The Beauty Myth (35 page)

If women suddenly stopped feeling ugly, the fastest-growing medical specialty would be the fastest dying. In many states of the United States, where cosmetic surgeons (as opposed to plastic surgeons, who specialize in burns, trauma, and birth defects) can be any nonspecialist M.D., it would be back to mumps and hemorrhoids for the doctors, conditions that advertising cannot exacerbate. They depend for their considerable livelihood on selling women a feeling of terminal ugliness. If you tell someone she has cancer, you cannot create in her the disease and its agony. But tell a woman persuasively enough that she is ugly, you do create the “disease,” and its agony is real. If you wrap up your advertisement, alongside an article promoting surgery, in a context that makes women feel ugly, and leads us to believe that other women are competing in this way, then you have paid for promoting a disease that you alone can cure.

This market creation seems not to be subject to the ethics of the genuine medical profession. Healing doctors would be discredited if they promoted behavior that destroyed health in order to profit from the damage: Hospitals are withdrawing investment from tobacco and alcohol companies. The term for this practice, ethical investing, recognizes that some medical profit relationships are unethical. Hospitals can afford such virtue, since their patient pool of the sick and dying is always naturally replenished. But cosmetic surgeons must create a patient pool where none biologically exists. So they take out full-page ads in
The New York Times
—showing a full-length image of a famous model in a swimsuit, accompanied by an offer of easy credit and low monthly terms, as if a woman’s breasts were a set of consumer durables—and make their dream of mass disease come true.

Though the Surgical Age has begun, it remains socially, ethically, and politically unexamined. While the last thing women need is anyone telling us what we can or cannot do to our bodies, and while the last thing we need is to be blamed for our choices, the fact that no ethical debate has centered on the supply side of the Surgical Age is telling. This
laissez-faire
attitude is inconsistent for many reasons. Much debate and legislation constrains the purchase of body parts and protects the body from risks posed to it by the free market. Law recognizes that the human body is fundamentally different from an inanimate object when it comes to buying and selling. United States law forbids the commercial barter of the vagina, mouth, or anus in most states. It criminalizes self-maiming and suicide, and rejects contracts based on people assuming personal risks that are unreasonable (in this case, risk of death). Philosopher Immanuel Kant wrote that selling body parts violates the ethical limitations on what may be sold in the marketplace. The World Health Organization condemns the sale of human organs for transplant; British and American law banned it, as did at least twenty other countries. Fetal experimentation is banned in the United States, and in Great Britain Parliament debated the issue bitterly. In the Baby M. case in the United States the court ruled that it is illegal to buy or rent a womb. It is illegal in the United States and Britain to buy a baby. Ethical discussion is raised by the financial pressure on a woman to sell her uterus, or on a man to sell a kidney. Agonizing national debate centers on the life and death of the fetus. Our willingness to wrestle with such issues is taken as a sign of society’s moral health.

What the surgeons traffic in is body parts, and the method of the sale is invasive. Experimental fetal tissue is dead; it still raises complex questions. The women subjected to surgical experiments are still alive. Surgeons call tissues on a woman’s body dead so that they can profitably kill them. Is a woman entirely alive, or only the parts of her that are young and “beautiful”? Social pressure to let old people die raises questions about eugenics. What about social pressure on a woman to destroy the “deformity” on
her healthy body, or to kill off the age in herself? Does that say nothing about society’s moral health? How can what is wrong in the body politic be not only right but necessary on the
female
body? Is nothing political going on here?

When it comes to women and the ethical void opened by the Surgical Age, no guidelines apply and no debate follows. The most violent people set limits for themselves to mark that they have not lost their humanity. A soldier balks at killing a baby, the Department of Defense draws the line at poison gas, the Geneva Convention asserts that even in war there remains such a thing as going too far: We agree that civilized people can recognize torture and condemn it. But in this, the beauty myth seems to exist outside civilization: There is as yet no such thing as a limit.

The myth rests on the fallacy that beauty is a form of Darwinism, a natural struggle for scarce resources, and that nature is red in tooth and claw. Even if one is able to accept the fallacy that women’s pain for beauty can be justified—as generals justify war—as part of an inevitable evolutionary conflict, one must still recognize that at no point have civilized people said about it, as they do about military excesses, that’s enough, we are not animals.

The Hippocratic Oath begins, “First, do no harm.” A victim of medical experimentation quoted in Robert Jay Lifton’s
The Nazi Doctors
asked the doctors, “Why do you want to operate on me? I am . . . not sick.” The actions of cosmetic surgeons directly contradict the medical ethics of healing doctors. Healing doctors follow a strict code, established after the Nuremberg trials, to protect patients from irresponsible experimentation: The code centers on the ideas of free choice and informed consent.

Cosmetic surgical techniques appear to be developed in irresponsible medical experiments, using desperate women as laboratory animals: In the first stabs at liposuction in France, powerful hoses tore out of women, along with massive globules of living tissue, entire nerve networks, dendrites and ganglia. Undaunted, the experimenters kept at it. Nine French women died of the “
improved
” technique,
which was called a success
and brought to the United States. Liposuctionists begin their practice in the absence of any hands-on experience during training. “My surgeon has
never done that procedure before . . . so he will use me to ‘experiment,’” reports a surgery addict. With stomach stapling, “surgeons are continuing to experiment in order to come up with better techniques.”

To protect patients from medical experimentation, the Nuremberg Code emphasizes that in order genuinely to consent, patients must know all the risks. Though patients are asked to sign consent forms, it is extremely difficult to get accurate or objective information about cosmetic surgery. Most coverage stresses women’s responsibility to research the practitioners and procedures. But reading only women’s magazines, a woman might learn the complications—but not their probability; devoting full-time research to it, she still won’t find out the mortality rate. Either no one knows it who should, or no one’s telling. A spokeswoman for the American Society of Plastic and Reconstructive Surgeons says, “No one’s keeping the figures for a mortality rate. There are no records for an overall death rate.” The same is true in Canada. The British Association of Aesthetic Plastic Surgeons also states that statistics are not available. One cosmetic surgery informational source admits to 1 death in 30,000, which must mean that at least 67 American women are dead so far—though these odds are never mentioned in articles in the popular press. Most available sources omit levels of risk and all omit descriptions of levels of pain, as a random survey of popular books on the subject shows: In
About Face
, the authors cover five procedures including liposuction, chemical peel, and chemodermabrasion, but mention neither risks nor pain.
The Beautiful Body Book
covers procedures including breast surgery, dermabrasion, and liposuction without mentioning risks, pain, breast hardening, reoperation rates, or cancer detection difficulties. The author describes breast reduction surgery and “repositioning” surgery (for when, in her words, “the nipple is misplaced”). These procedures can permanently kill the erotic response of the nipple. She does mention this side effect only to dismiss it with the astonishing opinion of one doctor who “told me that it is not unusual for many women with oversized breasts to have little or no feeling in the nipple area anyway.” She goes on to claim that liposuction has resulted in “only four deaths” (
The New York Times
counted eleven in 1987) and that “to date, no long-term
negative effects have been observed.” Typically, the brochure of one West London clinic does not mention in their list of “risks” pain, loss of nipple sensation in any of the five breast surgeries they offer, or the risk of death. Another British brochure contains a flat untruth: Scar tissue development after breast surgery, it claims, “is rare,” happening only “very occasionally,” though estimates for scarring actually range from 10 percent of all cases to as many as 70 percent. One cosmetic surgeon’s approach to informed consent is characteristic: to “give [his] patients a paper designed to provide them with as much practical information as possible without scaring them half to death about the multitude of complications” that, despite what he calls their rarity, “could befall them.” It is also very difficult to tell which sources are impartial:
The Independent
(London), a respected newspaper, ran a positive article on surgery, ending in an advertisement for their
Independent Guide to Cosmetic Surgery
(two pounds), which plays down risk and advertises all the qualified surgeons in Great Britain. A woman cannot know what the chances are that a horror story will happen to her, until it does; her ignorance alone puts the cosmetic surgeons in violation of both the letter and spirit of Nuremberg.

Healing doctors respect the healthy body and invade the diseased only as a last resort; cosmetic surgeons call healthy bodies sick in order to invade them. The former avoid operating on family members; the latter are the first men to whom technology grants the ancient male fantasy of mythical Pygmalion, the sculptor who fell in love with his own creation: At least one surgeon has totally reconstructed his wife. Healing doctors resist being manipulated by addicts; there is already a class of women who are addicted to surgery, reports
Newsweek
, “scalpel slaves” who “indulge . . . in plastic surgery the way some of us eat chocolate—compulsively. Neither cost, pain nor spectacular bruising lessen [the] desire for a little more whittling.” One surgeon gives an addict a discount for repeat operations. Addicts “go from doctor to doctor, seeking multiple operations. . . . Their self-scrutiny becomes microscopic. They start complaining about bumps the average person doesn’t see.” And the surgeons operate: one in particular has cut up one woman at least half a dozen times, “and expects to keep up the remodelling work. ‘I guess it’s all right,’ he says, ‘as long as her husband doesn’t complain.’”

Medical coercion in service of a vital lie is less regulated than legitimate medicine. In the nineteenth century, sexual surgery was risky and unscientific, with few legal checks. Patients were more likely, until around 1912, to be harmed by medical intervention than helped. Little, according to today’s standards, was known about how the body worked, and strange experiments on women’s reproductive organs were common. The American Medical Association had no legal control over who could call himself a doctor. Doctors had virtually free rein to peddle opiate-based, addictive snake oils, and miracle cures for vague female maladies.

The new atrocities are flourishing without intervention from the institutions that promise to safeguard the welfare of citizens. In a sexual double standard as to who receives consumer protection, it seems that if what you do is done to women in the name of beauty, you may do what you like. It is illegal to claim that something grows hair, or makes you taller, or restores virility, if it does not. It is difficult to imagine that the baldness remedy Minoxidil would be on the market if it had killed nine French and at least eleven American men. In contrast, the long-term effects of Retin-A are still unknown—and the Food and Drug Administration has not approved it; yet dermatologists are prescribing it to women at a revenue of over $150 million a year.

The silicone injections of the 1970s, never approved by the FDA, have hardened “like a sack of rocks,” as one doctor puts it, in women’s breasts. The long-term carcinogenic effect of silicone is unknown, but surgeons are still injecting it into women’s faces. In the US “peeling parlors” have appeared where operators with no medical training at all use acid to cause second-degree burns on women’s faces. It wasn’t until 1988 that the FDA cracked down on quack cures for weight loss aimed at women, a $25-billion-a-year business. For the forty years before the crackdown, disreputable physicians prescribed, for “medically approved” weight-loss treatment: amphetamines and related addictive drugs, high doses of digitalis, a highly toxic heart drug, injections from pregnant women’s urine, extended fasting, brain surgery, jaw wiring, and intestinal bypass. Though all were promoted by doctors, none was backed by long-term animal studies or clinical trials for safety or
effectiveness. Mass-market diet formulas still place dangerous stresses on the body when normal eating is resumed; PPA (phenylpropanolamine), present in diet pills and herbal weight-loss remedies, causes danger to the heart, but need not be labeled on the product. Women are still prescribed addictive cocaine- and amphetamine-derived drugs for weight loss, but this does not merit the attention of the President’s task force on drugs. This lack of regulation is itself a message to women, a message that we understand.

In Great Britain, objective-sounding organizations have sprung up which specialize in cosmetic surgery—and make use on their literature of the winged staff and serpents of Asclepius, god of healing and of the medical profession, giving women the impression that they will get impartial information, when what the organisations do is lobby over the phone, through medically untrained “counselors,” for new patients. In the United States, it was not until 1989, ten years into the Surgical Age, that a congressional hearing was convened by Congressman Ron Wyden (Democrat, Oregon), to investigate what one witness called “the last refuge of freebooters charging what the market will bear” and their advertising, which is “often misleading and false . . . preying on the insecurities of American women.” Testimony accused the Federal Trade Commission of a failure to regulate the “profession,” and blamed it for permitting advertising in the 1970s and then abandoning responsibility for what the ads had wrought. An M.D/D.P.S. is “board-certified” by the American Board of Plastic Surgery, and therefore trained; but an American woman who is told that it is her burden to ensure that the surgeon is “board-certified” is unlikely to know that there are over one hundred different “boards” with official-sounding names that go unregulated. Fully 90 percent of cosmetic surgery in the United States is performed in unregulated doctors’ offices. Finally, asserted the congressional testimony, “there is no standard method for preoperative screening,” so any woman is operable. What did Congress do about the situation once it was staring them in the face? Nothing: the legislation proposed after Congress saw 1,790 pages of shocking testimony is, says Dr. Steve Scott, spokesman for Congressman Wyden’s office, more than a year afterward, “on
hold.” Why? Because it happens to women for beauty, so it is not serious.