It was once considered extreme, but cosmetic surgery has become normalised. In fact, writes Karen Kay, refusing to ‘have work done’ has made her unusual in many social circles. But is a more perfect self always a happier one?
Here is a confession: at 44 years of age, I have the face and body I deserve. My upper arms are fleshy and fulsome, bearing no resemblance to the sleek undulations of gym-honed muscle I paraded in my twenties. My post-caesarean belly protrudes over the waistband of my skinny jeans, pleading for the forgiving maternity styles I wore with pride eight years ago as I carried my then unborn daughter.
I have a bumpy nose that looks fine from the front, but makes me shudder if I see it in profile. I have a “well-defined jawline” – or a pointy chin, if you ask for my description. There are a few furrows on my brow, lines around my eyes, and the outsize bags beneath them would do Joan Collins proud checking in at Heathrow airport. My complexion reflects more than three decades of suffering from acne. In short, my face is, well, my face. It tells an honest story of a life lived. My life.
And there’s the rub. There shouldn’t be anything unusual in that but, increasingly, I’m aware that I’m in the minority when I mix in certain circles. Arriving at some social events or work appointments, I find unfamiliar faces looking back at me from people whom I know well. These are women who appear one day with startled expressions, unable to smile warmly as they used to, their skin taught, waxy and translucent – like glassine paper.
Having “work” done is the new norm, you see, and I am conscious that, while I am content to look my age and confidently declare myself an intervention-free zone, I frequently stand out from the scalpel-ed, Botox-ed crowd as the one “who doesn’t”. This is not some self-indulgent plea for validation but an observation that the Stepford-style masses are becoming the acceptable face of womanhood. The insidious march of cosmetic intervention in everyday life has concerned me for some time and then last week I read a piece in Time magazine confirming its alarming prevalence in the US.
“You’re going to have to do it. And not all that long from now,” the article states. “Probably not a full-on, general anaesthesia bone-shaving or muscle-slicing. But almost definitely some injections into your face. Very likely a session of fat-melting in some areas and then possibly moving it to some other parts that use plumping. Not because you hate yourself, fear ageing or are vain. You’re going to get a cosmetic procedure for the same reason you wear make-up: because every other woman is.”
No way, I thought to myself, and ploughed on, indignant. It proved sobering reading: in the US, doctors performed more than 15m cosmetic procedures last year, a 13% increase on 2011 and more than twice as many as in 2000. Dermatologists are no longer considered to be medical clinicians, but beauticians, with 83% of them providing Botox or similar treatments. What was once the preserve of Joan Rivers and a handful of Ladies Who Lunch in Beverley Hills is now accessible to secretaries in Salt Lake City, who nip into the local medi-spa in their lunch hour for a manicure and a facial filler. That quick “fix” offers a euphoric high that soon wears off and sees them coming back for a more. I believe that cosmetic intervention is addictive and, because we gradually lose sight of the person who once looked back at us in the mirror, all perspective starts to go.
“I think people chase compliments and once we start getting those, we want more,” says Dr Frances Prenna Jones, a London-based cosmetic doctor who counts a plethora of magazine beauty editors and celebrities including Davina McCall and Louise Redknapp as clients. “Most women come to me and their concern is that they look ‘tired’. They might not feel tired on the inside but they want the outside to reflect how they feel. Increasingly, I am using vitamin injections to give a natural, fresh-faced radiant appearance. Volume replacement (using hyaluronic acid) is popular, too, but you need to take into account the naturally changing proportions of the face. If what you see is markedly different to what you expect, then it jars.”
TV presenter and journalist Anne Robinson, herself no stranger to the cosmetic surgeon’s scalpel, says “anything that allows women to feel better about themselves is worth it”. And clearly, many of her compatriots are with her on that one. According to the most recent figures from the British Association of Aesthetic Plastic Surgeons, which represents one in three cosmetic surgeons in the UK, 50,122 surgical procedures were performed here in 2013, excluding walk-in treatments such as Botox. The audit noted an “impressive double-digit rise in all cosmetic procedures”, and that not a single individual procedure saw a decrease on the year. The Department of Health predicted in 2013 that the value of the cosmetic surgery industry in the UK would rise from £2.3bn in 2010 to £3.6bn this year.
Katharine Wright, assistant director of the Nuffield Council on Bioethics, is setting up a working party to explore the increasing use of cosmetic procedures and is linking with the Beauty Demands network to assess the pressures of beauty ideals in society.
“The Nuffield Council hosted a workshop on ‘professionals, practitioners and beauty norms’,” she explains. “We brought together academic experts on body image and fashion, psychologists, philosophers, lawyers, surgeons and GPs to debate the role of professionals in responding to the changing requirements of ‘beauty’ and the consequent changing uses of procedures that have traditionally been regarded as ‘medical’ in order to attempt to achieve beauty norms.”
If we simply accept these “ideals” as purported by the media, and go to such great lengths and take risks to conform to them, what are the implications? With society’s compulsion to share selfies, often distorted using photo-manipulation software and always curated to display our “best self” – whatever that is – is this tsunami of cosmetic surgery just the next phase in a vanity-obsesssed culture?
“Over a very short period of time, what is considered normal and required practice in terms of ‘routine maintenance’ has changed dramatically,” says ethicist Professor Heather Widdows at Birmingham University, who is researching her book Perfect Me! “The assumption that a beautiful, more perfect self is a happier, more successful self is deeply ingrained in popular discourse and the language used is exceptionally value laden: we are urged to be ‘the best we can be’ and to strive for our ‘best selves’. We should do this because we’re ‘worth it’ – the implication being that if we don’t, we are culpable and blameworthy for ‘letting ourselves go’,” she says.
Polly Vernon, author of Hot Feminist, believes that women have the right to choose and take ownership of their appearance. “But I would say that at this point in time women are succumbing to cosmetic surgery because they feel a pressure to,” she says. “When we inject our faces with stuff, that doesn’t come from the same place as putting on a colourful lipstick. We are navigating a new world, where we are much more conscious of our image, and we must own it and delight in it, rather than do things because of social pressure. Appearance should be an extension of who you are, not about trying to be someone you think society wants you to be.”
Recent findings by the British Association of Plastic, Reconstructive and Aesthetic Surgeons identified a range of factors driving aspirations for cosmetic surgery: 53% of those who have had surgery believe celebrity cosmetic treatments had made it more aspirational, and 45% felt there was social pressure to consider it.
“I do hear women talking about the pressure to look good,” says Susan Harmsworth, founder and chairman of beauty company ESPA, who recently celebrated her 70th birthday and proudly claims she is regularly mistaken for a woman in her 50s – without having done anything other than led a healthy lifestyle with regular facial massages and skincare regime. “I know lots of high-profile, successful, intelligent women who have had work done, especially in the City, in banking and law, because they feel they need to look a certain way in the workplace, but once you start messing with your face, you start to look strange.”
With a seven-year-old daughter, I fear for the expectations of the next generation of women, who are likely to have little respect for the glorious beauty of age and the natural lines that come with wisdom.
Psychologist Ros Taylor, author of Confidence at Work, says: “The availability and accessibility of cosmetic procedures, the lack of stigma about having work done and the rise in women’s disposable income has meant the gateway is clear for this to become normalised. And it is only going to increase. I feel a little like King Canute seeing this wave coming and being unable to stop it.
“Women are always blaming themselves for their lack of success, or not being tall enough, slim enough, beautiful enough. We constantly compare and contrast ourselves to other women, and although we are mostly fine as we are, we constantly desire to be different. The psychological impact of seeing someone different in the mirror can’t be underestimated.”
It is this broader impact of cosmetic intervention that Dr Mark Henley, of the British Association of Plastic Reconstructive and Aesthetic Surgeons,, says led to the organisation’s Think Over Before You Make Over campaign to educate the public on safe cosmetic surgery. “One of the things we have to do is give people a reality check on what are normal human behaviours and values, and what is social pressure.
“They may have perfectly reasonable reasons for wanting surgery, but we mustn’t enthusiastically accelerate them towards the theatre as a commercial commodity. We must get it right in terms of counselling, preparation and information about potential risk and benefits. We need to ensure the patient has a good mental insight and understanding of the limitations of proposed surgery, and they have to be in the right frame of mind: no divorce or deaths, which make them emotionally unstable and vulnerable.
“If I think someone is addicted to the high of procedures, I want them to see a psychologist or their general practitioner. No one ever said Margaret Thatcher or the Queen should have a facelift. If in doubt, don’t. That’s a really good starting point.”
■ Women accounted for 90.5% of cosmetic procedures in the UK in 2013, with a total of 45,365 procedures, according to figures from BAAPS.
■ Breast augmentation was the most popular procedure, with 11,123 procedures - up 13% on 2012. Blepharoplasty (eyelid surgery) was the second most popular cosmetic procedure, followed by face or neck lifts in third place.
■ The number of liposuction procedures rose by 43% year on year, 2012-2013.
■ The vast majority of cosmetic surgery is carried out in the private sector and the law currently allows any qualified doctor – surgeon or otherwise – to perform cosmetic surgery without undertaking further training or gaining additional qualifications.
■ The Royal College of Surgeons is working on new certification protocols to be introduced in 2016, which will identify those surgeons who have the appropriate skills and experience to provide cosmetic surgery.
guardian.co.uk © Guardian News and Media Limited 2010