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‘Let’s admit that money has become the driving force behind cosmetic surgery’

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In a culture obsessed with beauty, George Winter claims an industry of ‘face-lifters’ is perpetuating the view that undesirable features require medical intervention

The last episode of the current series of US television show Ugly Betty was screened recently. Rather oddly to me, the programme’s protagonist is deemed ugly on account of her having a dental brace and poor fashion sense.

The writers attempt to explore the concept of ‘beauty’ as a social phenomenon. The series is a parody of the demonisation of those whose faces don’t quite fit with the images in the pages of, say, Vogue. It offers one nugget of hope that a less than perfect set of gnashers need not pose an insuperable barrier to a career in print journalism.

To me there is another issue central to the show – why does Betty’s father spend so much time slicing vegetables? Do the Suarez family have a monstrous mutant rabbit chained outside in the yard? Are there hordes of pepper-munching illegal immigrants under the floorboards? Or is there a subliminal message there about the benefits of eating lots of vegetables?

I first became aware of ugliness in another periodical – The Beano, through the antics of the Bash Street Kids, one of whose anarchic number, Plug, had a face that... lacked teamwork. Yet Plug was never teased because of his appearance, nor was he anything other than ‘one of the gang’.

This short-trousered Beano aficionado soon realised some people stood out.

When my mother took me on my first-ever visit to a real tea room for grown-ups, my awe at the willow-patterned, tiered-plate arrangement of scones, cakes and biscuits was eclipsed when I glanced at a gentleman at an adjacent table. Transfixed by his heavily scarred, lop-sided jaw, I stared at him in bug-eyed amazement until my mother, wielding a teaspoon, delivered a less-than-genteel rap across my knuckles, with the whispered instruction to ‘butter that scone, now’.

On the bus home, she outlined the roles played by nature, disease and sheer bad luck in the lives of many people, and how it added little to their lot if small children like me were to gawp at them. It made sense then – and it made sense later to learn that one aim of reconstructive plastic surgery was to undo some of the results of, say, war trauma, burns, infections or prenatal malformations such as cleft lip and palate.

Advances in plastic surgery paved the way for cosmetic surgery. Cosmetic surgeons appropriated the language of clinical psychology – so anxiety, inferiority complex and sheer frustration became medical indications, often with a clever invocation of the World Health Organization’s definition of health as being a state of not only physical well-being but also mental and social well-being.

Today’s cosmetic surgeons have dropped the pretence that cosmetic interventions address psychological needs. After all, why should a cosmetic surgeon lose a sale by referring an anxious patient with an inferiority complex to a psychologist? Yesterday’s medical indications have been replaced by today’s enhancements.

I suspect that the lifters of faces, hosers-out of fat and inflaters/deflaters of breasts are doing little to reverse the trend that considers ugliness good grounds for medical intervention.

Few would disagree with a statement in a back issue of the Journal of the American Dental Association: ‘The width of an aesthetically pleasing central incisor seldom exceeds 80% of its length... When viewed from a patient’s midline, a smile is harmonious if the lateral incisors appear to be 62% of the width of the central incisors, and the canines appear to be 62% of the width of the lateral incisors.’

As well as the pontificating of those who maintain that ugliness can be assessed against an objective standard, the cosmetic surgery industry is driven by a notion that the customer is (nearly) always right. For example, a woman might pay handsomely for a cleavage that defies both gravity and the imagination. If she pronounces herself pleased with the result and says it makes her feel healthy, does it mean that her totally unnecessary surgery has conferred distinct health benefits? I suppose the answer is – if she says so.

George Winter is a former biomedical scientist at Edinburgh Royal Infirmary and City Hospital

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