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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.” [1]

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, 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.”[2] 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.[3]

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?



[1] 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.

[2] N.A. Papadopulos, “Quality of Life Following Aesthetic Plastic Surgery,” Journal of Plastic, Reconstructive & Aesthetic Surgery, 2007, Vol. 60, pp. 915-917, 199.

[3] Paul Bloom, How Pleasure Works (New York: W. W. Norton & Company, 2010), pp. 68, 151, 210.

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8 Comment on this post

  1. I think you're ignoring one very important reason to avoid these 'cheap' aesthetic fixes, i.e., there are myriad of unintended consequences that stem from such procedures. Oftentimes, these types of procedures can be detrimental to ones health. The human body is incredibly complex and to think that we can tweak it without unintended consequences seems delusional, in my opinion.

    This article seems to suggest that we should focus on treating the aesthetic symptoms rather than the root cause of the problem. For instance, one could eat a low calorie diet of junk food and still appear reasonably skinny. I would argue, however, that even though this person has the aesthetic appeal of being skinny they are likely doing a great deal of damage internally.

    1. Yes I do agree to a certain degree some ppl can lose the weight and their skin snap back great, but when having children or being obess dieting and excerise does not solve the hanging skin.

  2. Mass beauty enhancement opens up our looks to competition. Before, being ugly was a curse, but at least not one that you could plausibly be blamed for. Now, your looks become your responsibility, a drain on your ressources, something you have to take charge of. You can no longer leave it to nature; your looks are you.

    Of course, there no reason to just tolerate bad situations just so people can avoid responsibility; the medieval serf might have known his place, but any advantages from that was outweighed by the strong situational disadvantage. But I'd say a case can be made that it is psychologically healthier for people to not have to take resonsibility for every aspect of their being, to be able to relax about some things, and shunt the responsibility off to nature or nuture or class or whatever. Having too many choices does damage us; there is an unanticipated joy in being completely stuck.

  3. Thanks for your comments, Greg and Stuart.

    Greg: You seem to have two arguments against my position. The first argument is that there are dangers involved in cosmetic surgery. This is undeniably true, especially for surgeries that require general anesthesia. For standard of cosmetic surgeries, however, my impression (warning: I'm a philosopher, not an MD) is that the risks are fairly small and fairly well known. Of course, it's better to be safe than sorry — and, yes, the human body is complex — but it's also important to remember that we expose ourselves to risks all the time. Risks are not always bad; there are risks worth taking and risks not worth taking. It would be interesting to see the exact figures, but I doubt that undergoing standard cosmetic surgeries is more dangerous than, say, getting drunk — and the benefits are no doubt greater.

    Your second argument is that cosmetic surgery does not treat the root cause of problems such as obesity. This is also undeniably true. If you eat junk food, and surgically remove fat every now and then, you will be in bad shape. Cosmetic surgery won't make you healthy. But is health a reasonable thing to expect from cosmetic surgery? I think one must judge cosmetic surgery for what it is: cosmetics.

    Stuart: That's an interesting point. There are definitely negative sides to having many choices (and thus many responsibilities). But isn't your argument a global argument against choice more than a local argument against cosmetic surgery? It seems that it is. If so: Where should we draw the line and say that we have enough choices? Why stop now and not, say, in the middle ages? Or in 70 years from now? My view is that although choices have real costs, they also have real and significant benefits — and though we might be skeptical of new realms of choice when they initially open up, we tend, retrospectively, to be glad that we're now able to choose (say, choose who to marry, where to live, where to work, etc.). I think I'm in the transhumanist camp when it comes to choices, for I'm radically in favor for them. I'd rather be ugly and know that I have the option of improving my looks than be ugly and know that I don't have such an option.

  4. Thank you for the thoughtful reply as well, Ole Martin!

    In response to your point #1: You write: "For standard of cosmetic surgeries, however, my impression (warning: I’m a philosopher, not an MD) is that the risks are fairly small and fairly well known." I'm not a MD either, but I'm still highly skeptical of this assumption. Even if a MD told me that the risks were low, I'd still be skeptical. Most MD's knowledge of nutrition is abysmal (see here: <a href="; title="Lies, Damned Lies, and Medical Science"> Also, it's true that we expose ourselves to risks frequently, but every situation is different. In this situation of aesthetic surgery, personally, I think the costs (or potential costs) far outweigh the benefit (or perceived benefit).

    In response to point #2: My point is that cosmetic fixes may fix cosmetic problems, albeit there are often silent and unintended health problems associated with these procedures. Are you assuming that the patients are fully aware that the risks are not necessarily calculated properly? Furthermore, these procedures can mask a lot of the silent damage that is occurring beneath the surface. 'A cheap fix', like a tummy tuck, can give an individual the illusion that they're treating the problem when really they're only treating the symptom.

  5. This article somewhat conflates to distinct questions: whether we should resort to cosmetic surgery more often and why we don't. "Why not go for cosmetic surgery?"and "Why are we so hesitant?" are two separate questions. To the second question, the first of four answers strikes me as the most plausible, although others also spring to mind, such as "We're scared," or "It hasn't really caught on yet." the other answers are probably just stories we tell ourselves to justify our reticence.

    To the first question, I like your "radical" conclusion, and I think it's a good counterweight to the excuses. But do we really need to make a moral issue out of this at all?

  6. I believe that a tummy tuck surgery is worth it when u have excerised and lost weight but from mutiple babies have extra skin or was obess and lost weight and have extra skin hanging, that is so not cool. you can loose weight and be skinny but also with nasty flabby skin that is not going to go away unless cosmetic surgery and for that type of reason it shouldn't even be called cosmetic surgery.

  7. Why, with all the emptiness that is currently evidenced in our modern culture, the antidote recommended in this article centers on cosmetic surgery. This recommendation is part and parcel of our alienated society where happiness is believed to be based upon looks and material possessions. How often do unhappy people with unresolved issues and no inner life resort to cosmetic enhancement to bestow happiness upon themselves.
    Certainly we all would wish to be appealing attractive to others in some way, but as I reflect on people in both public and private life it seems that those most endearing are those who possess, whatever their beauty quotient, some intangible attractiveness that springs from intelligence, empathy or humor. These are the things that are the genuine magnets for affection, respect, or love from others.
    I wish the author luck with his ideas and situation, he obviously has much to learn.

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