Cosmetic Surgery – What is the Matter with Dr Salesman?
Written by Roman Gaehwiler
Reconstructive plastic surgery to correct ravages of disease and injuries as well as gross physical abnormalities constitutes a core medical practice. Reconstructive procedures, however, lie along a continuum, without any clear boundary between therapeutic reconstructive surgery for diagnosable problem and purely cosmetic surgery.
In my mind, this excerpt out of a bioethics special section called “In Pursuit of Perfect People – The Ethics of Enhancement” reflects concisely what the current cosmetic surgery debate is all about. Nevertheless, I am not quite sure if such vague differentiations are capable to sustain a fruitful discussion towards a constructive conclusion. Particularly, the term ‘continuum’ rather summarises a historical development than a justification referring why we are obviously not able to distinguish between medicine and cosmetic surgery. In fact, modern aesthetic surgery has its origins in the medieval times, as disfigured faces of syphilis patients had to be reconstructed. Almost four hundred years later, during the 1880s, reconstructive surgery started to transform into a kind of operational method to serve ethnical assimilation of Irish immigrants in the United States. “Typical” Irish snub noses and stick-out ears had to be “denationalized” in order to be considered as American. As a result, the first face-lift could have been realised in 1901 by Eugen Hollander (himself surgeon and cultural-historian) who used to ease wrinkles of a female Polish aristocrat. Therefore, the so-called ‘continuum’ might rather fit a historical context, otherwise there would be no necessity to classify aesthetic interventions into reconstructive, plastic or even cosmetic surgery nowadays. Within the following listing I will try to reveal the obvious lack of medical traits in cosmetic surgery. Consequently, it may be in the interest of medicine itself regard cosmetic surgery as a non-medical supply of services.
1. Medicine is definable
Medicine is the practical appliance of medical sciences including physiology, biochemistry, physics, psychology or anatomy in order to support humans (and animals as well) recovering from pathological states and diseases. Therefore, the ultimate goal of medical treatment is neither to provide happiness nor joy. Such outcomes represent just a positive side-effect of a successful medical intervention while restoring someone to a worth living existence. I deliberately do not make use of the term health, because health implies full functioning of the human body. A medical measurement might also be interpreted as ‘successful’ if a diabetic is able to enjoy positive effects by the administration of insulin, even though his pancreas is still not capable to produce enough insulin itself. In contrast, cosmetic surgery aims just to lift somebody from a subjective unhappy into a subjective happy state without reconstructing any functional misbalance. As a consequence, if the assistance of a transformation from unlucky to lucky, ugly to beautiful or even shy to self-conscious allows you to call yourself a medical professional every Bentley car-salesman may be eligible for a doctor-degree, as well.
2. Medicine acts objectively
The definition above involves reconstructive and plastic surgery as a surgical alteration of objective aesthetic abnormalities. By contrast, cosmetic surgery merely feeds one’s subjective appetite for individual enhancement. In fact, objectivity is an important medical trait in order to legitimise certain measures in social frameworks like health-care-systems. So, real medical interventions are financially and socially defensible whereas cosmetic alteration founds on a self-payer basis. Regarding this, cosmetic surgery lacks a very important medical component and disqualifies itself to be seen as a part of real medical environment.
3. Cosmetic surgery suggests disease
The suggestion of physical insufficiencies or even exploitation of sore points reveals most obvious within the advertising policy of cosmetic surgeons.
The role of physician as salesman is displayed by the frequent offer in cosmetic surgery ads of free consultations, often with the aid of computer imaging. Targeted at women, these ads play on, and possibly contribute to, widespread dissatisfaction with body image and foster unrealistic expectations of what can be achieved by cosmetic surgery. Moreover, they give no indication of risks or complications from cosmetic surgery or the chance of less than fully satisfying outcomes (p. 360).
In this concern, cosmetic surgery might also be seen as deliberate creation of disease. Almost superfluous to mention that such kind of advertisement lacks of ethical or even moral considerations regarding a ‘patient’s’ mind (maybe I would be more precise by using the term ‘customer’) and is therefore completely antithetic to what medical doctors take a Hippocratic oath on. Furthermore, undermining patient’s self-consciousness may presumably not be accepted as a common medical strategy in order to become healthier.
4. Moral degeneration of medical ethics
In my opinion, that is probably the most important issue in the course of this argumentation. Regarding cosmetic surgery as a legal part of medicine would imply a certain degeneration of medical ideals and values. Especially, the striving to financial benefit by the common aid of advertisement and propaganda misses altruistic and transparent behaviour as two of the medical ideals. In no other discipline medical professionals are able to influence the outcome of their treatment such like within cosmetic surgery. Many cosmetic surgeons regard themselves as a kind of artist holding the privilege to create something extraordinary out of a healthy human body. In my opinion, the so-called “art of medicine” is actually to be able to transform scientific knowledge into practical appliance rather than praising the creator of a visible result. Medicine is less about personality cult or even image cultivation it is more about altruism and moral responsibility. To fulfil such social standards every day might be hard, but that is actually the legitimation or even the price you have to pay to come a little bit closer to what the definition of medicine is all about.
Nevertheless, I have to admit that there is at least one medical trait which is especially well pronounced in cosmetic surgery, namely the centralisation of patient’s self-esteem and individual interest. As Brasilian surgeon Ivo Pitanguy uses to explain it: “Plastic surgery is exercised democracy.”
To come to a conclusion, cosmetic surgery does not represent a social problem. Whoever decides to undergo surgical procedures in order to enhance his/her appearance instead of normalising it should absolutely not be prohibited to go for it. Everything else would affect the human right of individual freedom. As a consequence, I would like to emphasise that I do not reject cosmetic interventions at all, admittedly it is a really good business idea, BUT I strongly do reject the promotion of such businesses on behalf of “medical treatment”. This would be hypocritical and deceptive. Cosmetic surgery acts among the ‘supply and demand’ ideology of Adam Smith (1723-1790) and not among the ‘medical-ethos’ of Hippocrates (460-370 B.C.). We can be thankful for both, but we might have to be aware of mixing it.
 Cosmetic Surgery and the Internal Morality of Medicine. Franklin G. Miller, Howard Brody, and Kevin C. Chung, Cambridge Quarterly of Healthcare Ethics (2000), 9, 353-364 (Cambridge University Press)