Should one have a tummy tuck?
“Beauty is a greater recommendation than any letter of introduction.” – Arthur Schopenhauer, Aphorisms on the Wisdom of Life
As our wealth increases, more and more of us undergo cosmetic surgery: From tummy tucks, breast enlargements and nose jobs to hair transplants and face-lifts: You name it—and pay—they fix it.
Even though cosmetic surgery has grown to become a multi billion-dollar industry, it is looked at with some suspicion. Many feel that there is something superficial and, perhaps, slightly desperate about undergoing surgery for aesthetic reasons. In academia, at least, although a hair transplant and a teeth bleaching might pass, chances are that a breast enlargement would raise eyebrows.
It is not be unlikely, however, that the eyebrows in question would be both plucked and colored—for we already do quite a bit to enhance our looks. We work out, try to dress well, shave, and go to the hairdresser. We make sure we get tanned during summer. Some of us are on a diet, wear make up, or dye our hair.
We seem to do these things, moreover, for a reason: That looks matter to us. One thing is that what meets us in the mirror is important for our self-esteem, and that better looks give us better chances in the mating market. Another thing is that in all areas of life, we are judged by our looks. This is true even of areas of where, ideally, looks should not matter. Pretty people are treated better than those who are less pretty, and studies find robust evidence that we systematically attribute unobservable characteristics such as moral stature, intelligence, and productivity based on physical attractiveness. The results of this are readily observable: Pretty people receive milder prison sentences and according to The Economist, “over a lifetime and assuming today’s mean wages, a handsome worker in America might on average make $230,000 more than a very plain one.” 
Should I, as an academic, be concerned? It’s easy to think that academics don’t have much to worry about. After all, a lot of the importance decisions in academia are made through blind review. But even in the ivory tower, good looks are beneficial. Small things, such as how much attention you get, how many want to work with you, and how many feel that they can trust you, probably count as much in a university as it does in private industry. Moreover, good-looking professors tend to receive higher teaching evaluations and, famously, RateMyProfessors.com has a hotness scale.
If looks matter so much: Why don’t more people get that hairline lowered, those wrinkles smoothed out, and that tummy tucked? After all, the price of cosmetic surgery isn’t outrageously high, and the risks are low. Moreover, cosmetic surgery has a good track record. Nikolaos Papadopulos has interviewed people who have undergone cosmetic surgery, and has found that “over 86% were satisfied or very satisfied with the aesthetic result. 85% would undergo the same treatment again and 94% of the patients would further recommend their operation.” Yale psychologist Paul Bloom makes the case that while most other things you can spend your money on merely make you spin faster on the hedonic treadmill, an improvement of your looks has a lasting positive effect on your subjective well-being.
So why not go for cosmetic surgery? Why are we so hesitant?
One reason might be that we have bad connotations with cosmetic surgery. When we think of cosmetic surgery, we think of desperate Hollywood wives paralyzed by fear of turning 40; people who have serious psychological issues with their bodies and who should seek psychological, not surgical, help; and 60 year olds who desperately try to look like 20 year olds rather than aging with calmness and grace. These might be sensible worries, and it might well be that that cosmetic surgery clinics are filled with people with unhealthy attitudes to their bodies. Two things, however, should be kept in mind. First: This is pretty much what we should expect granted that cosmetic surgery is taboo. A taboo works as an entrance barrier, and makes it the case that only (or almost only) those who desire new looks very badly find it worthwhile going for cosmetic surgery. This skews the sample in favor of people who have issues with their bodies. Second: Does the fact that many of those who undergo cosmetic surgery have such issues mean that you get these if you undergo cosmetic surgery? There is little reason to believe that you would. If you undergo cosmetic surgery, it is true that you start belonging to the group “those who undergo cosmetic surgery” – but that does not make you inherit contingent traits from others in that group. Inferring that you would is to commit the association fallacy.
Another reason why we are reluctant to call the cosmetic surgery clinic right away could be that we think cosmetic surgery is unfair – that it’s cheating. Before we draw that conclusion, however, we should ask ourselves this: What is the alternative to cosmetic surgery? The alternative is by no means perfect fairness, but rather distribution of beauty according to biological luck. Since beauty is unevenly distributed, and none of us did anything to deserve our genetic make up, cosmetic surgery might work as an equalizer – a revenge of the nerds, if you’d like; a chance for at least some of the biological “have nots” to become “haves.”
A third reason could be that undergoing cosmetic surgery is a bit like standing up while watching a football match: If you do stand up, you get an advantage, but you get it at the expense of those around you, and if they stood up as well, no one would benefit. This logic seems applicable to cosmetic surgery, for it might well be worse to look bad, and less fun to look good, if everyone else is pretty. I think, however, that there are three ways to respond to this challenge. One is the cynical response: Regardless of whether you push others down by undergoing cosmetic surgery, you might still have a good prudential reason to go for it. A second response is that cosmetic surgery is most likely no worse in this respect than, say, dressing smartly or getting a nice haircut. Why should it be? What is the relevant difference? If there is no relevant difference, then should we dress worse and get bad haircuts to make others feel better? That seems unacceptable. A third response is to deny that looks are all relative, and claim that in spite of some relativity, there is also an absolutist element involved. It seems plausible, after all, that an isolated group of good looking people would be more satisfied with their looks than an isolated group of bad looking people. We do have a fairly steady biology telling us what is nice and what is ugly, so though there might be some inflation if a lot of people improved their looks, the benefit might outweigh the inflation. If this is right, you might well make the world better overall by undergoing cosmetic surgery. You might push others down a little, but your benefit might be greater than their misery. What more could a utilitarian want?
A fourth reason could be that cosmetic surgery takes up the time and energy of scarce medical personnel, and uses it for a trivial purpose in a world where these are urgently needed to save lives. This reason has some force. But let’s play devil’s advocate: Do medical personnel have more duties than non-medical personnel to spend their time and effort on saving lives? It seems that they don’t, for why should the reward for actually helping some be a burdensome duty to help even more? If we grant that medical personnel don’t have more duties than others, then it seems no more reasonable to blame a medical doctor for working in cosmetic surgery – and thus abstaining from saving, say, 100 lives – than to blame you for having bought a nice house, a nice car, and a nice computer with the money that you could have given to Schistosomiasis Control Initiative to save 100 lives. Clearly, a utilitarian (who really means it) would be opposed both to the cosmetic surgery and to the nice house, the nice car, and the nice computer. That’s a consistent position. My point is that if it is okay that we cut ourselves some slack and spend money on ourselves, we might just as well spend it on a tummy tuck as on a computer. Since every single dollar that we have could potentially be spent on saving lives, it seems that the difference between a tummy tuck and a nice computer is only that in the former case, it is more visible that the resources could have been spent on saving lives. Visibility, however, is hardly a morally relevant factor.
For these reasons, cosmetic surgery might have more positive sides and fewer negative sides than we tend to assume.
Indeed, here is a radical suggestion: Perhaps by paying for cosmetic surgery—and thus allocating resources to cosmetic medicine—we do something for which future generations will thank us. This could be the case if two premises hold true: The first premise is that transhumanists are right that real technological improvement comes when we start manipulating, not just our environments, but also our bodies. The second premise is that the cradle of such improvements is cosmetic improvement; that the most likely starting point of human enhancement is aesthetic enhancement. Aesthetic enhancement has a long tradition, going back to early body painting, tattoos, and primitive jewelry, showing that we have a significant drive towards looking better. Today, that drive manifests itself in a formidable willingness to spend money on our looks. That drive and that money could make the most fascinating technologies of the future grow out of the cosmetic industry.
So why not go for a tummy tuck?
 For more research on the social impact of beauty, see Daniel Hamermesh and Jeff Biddle, “Beauty and the Labor Market,” The American Economic Review, 1994, Vol. 84, No. 5; Barry Harper, “Beauty, Stature, and the Labour Market: A British Cohort Study,” Oxford Bulletin of Economics and Statistics, 2000, Vol. 62, No. 1, pp.771-800; Alan Feingold, “Good-Looking People Are Not What We Think,” Psychological Bulletin, 1992, Vol. 111, No. 2, pp. 304-341.
 N.A. Papadopulos et.al., “Quality of Life Following Aesthetic Plastic Surgery,” Journal of Plastic, Reconstructive & Aesthetic Surgery, 2007, Vol. 60, pp. 915-917, 199.
 Paul Bloom, How Pleasure Works (New York: W. W. Norton & Company, 2010), pp. 68, 151, 210.