Beauty Unlimited

8. Is Medical Aesthetics Really Medical?

175 8. Is Medical Aesthetics Really Medical? mary devereaux Medicine is the art of healing, aesthetics the study of our response to art and beauty. What happens when the two come together in the practice of cosmetic surgery? This is my question, a foray into what I will call “medical aesthetics.” In what follows, I examine how practitioners of cosmetic surgery and related specialties have appropriated the language of medicine and healthcare to reframe and legitimize various nonmedical elective procedures designed to modify appearance. I begin with a short discussion of the history and terminology of cosmetic surgery. Against this background, I critically assess the claim that cosmetic surgery qualifies as a form of healthcare, and hence a legitimate branch of medicine.1 The argument for this claim takes a variety of forms, the main variants of which I consider in turn. Of particular relevance is the relation of the norms of beauty and health. It is the human attraction to attractiveness —to beauty, good looks, and social acceptance—that impels popular demands for cosmetic interventions of seemingly endless variety. That it is to medicine that we turn to meet this need is, as we will see, not surprising. But the effort to wed health and beauty creates challenges both for the medical aesthetician, or “beauty doctor,” and for medicine. In pressuring medical professionals to place beauty above health, cosmetic surgery and related specialties such as cosmetic dentistry unavoidably raise questions about the definition of medicine itself. In particular, patient demand for what I am labeling “medical aesthetics” may collide with the Hippocratic requirement that physicians “do no harm.” It is to those harms and related concerns that I turn in the final section. 176 MARY DEVEREAUX History and Terminology The field of cosmetic surgery has its roots in medical techniques developed to treat noses ravaged by syphilis, a disease epidemic by the end of the sixteenth century, and the facial wounds incurred by soldiers in the trenches of World War I. As Sander L. Gilman and other medical historians have noted, surgical skills first honed in the repair of disease and war-related injuries eventually found employment in altering ethnic noses and eradicating signs of aging.2 Cosmetic surgery, its chroniclers point out, evidences a pattern typical of medical technology: techniques invented with strictly medical ends in mind soon became adapted to broader goals. Rhinoplasty, for example, a surgery designed to treat the ravages of war or disease, soon finds a new task: “making the body beautiful,” more socially acceptable, or otherwise more in line with individual preference. In part this shift arose with the aesthetics of the Renaissance. The emerging emphasis on the beauty of the human form only heightened the stigma of syphilitic disfiguration and other “unaesthetic” deformities, defects that helped fuel the rise of aesthetic surgery.3 From early on, charges of quackery and debates about the legitimacy of their field spurred practitioners of “aesthetic ” surgery to create medical terminology and a serious rationale for work that replaced health with other priorities: the creation of a “beautiful” face, the correction of ugliness, the erasure of signs of disease, and the creation of a façade of health.4 In contemporary medicine, “cosmetic surgery” or “plastic surgery” serves as a generic or umbrella term, covering both reconstructive procedures aimed at restoring basic function, e.g., repairing a hand maimed in an industrial accident, and elective procedures such as Botox injections, meant simply to better appearance. To avoid ambiguity, in what follows I reserve the term “cosmetic surgery” solely for procedures that are both elective and aimed primarily at non-health-related goals, such as a younger appearance.5 I adopt the standard use of “reconstructive surgery” for interventions undertaken to reconstruct the body’s normal appearance or repair functional deficits .6 In some cases it may be difficult to draw a clear distinction between cosmetic and reconstructive surgery because the line between health-related and non-health-related goals is not sharp.7 But for now, a rough distinction will suffice. The proposed distinction between cosmetic and reconstructive surgery aligns with the oft-made distinction between therapy and enhancement . Here too the effort is to differentiate between health-related and 177 Is Medical Aesthetics Really Medical? non-health-related uses of medical tools and procedures. In some cases, we can easily tell the two apart. So, for example, administering human growth hormone to a child...