If you want to feel bad about your looks, spend some time in Seoul. An eerily high number of women there—and men, too—look like anime princesses. Subway riders primp in front of full-length mirrors installed throughout the stations for that purpose. Job applicants are typically required to attach photographs to their résumés. Remarks from relatives, such as “You would be a lot prettier if you just had your jaw tapered,” are considered no more insulting than “You’d get a lot more for your apartment if you redid the kitchen.”
South Koreans do not merely brood about their physiognomy. They put their money where their mouths—and eyes and noses—used to be. By some estimates, the country has the highest rate of plastic surgery per capita in the world. (Brazil, if you want the title you’re going to have to lift a few more rear ends.) The United States has sagged to No. 6, though we still have the greatest total number of procedures. It has been estimated that between one-fifth and one-third of women in Seoul have gone under the knife, and one poll reported by the BBC puts the figure at fifty per cent or higher for women in their twenties. Men, by one account, make up fifteen per cent of the market, including a former President of the country, who underwent double-eyelid surgery while in office. Statistics in this field are iffy because the industry is not regulated and there are no official records, but we’ll get to that in a grimmer paragraph.
In January, I spent a couple of weeks in Seoul’s so-called Improvement Quarter. This area is in the high-end Gangnam district, the Beverly Hills of Seoul. I realized that getting stuck in traffic would give me more worry lines, so my translator and I took the subway, which is equipped with Wi-Fi, heated seats, and instructional videos about what to do in the event of a biological or chemical attack. The walls of the stations are plastered with giant ads for plastic-surgery clinics, many picturing twinkly cheerleader types, sometimes wearing jewelled tiaras and sleeveless party dresses, and often standing next to former versions of themselves (“before” pictures)—dour wallflowers with droopy eyes, low-bridged noses, and jawlines shaped like C-clamps. “This is the reason celebrities are confident even without their makeup,” one caption read. “Everyone but you has done it,” another said.
You know you are in the right neighborhood by the preponderance of slightly bruised and swollen-faced men and women in their twenties and thirties going about their business, despite the bandages. Another clue: there are between four and five hundred clinics and hospitals within a square mile. They are packed into boxy concrete buildings that look as if they were all built on the same day. (The area consisted largely of pear and cabbage farms and straw-roofed houses until it was treated to its own speedy face-lift in preparation for the 1988 Seoul Olympics.) Some clinics occupy as many as sixteen floors, and the largest encompass several high-rises. Most are more modest. Tall vertical signs in Korean jut from the buildings and overhang the sidewalk like unwrapped rolls of surgical tape. They advertise the names of the clinics, several of which my Korean friends translated for me: Small Face, Magic Nose, Dr. 4 Nose, Her She, Before and After, Reborn, Top Class, Wannabe, 4 Ever, Cinderella, Center for Human Appearance, and April 31 Aesthetic Plastic Surgery. There is also a maternity clinic that specializes in beauty enhancement for brand-new mothers and mothers-to-be.
My translator, Kim Kibum, agreed to pose as a potential patient, and I tagged along with him as we went from one clinic to another, conferring with doctors about possible ways to remodel ourselves. Kibum, a professor at Sotheby’s Institute of Art, visiting his family in Seoul, is thirty-one. He is not considered young for cosmetic surgery, which, like computer coding, competitive gymnastics, and Trix cereal, is for kids. A typical high-school graduation gift for a Korean teen-ager is either a nose job or a blepharoplasty, also called a double-eyelid surgery (the insertion of a crease in the eyelid to make the eye look bigger), which is by far the most common procedure performed in Korea.
“When you’re nineteen, all the girls get plastic surgery, so if you don’t do it, after a few years, your friends will all look better, but you will look like your unimproved you,” a college student who’d had a double-eyelid procedure told me. “We want to have surgeries while we are young so we can have our new faces for a long time,” another young woman said. That is no longer a possibility for me, I’m afraid.
“Let’s ask if they can make us look alike,” Kibum whispered, at Small Face Plastic Surgery, a hospital that specializes in facial contouring, before we met with a consultant to discuss surgical options and to haggle over the price. (The cost of procedures and services in South Korea varies tremendously, but it is not uncommon to pay a third of what it would cost in the United States. As with Bloomingdale’s towels and sheets, it’s impossible not to get a discount.) Kibum has monolid eyes, a sculpted nose, a perfectly M-shaped upper-lip line, and chin stubble. I have none of those things, nor am I as handsome as Kibum. We were seated on a leather sofa in a purple-lit reception area that looked like the Starship Enterprise, redecorated by Virgin Atlantic. The women who work there—as in all the clinics that I visited—wear uniforms of short skirts, high heels, and tight tops. Their bodies and faces, aside from the occasional nose shaped too much like a ski jump, are advertisements for the handiwork of the Korean medical profession. Everyone is female, except most of the doctors and the barista at the coffee bar (complimentary cappuccino!) in the waiting room of I.D. Hospital.
I asked Kibum to explain the name Small Face. “Koreans, and Asians in general, are self-conscious about having big heads,” he said. “This is why in group photos a girl will try to stand far in the back to make her face relatively smaller. This is also why jaw-slimming surgery”—sometimes called V-line surgery—“is so popular.” The desirable, narrow jawline can be achieved by shaving the mandible using oscillating saws or by breaking and then realigning both jaws, an operation that originated as a treatment for severe congenital deformities. (Last year, a clinic was fined for exhibiting on its premises more than two thousand jaw fragments in two vitrines, each bone labelled with the name of the patient from whom it was carved.)
Kibum and I paged through the “Look Book” of testimonials and photographs of former patients. (From a similar binder at Grand Plastic Hospital: “Pain for a short moment! Living as a perfect, beautiful woman for the rest of my life!” “I used to look like I had been starving for a while, with no hint of luxury. My eyes were sunken, my forehead was flat. . . .” “Now I’m good-looking even from the back!”) “When I was growing up, in the eighties, the ideal look was Western—sculpted, well-defined faces with big eyes,” Kibum told me. “I would argue that that has changed as a result of the plastic-surgery culture. Everyone started looking alike, so ‘quirky’ and ‘different’ came to be prized.” Many dispute the notion that Korean plastic surgery today emulates a Western aesthetic, pointing out, for example, that big eyes are universally considered appealing and that pale skin connotes affluence. Still, just about everyone I talked to in Seoul confirmed the trend toward a baby-faced appearance. The Bagel Girl look (short for “baby-faced and glamorous”), a voluptuous body with a schoolgirl face, was all the rage. Another popular procedure is aegyo sal, meaning “eye smiles” or “cute skin.” It entails injecting fat under the eyes, which gives you the mug of an adorable toddler.
In the Small Face reception area, a TV was showing a program called “The Birth of a Beauty.” The episode was about a woman who had always wanted to be an actress but, because of her looks, had had to settle for being an extra, until . . . you guessed it. Meanwhile, Kibum answered a new-patient questionnaire. Here are a few of the questions:
Reason you want surgery?
 Preparing for job
 Regaining self-confidence
 Suggestions from people
What kind of a look do you want?
 Very different
 Completely different
Which entertainer do you most want to resemble? __________
Do you have other friends who are considering plastic surgery? How many?
If you get the result you want from plastic surgery, what’s the thing you want most to do?
 Upload a selfie without using Photoshop
 Get a lover
 Find a job
 Enter a competition for face beauty
We visited three clinics that day, including one that featured a plastic-surgery museum (complete with, among other oddments, deformed skulls, postoperative shampoo, and a fun-house mirror) and a flashy medical center (white leather sofas and marble floors) that was investigated last year after photographs turned up on Instagram showing staff members whooping it up in an operating room—blowing out birthday candles, eating hamburgers, posing with a pair of breast implants—while the killjoy patient lay unconscious on the table. We met with three consultants and two doctors. The protocol often involves talking to a consultant, who then briefs a doctor, who then looks you over and draws lines on your face before you meet again with the consultant, who closes the deal. In most of the offices, there was a skull on the table for educational purposes.
When Kibum asked the practitioners what they thought he should have done, most asked, “Do you really need anything done?” When I asked what procedures I might need, I was told that, in addition to laser therapy and a forehead pull (“Asians don’t have wrinkles there, because raising your eyebrows is rude,” a doctor told me), I should get a face-lift or, at least, a thread-lift—a subcutaneous web of fibre implanted in the face to hoist my skin upward, like a Calatrava suspension bridge—except that, because I’m Caucasian, my skin is too thin for a thread-lift. I also heard so many tut-tuts about the bags under my eyes that I started to worry that Korean Air wouldn’t let me take them aboard as carry-ons on the flight home.
One doctor, as he talked to me, made a broad, swiping hand gesture that suggested that a lot of erasing was in order. Kibum translated: “He thinks you should get Botox around your eyes and forehead, and reposition the fat under your eyes.”
Me: Does he think I should put filler in my cheeks?
Kibum: He doesn’t recommend filler, because it’s gone in eight months and you’d need a shitload of it.
Kibum and I didn’t have the nerve to request that we be turned into a matching pair, but it wouldn’t have been much of a stretch. Every doctor I interviewed said that he had patients who’d brought in photographs of celebrities, asking to be remade in their likenesses; or, for instance, with Kim Tae-hee’s nose and Lee Min-jung’s eyes. One doctor told me that he had a patient who showed him a cartoon that she wanted to resemble. (He said no.) Also, an increasing number of women are having procedures at the same time as their daughters, arranging for matching operations so that the daughters’ looks are attributed to nature rather than to suture.
“Surgery tourists” from abroad make up about a third of the business in South Korea, and, of those, most come from China. One reason is that, throughout Asia, the “Korean wave” of pop culture (called hallyu) shapes not only what music you should listen to but what you should look like while listening to it. Cosmetic transformations can be so radical that some of the hospitals offer certificates of identity to foreign patients, who might need help convincing immigration officers that they’re not in the Witness Protection Program.
We all want to look our best, but not since seventh grade had I been in the company of people for whom appearance mattered so much. In search of a clearer understanding of why South Koreans are such lookists, I stopped by the book-cluttered office of Eunkook Suh, a psychology professor at Yonsei University, in Seoul. “One factor is that, in contrast to Western cultures, the external aspects of self (your social status, clothes, gestures, and appearance) versus the inner aspects (thoughts and feelings) matter more here,” he explained. Suh described an experiment he did in which he gave students, both at Yonsei University and at the University of California at Irvine (where he once taught) a photograph and a written description of the same person. Which format, he asked the students, gives you a better understanding of this person? The Koreans chose the photograph, and the Americans chose the description. Suh, like others, partially attributes the Korean mind-set to Confucianism, which teaches that behavior toward others is all-important. He elaborated, “In Korea, we don’t care what you think about yourself. Other people’s evaluations of you matter more.”
Suh went on to explain that the two societies also have different ideas about personal change: “In Asian societies like Korea, a lot of people hold an incremental theory versus an entity theory about a person’s potential.” If you subscribe to the latter, as Suh claims we do in the United States, you believe that a person’s essence is fixed and that there is only a limited potential for change. “If your American ten-year-old is a born musician and not a soccer player, you’re not going to force her to play soccer,” Suh said. “In Korea, they think that if you put in effort you’re going to improve, so you’d force your kid to play soccer.” So, in Korea, not only can you grow up to be David Beckham; you can—with a lot of work—grow up to look like David Beckham, too.
This is not a country that gives up. Surely one of the most bullied nations on earth, Korea, some historians believe, has been invaded more than four hundred times through the years, without once being the aggressor, if you don’t count the Vietnam War. After the Korean War, the country’s G.D.P. per capita ($64) was less than that of Somalia, and its citizens lived under an oppressive regime. Today, South Korea has the fourteenth-highest G.D.P. in the world. Is it really surprising, then, that a country that had the resilience to make itself over so thoroughly is also the capital of cosmetic about-faces?
The national fixation on plastic surgery began in the aftermath of the Korean War, triggered by the offer made by the American occupational forces to provide free reconstructive surgery to maimed war victims. Particular credit or blame—you choose—goes to David Ralph Millard, the chief plastic surgeon for the U.S. Marine Corps, who, in response to requests from Korean citizens wishing to change their Asian eyes to Occidental ones, perfected the blepharoplasty. As Millard wrote in a 1955 monograph, the Asian eye’s “absence of the palpebral fold produces a passive expression which seems to epitomize the stoical and unemotional manner of the Oriental.” The procedure was a hit, and caught on fast, especially with Korean prostitutes, who wanted to attract American G.I.s. “It was indeed a plastic surgeon’s paradise,” Millard wrote.
There is a word you hear a lot in Korea: woori. It means “we” or “us” or “we-ness,” but, as explained by Kihyoung Choi in his book “A Pedagogy of Spiraling,” it blurs into a collective “I.” Choi writes, “When one refers to one’s spouse, one does not say ‘my husband’ or ‘my wife’ but ‘our husband’ or ‘our wife.’ ” (The divorce rate in Korea has tripled in the last two decades.*) “It is very important to be part of the woori group, to be part of your coalition or clique,” Eugene Yun, a private-equity fund manager, told me. “This is the antithesis of individualism. If we go to a restaurant in a group, we’ll all order the same thing. If we go into a shop, we’ll often ask, ‘What is the most popular item?,’ and just purchase that. The feeling is, if you can look better, you should. Not to do so would be complacent and lazy and reflect badly on your group.” He went on, “It’s not that you’re trying to stand out and look good. It’s that you’re trying not to look bad.” He continued, “This is a very competitive society. In the old days, if your neighbor bought a new TV or new car you would need to buy a new TV or car. Now we all have these basic things, so the competition has moved up to comparing one’s looks, health, and spiritual things as well.”
For the good of all, then, let’s get back to the hospitals. Options offered at various establishments we visited included Barbie-Nose Rhinoplasty (“Let it up to have doll-like sharp nose!”), Forehead Volumization (“Your beauty will increase!”), Hip-Up surgery (to achieve “a feminine and beautiful Latino-like body line”), arm-lifts, calf reductions, dimple creation, whitening injections (called Beyoncé injections by one clinic), eye-corner lowering (so you don’t look fierce), smile-lifts that curl the corners of your lips and chisel an indentation into the crooks so that your now permanently happy mouth looks as if it were drawn by a six-year-old (this operation is popular with flight attendants), and “cat surgery,” to fix your floppy philtrum.
But most of the surgery performed in South Korea isn’t usually too drastic, and seems technically superb. The blepharoplasty can take as little as fifteen minutes (“Less serious than getting a tooth pulled,” one man I talked to said). Unlike in America, where the goal is to have the biggest you-know-whats, the desired aesthetic in Seoul is understated—“A slight variation on what everyone else has” is the way Kibum put it. “Koreans are still very conservative,” Kyuhee Baik, an anthropology graduate student, told me. “It would be a disaster for a girl to show cleavage—it would make you look shallow,” a nineteen-year-old who’d had her eyes and jaw done told me. “You don’t want to stand out,” Baik went on. “That goes back to our Confucian foundations. It’s a very conformist society.”
“I never thought about doing plastic surgery,” said Stella Ahn, whom I met at a coffee bar with her friends Jen Park and Sun Lee, all college sophomores. “But then my father told me, ‘You have my eyes, so I spoke to a plastic surgeon who’ll make you more beautiful.’ Afterward, I regretted it a lot. I felt: I’m not me, I lost my true self. My eyes were bruised at first, so they seemed smaller.” When the swelling went down, Ahn came to like her eyes. Lee also had her eyes done at her father’s urging. “He told me that beauty could be a big advantage for girls. For instance, when you go on a job interview if the interviewer saw two women who had similar abilities, of course he’d go with the better-looking one.” It bears mentioning that, among the twenty-seven countries in the Organization for Economic Coöperation and Development, Korea, where the pressure to get married is significant, ranks last where gender equality is concerned.
Ahn continued, “Before I got double eyelids, the boys didn’t appreciate me so much.” Lee concurred. I asked if they were ever tempted to lie and say that they hadn’t had surgery. “These days, the trend is to be open,” Park said. “The reason girls don’t lie is that we don’t feel guilty,” Lee explained. “We are congratulated for having plastic surgery.”
Remember “Queen for a Day,” the TV show in which a jewelled crown and prizes, such as a washer-dryer, were awarded to the woeful housewife contestant who could convince the studio audience that she was the most woeful of all the other housewife contestants? A version of that show, “Let Me In,” is among the most widely viewed programs in South Korea. Each contestant on the show—given a nickname like Girl Who Looks Like Frankenstein, Woman Who Cannot Laugh, Flat-Chested Mother, Monkey—makes a case to a panel of beauty experts that his or her physical features have made it so impossible to live a normal life that a total surgical revamping is called for. The contestants’ parents are brought onstage, too, to apologize to their offspring not only for endowing them with crummy genes but also for being too poor to afford plastic surgery. At the end of every show, the surgically reborn contestant is revealed to the audience, which oohs and aahs and claps and cries.
There are a number of plastic-surgery reality shows in Korea along these lines, but one, “Back to My Face,” has taken a different approach. I met with Siwon Paek, the producer of the show’s pilot. In the pilot, contestants who had had at least ten surgeries compete to win a final operation that promises to undo all the previous reconstructions. Paek emphasized that the aim is to help plastic-surgery addicts come to terms psychologically with their appearance. Those with lower incomes, she said, tend to be the most compulsive about plastic surgery. “They feel they have no other way to prove themselves to people and lift themselves socially and economically,” she said. Although the “Back to My Face” pilot was popular, Paek said that she will produce no more episodes. “I didn’t have the strength to continue,” she told me. The responsibility of changing people’s lives weighed too heavily on her, she said, and finding contestants was hard. “For one month, I stood outside a dance club,” she told me. “I solicited two hundred people. Most didn’t want to go back to the way they looked before.”
In recent years, a new Korean word, sung-gui, began to surface online. It means “plastic-surgery monster.” A college student I spoke to defined the term for me as a person who has had so much cosmetic alteration that he or she “looks unnatural and arouses repulsion.” Not long ago, the Korea Consumer Agency reported that a third of all plastic-surgery patients were dissatisfied with the results, and seventeen per cent claimed to have suffered at least one negative side effect. The agency keeps no official records of accidents or botched surgeries, but every few months there is a story in the newspaper about someone not waking up from the anesthetic after a procedure.
Amazingly, this does not seem to hurt business. Hyon-Ho Shin, who heads the malpractice branch of the Korean lawyers’ association, told me, over tea in his office, “These days, there are so many accidents, and nearly every hospital has had a serious incident, so it doesn’t matter so much. People who are having plastic surgery accept that it’s a risk they take.” Just before I arrived in Korea, a college student who had gone in for eyelid surgery died. Before the anesthetic was administered, the doctor offered to give her a bonus jaw operation free of charge if she allowed the hospital to use her before-and-after photographs. It was later reported that the doctor was actually a dentist. Shin estimates that as many as eighty per cent of doctors doing plastic surgery are not certified in the field; these are known as “ghost doctors.” A 2005 BBC report mentioned radiologists performing double-eyelid surgeries and psychiatrists operating the liposuction machine. Shin believes that nurses and untrained assistants are wielding the scalpel, too. Sometimes a hotshot doctor with a recognizable name will be there to greet the patient, but after the anesthetic kicks in it’s hello, Doogie Howser!
Another surgeon, Dr. Ha, told me, “The larger hospitals have become factories. One hospital even sets timers in the operating room so that, for instance, each doctor has to finish an eyelid surgery in under thirty minutes, or a nose job in under an hour and a half. If they go over, there are financial consequences and verbal reprimands.” These lapses have become an issue of national concern. Last year, a Korean lawmaker complained to parliament that seventy-seven per cent of plastic-surgery clinics were not equipped with mandatory defibrillators or ventilators.
When the mother of South Korea’s former President Chun Doo Hwan was trying to conceive a child, in the nineteen-twenties, she met a wandering monk who told her that she had the face of someone who would be the mother of a great man—unless her buckteeth got in the way of destiny. With dispatch, she knocked out her front teeth using a log. (Some accounts say that she used a rock.) Her son ruled Korea from 1980 to 1988 as a brutal and repressive dictator.
If it worked for the President’s mother**, it could work for you. It is not uncommon for a Korean who is considering face alteration to seek the opinion of a professional face reader—i.e., someone who offers advice on which nips and tucks will do the most good. The occupation grew in prominence after the financial crisis of 1997-98, when competition for jobs became fierce.
On my last day in Seoul, I decided to pay fifty dollars to consult a face reader. “Should I smile?” I asked my translator, who communicated the question to a squat old man in a quilted Chinese-style jacket, who was, like so many others I met that week, gazing critically at my countenance. “Just be natural” came the answer. We were in the face reader’s dark, tiny office, which was crammed with oil paintings, an old TV, drawings of the body segmented as if they were cuts of beef, and lots of tchotchkes (a Manchester United paperweight, a small Buddha, a piggy bank).
After asking me when my birthday was, the face reader offered some general truths. “He says if there is a scar between your eyes it makes you desolate from all your wishes and hopes. Then totally, yes. One should have plastic surgery,” my translator said. “He says if there’s a nose bridge that isn’t straight enough, it disconnects you from your family.”
But, I asked, what about me?
“He says your eyebrows look like you have a lot of friends,” the translator said. “And your nose indicates that you are going to be wealthy.”
Should I change anything?
“He doesn’t have a bad thing to say about you. But your teeth might be a little weak. And you should eat a lot more beef.” __♦
*A previous version of this article misstated how quickly the divorce rate increased.
**An earlier version misstated Mrs. Kim’s last name.
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.