Wednesday, 21 November 2012

A Slice of the Good Life

In a plastic surgery snafoo Chinese Jian Feng has succeeded in suing his wife for marrying him under false pretenses. After she gave birth to their first child Feng was furious. Initially he called the child incredibly ugly, far too ugly to be his child, and accused her of cheating on him. It was not until she admitted to almost 100 000$ dollars worth of plastic surgery that he accepted the child was his. His fury from suspicions of being cheated on quickly changed to the fury of being deceived. He promptly divorced his wife, and took her to court where the judge agreed with his plight and awarded almost 120,000$.

Plastic surgery is a strange phenomenon. While it is still taboo in many parts of the world, the amount of people getting some form of artificial improvement has been steadily increased over the past 50 years. There are approximately 30,000 registered, legal and practicing plastic surgeons in the world, and they performed over 8.5 million surgical procedures (rhinoplasty, etc.) and 8.75 million nonsurgical procedures (botox injections, etc.) in 2009.  With everything from a large gut to a crooked nose being 'fixable', and plastic surgery becoming more accessible and affordable, these numbers aren't likely to dwindle. America, unsurprisingly is leading the pack with most surgeries done every year, with Brazil and China following close behind.

My current slice of paradise (pun intended), however, is a plastic surgeon's dream. South Korea is a country controlled by image. Shiny cars, designer handbags and the latest threads are considered the necessities of everyday life, to the extreme that some people will forego even proper nutrition to get their hands on the most fashionable items. This is only exasperated by the competitive marriage market, where less attractive people find themselves less and less likely to meet their ‘true love’. In a country that requires pictures to be attached to resumes plastic surgery may not even be an optional expenditure.

After experiencing the fierce competition, both for physical image and in virtually every other way, it surprised me to find out that most of the students at my middle school are fervently against plastic surgery.  When I asked the students if they thought celebrities who have plastic surgery make good role models, the majority likened them to liars and said that we should stay who we are. A rare few admitted that they were looking forward to the days when they could go under the knife, and with 1.32% of Koreans having had some form of plastic surgery (second per capita only to Hungary) they may be the only honest ones in the lot.  

While my students still have the advantage of being young and idealistic it appears that the more aged Koreans are seeing some interesting economical ripples. Korea only recently opened its hospitals to foreigners, but has since become one of the top spots for medical tourism. At some clinics in Seoul's booming plastic surgery strip foreigners account for 50% of the patients, most coming from China and Japan. Hospitals have even begun setting up translators and shuttle busses for the hordes of hopefuls looking to get safe, clean and cheap plastic surgery. It seems that in Korea beauty isn't something to be envied, it is something to be attained (I stole this line).

South Korea isn't the only country that has decided to take advantage of this new craze. Thailand, Malaysia, Lithuania, Costa Rica, Egypt...the list continues, but each of these countries is trying to get a piece of the action. Each offers varying levels of sanitation, skill and legality, but gives people the opportunity to have procedures which would otherwise be far beyond their reach. Travellers can find prices going as low as 60-70% the costs they would see in their home countries and get themselves a beach vacation in the process. The residents of these countries benefit from the influx of funds, especially countries like Cuba which don't have a lot of other international trade.

Many people, however, fall prey to the terrible risks that lie with getting something as risky as surgery in a foreign land. The internet is riddle with stories of people who took bad deals and ended up at disreputable locations. Excited none the less they chose to continue with the surgeries and found themselves with horrifying and sometime fatal results.  One website tells of a woman who journeyed to the Dominican Republic with hopes of surprising her husband and daughter by shedding some unwanted belly fat via liposuction. Unfortunately, her surgeon turned out to be a unscrupulous man lacking in proper cleaning skills. After the surgery she developed an infection, which was exasperated by his unsanitary recovery ward. Instead of delight at her new look, her family was left stunned to find out that she wouldn't be returning to them. The sudden boom of the industry has allowed hundreds of hospitals to open outside the bounds of governments unable to keep up, and with no one to protect these men and women many are lost in the bitter corners of the world.

Despite these horror stories people continue to make long journeys to distant lands for what they consider self improvement. India is one country that is genuinely benefiting from the new plastic surgery surge. India's top rated education system sends 20-30 thousand new doctors and nurses into the world every year. These doctors are young, eager and ready to make their mark, and plastic surgery is  lucrative industry in which to begin their careers. India has seen a growth of roughly 30% a year in the plastic surgery industry for over a decade, unsurprising with the country’s economic boom. The clean hospitals in the larger cities are also extremely attractive for medical tourists. The money made from the surgeries is only a small part of the flights, housing, transportation and other costs that benefit the peoples of India.

India makes an interesting case, as it is considered to be the birth place of plastic surgery. Ancient texts dating as far back as 600 BCE describe procedures to repair ears and noses lost as punishment for crimes or in battle. By cutting skin from the cheek and forehead, twisting it into a fascimile of a nose, putting wooden tubes to leave paths for air and sewing the skin into place ancient Indian surgeons created new faces for societal outcasts.   Sushruta , the most famous of the ancient Indian physicians describes this procedure in his work the Sushruta Samhita, along with many other revolutionary ideas such as practicing surgery on inanimate objects such as watermelons and clay pots.

Ancient Romans also felt the pressure to amend nature’s little errors. Romans were extremely fond of there public bath houses and this made life difficult for some. They viewed any physical abnormality with suspicion and ridicule so many Romans would seek out the help of surgeons to give them a sense of normalcy in a cruel society. One of the more popular procedures in ancient Rome was the removal of scars on the back which suggested that the possessor may have retreated in battle or, even worse, may have been whipped like a slave.  

Plastic surgery faded away (in Europe at least) after the rise of Christianity which viciously condemned any form of vanity. It resurged, however, during the Renaissance. In 1794 British surgeons witnessed an Indian bricklayer repair the nose of a British cattle driver who had had his nose cut off while a prisoner of the current Sultan. The surgeons took the practice back to England where it was eventually picked up by a young man named Karl Ferdinand Graefe. Graefe coined the terms plastic surgery as well as rhinoplasty. Gaeffe used the medical sounding word rhinoplasty, another term for a nose job, to remove the moral stigma created by the Christian values against vanity surgeries. It was not until the First World War that plastic surgery became a respected profession. Trench warfare left heads and necks more vulnerable to injury, and new technologies such as airplanes and tanks often caused unprecedented facial injuries. The surgeons who worked in these abhorid conditions were forced to refine their craft, and eventually became incredibly proficient at repairing burns and scars.

It was when American surgeons returned home and created the American Association of Plastic Surgeons that created reform and regulation in 1931 that plastic surgery began its modern day manifestation. After the war was finished the triage surgeons needed new patients and began a widespread marketing trend towards certain groups, notably middle-aged middle-class women who were no longer raising their families. From there plastic surgery crawled slowly along until the 1990's when the taboo lessened and vanity boomed.

While society has long been against it the evidence can make strong arguments for artificial augmentation. It is well known that pretty people tend to do better in life. People are more likely to help them in random situations, they earn an average of 4-5% more than there more homely looking counterparts and their romantic prospects are significantly increased. We are naturally hardwired to assume that pretty people are better people. We automatically assume, generally within seconds of meeting someone, that the better looking ones are smarter, braver, kinder and wiser despite there being no empirical evidence correlating looks and personality.

While some may argue that the money spent by the rich on prettying themselves up could be put to better use in many other ways (feeding the poor, combating slavery, education) , it's hard to argue against those who continue to use plastic surgery for its original intents. Recently in Pakistan there have been a brash of attacks against women for daring to do such audacious and unthinkable things as talk to boys or get an education. One attack by the Pakistani Taliban left two women with horrible scars. The two were in a van full of graduate students heading home from Kohar University in the city of Parachinar. The van was stopped by masked assailants who then opened fire on the students and threw acid at two women and a gentleman. 

All of the people survived, but many are now in need of surgery to help repair their wrecked faces and broken bodies. The surgeries that help make the rich look better can also be used to help these unfortunates look normal again. The same could be said of surgery to help those with cleft lips, webbed fingers or other birth defects, burn victims or cancer survivors. These surgeries make it possible for many people to function in societies that are wary, and often outright cruel to those whose physical appearance doesn't fit the norm.

While it may be unfortunate, it is the money from the liposuctions and boobjobs that advances plastic surgery. The cheaper and more refined those surgeries become the easier it is for poorer members of society to get the help they need. Until we can convince governments to spend more on reconstructive surgeries it seems that boob-jobs and botox will be the only means of research.

It's unfortunate that the pressure to be beautiful ways so much more heavily on women. Some 90% of surgeries are done on the creator sex. Plastic surgeons feed off these women's insecurities. None would ever tell one of their patients that her boobs are perfect, or that she doesn't need to shed a few pounds. That would be bad business. The first step in combating vanity is to stop making women feel bad about their bodies, but until that happens plastic surgery will also continue. Besides, medical tourism does help out struggling countries. And who can blame a burn victim for wanting to look like their old self? Most of my students say they'll never get plastic surgery. I say the same now. But who knows what the future holds.

Sources and Such

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