PLASTIC SURGERY: AN ADVANCEMENT THAT DEFIES THE LAW OF NATURE, OR A BEAUTY PAID IN BLOOD

In order to salvage or upgrade their natural look, humans were willing to take over the world of God as they overcame the laws of nature with the means of plastic surgery. But the question is also the same as that in the case of Icarus and his wings: Are we burning ourselves alive trying to take over the sky?

Upturned eyes, plump lips, an aquiline nose, a busty chest, a 56-cm waist, a fine ass and a long, slender pair of legs to compliment that perfect hourglass body — the standards of beauty has nowadays become so detailed and highly cosmetic that it almost feels like a non-intervened woman can hardly have a life, even when the look they have could be considered beautiful by the standards before cosmetic surgery. The Ideals of the beauty of today feels almost as fictional to nature as the look of anime characters. As a result, women grew to look less and less like themselves, while being more and more similar to a certain model. A survey published on Time combined all the ideals of men and women of a perfect body by combining the body parts of the celebrities most popularly idolized for their looks [1]. The result was a body that should be flawless on paper but actually looked more doll-like than human-like.

In order to triumph over nature, humans relied on creativity. In order to salvage or upgrade their natural look, humans were willing to take over the world of God as they overcame the laws of nature with the means of plastic surgery. But the question is also the same as that in the case of Icarus and his wings: Are we burning ourselves alive trying to take over the sky?

1. When the magical becomes unmagical

World War One (WWI) was an unprecedented war for mankind in both its scale and forms. The newly introduced technologies of mass destruction like bombers, tanks, machine guns, poison gas, etc. had left most parts of the world in ruins and turned soldiers into cripples. Most of these soldiers returned home with their bodies severely deformed, a lot facially so. These few survivors suffered such great handicaps they experienced breathing and eating difficulties, as well as a horrendous look that chased people away. These handicaps had caused the military doctors to face an entirely new challenge that forced them to be more resourceful, innovative and brave. They had to work with their patients for years, not only for rehabilitation but also for the restoration of their looks. The aftermath of wounds from shrapnel and gunshots were utterly brutal; but upon working to overcome that, medical sciences had risen with one magical feat after another: From skin implementation to replace gluteal and thigh skin to the restoration of shattered jaws with implanted leg bone fragments, or the filling of the cheek hollows with body tissues. And even when restoration using body tissues were impossible, they could still implant masks that could allow handicapped soldiers to appear in public with a decently normal look that didn’t attract attention” [2].

Prof. Dr. Jacques Joseph — who was considered the father of modern plastic surgery, had made achieved some spectacular feats during wartime as he performed restorative surgeries for countless handicapped soldiers. Despite being driven by his great patriotism toward his country of Germany, he was also proud of his Jewish origin; and not only did he treat the victims of war, he also helped other Jewish to cover up the racial trace in their looks and thus kept them safe in a time where they were made into public enemies [3]. The abundant materials on surgery, as well as the ideas much ahead of his time that he left for the world, had greatly contributed to plastic surgery’s becoming a serious pursuit for medical science and opened up the promised land where people could improve their appearance.

And just within the next 100 years, plastic surgery had, from a practice used to alleviate the pains of war, transformed into a tool of god to create beauty in the time of peace. Despite the risks of permanent/semi-permanent deformation, dysfunctions or even death [4], nowadays plastic surgery is considered the most powerful and most popular means for changing appearance in the world. A global survey of the International Society of Aesthetic Plastic Surgery (ISAPS) showed that the proportion of people taking plastic surgery from 2015 till now has increased by 20% compared to the previous record. In the U.S. alone, there are already 18 million surgeries per year; Korea has a plastic surgery industry of 10.7 billion USD in value; Brazil, Japan Mexico, Italy and Germany were always the top countries in ISAPS statistics [5]. The global popularity of plastic surgery had a lot to do with the beauty standards that were largely unattainable for women and thus required them to be medicalized. An example is a standard for women to have a slim body: It has almost become the ideal across all cultures, especially so in Asia, despite how some of these countries used to consider chubby women the standard for traditional beauty, as it symbolizes wealth and happiness) [6]. Alongside the skinny body, other modern standards of beauty, such as a larger hip, plumper lips, table-flat stomach have also been spreading with incredible pace. Despite how these standards were never easily attainable and thus were never really so commonly found, technological advancements like TVs, the internet, the social networks have made them seem ubiquitous and thus be a staple requirement for any woman. When it comes to biological functionality, a faster-aging face, small breasts or small bums are not defects that require medical intervention; but with the spreading of modern culture, they were devilized as some kind of unforgivable appearance abnormalities that many women felt they had to be corrected.

Modern plastic surgery takes 2 main approaches: to restore anatomical defects and to enhance appearance aesthetics [7]. We will skip the former and discuss the latter to find out for what reason are humans so unhesitating to accept the horrendous interventions that add or cut parts from their biological bodies. Was it all about the inferiority complex, the fear of being alienated for not being able to stand up to society’s expectations?

There are 3 main factors that have led to the boom of the plastic surgery industry, namely: The industry’s endogenous charm, the influence of media and the intervention of the government, all will be discussed below.

2. How modern beauty works

It can be said that the plastic surgery industry has done a great job in identifying their potential customers and feeding those groups with artificial demands and introducing themselves as the solution for those demands.

Each person in the world has their own demand for beautification, which depends a lot on their identity and the culture where they belong. Starting from the erasure of racial facial characteristics (like in the previously mentioned example of Jewish people in WW Germany), modern plastic surgery had quickly extended its reach to body parts that were previously hardly ever considered a component of the beauty or a component of racial, cultural or any other stereotypical identity (such as the intervention on thighs, butts and chests). Plastic surgery clinics expanded their services based on the body parts for which proper medical intervention procedures had been readily developed, while also working together with the media to implant in the public the clues that could lead them to an idea of the modern beauty, where the said body parts should meet a certain standard (despite how they previously might not have anything to deal with beauty). And with that comes the ingenious dilemma of the plastic surgery industry being the provider of the means for people to reach the beauty standard while also playing a massive role in the definition and promotion of that standard and any other standard to replace it in the future (which of course would be obtainable only with plastic surgery).

For example, in the 1980s, when the Brazilian Butt Lift (BBL) procedure, which involved the extraction of one’s fat (often from the thigh or belly) to inject into their butt, caused it to become more round and plump without using implants. As soon as this procedure was born in the country, the Brazilian Playboy magazine already published content stating that the butts were the passion of the nation. And nowadays, the love for the Brazilian big butt has spread out throughout the world to become virtually a beauty standard of global scale. And the women who had small butts and wanted the butts similar to those created by BBL had no choice but to rely on plastic surgery, because workout and diets would result in bigger butts with not as good shape, while also leading to the new problem of oversized thighs created by the workout and uneven muscle development).

(Note: You may wanna skip the next part because the next issue we discuss might be rather sensitive).

It was also the plastic surgery industry that was the mastermind behind the media campaign to promote the unrealistic beauty standard for women’s genitals. Labial Hypertrophy is a recently introduced medical term, and about more than 50% of adult women naturally have this condition[9]; but nonetheless, the plastic surgery advertisements deemed it as an abnormality that needed to be fixed. So, with this move, not only did the advertisement try to set out the standard of the beauty of women’s genitals (and an unrealistic one at that), they also medicalized it, terming it as a medical condition that requires intervention. When being asked for the reason, the “patients” would explain that it was them finding themselves abnormal from comparing their own genitals with the images shown on plastic surgery websites, instead of them experiencing any kind of inconvenience or any other medical reason.

And that is how this whole thing work: (1) they develop a procedure to intervene with a certain body part, (2) they promote a beauty standard in which a certain body part is expected to have certain characteristics, (3) they medicalize those characteristics and identify not having those characteristics as a problem. and (4) then they make all the said information public so that everyone would scramble to correct this defect of their bodies.

The pursuit of modern beauty had escalated to a whole new level with the involvement of the media — the tool that played an active role in reinforcing the unrealistic beauty standard. The booming of social media platforms also helped to amplify the influence of celebrities; for example, while the Brazilians were the ones to create BBL it was actually Kim Kardashian who had made it a global sensation. Reality shows like “Keeping Up with The Kardashians” (KUWTK), “The Real Housewives” had contributed to promoting the preconception that the look was the factor that decided both the personality and the capacity for success of a person, and investment in appearance-enhancement was greatly encouraged. These reality shows had a certain pattern to their stories, where the characters would use plastic surgery as a means to attain the beauty that they desired [10]. Just like how Kylie Jenner, the Instagram user with 272 million followers once admitted that her plump lips were the products of lip plumping surgery in an episode of KUWTK, or how the ‘Australian swan’ Nicole Kidman disclosed that she had once tried Botox injection [11]. And with that, even though not so long ago Botox injection was considered a procedure that only insane celebrities would try because it was the strongest toxin that humans had ever known of [12]; nowadays it had become commonplace.

Despite having certain proven medical functions in treating cockeye and migraine, the injection of botox type-A, which was extremely risky, had shown how powerful the desire for beautification of humans had become. How much courage would people need to inject in their face a neurotoxin of which one gram would be sufficient to kill over a million people, just so their wrinkles can be removed? It can be said that it was the beautiful celebrities and their influence amplified by the media with its unlimited extended reach of all types of media that had spread the idea far and wide and turned lots of women into “beautification experts”. In the 2000s, reality shows like “The Swan” or “Extreme Makeover” (U.S.), “Let Me In” (Korea) also praised the popularity of plastic surgery and sold the idea that medical science can help every woman become beautiful. The participants often told the same story: they were insecure about their looks for having certain parts that were defected, deformed or unnatural (but hey, how can something you were born with be unnatural?) and then told about the things they wished to change. The producer’s squad, which consisted of surgeons, therapists, dentists and coaches would perform the “Cinderella magic” and the participants would clash against each other in the final beauty contest. Millions of TV audiences were completely captivated by the show, and countless applications for participation in the next season were sent to the producers. These shows had implanted in the viewers’ consciousness the faulty idea that the divergences from the strict beauty standard were medical abnormalities that needed surgical intervention. By this method, media had been used as an effective tool to even further promote the popularity of plastic surgery.

The final key driving force was the policies of certain countries, most notable of which was the beautification culture of Brazil in the XX century. In the 1950s, in Brazil, as the urbanization machine began to rumble, tons and tons of poor laborers from the countryside migrated to the city for jobs. Their filthy look (Rough faces, blackened skin from the daily dozen of hours working in the sun) soon became an eyesore for the elites. As a result, the migrants, especially females, were severely mistreated and stigmatized based on their inferior appearance, including the denial of their job opportunities. The man to create a gigantic wind to sail for the overturn of this process was the brilliant doctor Ivo Pitanguy, who was honored as “the Pope of plastic surgery” and was also the father of the BBL procedure [13]. In 1960, Pitanguy had managed to convince the Brazilian government that the need for beautification was just as fundamental as any other medical needs; and he proposed an unorthodox solution that could help solve the turmoil of stigmatization that had been spreading throughout the country. Pitanguy convinced the government that if they invested in the right medical treatment for the people of the lower class who had the problem of “ugliness”, they could level the inequality of beauty and thus eradicate the stigmatization. Realizing that this solution could be the breakthrough that they needed, the Brazilian government began to subsidize plastic surgery and, for the first time, the affair of beauty had been systematically medicalized. Nowadays, almost every Brazilian has the access to any surgical (or non-surgical) beauty intervention, and they could tell others (including strangers) about their plastic surgeries without any inconvenience. The treatment wasn’t limited to the rich people; it is also provided by public hospitals either for free or at cost affordable even to the non-affluent. With half a million procedures being subsidized by the Brazilian government per year, Brazil has become the country with the second-largest percentage of the population with plastic surgery. Dr. Ivo Pitanguy himself was also honored as a national hero (and he also performed free surgery for the poor), while also owning a private island and attracting a whirlwind of admirals whenever he showed up at a Carnival. So essentially Brazil was the first country where the government made policies around the beauty standard. The same process took place in Korea when their government introduced a subsidy for medical tourism [14], and coined an entire term for the practice of taking plastic surgery to improve employment prospects — Chwieop Seonghyeong (Employment Surgery). The Hallyu wave of culture exportation owed a large part of its success to the advanced plastic surgery industry of Korea that enabled the mass manufacturing of idols, actors and boy/girl bands with flawless beauty that had quickly taken over Asia as the standard for beauty.

So basically, the biggest factors that had contributed to the emergence in popularity of plastic surgery were, namely, endogenous promotion, social media and governments’ policy-making; which all had contributed to establish a modern beauty standard that could dictate the life of all people and place across the globe.

3. The vicious circle and whether time would fix it

To be born with a normal look without any deformations has already been enough of a blessing, but then that would make being born with beauty a grand prize in the game of lottery that is genetics. The obvious advantages of being born with attractive looks, like enjoying a better average income, a better chance to pass an employment interview or to get a promotion, to be positively considered by everyone and as a result have an easier time networking and attracting partners, etc. have been all too familiar to the society [15]. As a result, to own an attractive look is definitely a rightful need for anyone; however, it is their outlook toward beauty that decides whether the pursuit of it would benefit or hurt them. And more and more people are seeing plastic surgery as the ultimate solution for their problem. With the deeper involvement as well as rapid progress of technology, people of both genders (though predominantly females) have been, both intentionally and unintentionally, swayed (by the 3 factors we discussed earlier) to favor plastic surgery. And with that, an unexpected vicious circle began to emerge, as the people who underwent plastic surgery are actually being judged poorly by the people around them, both as a projection of the practice that is plastic surgery and as themselves as an individual. Despite how society has given birth to plastic surgery and embraced it, the objection against it also began to emerge. In many surveys on people’s opinion on the people to receive plastic surgery, most surveyed people attributed to these people negative traits like being materialistic, narcissistic, perfectionist, having poor mental health, etc. Even the receivers of plastic surgery admitted that their commitment to change their own look was in order to fix their low self-esteem as they were uncomfortable with their own appearance (regardless of whether or not the change brought by plastic surgery satisfied them) [16]. So the stigma against plastic surgery is real and existing in our current society. But then the question is, why are we growing the distaste for it after we invented plastic surgery and crowned it as the ultimate weapon of science to fight back nature’s edict over our appearance? The following 3 factors are the reasons:

- The physical and mental risks: While complications in plastic surgery (like hematoma, infection, scars, etc.) are few in proportion and in most cases predictable [17], the risk still exists in any procedure from the most simple, even when the strictest standards of safety are in place. Unlike any other kind of operation, plastic surgery is not medically necessary. Despite being rare, the complications of plastic surgery can be severe and, in many cases, life-threatening, and yet people are taking it anyway. What’s more, the potential for the outcome not matching the expectation (which is more common) also brings the risk of the patient’s not gaining the positive mental boost they wish for but instead the exact opposite. But that alone is not enough to explain the rather similar distaste of society toward cosmetics — a non-surgery means of beautification. For example, women who use a lot of makeup are often perceived as having poorer intellect, skill or morality than those not using makeup [18]. So the stigma doesn’t solely stem from the risks that these procedures run.

- The fallacy of naturalism: It’s the common paradox where the promotion campaign for beautification would most of the time selling the idea of their products being the key to “natural beauty”, despite how these products certainly involve medical intervention. This naturalistic fallacy depicts the false preconception of the masses that anything natural is, by default, virtuous[19]. In history, the argument of naturalism had always attempted to shackle women to certain gender identities and with that worked to justify the devaluation of women. For example, in the Bible, women wearing makeup are considered unvirtuous, and Christianity in general strongly favored the idea that people should care less about their look (Philippians 2:3–4) and more about inner beauty (1 Peter 3:4) [20]. Religious messages indoctrinated that humans were created using God himself as the model; therefore to permanently alter one’s appearance is considered a sin. Society was filled with ideas that natural beauty was superior to man-made beauty.

So the campaigns in which plastic surgery was promoted as the key to natural beauty was an attempt to maintain the illusion of naturalism despite how it involves an entirely unnatural practice that was medical interventions. The example for this hypocrisy is that while modern beauty standards require women to maintain their charm and youthfulness even when they’ve grown old, they were also criticized for seeking medical means that could slow or revert aging. And another is how men desire beauty that’s unachievable for most normal women while also pushing forward the anti-cosmetics agenda — for the “beautiful, cosmeticless you”. This fallacy has achieved such widespread popularity it has sparked anti-cosmetics sentiment in even the most pro-cosmetics countries. For example, in Korea, most plastic surgery would only be acceptable to customers if the outcome looked perfectly natural, despite how the standard to measure for the naturality is often how close one’s look resemble the looks of flawless actors, idols and singers, who are seeming more and more like they are mass-manufactured using the same mold of a doll factor. And the Korean netizens often completely lose their minds when they discover that the idols/actor has taken major plastic surgery like breast lifting or nose fixing; and on the other side, the celebrities are absolutely feeling a lot more uncomfortable to admit that they have undergone plastic surgery. With that, the fallacy of naturalism was definitely one of the factors that contributed to the hatred stigma against plastic surgery.

- The unfair seizing of advantage: Attractive looks bring lots of benefits to its owner, and often guarantees positive reception of people for them. For this crucial attribute, beauty was considered one of key assets in attracting partners and establishing romantic relationships. And the social categorization of beauty as a women’s trait has given women even more reasons to turn it into a competition, they weaponize beauty for all competitions in life, including the struggle to secure the best male partner. But then the (ideal) partners are indeed a finite resource, and as such the competition was utterly severe, turning the pursuit of beauty into a full-fledged arms race. So the common belief in beautification was true and accepted for the more commonly accessible means like hairstyling, makeup or dressing. But plastic surgery, on the other hand, is considered a breach of this social consensus, because it is a means not equally attainable to everyone (as not everyone has the finance or the bravery to risk their lives for it). What’s more, achieving beauty by cosmetic surgery also denies the merit of other traditional and laborious methods like workout or dieting, making it seem like you’re winning a marathon with a race car and still get away with the prize. As a result, plastic surgery was seen as an underhand method in the competition between women, that devalued the efforts of other women and the results of other more virtuous methods like workouts or dieting; it’s also considered as the act of deceiving potential partners. In a study, as the interviews found out, the participants often saw plastic surgery as a method only resorted to by undisciplined, low on self-esteem, people, who wished to transform themselves but were too lazy and vainglorious to take the high road of dieting and workout — the cheaters who wanted technology to do all the hard work in life [21]. As such, the negative reception toward plastic surgery could also be a problem of perceived inequality as well.

So the bottom line is that while plastic surgery was a godly invention that enabled humans to alter their appearance at will, it also established and pushed to an unhealthy level the bar for beauty; and from that born the utterly unrealistic beauty standards that we have today. But at the end of the day, there is simply no inherent right or wrong to it, because plastic surgery is a choice and each individual has their own consideration of it. While some claimed that their life had taken a better turn thanks to cosmetic surgery, there are also others who find it unrealistic to make it a reasonable expectation. Plastic surgery doesn’t make people more than they did (and if it does then that love would be so shallow that you should not be counting on it at all). The real problem, though, is how women are nowadays trapped in the rock that is that unrealistic beauty standard created by the plastic surgery industry and the hard place that is the “natural” status we use to crown the daily beautifying activities like washing ourselves, shaving, curling our hair, eye-lining or moisturizing our skin. All these practices that were accepted as normal, natural or healthy were never available in the natural life of our ancestors, and perhaps plastic surgery is being an upgrade so novel it looks alien to us similar to the way our modern cosmetics should, reasonably, appear to our ancestors. Why are we so fixated to things that we don’t have, and why are we trying so hard to build ourselves up to those standards: straightening our hair that was born curly, englongating our eyelashes that never need to be so long, or plumping up our born-skinny face, or trying all kinds of way to fool other on our true age and attractiveness by concealing the signs of aging. With plastic surgery, humans are picking for an entirely new self that’s different from how we are genetically made; we appear stronger, younger and better restored than humans in any age could ever be without these advanced technologies. But then that would also mean we are taking away the rights of future generations to live happily and satisfied with what they are born with, without plastic surgery, because the standard for beauty has already been pushed beyond the point that it could be matched without intervention. Even the godly feat of mankind has become mundane; as it becomes mundane, it becomes standard.

The creativity of humans is so limitless it has allowed us to trick even the most unbreakable rule of life that is aging. Humans will interfere more and more with nature; that is the inevitability that cannot be reversed. So the question should not be whether or not we should do so; that would be us being way too occupied with the question of how much control we should have on what we will become. It should be “How can we effectively control the power that we currently have in our hands, so we could use it for our own good instead of hurting ourselves.

Scientific and technological advancements don’t guarantee heaven for us. They certainly are changing the world, but all positive changes would always come with their own set of problems, the best we could do is to keep our head above that chaotic water.

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Further reading:

The cosmetic surgery paradox — Sarah Bonell, Fiona Kate Barlow, Scott Griffiths: https://www.sciencedirect.com/.../abs/pii/S1740144521000632

Netflix Explained, “Plastic Surgery”

Plastic Surgery: Is It Natural Or Unnatural? — Stacey Hou

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