar TV drama medical emergency scenes. In part, this is because <a href="https://theconversation.com/greys-anatomy-is-unrealistic-but-it-might-make-junior-doctors-more-compassionate-92040">TV programmes often portray the staff</a> who work on the wards also working in the operating theatre – but this isn’t the case. </p>
<p>In fact, it’s not just doctors and nurses that make up part of the team involved in an operation, there is also a group of professionals, known as <a href="https://www.healthcareers.nhs.uk/explore-roles/allied-health-professionals/roles-allied-health-professions/operating-department-practitioner">operating department practitioners</a> (ODPs), who are trained specifically to look after you when you’re under the bright lights of the operating theatre. </p>
<h2>What happens when I arrive?</h2>
<p>Having an operation can be highly stressful. You might have been told not to eat before. It all feels a bit unknown, and you aren’t exactly sure what will happen. But the staff at the hospital are on hand to try and make things easy for you. </p>
<p>As you are arrive on the ward, a whole team of staff are busy preparing for your surgery. You’ll be asked to confirm who you are and what you’re being admitted for. You will also be asked to change into a very fetching hospital gown. Someone will also sit down and talk you through what’s happening and check you have not eaten – this is so you don’t vomit <a href="https://theconversation.com/science-lesson-how-anesthetics-work-and-why-xenons-perfect-83744">during your anaesthetic</a>. </p>
<h2>Who looks after me?</h2>
<p>The team looking after you has three sub teams working as one. They are the anaesthetic team, the surgical team and the post anaesthetic team. These teams work like cogs and your care and treatment is seamless. As a minimum, this would mean you would have nine health professionals caring for you at any one time. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/218471/original/file-20180510-34021-n03u0l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/218471/original/file-20180510-34021-n03u0l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=316&fit=crop&dpr=1 600w, https://images.theconversation.com/files/218471/original/file-20180510-34021-n03u0l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=316&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/218471/original/file-20180510-34021-n03u0l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=316&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/218471/original/file-20180510-34021-n03u0l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=398&fit=crop&dpr=1 754w, https://images.theconversation.com/files/218471/original/file-20180510-34021-n03u0l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=398&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/218471/original/file-20180510-34021-n03u0l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=398&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Knowing you’re in safe hands is important.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?u=http%3A%2F%2Fdownload.shutterstock.com%2Fgatekeeper%2FW3siZSI6MTUyNTk5MTk1OCwiYyI6Il9waG90b19zZXNzaW9uX2lkIiwiZGMiOiJpZGxfMjIxODgyODkwIiwiayI6InBob3RvLzIyMTg4Mjg5MC9odWdlLmpwZyIsIm0iOjEsImQiOiJzaHV0dGVyc3RvY2stbWVkaWEifSwiOEhvV2xNNVVYQW5XazNKcytkYkczVytlWlRzIl0%2Fshutterstock_221882890.jpg&ir=true&pi=11079995&m=221882890&src=lBmi03gtGnpC4nP43quMWQ-1-3">Shutterstock</a></span>
</figcaption>
</figure>
<p>Your operating team on the day will have doctors – who are the anaesthetist, and the surgeon – but the rest of the team could be made up nurses, ODPs and healthcare assistants. ODPs are generally a graduate professional and they train through university in partnership with the hospital operating theatres.</p>
<h2>When do I have the anaesthetic?</h2>
<p>When the team is ready and it’s time for your surgery, you have your anaesthetic. This will be delivered by an anaesthetist, but there always has to be trained assistance – normally an ODP.</p>
<p>On arrival in the <a href="https://theconversation.com/scientists-find-way-to-predict-who-is-likely-to-wake-up-during-surgery-53217">anaesthetic room</a>, it is the ODP that greets you with a big smile and often a cheesy joke. After all, they have minutes to get to know you and for you to trust them with your life. They will attach you to the monitoring equipment and measure your baseline pulse and blood pressure readings. </p>
<p>You will need a cannula (a plastic tube) inserting into a vein, so the anaesthetist can give you the drugs. This is the point where you may be asked to start counting back slowly from ten – you won’t even get to seven.</p>
<h2>What happens during surgery?</h2>
<p>While the anaesthetic team continue to look after you, the surgical team carry out your operation. The surgeon will have at least one assistant – I have known more than ten people to be part of this team for major head and neck cancer surgery. The first assistant and other assistants scrub up with the surgeon and help with the surgery. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/218485/original/file-20180510-5968-1gco6wx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/218485/original/file-20180510-5968-1gco6wx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/218485/original/file-20180510-5968-1gco6wx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/218485/original/file-20180510-5968-1gco6wx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/218485/original/file-20180510-5968-1gco6wx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/218485/original/file-20180510-5968-1gco6wx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/218485/original/file-20180510-5968-1gco6wx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Laser-like precision.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/search?searchterm=black+hospital+patient+smiling&search_source=base_search_form&language=en&page=1&sort=popular&image_type=all&measurement=px&safe=true">Shutterstock</a></span>
</figcaption>
</figure>
<p>Adding to this team there is a scrub practitioner and their role is to provide the swabs, needles and equipment to the surgeon and the assistants. They are the ones who also count everything to make sure you don’t leave the operating theatre with any unwanted extras. </p>
<h2>When can I go home?</h2>
<p>Once your <a href="https://theconversation.com/will-you-feel-better-after-surgery-now-you-can-find-out-using-this-online-tool-72758">surgery is complete</a> your wounds will be dressed by the surgical team. Your anaesthetic will be reversed and you will be taken to the post anaesthetic care unit – which used to be called recovery. Here you will be looked after until you are ready to be discharged back to the ward. Here, you wounds will be inspected, and whoever’s looking after you will make sure your <a href="https://theconversation.com/anthill-19-pain-87538">pain is under control</a> and you are not feeling sick. </p>
<p>Once you are awake and comfy, you will be taken back to the ward where your relatives may be waiting and you should be able to have something to eat and drink. Depending on your surgery and who you have at home to look after you, you may even be allowed to go home the same day.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-why-can-you-feel-groggy-days-after-an-operation-74989">Health Check: why can you feel groggy days after an operation?</a>
</strong>
</em>
</p>
<hr>
<p>.</p><img src="https://counter.theconversation.com/content/95719/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deborah Robinson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>What to expect when you’re expecting an operation.Deborah Robinson, Senior Lecturer and Head of Health and Social Work School, University of HullLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/941592018-05-02T10:41:57Z2018-05-02T10:41:57ZIn Brazil, patients risk everything for the ‘right to beauty’<figure><img src="https://images.theconversation.com/files/216868/original/file-20180430-135817-1pza6i0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A plastic surgery-themed magazine is displayed in a Brazil storefront.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/keishaf/5094464539/">hollywoodsmile310</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>In the U.S., if you want a face lift or a tummy tuck, it’s generally assumed that you’ll be paying out of pocket. Insurance will tend to cover plastic surgery <a href="https://www.zwivel.com/blog/insurance-coverage-plastic-surgery/">only when the surgery is deemed</a> “medically necessary” and not merely aesthetic. </p>
<p>In Brazil, however, patients are thought of as having the “right to beauty.” In public hospitals, plastic surgeries are free or low-cost, and <a href="http://www.osul.com.br/cirurgia-plastica-reparadora-cresce-mais-que-a-cirurgia-estetica-no-brasil/">the government subsidizes nearly half a million surgeries every year</a>.</p>
<p>As a medical anthropologist, I’ve spent years studying Brazilian plastic surgery. While many patients are incredibly thankful for the opportunity to become beautiful, the “right to beauty” has a darker side to it.</p>
<p>Everyone I interviewed in Brazil admitted that plastic surgeries were risky affairs. In the public hospitals where these plastic surgeries are free or much cheaper than in private clinics, I heard many patients declare that they were “cobaias” (guinea pigs) for the medical residents who would operate on them.</p>
<p>Yet these patients, most of whom were women, also told me that living without beauty in Brazil was to take an even bigger risk. Beauty is perceived as being so central for the job market, so crucial for finding a spouse and so essential for any chances at upward mobility that many can’t say no to these surgeries.</p>
<p>The very long queues for plastic surgery in public hospitals – with wait times of several months or even years – seem to confirm this immense longing for beauty. It’s made Brazil the second-largest consumer of plastic surgery in the world, with <a href="http://g1.globo.com/bemestar/noticia/2016/08/cai-numero-de-plasticas-no-brasil-mas-pais-ainda-e-2-no-ranking-diz-estudo.html">1.2 million surgeries carried out every year</a>. </p>
<h2>Brazil’s ‘pope of plastic surgery’</h2>
<p>Today, Brazil considers health to be a basic human right <a href="https://www.carnegiecouncil.org/publications/articles_papers_reports/0236">and provides free health care</a> to all its citizens – a hard-won victory of social activists after Brazil’s dictatorship fell and a new democratic constitution was written into law in 1988. However, public hospitals remain severely underfunded, and most middle-class and upper-class Brazilians prefer to use private medical services. </p>
<p>In effect, Brazil has a two-tiered system. There is a private health care system that is cutting-edge and luxurious and a public one that is strapped for cash but provides essential services to the working class.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/216871/original/file-20180430-135840-13ez7kh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/216871/original/file-20180430-135840-13ez7kh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=458&fit=crop&dpr=1 600w, https://images.theconversation.com/files/216871/original/file-20180430-135840-13ez7kh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=458&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/216871/original/file-20180430-135840-13ez7kh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=458&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/216871/original/file-20180430-135840-13ez7kh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=576&fit=crop&dpr=1 754w, https://images.theconversation.com/files/216871/original/file-20180430-135840-13ez7kh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=576&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/216871/original/file-20180430-135840-13ez7kh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=576&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A billboard advertises a private plastic surgery clinic in Barra da Tijuca, a wealthy neighborhood in Rio de Janeiro.</span>
<span class="attribution"><a class="source" href="http://pictures.reuters.com/C.aspx?VP3=SearchResult&ITEMID=PBEAHULRNBZ&RW=1317&RH=708">Gregg Newton/Reuters</a></span>
</figcaption>
</figure>
<p>Plastic surgery is considered an essential service largely due to the efforts of a surgeon named Ivo Pitanguy. In the late 1950s, Pitanguy – <a href="http://www.cmjornal.pt/mais-cm/obituario/detalhe/morreu_brasileiro_ivo_pitanguy_papa_da_cirurgia_estetica">now known as the “pope of plastic surgery”</a> – convinced President Juscelino Kubitschek that the “right to beauty” was as basic as any other health need. Pitanguy <a href="http://www.ciplastica.com/ojs/index.php/rccp/article/view/28">made the case</a> that ugliness caused so much psychological suffering in Brazil that the medical class could not turn its back on this humanitarian issue. </p>
<p>In 1960, <a href="http://www.iip.org.br/instituto.html">he opened the first institute that offered plastic surgery to the poor</a>, one that doubled as a medical school to train new surgeons. It was so successful that it became the educational model followed by most other plastic surgery residencies around the country. In return for free or low-cost surgeries, working-class patients would help surgeons learn and practice their trade.</p>
<p>Brazil was the perfect testing ground for this idea. In the early 1920s, Brazilian eugenic scientists suggested that <a href="https://www.tandfonline.com/doi/pdf/10.1080/13569325.2015.1091296">beauty was a measure of the nation’s racial progress</a>. Beauty started to assume more cultural clout, and plastic surgeons inherited these ideals, seeing their trade as “fixing” the errors of too much racial mixture in Brazil, particularly among the lower classes.</p>
<h2>Beauty’s hidden costs</h2>
<p>In my recently published book, “<a href="https://www.ucpress.edu/book.php?isbn=9780520293885">The Biopolitics of Beauty</a>,” I question the idea that humanitarianism is the driving force of plastic surgery in Brazilian public hospitals. </p>
<p>Burn victims and individuals with congenital deformities were once the main beneficiaries of plastic surgery in these hospitals. But at many of the clinics where I carried out my research, nearly 95 percent of all those surgeries have become purely aesthetic. I documented hundreds of instances where surgeons and residents purposely blurred the boundaries between reconstructive and aesthetic procedures to get them approved by the government. </p>
<p>Since most of the surgeries in public hospitals are carried out by medical residents who are still training to be plastic surgeons, they have a vested interest in learning aesthetic procedures – skills that they’ll be able to later market as they open private practices. But they have very little interest in learning the reconstructive procedures that actually improve a bodily function or reduce physical pain.</p>
<p>Additionally, most of Brazil’s surgical innovations are first tested by plastic surgeons in public hospitals, exposing those patients to more risks than wealthier patients. Working-class patients are understood as subjects for inquiry, and I spoke to the small but significant number who were very unhappy with the results of their surgery. </p>
<p>Take one woman I interviewed named Renata. The medical resident who operated on her left her with deformed breasts and uneven nipples. She also developed severe infections that took months to heal and left significant scars. She considered suing the doctor, but discovered she would need a costly expert medical evaluation. She also knew that the Brazilian legal system would likely grant her very little in terms of damages. In the end, she settled for another free surgery, one that she hoped would provide a better result and leave her less unhappy.</p>
<p>This was a typical story among low-income patients that were harmed by plastic surgeons. Their lack of financial resources made it nearly impossible for them to find any justice if anything went wrong, so they assumed all of the risk.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/217100/original/file-20180501-135810-xm2zk5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/217100/original/file-20180501-135810-xm2zk5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=801&fit=crop&dpr=1 600w, https://images.theconversation.com/files/217100/original/file-20180501-135810-xm2zk5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=801&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/217100/original/file-20180501-135810-xm2zk5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=801&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/217100/original/file-20180501-135810-xm2zk5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1007&fit=crop&dpr=1 754w, https://images.theconversation.com/files/217100/original/file-20180501-135810-xm2zk5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1007&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/217100/original/file-20180501-135810-xm2zk5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1007&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Extensive necrosis in a patient after an application of PMMA.</span>
<span class="attribution"><span class="source">Anderson Castelo Branco de Castro</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Plastic surgeons, on the other hand, are eager to try new techniques if they seem promising, no matter how risky they might be. A technique known as “bioplastia,” for example, consists of injecting a liquid compound called <a href="https://en.wikipedia.org/wiki/Poly(methyl_methacrylate)">PMMA</a> into the body in order to permanently reshape a patient’s features. The compound, which is similar to acrylic glass, doesn’t cause problems in most patients. But in a small minority <a href="http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-72992007000600019&lng=en&nrm=iso&tlng=en">it causes very severe complications</a>, including necrosis of facial tissue. Yet many doctors I interviewed strongly defended the technique, claiming it was a phenomenal tool that allowed them to transform the human body. Risk, they argued, was inherent in any surgical procedure.</p>
<p>Around the world, Brazilian plastic surgeons are known as the best in their field, and they gain global recognition for their daring new techniques. During an international plastic surgery conference in Brazil, an American surgeon I interviewed told me, “Brazilian surgeons are pioneers… You know why? Because [in Brazil] they don’t have the institutional or legal barriers to generate new techniques. They can be creative as they want to be.”</p>
<p>In other words, there are few regulations in place that could protect low-income patients from malpractice.</p>
<p>In a country where appearance is seen as central to one’s very citizenship, patients agree to becoming experimental subjects in exchange for beauty. But it’s often a choice made under duress, and the consequences can be dire.</p><img src="https://counter.theconversation.com/content/94159/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alvaro Jarrin received funding from the Wenner-Gren Foundation and the American Council of Learned Societies to carry out his research on beauty in Brazil.</span></em></p>Who’s really benefiting from a health care system that provides free or low-cost plastic surgeries for the poor?Carmen Alvaro Jarrin, Assistant Professor of Anthropology, College of the Holy CrossLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/940102018-04-05T10:44:48Z2018-04-05T10:44:48ZWhy are fewer and fewer Americans fixing their noses?<figure><img src="https://images.theconversation.com/files/212825/original/file-20180402-189795-aia0jr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The nose isn't going under the knife like it once did.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/medical-nose-care-concept-doctor-climbing-156779312?src=LAq4odgEPzSRK6BIMwFpRg-1-37">Lightspring/Shutterstock.com</a></span></figcaption></figure><p>Americans love <a href="https://www.plasticsurgery.org/news/press-releases/new-statistics-reveal-the-shape-of-plastic-surgery">cosmetic surgery</a>.</p>
<p>In 2017 in the U.S., there were 1.8 million plastic surgeries and nearly 16 million nonsurgical procedures, like Botox – about one for every 20 Americans. </p>
<p>The <a href="http://www.businessinsider.com/plastic-surgery-growth-statistics-facts-2016-2017-5">US$8 billion industry</a> now has entire <a href="https://www.newbeauty.com">beauty magazines</a> devoted to cosmetic procedures, along with TV shows like “Nip/Tuck” and “Botched” that explore plastic surgery in all its gory glory. There are <a href="https://play.google.com/store/apps/details?id=com.hamsoft.face.follow&hl=en">apps</a> for your phone that let you see your face or body modified by surgery and even <a href="https://www.amazon.com/Beautiful-Mommy-Michael-Alexander-Salzhauer/dp/1601310323">children’s books</a> to explain why mommy looks so different now. </p>
<p>As someone who’s written <a href="http://www.beacon.org/American-Plastic-P767.aspx">a book</a> about the economics of plastic surgery, none of this comes as a surprise.</p>
<p>Recently, however, I ran across a statistic that stopped me in my tracks: Americans are no longer obsessed with fixing their noses. In fact, the number of nose jobs, or rhinoplasties, has gone down <a href="https://www.plasticsurgery.org/documents/News/Statistics/2016/plastic-surgery-statistics-full-report-2016.pdf">43 percent</a> since 2000. </p>
<p>Over a decade ago, nearly 400,000 Americans were having their noses made smaller, thinner and more symmetrical; now only about <a href="https://www.plasticsurgery.org/documents/News/Statistics/2016/plastic-surgery-statistics-full-report-2016.pdf">225,000 Americans</a> are doing so each year.</p>
<p>What might explain the overall decline in nose jobs, even as breast implants and tummy tucks are more popular than ever before? </p>
<h2>Why people get plastic surgery in the first place</h2>
<p>This decline is happening despite the fact that rhinoplasty procedures – which cost, on average, around <a href="https://www.plasticsurgery.org/cosmetic-procedures/rhinoplasty/cost">$5,000</a> – have become less painful and more convenient. </p>
<p>In the 20th century, rhinoplasties were usually performed with a hammer and chisel – a bloody, bruising affair. Now noses can be reshaped with a <a href="https://www.huffingtonpost.com/entry/the-nose-job-takes-a-giant-leap-in-new-technology_us_593b8523e4b0b65670e56a95">vibrating crystal</a> that’s able to cut through bone but avoid damaging soft tissue – a method that decreases the pain and recovery time quite significantly. </p>
<p>But pain has never really been part of the equation. If there’s one thing I learned from interviewing over 100 cosmetic surgery patients for my book, it’s that they’re willing to suffer for what they believe will lead to a better life. </p>
<p>Today, <a href="https://www.plasticsurgery.org/documents/News/Statistics/2016/plastic-surgery-statistics-full-report-2016.pdf">92 percent</a> are women, disproportionately white, and mostly members of the <a href="https://www.nytimes.com/2007/08/16/fashion/16skin.html">working and middle classes</a>. They fervently believe that if they look younger, thinner or more attractive, then they’ll be more likely to keep their job or husband (or get a better job or a better husband). </p>
<p>In the end, they’re motivated by a deep desire for a more secure future – which, somewhat paradoxically, compels many of them to take on large amounts of debt to pay for the procedures.</p>
<p>A perfect nose, apparently, is less likely to be viewed as a path to a secure future. </p>
<h2>A historic aversion to ‘ethnic’ noses</h2>
<p>While there’s probably no definitive way to explain the nose job’s decline, the answer could be as plain as the nose on my face. </p>
<p>My nose, not coincidentally, is large, the genetic effect of my Jewish ancestors. Nose jobs were originally performed for people like me – immigrants who were not quite “white” because they didn’t look like Northern Europeans.</p>
<p><a href="http://broughttolife.sciencemuseum.org.uk/broughttolife/themes/surgery">In the 1800s</a>, surgeons discovered that if they put their patients under with gas and sterilized their instruments, they could stop people from dying of sepsis. These surgeons soon realized that they could also earn a quick buck by making ethnic immigrants look more American – which really meant looking more like immigrants from Northern Europe.</p>
<p>By the late 1800s, the cosmetic surgery industry had blossomed. <a href="https://press.princeton.edu/titles/6545.html">According to historian Sander Gilman</a>, cosmetic surgery was first used to help Irish and Jewish men. For Irish men, it was their noses, which they viewed as a sign of their “racial degeneracy” and “syphilitic nature.” Jewish men were actually less concerned about their noses and far more worried that their detached earlobes “Africanized” them.</p>
<p>Needless to say, the 20th century shifted which bodies and which parts needed repairing, and the focus turned to women – particularly young, white women. </p>
<p>A kind of beauty capitalism was born, teaching women that if there was something wrong with their bodies, it could be fixed. All they had to do was buy the right lipstick, stick to the newest diet, or surgically alter their bodies – especially their noses. </p>
<p>Breast implants, tummy tucks, buttock implants and <a href="https://www.chronicle.com/blogs/brainstorm/frankengina/26790">vaginoplasty</a> would eventually gain popularity. But for the first several decades of the 20th century, most of the women who filled the offices of cosmetic surgeons wanted their noses fixed.</p>
<h2>Shifting standards of beauty?</h2>
<p>Today’s beauty industry is worth <a href="https://www.forbes.com/sites/chloesorvino/2017/05/18/self-made-women-wealth-beauty-gold-mine/#5fbe06d62a3a">$445 billion dollars</a>. It mostly teaches women (although increasingly men and even children) that they need to buy things in order to become beautiful.</p>
<p>So why are our natural, imperfect noses all of a sudden more okay? </p>
<p>It could be that the beauty industry has stopped selling us the idea that there is one racial standard for beauty. The sort of racial hierarchy that put Northern European features at the top – and everyone else scrambling to catch up – might be weakening due to demographic and economic changes within a globalized culture.</p>
<p>According to the <a href="http://www.pewresearch.org/fact-tank/2016/03/31/10-demographic-trends-that-are-shaping-the-u-s-and-the-world/">Pew Research Center</a>, by 2055 everyone in the U.S. will be a racial or ethnic minority – there will be no clear majority.</p>
<p>After centuries of worshiping a certain form of <a href="https://thesocietypages.org/socimages/2014/05/16/white-as-beautiful-black-as-white/">whiteness as beautiful</a>, future beauty standards might look very different. It’s also possible that as other countries, particularly China, dominate the world economy, those countries will have more of a say in determining what’s beautiful. And popular media is increasingly depicting beautiful characters <a href="https://theconversation.com/why-its-so-important-for-kids-to-see-diverse-tv-and-movie-characters-92576">of all races</a>.</p>
<p>At this point, without interviewing those who go under the knife but refuse to reshape their noses, it’s tough to tell what’s inspired the change.</p>
<p>What I do know is that if the beauty industry can sell us something, it will. In fact, it’s invented <a href="https://galoremag.com/nose-bump-nose-job-reverse-plastic-surgery-unique/">reverse nose jobs</a> for people who are embarrassed that their noses have been modified – and want to make them look “real” again.</p>
<p>So fear not: The industry’s ability to profit off of our anxieties is as strong it’s ever been.</p><img src="https://counter.theconversation.com/content/94010/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laurie Essig does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People who’ve gotten nose jobs are also trying to revert to a more natural look.Laurie Essig, Director and Professor of Gender, Sexuality, & Feminist Studies, MiddleburyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/906932018-02-23T04:58:01Z2018-02-23T04:58:01ZChildren with facial difference have a lot to teach us about body image<figure><img src="https://images.theconversation.com/files/207203/original/file-20180221-161923-1axu1ki.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The film Wonder tells the story of a boy with severe facial defects.</span> <span class="attribution"><a class="source" href="http://www.imdb.com/title/tt2543472/mediaviewer/rm178017792">IMDb/Lionsgate, Mandeville Films, Participant Media, Walden Media</a></span></figcaption></figure><p>The recently released film <a href="http://www.imdb.com/title/tt2543472/"><em>Wonder</em></a> is based on the true story of Auggie, a boy born with a severe facial deformity. The film picks up at the point where Auggie, having been home-schooled by his mother, attends a regular school for the first time and must negotiate the varied reactions – not just of his new peers, but of their parents and the other adults.</p>
<p>Auggie was born with <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/treacher-collins-syndrome">Treacher Collins syndrome</a>, a genetic disorder that affects the development of the skull, jaw and cheekbones and causes facial defects and hearing loss. People can be born with facial differences, or they can be acquired through trauma, burns or treatment of facial tumours.</p>
<p>Either way, these differences can have as big an impact on life as loss of a limb or a chronic illness. People often associate plastic surgery with enhancement of beauty, but a more common aim, especially for surgeons who work with children, is to restore facial appearance to the point where a normal life becomes possible.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/ngiK1gQKgK8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Auggie has had 27 surgeries to help him see and breathe.</span></figcaption>
</figure>
<p>Much more than just a loss of attractiveness, a facial defect affects every aspect of daily life, because faces are so important to us as social beings. And yet, despite significant challenges, children with facial difference tend to score better on perceptions of body image than their “normal” counterparts. </p>
<p>By studying how people with facial difference overcome their challenges, we may not only find ways to help other such children, but also learn how to help all young people be comfortable with how they look and who they are. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-we-dont-know-what-causes-most-birth-defects-78592">Why we don't know what causes most birth defects</a>
</strong>
</em>
</p>
<hr>
<h2>The wonder of faces</h2>
<p>Try to draw someone’s face. Unless you’re a skilled artist, it’ll be difficult to produce an image that actually looks like that person.</p>
<p>This is because within the very narrow parameters of facial features (eyes, a nose, a mouth) faces are so different we expect to be able to recognise a particular face in a crowd, possibly having seen it only once and from a different angle. With more than 7 billion people in this world, it’s truly extraordinary that everyone’s face is unique.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/207207/original/file-20180221-161935-11c0act.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/207207/original/file-20180221-161935-11c0act.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/207207/original/file-20180221-161935-11c0act.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=924&fit=crop&dpr=1 600w, https://images.theconversation.com/files/207207/original/file-20180221-161935-11c0act.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=924&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/207207/original/file-20180221-161935-11c0act.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=924&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/207207/original/file-20180221-161935-11c0act.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1161&fit=crop&dpr=1 754w, https://images.theconversation.com/files/207207/original/file-20180221-161935-11c0act.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1161&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/207207/original/file-20180221-161935-11c0act.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1161&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">It’s very difficult to capture another person’s face in a drawing, because of the nuances of human perception.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Of course it’s not the face itself that’s extraordinary, but our ability to perceive it. We are programmed to effortlessly identify the most subtle differences between faces in a way we are not for other shapes or body parts. </p>
<p>This is one reason why, despite all the advances in plastic surgery in the last century, from microsurgery to face transplantation, our surgical efforts to reconstruct faces still sometimes appear inadequate.</p>
<p>Our sensitivity to subtle differences in facial appearance contributes to the challenges people like Auggie face each day. Faces are the primary means through which we navigate the many minor social exchanges of daily life. </p>
<p>Studies show that, in casual interactions, people <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1559-1816.1982.tb00855.x/full">tend to have certain responses</a> to those with a facial difference, such as standing further away, or to the side. These changes are subtle, but full of social meaning.</p>
<p>A more pervasive problem is unwanted attention in public spaces, from rude and intrusive comments to invasive curiosity. In <em>Wonder</em>, when Auggie first walks across a busy schoolyard, conversation stops as faces turn to him. Psychologist <a href="https://slideheaven.com/facial-disfigurement-problems-and-management-of-social-interaction-and-implicati.html">Frances MacGregor</a> has elegantly described this unique problem faced by people with a visible difference: </p>
<blockquote>
<p>The ‘civil inattention’ that is normally conferred by strangers on one another and that makes it possible to move anonymously and unhindered in public spaces is a right and a privilege most longed for by facially disfigured people who […] are victims of intrusions and invasions of privacy, against which they have little or no protection.</p>
</blockquote>
<h2>Facial difference and body image</h2>
<p>Given the challenges of looking different, and the important role of the face in identity, it might be expected adolescents with facial difference would score poorly on measures of body image and well-being.</p>
<p>However, <a href="http://journals.sagepub.com/doi/full/10.1597/15-167">research done in the UK</a> has shown when a standard body image questionnaire was administered to adolescents with cleft lip and palate or a craniofacial condition like Auggie, those with facial difference actually scored, on average, better on some measures of body image than their “normal” counterparts. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/207202/original/file-20180221-161932-1wfcx5b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/207202/original/file-20180221-161932-1wfcx5b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/207202/original/file-20180221-161932-1wfcx5b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/207202/original/file-20180221-161932-1wfcx5b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/207202/original/file-20180221-161932-1wfcx5b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/207202/original/file-20180221-161932-1wfcx5b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/207202/original/file-20180221-161932-1wfcx5b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/207202/original/file-20180221-161932-1wfcx5b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Children with a cleft palate generally score higher on body image tests than those who have ‘normal’ faces.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>There may be several reasons for this. Studies <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144503000056">consistently find</a> that the severity of a visible difference is a poor predictor of its psychological impact. Much more important is the quality of a person’s social skills. People with facial difference often develop strategies for smoothing over social awkwardness, such as ways of introducing the issue into conversation early and quickly moving on, or using humour to deflect attention. </p>
<p>Better body image scores may reflect greater social maturity and a comfort in their own skin, which adolescents who have not had to face such problems have not yet achieved.</p>
<p>On the flip side, children without a visible difference don’t score as well on body image measures as children who actually do. This and a wealth of other research indicates that, in the age of social media, selfies and consumer culture, we’re facing <a href="http://www.bbc.com/news/health-41972951">a rise in body image dissatisfaction</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/social-media-can-damage-body-image-heres-how-to-counteract-it-65717">Social media can damage body image – here's how to counteract it</a>
</strong>
</em>
</p>
<hr>
<p>Australian teenagers <a href="https://www.missionaustralia.com.au/what-we-do/research-evaluation/youth-survey">consistently rate</a> body image as one of their greatest concerns in life – above bullying, drugs and a range of problems that might be thought more important. </p>
<p>Body dissatisfaction is a key risk factor for eating disorders, and a key symptom of a condition known as <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/body-dysmorphic-disorder-bdd">body dysmorphic disorder</a> (BDD). People with BDD develop obsessive concerns with particular aspects of their appearance, including features others perceive as normal.</p>
<p>They <a href="https://link.springer.com/article/10.1007/s00266-017-0869-0">often seek surgery</a> to correct their perceived problems and, not surprisingly, are rarely satisfied with the outcome. They can undergo multiple cosmetic operations, often from a series of different surgeons, before their condition is recognised. Plastic surgeons have anecdotally reported seeing increasing numbers of <a href="https://www.surgery.org/media/statistics">young people seeking cosmetic procedures</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/body-dysmorphic-disorder-and-cosmetic-surgery-are-surgeons-too-quick-to-nip-and-tuck-74234">Body dysmorphic disorder and cosmetic surgery: are surgeons too quick to nip and tuck?</a>
</strong>
</em>
</p>
<hr>
<p>An important and unanswered question concerning BDD is whether it’s an isolated condition or one extreme of a <a href="https://journals.lww.com/psnjournalonline/Abstract/2010/07000/Psychosocial_Predictors_of_an_Interest_in_Cosmetic.11.aspx">spectrum of behaviour</a>. Body dissatisfaction in young people could have serious consequences for their mental and physical health.</p>
<p>Researchers will now focus on how children and adolescents <a href="http://www1.uwe.ac.uk/hls/research/appearanceresearch.aspx">cope with facial and other differences</a>, and how the knowledge gained can be applied to help others with a facial difference. This will inform ways to better <a href="https://www.youtube.com/watch?v=RxNhE0iGkzo">educate young people</a> to feel better about how they look.</p><img src="https://counter.theconversation.com/content/90693/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anthony Penington receives funding from the Jigsaw Foundation. He is chair of the scientific committee of the Australasian Foundation for Plastic Surgery.</span></em></p>People with facial difference often develop strategies for smoothing over social awkwardness, such as ways of introducing the issue into conversation early or using humour to deflect attention.Anthony Penington, Professor of Paediatric Plastic and Maxillofacial Surgery, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/847322017-10-19T08:26:30Z2017-10-19T08:26:30ZDespite appearances, not all people with scarred faces are movie villains<figure><img src="https://images.theconversation.com/files/189484/original/file-20171010-25615-16940z9.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Images from Plastic Surgery of the Face by Sir Harold Gillies, 1920</span> </figcaption></figure><p>At the end of Star Wars: The Force Awakens, villain Kylo Ren received a large facial scar after committing his darkest act in the film. Oddly, when the trailer for 2017’s The Last Jedi came out, <a href="http://metro.co.uk/2017/04/20/star-wars-director-forced-to-explain-why-kylo-rens-scar-has-moved-in-the-last-jedi-trailer-6586453/">this scar had moved</a>. There was an immediate uproar from continuity fans, but writer/director Rian Johnson took to Twitter to defend his decision: “It honestly looked goofy running straight up the bridge of the nose.”</p>
<p>Popular film culture has been using facial injury as a <a href="https://www.rd.com/culture/why-movie-villains-have-scars/">shorthand for evil</a> for so long that many filmmakers no longer treat scars as injuries, but as decorative features. Could this tradition be the reason why so many countries are yet to properly pay tribute to the facially injured servicemen of World War I in film? You may have read articles about these servicemen, or found photographs of their injuries online. You may even have seen them in a war documentary – but you will never have seen a British feature film in which they take centre stage.</p>
<p>During World War I, tens of thousands of servicemen were being sent home with facial injuries. There were pilots with severe burns and infantrymen whose cheeks had been torn off by flying shrapnel. Fathers whose mouths had been shot away and sons left without the ability to see or speak. </p>
<p>These men put their lives into the hands of ambitious surgeons with experimental methods, one of whom was Sir Harold Gillies, who would later become known as the “<a href="http://journals.sagepub.com/doi/abs/10.1177/1460408611428115?journalCode=traa">father of plastic surgery</a>”. Many servicemen endured years of procedures and painful recovery periods, but the results were groundbreaking. Suddenly, pioneering developments were being made in plastic surgery that would pave the way for modern techniques.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/189481/original/file-20171010-25643-wf6p5q.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/189481/original/file-20171010-25643-wf6p5q.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=408&fit=crop&dpr=1 600w, https://images.theconversation.com/files/189481/original/file-20171010-25643-wf6p5q.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=408&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/189481/original/file-20171010-25643-wf6p5q.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=408&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/189481/original/file-20171010-25643-wf6p5q.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=512&fit=crop&dpr=1 754w, https://images.theconversation.com/files/189481/original/file-20171010-25643-wf6p5q.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=512&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/189481/original/file-20171010-25643-wf6p5q.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=512&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Photos of facially injured WWI servicemen before and after reconstructive treatment.</span>
<span class="attribution"><span class="source">Images from Plastic Surgery of the Face by Sir Harold Gillies, 1920</span></span>
</figcaption>
</figure>
<p>Despite their impact, most countries that were involved in World War I have either included these disfigured servicemen as secondary characters in their war films, or nowhere at all. Perhaps filmmakers worry that profit margins won’t be as impressive for a realistic film drama, in which the disfigured characters are not represented as criminally insane. They see profit in the scarred villain, and this is made no clearer than in one of the UK’s most profitable franchises, <a href="http://www.independent.co.uk/voices/comment/why-do-bond-villains-need-facial-scars-8282714.html">James Bond</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/189465/original/file-20171009-25611-18o780.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/189465/original/file-20171009-25611-18o780.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=186&fit=crop&dpr=1 600w, https://images.theconversation.com/files/189465/original/file-20171009-25611-18o780.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=186&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/189465/original/file-20171009-25611-18o780.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=186&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/189465/original/file-20171009-25611-18o780.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=234&fit=crop&dpr=1 754w, https://images.theconversation.com/files/189465/original/file-20171009-25611-18o780.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=234&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/189465/original/file-20171009-25611-18o780.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=234&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Le Chiffre (Casino Royale, 2006), Raoul Silva (Skyfall, 2012), Ernst Stavro Blofeld (Spectre, 2015).</span>
<span class="attribution"><span class="source">MGM/Columbia Pictures</span></span>
</figcaption>
</figure>
<p>Scars are a regular facial feature among Bond villains – and, since Daniel Craig took over the role of Bond in 2006, three of the four villains have had a facial injury. The two that were actually taken from Ian Fleming’s original novels, Le Chiffre and Blofeld, were never described as having scars in the books.</p>
<p>Using facial injury as a shorthand for evil is not just a method used in films aimed at adults. There is the <a href="http://disney.wikia.com/wiki/Scar">tellingly named Scar</a> in Disney’s 1994 classic The Lion King and, for the new generation, the villainous unicorn Tempest Shadow in the 2017 film <a href="https://www.fatherly.com/play/my-little-pony-movie-review/?utm_source=facebook&utm_medium=social&utm_campaign=fbowned&utm_content=fatherly">My Little Pony: The Movie</a>, who has a large scar over her right eye.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/189476/original/file-20171010-25615-1u72t1e.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/189476/original/file-20171010-25615-1u72t1e.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=221&fit=crop&dpr=1 600w, https://images.theconversation.com/files/189476/original/file-20171010-25615-1u72t1e.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=221&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/189476/original/file-20171010-25615-1u72t1e.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=221&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/189476/original/file-20171010-25615-1u72t1e.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=278&fit=crop&dpr=1 754w, https://images.theconversation.com/files/189476/original/file-20171010-25615-1u72t1e.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=278&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/189476/original/file-20171010-25615-1u72t1e.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=278&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Scar (The Lion King, 1994), Shadow Tempest (My Little Pony: The Movie, 2017).</span>
<span class="attribution"><span class="source">Walt Disney/Lionsgate</span></span>
</figcaption>
</figure>
<h2>More than skin deep</h2>
<p>Every film that uses facial injury as a shorthand for evil is influencing negative perceptions that reflect, in many ways, the society that the disfigured servicemen reentered a century ago.</p>
<p>Many men left hospital with very successful reconstructions, but some level of disfigurement would often remain, in the form of uneven features or surgical scars. These were minor compared to their initial injuries, but some members of society could not see past the differences. This is evident in the <a href="http://blog.helion.co.uk/tag/faces-from-the-front/">stories of disfigured men</a> being turned out of employment, suffering verbal abuse in the street, and being abandoned by fiancees from before the war, simply because of their appearance.</p>
<p>Despite such challenges, most of these men went on to lead normal lives that did include successful careers and marriages, with no evidence that their changed appearances had any affect on their morality. There are certainly no statistics that show a spike in crime by disfigured ex-servicemen after World War I.</p>
<p>It was disappointing, then, when the villain for this year’s long-anticipated <a href="http://www.dccomics.com/blog/2017/06/06/wonder-woman-dr-poisons-toxic-legacy">superhero film Wonder Woman was revealed</a>. The film is <a href="https://www.cinemablend.com/news/1606130/why-wonder-woman-is-set-during-world-war-i-according-to-patty-jenkins">set during World War I</a> – and Dr Poison does not just have scars, but is a villain with a facial injury that mirrors the kind suffered by World War I servicemen. This injury does not appear on the comic book character – and neither does the skin-toned prosthetic mask that she wears, which is similar to those worn by facially injured servicemen.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/189478/original/file-20171010-25631-j97wmb.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/189478/original/file-20171010-25631-j97wmb.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=198&fit=crop&dpr=1 600w, https://images.theconversation.com/files/189478/original/file-20171010-25631-j97wmb.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=198&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/189478/original/file-20171010-25631-j97wmb.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=198&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/189478/original/file-20171010-25631-j97wmb.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=249&fit=crop&dpr=1 754w, https://images.theconversation.com/files/189478/original/file-20171010-25631-j97wmb.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=249&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/189478/original/file-20171010-25631-j97wmb.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=249&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Dr Poison (Wonder Woman).</span>
<span class="attribution"><span class="source">Warner Bros</span></span>
</figcaption>
</figure>
<p>Initially, we could hold out hope that Dr Poison might have some depth beyond pitiful destructiveness – or at least give us an explanation of how she received her injury. But it quickly became clear that there was no story – her appearance was for the sole purpose of making her seem more menacing. The disfigurement is a wordless explanation for why she is driven to commit such horrific acts of inhumanity – and, as such, reflects on the men who suffered similar injuries serving during that period.</p>
<p>But facially injured servicemen were <em>not</em> horrific – or horrors of war – as so many people still like to call them. The pain that they suffered may be described in this way, but the men themselves were ordinary human beings. Misrepresentation is a damaging thing, but when it comes to the laudable practice of paying tribute to servicemen through film, lack of representation can be just as harmful.</p><img src="https://counter.theconversation.com/content/84732/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Siân Liddle receives funding from Nottingham Trent University's Vice Chancellor PhD Scholarship.</span></em></p>Scars shouldn’t be a shorthand for evil.Siân Liddle, PhD researcher, Nottingham Trent UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/742342017-04-18T19:47:18Z2017-04-18T19:47:18ZBody dysmorphic disorder and cosmetic surgery: are surgeons too quick to nip and tuck?<figure><img src="https://images.theconversation.com/files/163017/original/image-20170328-3819-1g49c50.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The highest rates of body dysmorphic disorder are found among people seeking help from cosmetic surgeons, cosmetic dermatologists and other such specialists.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com">Shutterstock </a></span></figcaption></figure><p>Most of us have some insecurities about how we look, and some aspects of our appearance that we might secretly wish were different. But for people with body dysmorphic disorder, these issues become an obsession and constant focus of concern.</p>
<p>Body dysmorphic disorder is a psychiatric condition that leads people to adopt<br>
extremely distorted negative beliefs about their appearances: seeing themselves to be ugly, malformed, misshapen or hideous. Such beliefs do not reflect the reality of how they appear to others. The degree of concern and distress they may feel about their appearance is vastly out of proportion to any actual physical “defect”. </p>
<p>A small minority of the population is believed to experience the condition. One study found about <a href="http://onlinelibrary.wiley.com/doi/10.1080/13284200601178532/full">2.3%</a> of participants had the condition.</p>
<p>The mirror is a major problem for people with body dysmorphic disorder. Some sufferers become fixated with mirror checking, with hours of their day absorbed in inspecting their appearance. Mostly this checking is counter-productive, making them feel worse and increasing their distress. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/163070/original/image-20170329-1642-mdlopq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/163070/original/image-20170329-1642-mdlopq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=295&fit=crop&dpr=1 600w, https://images.theconversation.com/files/163070/original/image-20170329-1642-mdlopq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=295&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/163070/original/image-20170329-1642-mdlopq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=295&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/163070/original/image-20170329-1642-mdlopq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=371&fit=crop&dpr=1 754w, https://images.theconversation.com/files/163070/original/image-20170329-1642-mdlopq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=371&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/163070/original/image-20170329-1642-mdlopq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=371&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Body dysmorphic disorder should not be dismissed as extreme vanity.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/fixersuk/15425017231/in/photolist-pCoZcF-j38YYW-j2SP4L-j2Rc8r-j2PQXF-j2Mbey-j2JGne-j376dw-j2LkJB-gbBes-G66z2-j38YJY-hn4kkB-pv4fdX-vuZD7E-uQBbNq-vMZ6TP-uQA5oo-vv8tji-pda5TU-puDRng-pdax8A-punywa-puDRpk-pdax8W-vKhudC">fixersuk/flickr</a></span>
</figcaption>
</figure>
<p>Other people with the condition may avoid mirrors altogether. Some can even have catastrophic reactions should they happen to glance at themselves in a reflective surface such as a shop window. Lots of sufferers conceal themselves under hats, scarves, wigs, dark glasses or excessive layers of makeup or concealing clothing in an attempt to hide their supposed defects.</p>
<p>Body dysmorphic disorder should not simply be dismissed as an expression of extreme vanity or insecurity about looks. This condition often leads to substantial distress and social and occupational impairment. Rates of depression are high, while suicide is not an <a href="https://www.ncbi.nlm.nih.gov/pubmed/16816236">uncommon outcome</a> for those who do not receive appropriate treatment. Many avoid social situations for fear of others judging them negatively because of how they look. </p>
<h2>Cosmetic solutions?</h2>
<p>Because people with body dysmorphic disorder “see” themselves as having a cosmetic problem, it’s not surprising they often seek a cosmetic “solution”. </p>
<p>The highest rates of body dysmorphic disorder are found among people using cosmetic services like plastic surgeons, cosmetic dermatologists and cosmetic dentists. One study found up to <a href="https://www.ncbi.nlm.nih.gov/pubmed/19332010">70%</a> of people with body dysmorphic disorder had sought cosmetic procedures, and half had received such interventions.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/163015/original/image-20170328-3772-ilirzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/163015/original/image-20170328-3772-ilirzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/163015/original/image-20170328-3772-ilirzt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/163015/original/image-20170328-3772-ilirzt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/163015/original/image-20170328-3772-ilirzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/163015/original/image-20170328-3772-ilirzt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/163015/original/image-20170328-3772-ilirzt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Cosmetic procedures of all types are becoming increasingly available and accessible to a wider public.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com">From www.shutterstock.com'</a></span>
</figcaption>
</figure>
<p>The tragedy is that cosmetic procedures – by definition – do not solve the underlying psychological problem. They leave a majority of sufferers worse off: they pay for the procedure and suffer the pain and inconvenience of it, yet “see” the resulting cosmetic outcome as unsatisfactory, even if objectively the result is excellent. </p>
<p>This often leads to requests for more treatments, with ensuing worsening of the mental state of the patient and increasing frustration on behalf of the cosmetic specialist. The situation can become so heated that <a href="https://www.ncbi.nlm.nih.gov/pubmed/19332010">legal action</a>, physical threats and even homicide have been known to be perpetrated by body dysmorphic disorder patients. </p>
<h2>How can these outcomes be avoided?</h2>
<p>Cosmetic interventions of all types are becoming increasingly accessible to a wider public. Therefore, it would be ideal for cosmetic specialists routinely to screen for body dysmorphic disorder.</p>
<p>Australian cosmetic specialists are not mandated to screen for body dysmorphic disorder and there’s no available information on the proportion of cosmetic clinics that screen for the condition. From my experience of speaking to patients who have sought cosmetic intervention, screening is variable at best.</p>
<p>There are certainly some practitioners who are very aware of the risks associated with body dysmorphic disorder and ensure their clients are screened and offered referral for further help if required. Unfortunately, too often screening is not performed and patients suffer as a consequence.</p>
<p>Screening should be mandated for people seeking any cosmetic procedure that might be seen as “enduring”: this includes surgical procedures. My colleagues and I have developed a questionnaire for practitioners, which through a series of simple questions can help diagnose body dysmorphic disorder. </p>
<p>For those who may body dysmorphic disorder, careful further questioning and referral to a body dysmorphic disorder specialist is required. A range of psychological therapies (such as cognitive behaviour therapy) and medications (mostly antidepressants) can be very effective at treating the condition’s underlying problems.</p>
<p>Simply providing cosmetic clinics with screening tools won’t guarantee all doctors accurately assess for body dysmorphic disorder. This is because we cannot expect all clients to answer questionnaires truthfully. However, in my experience, having seen hundreds of people with body dysmorphic disorder, they usually do. </p>
<p>At the end of the day, it would be ideal if cosmetic specialists did everything in their power to fulfil their ethical obligations. To not screen and then deliver cosmetic procedures to people who may have body dysmorphic disorder goes against the medical dictum “first do no harm”.</p><img src="https://counter.theconversation.com/content/74234/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Jonathan Castle does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>To not screen, and then deliver cosmetic procedures to people who may have body dysmorphic disorder, goes against the medical dictum “first do no harm”.David Jonathan Castle, Chair of Psychiatry, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/684312016-11-29T19:16:55Z2016-11-29T19:16:55ZWomen don’t always get what they want from labiaplasty<figure><img src="https://images.theconversation.com/files/147837/original/image-20161129-22735-r2g0ne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Australian rates of labiaplasty – sometimes called 'the Barbie surgery' – have doubled since 2001. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/173260?src=9IWgmfitBEkTCfLlyjaiuw-1-68&id=173260&size=huge_jpg">Shutterstock/Uber Images</a></span></figcaption></figure><p>Labiaplasty is the <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2011.03088.x/full">most common</a> form of female genital cosmetic surgery and involves surgical reduction of the <em>labia minora</em> or the inner lips of the vulva. </p>
<p>However we still don’t really know what impact the procedure has on the lives of women who choose to have it. This is not that surprising given female genitals are still considered <a href="http://www.tandfonline.com/doi/abs/10.1080/02646830020032374">taboo</a>. The words “vulva” and “vagina” are difficult to say for most people, never mind an entire discussion on the topic!</p>
<p>But these questions can be addressed through research. Our <a href="http://journals.lww.com/plasreconsurg/Abstract/2016/12000/Psychological_Outcomes_of_Labiaplasty___A.11.aspx">latest study</a> shows although women are pleased with how their genitals look after labiaplasty, their self-esteem and general sexual confidence do not improve. This sort of information is vital to help women weigh up whether labial surgery is the right option for them.</p>
<h2>Rising rates of labiaplasty</h2>
<p>Labiaplasty has become increasingly popular over the last 10-15 years in Western countries, including in Australia. From 2001 to 2013, the number of these procedures <a href="http://medicarestatistics.humanservices.gov.au/statistics/mbs_item.jsp">more than doubled from 640 to 1,605</a> in public patients across Australia. These numbers do not include women undergoing procedures in the private sector, for whom we have no national data.</p>
<p>In <a href="https://www.mja.com.au/journal/2016/205/8/vulvoplasty-new-south-wales-2001-2013-population-based-record-linkage-study#1">NSW</a> specifically, numbers in both public and private hospitals rose from 256 in 2001 to 421 in 2013, representing a total increase of 64%.</p>
<p>Although there is a common misconception teenagers are the age group most interested in labiaplasty, women are most often aged between <a href="https://www.mja.com.au/journal/2016/205/8/vulvoplasty-new-south-wales-2001-2013-population-based-record-linkage-study#1">25 and 34</a> when they undergo surgery.</p>
<h2>Why do women have ‘the Barbie surgery’?</h2>
<p>Although there are physical or functional reasons for having labiaplasty (discomfort participating in sports like <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2011.03088.x/full">cycling</a> or <a href="https://www.cambridge.org/core/journals/psychological-medicine/article/psychological-characteristics-and-motivation-of-women-seeking-labiaplasty/350027B1EBCB5050A0CEFA57FAF2C38F">during sexual intercourse</a>), most women do it due to reported unhappiness with their <a href="http://asj.oxfordjournals.org/content/36/4/469">genital appearance</a>. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/147862/original/image-20161129-10961-1ccsntm.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/147862/original/image-20161129-10961-1ccsntm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/147862/original/image-20161129-10961-1ccsntm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=790&fit=crop&dpr=1 600w, https://images.theconversation.com/files/147862/original/image-20161129-10961-1ccsntm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=790&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/147862/original/image-20161129-10961-1ccsntm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=790&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/147862/original/image-20161129-10961-1ccsntm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=993&fit=crop&dpr=1 754w, https://images.theconversation.com/files/147862/original/image-20161129-10961-1ccsntm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=993&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/147862/original/image-20161129-10961-1ccsntm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=993&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Labiaplasty involves cosmetic reduction of the labia minora that surround the vagina.</span>
<span class="attribution"><a class="source" href="http://www.labialibrary.org.au/">The Labia Library/Women's Health Victoria</a></span>
</figcaption>
</figure>
<p>Women desire a smooth genital surface, with <em>labia minora</em> (the inner lips) that do not protrude beyond the <em>labia majora</em> (the outer lips). As a result, this surgery is sometimes nicknamed the “<a href="http://link.springer.com/article/10.1007/s00192-013-2117-8">Barbie surgery</a>” as these dolls have no obvious genital features.</p>
<p>The way women’s genitals are portrayed in the media – particularly in pornography and on the internet – may be promoting this “<a href="http://pwq.sagepub.com/content/39/2/182">ideal</a>”. And men appear to be picking up on this too, prompting some to <a href="http://asj.oxfordjournals.org/content/36/8/920">criticise</a> their partner’s genitals. As a result, an increasing number of women are becoming concerned their genitals are unacceptable and need to be surgically altered.</p>
<p>But what happens to women after undergoing labiaplasty – do they really get what they were hoping for?</p>
<h2>Labiaplasty won’t fix your sex life</h2>
<p>In our most recent research published in <a href="http://journals.lww.com/plasreconsurg/Abstract/2016/12000/Psychological_Outcomes_of_Labiaplasty___A.11.aspx">Plastic and Reconstructive Surgery</a>, we applied a forward-looking study design to examine psychological outcomes of labiaplasty. We found women experienced significant improvements in satisfaction with their genital appearance from pre- to post-surgery. But we found no significant improvements in any other psychological domains, such as self-esteem and sexual confidence.</p>
<p>Labiaplasty is often <a href="http://bmjopen.bmj.com/content/2/6/e001908.full">advertised online</a> as a way for women to restore self-confidence and esteem, and improve their sexual relationships: our results suggest this is not necessarily the case. Instead, it appears although labiaplasty allows women to stop worrying about their genital appearance, it does not radically change how they view themselves and their intimate relationships.</p>
<p>Our <a href="http://journals.lww.com/plasreconsurg/Abstract/2016/12000/Psychological_Outcomes_of_Labiaplasty___A.11.aspx">research</a> was the first to examine preoperative characteristics of women who are likely to be dissatisfied with their surgical outcomes. We found women who were more psychologically distressed – showing depression and anxiety symptoms in particular – or were currently involved in an intimate relationship were more likely to be dissatisfied after labiaplasty. </p>
<p>Although further investigation is required, we reasoned these women may have had unrealistic expectations for how labiaplasty might improve their psychological well-being or their relationship with their partner, and when this did not happen, they were dissatisfied.</p>
<p>It’s important for doctors to be able to identify these women before they undergo labiaplasty so they can be guided into another form of treatment that may be more beneficial, such as psychological therapy.</p>
<h2>Avoiding disappointment after surgery</h2>
<p>It looks like most women are getting what they want out of labiaplasty in terms of becoming more comfortable with their genital appearance. </p>
<p>But when women have unrealistic expectations for improvements in other areas of their lives such as their self-esteem and sexual relationships, they are more likely to be disappointed. For this reason, we recommend doctors thoroughly explore their patients’ motivations and expectations for labiaplasty so women can get treatment that will best address worries about their genital appearance. </p>
<p>Now we’ve started to identify some of the issues related to women’s dissatisfaction with labiaplasty, we hope our findings might assist doctors when they’re considering a patient’s suitability for cosmetic genital surgery.</p><img src="https://counter.theconversation.com/content/68431/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Although women like how their genitals look after labial surgery, self esteem and sexual confidence may not improve.Gemma Sharp, PhD candidate (submitted), Flinders UniversityJulie Mattiske, Senior Lecturer , Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/637352016-08-10T10:08:40Z2016-08-10T10:08:40ZObituary: Ivo Pitanguy, pioneer of the ‘Brazilian butt lift’<p>The world of aesthetic surgery owes a lot to <a href="https://www.theguardian.com/lifeandstyle/2016/aug/09/ivo-pitanguy-obituary">Ivo Pitanguy</a>, his many grateful patients owe more, not least for his role as a champion of the <a href="http://www.bbc.co.uk/news/world-latin-america-37009138">“Brazilian butt lift”</a>. The International Society of Aesthetic Plastic Surgeons has over 3,000 members from 14 countries and has itself massively contributed to global education in aesthetic plastic surgery for over 43 years. Although not a founding member, Pitanguy was a senior honorary member of the organisation for many years, right up until his recent <a href="http://www.bbc.co.uk/news/world-latin-america-37001270">sudden death aged 93</a> following the opening ceremony of the 2016 Olympic games in Rio de Janeiro. The day before, he had held the Olympic torch.</p>
<p>Born in Belo Horizonte, Brazil, in 1926, Pitanguy was inspirational in championing the philosophy of making people feel better on the inside by making them look good on the outside. He trained in plastic surgery in the UK and US before returning to treat patients of all social classes suffering from illness and deformity in his beloved Brazil, often for free. Recently, <a href="https://www.theguardian.com/lifeandstyle/2016/aug/09/ivo-pitanguy-obituary">he told an international conference</a>:</p>
<blockquote>
<p>One day, it will be clear that aesthetic surgery brings the desired serenity to those that suffer by being betrayed by nature.</p>
</blockquote>
<p>Such was his magnetic personality and earned respect that his <a href="http://pitanguy.com.br/pitanguy/">Clínica Ivo Pitanguy</a> became renowned as a training centre of excellence for plastic surgeons from all over the world. The Pitanguy library at the clinic is a testament to the great man and his many publications and chapters in authoritative books. Among them are contributions supporting polyurethane breast implants as being <a href="http://www.eurosurgical.co.uk/wp-content/.../Myths-failures-and-the-future-draft-2.docx">safer</a> than <a href="http://www.ukaaps.org/wp-content/uploads/2015/01/PMFA-News-June-July-2014.pdf">traditional silicone ones</a>, with 17-times fewer complications. </p>
<h2>The Brazilian factor</h2>
<p>Even in the late 20th century, facelifts often involved aggressive dissection and a three-month recovery period. Modern, less aggressive techniques championed by Pitanguy mean safer surgery but with similarly long-lasting results. The key is <a href="http:%20www.thewebinarsurgeon.com">less trauma and less dissection</a>. Mini-facelifting involves far less soft tissue undermining but is an effective way of elevating the tough membrane layer deep within the cheek known as the SMAS layer (Sub-muscular aponeurotic system) and closing dead space via elevation of skin and underlying soft tissues. Mini-facelifting takes anything from one to three hours to perform but is now the vogue with faster recovery times, less swelling and <a href="http://www.thewebinarsurgeon.com">high satisfaction among patients</a>. </p>
<p>The modified Brazilian abdominoplasty, also championed by Pitanguy, is now the technique of choice for tummy tuck operations. This was developed directly after a 2008 presentation by prominent Brazilian surgeon, Erfon Ramos, lecturing at a ISAPS meeting in Melbourne, Australia. The usual 20% complication rate following conventional abdominoplasty, that is still unfortunately seen in the UK and other countries, is reduced to less than 1% if the modified Brazilian technique is used. This is a major risk procedure for those contemplating cosmetic tourism to a country not practising the modified Brazilian procedure. </p>
<p>Of course, buttock augmentation with implants or fat grafting is now routine throughout the world, especially given the rise in weight loss surgeries – but was championed by Pitanguy, the greatest of many brilliant Brazilians. Implants are now inserted intramuscularly within the gluteus maximus muscle and autologous fat grafts are used to compliment the fullness and shape of the overlying soft tissues. The ideal buttock shape was well described by Brazilian plastic surgeons, such as Pitanguy <a href="http://www.instituteplasticsurgery.com/home-female/about-plastic-surgery-office-columbus/cosmetic-surgeon/">and others</a>, but also credit must be given to US-based surgeon <a href="http://www.constantinomendieta.com">Tino Mendietta</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/133647/original/image-20160810-11853-udb3n4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/133647/original/image-20160810-11853-udb3n4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=389&fit=crop&dpr=1 600w, https://images.theconversation.com/files/133647/original/image-20160810-11853-udb3n4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=389&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/133647/original/image-20160810-11853-udb3n4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=389&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/133647/original/image-20160810-11853-udb3n4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=489&fit=crop&dpr=1 754w, https://images.theconversation.com/files/133647/original/image-20160810-11853-udb3n4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=489&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/133647/original/image-20160810-11853-udb3n4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=489&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Check their credentials.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/dl2_lim.mhtml?src=wpcwjQjjyQNPZQDLC0DWJg-1-10&id=297132521&size=medium_jpg">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Quality control</h2>
<p>Concomitant with advances in levels of surgical skill and developments in technique, cosmetic surgery is also now available to the many and is no longer the exclusive preserve of the rich because it is readily available and often affordable if researched correctly. Indeed, Pitanguy regularly offered his services for free. Rising numbers of procedures are being recorded annually throughout the world and the international spotlight remains on who is qualified to perform these procedures and what constitutes a recognised training programme or qualification. </p>
<p>According to the <a href="http://www.isaps.org">ISAPS</a>, the majority of countries have a five or six-year plastic surgery training programme with an exit exam but many have no training programme at all. Membership of the ISAPS is only available to surgeons meeting strict criteria, but untrained and often unscrupulous “surgeons” have also joined the gravy train, putting patients at huge risk. Vulnerable patients must be better protected.</p>
<p>Education, training and the transfer of knowledge and skills to young plastic surgeons were always at the forefront of Pitanguy’s thoughts – but he also cared for people and patients. His many friends from around the world will miss him, but his memory will live on. Those of us privileged to have even briefly met him are grateful for his inspiration and lead – and hope to emulate his high professional standards.</p><img src="https://counter.theconversation.com/content/63735/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jim Frame does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Brazilian who transformed the face of plastic surgery.Jim Frame, Professor of Aesthetic Plastic Surgery, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/590782016-05-10T05:08:41Z2016-05-10T05:08:41ZCall yourself a cosmetic surgeon? New guidelines fix only half the problem<figure><img src="https://images.theconversation.com/files/121808/original/image-20160510-20575-zniccr.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">New cosmetic surgery guidelines need to go further in specifying qualifications required to call yourself a cosmetic surgeon.</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>The dangers associated with cosmetic surgery, detailed in a report by the Health Care Complaints Commission in <a href="http://www.hccc.nsw.gov.au/Publications/Corporate-Documents">1999</a>, are well known and still present. The <a href="http://www.medicalboard.gov.au/News/2016-05-09-media-statement.aspx">new cosmetic guidelines</a> for doctors, published this week by the Medical Board of Australia, are welcome, but tackle only half the problem.</p>
<p>The guidelines for registered medical practitioners who perform cosmetic medical and surgical procedures cover all phases from patient assessment through to aftercare. They will be a valuable tool for cosmetic surgeons. But two areas of public concern – the use of the title cosmetic surgeon and the facility in which the surgery is performed – remain untouched.</p>
<h2>Who is a cosmetic surgeon?</h2>
<p>The public can be forgiven for thinking a person who calls themselves a cosmetic surgeon has surgical qualifications. But this is not the case. Any registered medical practitioner can use the title, even those without any specialist training. </p>
<p>The 1999 cosmetic surgery report recommended any medical practitioner performing invasive cosmetic surgical procedures should have adequate surgical training equivalent to that required for fellows of the Royal Australasian College of Surgeons. </p>
<p>It is unthinkable today that any registered doctor could start performing non-cosmetic surgical operations without qualifications from an accredited training body. But this remains permissible for surgery that is “cosmetic”, although cosmetic surgery is as complicated and risky as other forms of surgery.</p>
<p>The guidelines tackle this problem by recommending procedures should be provided only if the medical practitioner has the appropriate training, expertise and experience to perform the procedure and to deal with all routine aspects of care and any likely complications. </p>
<p>This guideline is steering doctors towards having appropriate qualifications and training. However, it stops short of mandating a minimum qualification. The decision as to the level of expertise or experience is left to the doctor.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/121810/original/image-20160510-20581-12nibia.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/121810/original/image-20160510-20581-12nibia.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/121810/original/image-20160510-20581-12nibia.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/121810/original/image-20160510-20581-12nibia.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/121810/original/image-20160510-20581-12nibia.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/121810/original/image-20160510-20581-12nibia.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/121810/original/image-20160510-20581-12nibia.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/121810/original/image-20160510-20581-12nibia.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Cosmetic surgery can be performed outside a hospital in private consulting rooms.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>The effect of not requiring a minimum surgical qualification or accreditation is that when doctors provide surgery without the required knowledge, expertise and experience, it will primarily leave patients responsible for bringing them to the medical board’s attention using the complaint system.</p>
<p>We know qualified surgeons also harm patients and generate complaints. But the fact that the public, in the case of qualified surgeons, can trust the level of training and supervision involved is some reassurance a minimum level of skill has been obtained.</p>
<p>The guidelines would have had more force, and offer more protection to the public, if the requirement was for any person who performs major cosmetic medical or surgical procedures to have a minimum qualification of general surgery awarded by an accredited training body.</p>
<h2>Where is cosmetic surgery performed?</h2>
<p>Doctors performing cosmetic surgery such as breast augmentations in their rooms, outside of a licensed hospital or day surgery centre, are prohibited from administering a general anaesthetic. They may only use conscious sedation – where medications to help patients relax and to block pain during a medical procedure are given. The patient stays awake but can’t usually speak. </p>
<p>This is because the real risks associated with general anaesthesia and unconscious patients require a properly equipped theatre and trained staff.</p>
<p>Cosmetic surgeons have been able to bypass this requirement and perform surgical procedures in unlicensed facilities because they use local anaesthetic agents and sedatives. Risks such as seizures, cardiac arrest and rapid heartbeat <a href="http://emedicine.medscape.com/article/1844551-treatment">are associated with</a> overdosing of local anaesthetic agents and sedatives. </p>
<p>Patients need to be still during any procedure. So, if a patient is moving about or agitated, additional local anaesthetic may be administered. But this could lead to an overdose, which is potentially fatal. Local anaesthetic overdose is a preventable adverse event, which can be avoided if the surgery is in a licensed facility with the equipment to manage an emergency.</p>
<p>Since March 2015, the Health Care Complaints Commission has identified 33 patients who had breast augmentation surgery where the level of sedation was of concern. Six had an adverse event associated with sedative drug combinations consistent with deep sedation – some even at the level of general <a href="http://www.abc.net.au/news/2016-04-19/breast-implant-patients-knocked-out-without-consent/7329324">anaesthesia</a>.</p>
<p>The new guidelines require doctors to perform surgery in a facility that is appropriate for the level of risk involved in the procedure. Facilities should be appropriately staffed and equipped to manage possible complications and emergencies. The judgement as to risk and equipment is left to the doctor to decide. </p>
<p>Cosmetic surgeons have a significant conflict of interest – putting patient interest ahead of profits. The guidelines make clear cosmetic surgeons must place the safety of their patients first. But the Medical Board of Australia has no jurisdiction over facilities and cannot mandate the level of facility for major cosmetic medical and surgical procedures. Only the state and territory governments can do this.</p>
<p>The new guidelines present for the first time an opportunity to bring the cosmetic “industry” back into medicine – where ethical obligations to patients override profits. This is an important first step, but it cannot be the last.</p><img src="https://counter.theconversation.com/content/59078/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Merrilyn Walton is affiliated with the Australian Health Practitioners Regulation Agency (AHPRA). She is a Board member the Agency Management Committee (AHPRA) but writes in her personal capacity as an academic researcher, and does not represent the views of AHPRA.</span></em></p>The use of the title cosmetic surgeon and the facility in which the surgery is performed remain untouched in new cosmetic surgery guidelines for doctors.Merrilyn Walton, Professor of Medical Education (Patient Safety), University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/186712013-10-03T13:45:40Z2013-10-03T13:45:40ZStem cells offer a more natural approach to plastic surgery<figure><img src="https://images.theconversation.com/files/32419/original/t8rtc9mg-1380801321.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1024%2C768&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Man in the mirror.</span> <span class="attribution"><span class="source">Shareski</span></span></figcaption></figure><p>The potential of stem cells is everywhere in medicine - from growing new tissue that could go on to provide replacement organs, repairing damage from disease or injury and in reconstructive surgery.</p>
<p>And a team of Danish researchers recently <a href="http://bit.ly/1fKCUW2">suggested in The Lancet</a> that stem-cell enriched fat grafts had the power to transform reconstructive surgery, including procedures such as breast surgery. Not only can they improve the survival of grafts, but also success of a more natural approach to reconstruction. </p>
<p>Stem cells are a class of undifferentiated cells that are able to become (differentiate into) specialised cell types, and they repair and replace cells in tissues. They have three vital characteristics: they are long-lived, they are self-renewing (we can make more of them) and can differentiate into more mature, specialised cells. Adult stem cells, also known as somatic stem cells, are found throughout the body and can multiply to regenerate damaged tissue or replace dying cells. They can be derived from many sources, including from fatty (adipose) tissue.</p>
<p>Stem cells have the potential to revolutionise plastic and reconstructive surgery, a speciality which focuses on restoring form and function. And introducing them to techniques in this field, such as fat grafting (otherwise known as lipofilling, where a patient’s own fat is harvested to increase its volume elsewhere in the body) could improve the outcome of the procedure and its longevity.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/32413/original/zp8bygkj-1380797349.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/32413/original/zp8bygkj-1380797349.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/32413/original/zp8bygkj-1380797349.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/32413/original/zp8bygkj-1380797349.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/32413/original/zp8bygkj-1380797349.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/32413/original/zp8bygkj-1380797349.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/32413/original/zp8bygkj-1380797349.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A breast procedure without implants.</span>
<span class="attribution"><span class="source">Tips Times</span></span>
</figcaption>
</figure>
<p>Lipofilling is commonly performed in plastic surgery to replace lost volume. The procedure is used to improve breast symmetry following breast reconstruction surgery, augmentation and for congenital breast deformities without using breast implants. </p>
<p>But one of its drawbacks is the variation in how quickly the fat graft is reabsorbed by the body. Some studies have suggested <a href="http://cdn.intechopen.com/pdfs/33483/InTech-Autologous_fat_grafting_factors_of_influence_on_the_therapeutic_results.pdf">a gap as wide</a> as 20-80%. The Danish researchers in the Lancet suggest that by enriching these fat grafts with fat-derived stem cells, the amount of graft that survives absorption by the body is substantially improved.</p>
<p>While this has been shown in animal studies, the result in humans is a significant step forward for reconstructive medicine. It adds greatly to the prospect of stem cell use in clinical practice especially in breast reconstruction where large volumes of lipofilling are required. </p>
<p>It has the potential to significantly reduce the number of operative procedures a patient may require. It is also a step forward in other procedures where lipofilling is used such as filling in scars and traumatic defects.</p>
<h2>Nerve and burn injuries</h2>
<p>Stem cells are also being used tissue engineering and other areas of reconstructive medicine. For example, in patients with traumatic nerve injuries, artificial conduits are being used to guide new regrowth and have emerged as an alternative to nerve grafts taken from elsewhere in the body. Fat-derived stem cells have also been incorporated into these nerve conduits in recent experimental studies so that they differentiate into Schwann cells, which play and important role in conducting nerve impulses, to promote nerve regeneration.</p>
<p>There is a potential for the use of epidermal stem cells in burns. The stem cells can be sprayed on directly or transferred onto a scaffold of skin substitute or graft. This has been shown to <a href="http://www.ncbi.nlm.nih.gov/pubmed/21200267">improve wound healing</a>. In the same way, these stem cells have also been used to heal chronic wounds such as ulcers either as epidermal stem cells sprayed directly on to the wound or through fat-derived stem cells injected into the wound.</p>
<h2>Cosmetic procedures</h2>
<p>Cosmetic procedures and in particular facial rejuvenation has become an integral part of aesthetic plastic surgery. Many people are now opting to counter volume loss and wrinkles as they age. Synthetic fillers are used for this but they <a href="http://www.independent.co.uk/life-style/health-and-families/health-news/filler-injections-can-cause-permanent-damage-say-doctors-398943.html">have significant limitations</a>. One of the fundamental principles of plastic surgery is replacing like with like and using fat grafts from a patient’s own body is preferable. But the unpredictability of retention means that many still opt for a synthetic substance.</p>
<p>One must be aware, however, that studies show that stem cells do retain memory of their donor site. This has implications for cosmetically sensitive areas such as the area surrounding the eye should the patient gain weight. So if fat-derived stem cells were taken from the hip, for example, if the patient put on weight they might put on more where the graft is.</p>
<p>Claims are also being made that these cell therapies <a href="http://fabfitfun.com/stem-cells-in-skin-care">improve skin quality</a> and tightening. While this would be a boon for the beauty and cosmetics industry, there’s no concrete evidence for this.</p>
<p>There is no doubt that this is an important and exciting field. Stem cells look to become the corner stone of regenerative medicine. And in reconstructive surgery there is yet more to come.</p><img src="https://counter.theconversation.com/content/18671/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ash Mosahebi works as a Consultant Surgeon for a number of NHS organisations as well as in private practice.</span></em></p>The potential of stem cells is everywhere in medicine - from growing new tissue that could go on to provide replacement organs, repairing damage from disease or injury and in reconstructive surgery. And…Ash Mosahebi, Honorary Senior Lecturer, UCLLicensed as Creative Commons – attribution, no derivatives.