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After shedding 100 pounds and enjoying her 'natural' new look, 60-year-old actress Kirstie Alley said last week, "I haven't had plastic surgery and here's the reason: I don't think it makes you look younger. I think it can make you look weirder."
Not so, according to the renowned plastic surgeon who shared the stage with me recently to discuss "Aging Gracefully"—he, from the medical perspective, and me, the psychological one. He said, "When it comes to aging, cosmetic surgery is less about beauty and more about improving how patients feel about themselves."
His words sounded great, but it made me think of Alley's comment. So I asked, "How do we know that surgical alterations lead to positive emotions?" To which he answered, "If I didn't believe my work made people happier, I wouldn't be in this profession." Still curious, I asked, "Does happiness come from looking younger or looking better? Does it provide short term or long term happiness? For some people or most everyone?" So many questions! This physician seemed particularly articulate and passionate about his work, so I thought he'd be a great person to talk to about these gray areas inherent to his field. I wanted to go deeper. He was glad to oblige. Here is a summary of our post-panel discussion.
His comment that "surgery was less about beauty" intrigued me. If true, then why do women far outnumber men in choosing elective cosmetic procedures? Excluding those that repair disfigurement —due to injury, illness, and congenital deformities—statistics show that 91% of all other optional surgeries are performed on women. If cosmetic surgery is not about beauty, it's difficult to understand this inequity. For example, how do we explain 'designer vaginas,' the recent trend among women to surgically refine the appearance of their labia? Is this not aesthetics to the extreme?
I also wanted to know this surgeon's thoughts about 'anti-aging?' This phrase never made sense to me—unless you are Benjamin Button! I wondered if he believed that cosmetic surgery was the best solution to our culture's obsession with maintaining a youthful appearance. And if so, when should such efforts begin? Proactively during one's teens, 20s and 30s? I cited the troubling increase in teenage use of botox and similar procedures. And what about the other end of the spectrum? I was thinking of the rising number of seniors over age 80 requesting face-lifts and breast implants. Could a person ever be too young or too old to be surgically rejuvenated?
Lastly, I was interested in the notion of the "right to be beautiful," called "Necessary Vanity" in a recent New York Times opinion piece. Alexander Edmonds wrote that beauty, like education or health, should be made available to all "with the help of public institutions and expertise. Do cosmetic surgeons view themselves as providers of that right? Is everyone entitled to achieve their ideal image —or culture's version of that image? I cited the recent trend by Asian women to surgically alter their eyes to look more Western. Was the homogenization of beauty a positive or negative trend across the globe?
We both agreed that these issues were interesting and challenging, not just as they related to plastic surgery, but in terms of the larger questions they raise about contemporary culture.
Before going further, we first had to narrow the topic by differentiating among the wide spectrum of procedures that are often lumped together under the term plastic surgery. For example, there is an obvious difference between surgeries that correct genetic deformities (e.g. cleft palette, hair lip, webbed toes) or reconstruction work (e.g. following burns, breast cancer) and those performed for 'enhancement' purposes. There are also differences even among optional surgeries—a 14-year-old boy who undergoes treatment for gynecomastia (breast reduction) after years of humiliation versus the 17 year old girl who requests breast implants believing they will give her a social advantage at college. We narrowed our discussion to optional, enhancement surgical procedures only.
So why more women? We both agreed that even if a surgeon's focus is not on beauty, for most women, it was. Physical good looks have been, and continue to be a female preoccupation. Although much has changed since the feminist revolution, beauty—especially youthful beauty—is experienced as a woman's currency in contemporary culture. And while plastic surgery may be viewed as offering solutions to a wide variety of other problems, clearly optional procedures serve beautification. They appeal to women's insecurities about physical inadequacy, from teenage years right through old age. If this weren't the case, it would be hard to explain the physical and financial risks women take—but men don't—to alter their image. We both agreed that if surgical options were available for other kinds of alterations—say for greater potency, height or fortune—the statistics would not be so one sided.
Anti-aging? Even the surgeon said that the term itself didn't make sense. There is no real way to stop the clock or turn back the hands of time. But we both agreed there are lots of things we can do to look our best for our age, especially as we live longer than ever before. Surgery is not for everyone. Good health care, exercise and remaining vital and active goes a long way too. But there are some procedures that do help people feel and look better about themselves when thoughtfully pursued and carefully performed. For some the results are short-lived, problematic and lead to multiple follow-up procedures. But for others surgery has longer lasting impact on their self-esteem and is viewed as a very positive experience. For most, it's a temporary solution to the challenges we face during the aging process.
Regarding age limits—when is too soon and too late? Here we agreed too. First, people with body image distortion (sometimes diagnosed as having Body Dysmorphic Disorder or BDD) needed to be ruled out as poor candidates for plastic surgery at any age. But, we both acknowledged the difficulty distinguishing between this diagnosable disorder and a natural response to culture's obsession with youth and beauty. Many young people—in their 20s and 30s—are afraid to look older. They see fear in their aging parents and grandparents and our culture reinforces it. We both agreed, the solution doesn't lie in feeding into fear, but rather in teaching people of all ages how to prolong the health of their faces and bodies. Although surgeons like to say, "age is just a number," we agreed this didn't make sense. Likewise, when psychologists counter with, "it's what's inside that counts," this too makes little sense. Age does matter. Inside and outside matters too. We concluded that moderate use of safe cosmetic procedures required careful screening by licensed professionals at any age, but they are generally most suitable for patients between the ages of 25 and 75 with few exceptions.
The right to good looks and the homogenization of beauty? This issue has such huge and complex ramifications, we weren't sure where to start. We both felt that the problem lies in the popular belief that beauty was based on a single ideal image. Beauty, we agreed, is more complicated, subjective, variable and ever-changing. Feeling good about oneself is dependent upon multiple factors—physical, psychological, developmental, environmental. If it was rooted primarily on self-image, men and women who were born with beautiful features—fashion models, beauty icons—would be assured happiness, which we know is not true. Or, taken from a different perspective, someone who is successful wouldn't desire physical alterations—take Michael Jackson for example. As a plastic surgeon and a psychologist, we both believed it was important to emphasize the difference between beauty and attractiveness.
Other issues were raised and perhaps will be discussed in a future article or panel, but we ended our discussion with this theoretical question: If future research proves that happiness and success are associated with certain physical standards—say, for instance with being male, tall and white—would surgeons be willing to make those alterations? Would performing those transformation, if surgically and psychologically possible, make practitioners complicit with a social system that devalues natural differences? Sounds almost like a Twilight Zone episode—remember, "Number Twelve Looks Just Like You?" where this fiction became a frightening reality. Complicated issues that require more thought and discussion.
Clearly, even today's trends in plastic surgery raise more than skin-deep issues. For Jane Fonda, looking great at 78, surgery seems to continue to serve her needs. There are 11 million Americans who are making similar cosmetic choices and should be asking themselves the psychological questions that were raised above. For Kirstie Alley, surgery does not seem to serve her current needs—or current size. Having made no secret of her long, circuitous route to where she is today, Alley may have learned an important lesson—that beauty can be found in different shapes and ages —and that happiness starts from the inside out.
What do you think about recent trends in cosmetic surgery? Do they result in beauty, happiness or neither?
