Are we making good choices about cosmetic procedures?

The growing demand for cosmetic procedures is showing no signs of slowing down. New figures from the British Association of Aesthetic Plastic Surgeons are quite amazing: there was a 17 percent increase in the number of cosmetic operations performed between 2012 and 2013 and not one single procedure decreased in popularity. Liposuction increased by 41 percent.

But it is also increasingly clear, with disaster stories regularly reported in the media, that these kinds of procedures don’t come without risk. And last year, a Government-commissioned review found that the safety of patients was being neglected. It recommended a range of new regulatory measures to tighten up the industry, including standardised training and qualifications for those providing procedures, a ban on irresponsible advertising, and a national register so that patients can be followed-up if necessary. We are waiting to hear if the Department of Health is going to implement these measures.

Putting proper regulation in place is an important step for this growing industry, but the popularity of cosmetic procedures forces us to ask some wider questions. Why are so many people spending their hard earned cash on risky injections and incisions that they think make them look or feel better? And when I say people, I mostly mean women, who underwent 90 percent of cosmetic procedures performed in 2013.

The media is often blamed, and television and the press certainly have a fascination with all things laser and lipo. Anyone who soaks up popular culture (i.e. a lot of people) is constantly bombarded with news and images of perfect looking women, many of whom are open about having had some ‘work’. But there are likely to be others influencing the way we think about cosmetic procedures and the way we look, such as the fashion and pornography industries, and those who are developing, advertising and providing the procedures. With all this being thrown at us, we perhaps can’t be blamed for thinking that everyone is doing it, and in order to keep up, so should we.

So, if people are starting to think of cosmetic procedures as normal, trivial or even essential, should we be worried? Here at the Nuffield Council on Bioethics we have been worrying about whether we should be worried since we discussed the rise in cosmetic procedures at our 2013 horizon scanning meeting. To guide us towards an answer (or maybe just towards more questions), two weeks ago we brought together a multidisciplinary group of people (medical professionals, counsellors, campaigners, artists, academics) to discuss the big questions this raises for our society and what might be done about it.

At the meeting - which was extremely interesting and helpful, and our thanks go to all those who took time out to take part - a recurring theme was that of patient consent. It is of course vital that proper consent is obtained from people before they undergo any procedure, and that they have been made fully aware of the risks and limitations of the procedure. But, however thorough the efforts of the healthcare team at the clinic, are wider societal influences affecting people’s ability to make genuinely informed decisions? In other words, if we go along with culturally-entrenched ideas about what we think breast enlargement will do for us, are we going to be able to make ‘good choices’ about seeking a medical solution to a problem we have with our appearance?

This raises the question of whether those influencing how people think about body image and cosmetic procedures more generally should take some measure of responsibility by trying to counteract these developments? For example, should they (exactly who ‘they’ are is another question) help tackle the trivialisation, normalisation and glorification of cosmetic procedures in our culture; raise awareness of the risks and limitations of cosmetic procedures; and promote better understanding of diversity of appearance in society? There are already some excellent campaigns underway, such as the Campaign for Body Confidence and Changing Faces, but they could probably do with some help in tackling the tidal wave of perfect bodies and high-end grooming coming at us through our screens.

Or, maybe there isn’t a problem here at all, particularly if the Government does implement more stringent regulatory measures in the cosmetic procedures industry. Is it another case of us recoiling at a cultural shift that will soon become uninteresting? Cosmetic dentistry, piercing and tattooing doesn’t cause us too much bother after all. Perhaps it’s just a case of science and medicine meeting the age-old demand for the latest methods of beautification.

The Nuffield Council on Bioethics specialises in tackling the challenging questions raised by developments in biology and medicine, with the aim of informing policy makers and getting people talking about the issues. We have a feeling that any new regulations announced by the Government won’t mean an end to this debate, and that there is a role for us in exploring the ethical questions further. A note of our meeting will be published on our website shortly.

For now, I’ll leave you with the words of Dr Leah Totton, winner of the Apprentice 2013, in last week’s Stylist magazine (Issue 207, p72) as she opens her first Cosmetic Skin Clinic in London: “Do I agree that women need these treatments? It’s not my decision to make. It’s a personal choice. If you’re conscious of how you look and want to enhance or maintain your looks using injectables, then there’s no way of me preventing that.”