Cosmetic surgery—where does it begin?

Abstract

“Cosmetic surgery: the undertaking of an operation plastic or otherwise which will improve appearance, or the avoidance of one which will having a disfiguring effect.” Butterworth’s Medical Dictionary (1978). In contradistinction to other fields of surgery plastic surgery has dual objectives: to restore function and to restore and preserve normal appearance. The plastic surgeon has the latter objective in view in all that he does, be it the repair of a cleft lip, the treatment of a burn injury, the augmentation of hypoplastic breasts or the reconstruction of a defect left after excision of a malignant lesion. Cosmetic surgery began with the plastic surgeon’s sympathy with the lot of the disfigured. The abnormalities of appearance that are dealt with by cosmetic surgery can be classified aetiologically as those resulting from: (i) congenital malformation; (ii) disease and injury; (iii) physiological processes such as carbohydrate storage, reproduction and ageing; (iv) disproportionate development of bodily and facial features. But such a classification is of little value to an understanding of cosmetic surgery, the purpose of which is to relieve and prevent the distress that is suffered by those who are self-conscious of abnormal appearance. Experience has taught plastic surgeons that the amount of distress caused by abnormal appearance varies from one person to another and bears little relationship either to its aetiology or to the degree of abnormality as judged by the observer. One person may be only slightly distressed by an extensive port wine stain of the face whilst another may be severly distressed by a relatively insignificant hump on the nasal bridge. In contrast to other branches of surgery, the application of cosmetic surgery should be judged, not on the grossness of the abnormality but on the degree of emotional distress that an abnormality of appearance produces. Cosmetic surgery is psychotherapeutic. To understand the raison d3tre of cosmetic surgery (the question posed by the title of this essay) it is necessary to understand the rBle of appearance in society, the factors which determine the distress suffered by those who are selfconscious of abnormal appearance and the attitudes of their observers.