The Normalization of Cosmetic Surgery and its Impact on Society and Human Development

(submitted as a final paper for Advanced Human Development, College of Education and Human Development, Counseling and Development Program, GMU, Fall 2011)

Abstract

In 2010, Americans spent nearly $10.7 billion on 9.5 million cosmetic procedures (American Society for Aesthetic Plastic Surgery, 2011). Since 1997, the first year in which the American Society for Aesthetic Plastic Surgery (ASAPS) began collecting data, there has been a 155% increase in the total number of cosmetic procedures. According to a recent survey, more than half of Americans approve of cosmetic plastic surgery. As surgical and nonsurgical cosmetic procedures become normalized in our culture, changing expectations about age and beauty ideals may be altered in a way that can impact physical, cognitive, social, and emotional development throughout the life cycle. This paper explores the culture of cosmetic medicine, the social implications of its increasing popularity, and the resulting shift in ideologies that can contribute to increasing ageism and the unending quest for unachievable ideals, while also considering a cross cultural perspective and counseling implications.

Literature Review

There has been extensive research on the motivations that drive consumers of cosmetic procedures. While much of the literature focuses on college-age females, some studies have looked at the attitudes of older men and women. Regardless of age, many respondents who have either had one or more cosmetic procedures performed, or approve of cosmetic procedures, place less emphasis on the features for which they sought alterations, and more on the extraphysical benefits of doing so (Adams, 2010). In a study of motivational narratives, Adams found that the most prominent theme for the basis of opting for one or more procedures was “the notion that having surgery would have extraphysical effects, such as increased self-esteem or increased attractiveness to potential partners.” (p. 764). Adams went on to add “there was also an acute cognizance of the societal pressures to look young and attractive, and many respondents suggested that these messages, from media outlets and society in general, played a role in their decisions to have surgery.” (p. 764). The impact of media and the expectations of society are shown to have an impact in virtually every piece of literature reviewed for this paper.

In a study of the factors affecting the likelihood of having cosmetic surgery, Swami et al. found that there is a greater sociocultural pressure on women than men to attain and incorporate beauty ideals, and because these pressures are seen as normative for women, cosmetic surgery can appeal to those seeking a way to feel better about their bodies. (p. 217). Sarwer et al. had similar findings in their study of body image in its relation to the pursuit of cosmetic procedures. Their conclusion revealed that “for many individuals, cosmetic surgery appears to be an adaptive strategy to address body image dissatisfaction … thus, the pursuit of cosmetic surgery may be related to some form of psychopathology, which may be more appropriately treated by psychotherapy than cosmetic surgery.” (p. 107). Indeed, in the same study, breast augmentation patients reported more appearance related teasing, and more frequently used psychotherapy than the control group. (p. 106). In a case study by Lijtmaer (2010), a patient’s preoccupation with her outward appearance was a way to mask her intrapsychic feelings which were a result of unresolved conflicts with her mother.

It’s important to note that the pressures to move closer to an idealized image are not limited to women. Returning to the study by Adams, we see that men are opting for procedures that will make them more attractive to others in the “dating scene” (p. 759) and possibly give them more opportunities in a competitive job market where a younger generation is entering the workforce (p. 757).

Because some findings indicate the presence of a cohort effect from Baby Boomers who tend to feel that their physical age is incongruent with their mental age and are, therefore, more likely to resist aging naturally than pre-Boomers (Clarke, 2007), it is important to examine the motivations behind the largest age cohort in America. (Ferguson, 2010). In their examination of older women’s perceptions of natural and unnatural aging, Clarke and Griffin found that while women who had not had any surgical or non-surgical procedures viewed natural aging as the acceptance of the physical realities of growing older, another group who subscribed to the benefits of cosmetic procedures viewed natural aging as “unattractive, if not objectionable, as well as risky in light of the social and physical realties of growing older.” (p. 198). To this group, using medical technology to enhance or alter their appearance is a requirement of aging as later life becomes “further devalued and socially repugnant in a society underscored by ageist values and norms.” (p. 199). In a study by Slevec and Tiggemann (2010), they proposed and confirmed that aging anxiety defined as a “combined concern and anticipation of losses centered around the aging process” (Lasher, 1993), is a strong component in the decision to pursue cosmetic procedures. Aging anxiety and the pursuit of beauty are reinforced in the media and perpetrated by the cosmetic industry with books like The Wrinkle Cure (2000) by dermatologist Nicholas Perricone (as cited by Bayer, 2005) in which he refers to “wrinkled, sagging skin” as a “disease, and you can fight it”. Additionally, with the emergence of reality television programming touting the life-altering effects of cosmetic procedures while minimizing the risks involved, a normalization of participating in cosmetic enhancements has had a persuasive effect on potential patients. (Slevec, 2010).

While some people argue that age-defying and beauty-enhancing products and procedures can be liberating against the seemingly unstoppable effects of aging, Bayer proposes that such options “buttress the notion that looking old — and thus, being old — is socially, medically, and personally undesirable.” As cosmetic surgery and non-surgical procedures become more affordable in a competitive market, it is important to consider the psychological and social ramifications of body altering procedures. (Gilmartin, 2010). In her review of current literature, Gilmartin concludes that the medical system “bolsters and benefits from the larger consumer-orientated society by colluding with the beauty ideal and cultural mores.” (p. 1807). In a report on ethical challenges within the cosmetic surgery industry, Atiyeh et al. also concluded that physicians participating in the selling of cosmetic services and offering aesthetic services face inherent conflicts of interest, pointing out that it becomes “ethically suspect, breaching obligations of beneficence and honesty, when a physician trades on the status of doctor to sell a clinically unproven product (2008).” In so doing, not only is the culture at large exploited through their insecurities and poor body image, but those with psychopathologies such as eating disorders and body dysmorphic disorder are at greater risk of exacerbating their condition through procedures which by virtue of their disorder can not produce the results they seek. (p. 1804).

Discussion

The increasing popularity in cosmetic surgery and non-surgical procedures seems to take us down a slippery slope. Where does one draw the line between getting a pedicure, putting on lipstick, using Botox injections, or having abdominoplasty (tummy tuck)? By participating in a beauty culture, are we adding to our potential or entering into a vicious cycle of body dissatisfaction? According to Sarwer, some studies have revealed continued improvements in psychological functioning in the first year following cosmetic surgery. However, Sarwer also points out it is possible that “improvements may diminish, particularly if they are related to the frequency of positive feedback patients receive about their postoperative appearance.” (p. 109). More studies need to be done to research the long-term psychological impact of cosmetic surgery, particularly in a culture of medicine where many surgeons’ mantra is said to be ‘start early, do often’, (Gilmartin, 2010), a philosophy internalized by many pro-cosmetic procedure participants across numerous studies reviewed for this paper. Additionally, with 19% of cosmetic procedures performed on racial and ethnic minorities in 2010, more research needs to be done on the relationship between the work being done and its psychological impact on members of different cultures who have to mitigate the ideals from their own cultures with those of a new culture in which they desire to become a part of.

Though ideals of beauty change over time as a result of many influences, Western cultures, and in particular, white cultures seem to dominate the ethos of beauty. In Lijtmaer’s review of the literature, she found numerous studies that point to an increase in body dissatisfaction as non-white groups become acculturated into American culture. (pp. 205-207). With the current widening in socioeconomic gaps, access to cosmetic procedures could further reinforce the difference in status between the haves and have nots, which may be delineated across cultures with minority groups in lower income brackets and less access to expensive procedures.

Another concern I have is the possible pressure exerted on those who otherwise have a healthy body image and self perception. As cosmetic procedures become more accepted and affordable, we run the risk that it becomes a new standard and practice in which we are to participate if we wish to be deemed normal. Take for example the predominantly female practice of hair removal. Though women may not want to participate in the practice, in American culture, it is seen as socially unacceptable to have hair on the legs and underarms, and indeed, according to Toerien et al., “body hair is a flaw, unfit for public display”, (2005). Therefore, women practice hair removal as a necessary part of maintaining femininity, an act, which Toerien suggests serves to “reinforce the view that underpins all the body-changing procedures, from make-up application to cosmetic surgery: that a women’s body is unacceptable if left unaltered.” (p. 400). So, although at this time, I choose not to color my hair, accepting the gray as it comes with age, there may come a time when I am competing for a job, or perhaps even a mate, against peers who participate more extensively in the beauty culture and present a younger facade which in turn may give them an advantage — an advantage that I too could obtain by making similar choices. So one can be faced with giving in to a new norm or facing the consequences of trying to stay true to oneself.

There is no denying the inherent appeal of beauty throughout animal nature. Birds have their plumage to attract a mate, flowers have bright, bold colors to attract their pollinators, male lions have large manes to intimidate their opponents. All of these attributes signify their potential ability to be successful in their environment, surviving challenges and attracting a mate to produce offspring. It could be and has been argued that humans, in this regard, are no different, at the basic level, which provides a basis for our quest for youth and beauty. If, at our core, our purpose is to pro-create, then we are likely to seek out those who reflect the ability to successfully do so. However, as humans, we have the benefit of higher thinking to take in a bigger picture when assessing the desirability of others, whether we are seeking a mate, an employee, a friend, or a nanny. What alarms me about the rising numbers of people seeking cosmetic procedures is that it places an increasing importance on outward appearance while potentially diminishing the value of what is inside. As discussed in depth by Namir (2006), when the outward body becomes the ultimate means for expression through transformation, a person risks abandoning the inside for the outside. In Namir’s interpretation of one patient’s decision to have procedures done, she chose to hide “in homogenization, looking as the world deemed attractive rather than emerging from her own aliveness, radiance, sensuality and self-expression.” (p. 218).

Counseling Considerations

The counseling considerations in relation to the booming cosmetic surgery industry are wide reaching since its impact spans all four domains of development across the stages. As children enter into adolescence and face changes in their bodies, pressure to make their bodies conform to physical ideals that may only be met through unnatural means could lead to risky behaviors such as disordered eating. At a time when identity formation is at its peak, increasing emphasis on physical appearance can lead to a devaluation on internal qualities that make up the identity. As a person continues throughout the life cycle, the pursuit of physical ideals might lead to continued disappointments as an individual tries in vain to live up to fabricated ideals that hold no basis in reality. Maintaining a focus on superficial traits can influence social relationships as a person forms personal connections with others based on externally formed values. And while the long term physical affects of plastic surgery and more recent cosmetic procedures have yet to be extensively measured, it seems impossible to escape at least some negative physical ramifications of these procedures.

Interventions

As clients evaluate their own self worth in the therapeutic setting, it is important to consider the impact of the beauty culture within which we live and work with clients to set standards for self evaluation that are less dependent on external measures while also allowing for the inevitable pressures placed on us by society to look our best on the outside regardless of how we feel on the inside. With patients who are considering or have already used cosmetic procedures to enhance their self perception, counselors should evaluate the goals the patient ultimately believes they will attain by having procedures done and work to understand the underlying psychopathologies that may be contributing to a diminished self image. Interventions could include working with a client to discover internal measures of value, focusing on past accomplishments that occurred irrespective of the client’s physical appearance, and working on goals that can continue to build on a person’s inner qualities. Also, since a focus on external appearance may be a coping mechanism for masking interpsychic conflicts (Lijtmaer, 2010), a greater understanding of unresolved issues that may have arisen even far in the past may present a relevant context for their attitudes and allow for an opportunity of resolution.

As a counselor, I would have to be cognizant of my own body image and views on cosmetic surgery. Past struggles with an eating disorder and defining my value based on physical appearance predisposes me to judgements about others in decisions they make based on their own physical appearances, particularly when they engage in surgical and non-surgical cosmetic procedures. Prior to researching this topic, I felt certain that in most cases, a patient’s body image and overall psychic well being would not benefit long term from cosmetic procedures because my assumption was they were focusing on external, easily manipulated “problems” rather than focusing on deeper issues that may present bigger challenges a patient is not ready to face. While that may be the case for some, I would need to remind myself that each person presents different experiences and therefore different responses to those experiences and some may in fact benefit from the very procedures I naturally find myself opposed to.

References

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American Society of Aesthetic Plastic Surgery, Cosmetic Surgery National Data Bank Statistics, 2010.
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Bayer, K. (2005). Cosmetic surgery and cosmetics: redefining the appearance of age. Generations, Fall 2005, 13-18.
Clarke, L.H., & Griffin, M. (2006). The body natural and the body unnatural: beauty work and aging. Journal of Aging Studies, 21, 187-201.
Ferguson, R. & Brohaugh, B. (2010). The aging of Aquarius. Journal of Consumer Marketing, 27/1, 76-81.
Gilmartin, J. (2010). Contemporary cosmetic surgery: the potential risks and relevance for practice. Journal of Clinical Nursing, 20, 1801-1809.
Lasher, K.P., & Faulkender, P.J. (1993). Measurement of aging anxiety: development of the anxiety about aging scale. International Journal of Aging & Human Development, 37, 247-259.
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