February 13, 2013
Beauty. We each have different notions of what this elusive, enchanting word means. But in a world where society’s norms take precedence over individual opinion, one of the strongest influences is the desire to be beautiful: not to be beautiful on the inside, whatever that might be, but beautiful on the outside. We are surrounded by ads for beauty products such as anti-aging cream and skin care. Magazines promising quick abs or indulgent diets can be found from supermarkets to the doctor’s office. Regardless of societal pressures, beauty is sought by all. But to what degree should people alter themselves to fit a beauty standard? How far are we willing to go in to the pursuit of beauty?
Concerns such as these prompt me to ask if whether cosmetic surgery should be covered by insurance. Though insurance may seem to have no relation to beauty, the implications of our answer to such a question reveal — or betray — our commitment to attaining beauty. Are we willing to treat ugliness as an illness? Are we willing to accept the inevitable social changes if the quest for beauty becomes prevalent? Though there are many issues regarding cosmetic surgery, I will only address these principal questions. By mentioning a perceived lack of beauty, I do not mean to measure beauty but am instead suggesting that beauty is perceived by the individual. Furthermore, I will not provide an actuarial analysis of insuring cosmetic surgery (such as messy monetary details), but rather the social aspect of it. Given the effect insuring cosmetic surgery would have on our society, this paper will propose that insurance companies should generally not cover cosmetic surgery, with exceptions for cases in which one’s health is in danger.
As a teenage girl, I am affected by this emphasis on appearance. Having seen many models with piercing blue eyes, I have always wished that I had lighter colored irises instead of dull, ordinary brown ones. I could, of course, wear colored contacts, but I would prefer to permanently change my eye color. In fact, I can, with a procedure that inserts a colored silicone implant, altering iris color. Do I need to change my eye color to feel and be beautiful?
The pressure to be beautiful affects both men and women. In a society where flawless abs and pristine skin is the beauty norm, the easiest way to achieve such beauty is through cosmetic surgery, and ever more Americans are turning to its services. Despite a recession, over 9 million cosmetic procedures were done in 2011, a 197% increase from the 2 million procedures done in 1997 (American Society for Aesthetic). Some claim that this increase is a direct result of the poor economy: people choose to undergo cosmetic surgery with the understanding that more attractive people have a higher chance of getting a job than unattractive people. Even more telling, attractive people on average earn $230,000 more yearly than unattractive people along with other advantages: in his book Beauty Pays, Daniel Hamermesh states that beautiful people earn more respect, receive milder prison sentences, and have a higher chance of becoming married.
But after adding the cost of anesthesia, medical supplies, choice of surgeon, and location of the facility, the price of any surgery is high. Certain procedures, depending on the difficulty, may be more expensive than another. For example, the average cost of liposuction, a procedure that removes excess fat deposits, can range from $2,000 to $7,5000 depending on which part of the body the surgery is performed. But despite the high price, liposuction was the top surgical procedure in 2011 according to the American Society of Plastic Surgeons (ASPS). Considering that more people are willing to pay such high costs to better their appearance, should society take actions so that all could benefit from surgery, unrestricted?
The United States is but one country participating in what is a global increase in cosmetic surgery; the United States, in fact, ranks sixth in terms of number of procedures done in 2010. One country where cosmetic surgery is even more prominent is Brazil, which ranks as fourth with more than 2.42 million operations (“A Cut Above”). Cosmetic surgery is becoming a status symbol and even a societal norm: magazines such as Plastica e Beleza, or Plastic and Beauty, talk about the latest news in plastic surgery and display many acclaimed celebrities who have “gone under the knife”.
There is also a growing movement in Brazil to increase public access to cosmetic surgery. Supporters argue that beauty is a basic human right, like the right to shelter, and should be accessible by all with the aid of public institutions. This philosophy was developed by Dr. Ivo Pitanguy, a highly celebrated Brazilian plastic surgeon. Dr. Pitanguy and other surgeons believe that cosmetic surgery, besides acting as the route to beauty, has the healing potential of restoring self-esteem and offering freedom from anxiety over one’s lack of beauty. More than 220 clinics across Brazil have embraced this idea; in Rio, about two dozen public hospitals offer cosmetic surgery for free or at a lower cost to low income patients. Even the government has helped promote cosmetic surgery: in 2012, cosmetic surgery became deductible from income tax, in addition to a number of other government-based tax deductions for elective plastic surgery (“Is That Really What”. Though reductions on the cost of cosmetic surgery are not yet standard in Brazil, such actions are steps towards allowing both rich and poor to have easy access to beauty. With the evolution of our own health care, should we adapt Brazil’s goal of making cosmetic surgery available to the public, with the intention of bettering the health of our nation?
It is important to note that most insurance companies may already cover plastic surgery to some extent; reconstructive surgeries that correct a legitimate medical concern are usually insured on the basis that they are necessary for one’s health and well-being. Insurance does not normally cover cosmetic surgeries, however, which reshapes normal, functioning body part for the sake of appearance. To give an example, if rhinoplasty or nasal surgery were performed to correct a disfigured nose or trouble with breathing, then the surgery would be reconstructive in nature and would be insured. On the other hand, if rhinoplasty were performed to make one’s nose slimmer or produce a higher bridge, then the surgery would be cosmetic and thus would not be covered. But are there circumstances where cosmetic surgery could be deemed necessary for one’s health and could therefore warrant insurance coverage?
The ethical considerations around cosmetic surgery are no doubt complex. While there many more ethical issues that pertain to cosmetic surgery, I believe medicalization, the nature of cosmetic surgery, and the role insurance plays in society’s mindset are the most important when considering whether cosmetic surgery should be insured.
Nobody would argue that sickness is terrible. You should avoid illnesses, and if you are ill, then you must be cured. But what defines an illness? Should certain conditions, like one’s appearance, not be judged illnesses? Such questions pertain to medicalization, the expansion of medical categories and their subsequent treatments; simply put, when what were once non-medical problems become medical problems. Through the process of medicalization, more individuals are brought under medical jurisdiction as their life conditions become defined and treated as medical problems. Though it is often said beauty is in the eye of the beholder, our society actively shuns certain “ugly” features. In society’s pursuit of beauty, a perceived lack of beauty may be medicalized or condemned to the point where the medical institution must help “cure” it.
Not familiar with medicalization? You may be surprised to be a part of a common example: orthodontics. In the United States, the need for oral disease treatment has severely decreased thanks to access to fluoridated water and to common practice of brushing/flossing. As a result, the promotion of aesthetic treatment options has strongly increased. Most members of the recent generations, myself included, can remember the long months of aches, and oftentimes embarrassment, wearing braces. The purpose of bracers is to fix malocclusion, the misalignment of teeth and/or jaws; in other words, a bad bite. Conditions like overcrowded teeth, a gap between teeth, an overbite, an underbite, all constitute as forms of malocclusion and are arguably common in society (until they are fixed with braces). Other nations have not yet emphasized this alleged need for perfectly straight teeth. The change in America of oral aesthetics becoming a part of basic oral health is a clear demonstration of medicalization.
There are already trends in our society which support medicalization for perceived lack of beauty. Society, through the many images of young, slender, flawless male and female models, has adopted an “eternally young” or “forever beautiful” stance. Beauty companies reflect his mindset by using medical technologies for cosmetic means. The drug Botox, for example, is used primarily for the purpose of removing wrinkles. Through advertisements, beauty companies persuade consumers to purchase their products to better one’s life. The principal message of Bare Escentual’s Force of Beauty campaign states that all individuals are good or “pretty”, but they aren’t the best that they can be, “beautiful”. “Pretty is not enough. Pretty is nice. Pretty is what you are. But Beauty is what you do with it. There’s no limit to what you can do” (Bare Escentual). Though the latter part of this message may sound inspirational, it motivates the consumer to harness this unknown potential by purchasing their products. The ad never directly advises one to buy their product, but the pristine faces of the models get the picture across – how else would one achieve the same flawless skin?
Another example can be found in the numerous ads for anti-aging products, which offer individuals the chance to retain their youth through their products. For one, Olay’s Total Effects promises to “[help] fight the 7 signs of aging” (Olay). Individuals are encouraged to look upon their wrinkles, sagging skin, and other changes that naturally come with aging as enemies which should be fought and controlled. There is a considerable difference between makeup as a nice adjunct to one’s appearance and as something essential to one’s life. These ads imply the latter; if you do not buy their products, then your life is incomplete or unfulfilled. Consumers, wanting to better themselves, buy these products and create a high demand for them: almost $20 billion is spent yearly on the anti-aging skin care industry (Crary). Therefore, both consumers and the beauty industry drive medicalization.
With cosmetic surgery, perceived lack of beauty may now be directly changed through medical intervention. The vast number of surgeries available reflect how so-called “trouble spots” of the human body are increasingly diagnosed as medical problems. Flabby arms may be treated through brachioplasty, an “arm lift” which removes excess skin and fat deposits from the upper arms. Those who have a small chin, a weak jaw, or an overall lack of facial contour may obtain better balanced and proportioned features by undergoing surgery for facial implants.
Should we be worried if a perceived lack of beauty becomes an illness? To understand exactly what an illness is, we must first understand what is meant by health. As defined by the World Health Organization in 1946, health is a complete state of physical, mental, and social well-being and not merely the absence of disease or infirmity or impairment. We can then assume that an illness is anything that conflicts with these expectations; for a perceived of beauty to be an illness, it must harm us mentally, physically, and socially.
One potential area of concern is that a standard ideal of beauty may be established in order to properly judge which features are a form of illness. As a result, other marginal notions of beauty would be dismissed. Some may claim that there is already an ideal of beauty; I have observed that the Western standard of beauty, mainly youth and defined, slender features, dominates the media. Some might argue that if insured, cosmetic surgery may benefit those who do not match the standard to attain it. But although certain features are considered to be the more beautiful in society, such features are not appealing to everyone. Diversity is present not only in how we look but in how we each perceive beauty. Despite strong societal pressures, we are not forced to follow society’s standard. But medicalization of a perceived lack of beauty would cause the medical community to uphold a certain ideal of beauty. The current diversity in society would be destroyed if only one “look” was promoted. Furthermore, as medicine focuses on beautifying individuals’ bodies to reducing “suffering” from ugliness, its increasing influence steals attention away from changing the social structures and expectations that may produce such suffering in the first place. Instead of altering our appearance with a medical intervention, should we not instead change our societal expectations of how people “should” look?
The gradual medicalization of a perceived lack of beauty does not only mean that ugliness is becoming a sickness: it signifies that beauty is becoming necessary for one’s health. Medicine’s control and influence would extend to external in addition to internal conditions. Medicalizing variations in physical appearance may be a serious mistake. Though they may conflict with society’s standards, differences in appearance are a normal part human life. If medicalized, such “unappealing” features might be eliminated through influence of medicine. As a society, we must decide if we are ready for this.
As I have stated, cosmetic surgery is usually regarded as a procedure that is unnecessary for one’s health. Instead, it is seen strictly as simply enhancing one’s appearance. But are there instances in which cosmetic surgery could be therapeutic, perhaps even necessary for one’s health? To answer this question, I will explore three cases that highlight the different arguments in the debate over the necessity of cosmetic surgery: port wine stains, the elderly, and mental anxiety.
According to the President’s Council on Bioethics, therapy is the “use of biotechnology to treat ‘ill’ individuals to restore them to a normal state.” Surgery for an inflamed appendix is therapeutic because it may save one’s life. Conversely, an enhancement “alters or improves normal human functions” and is considered unnecessary for health; non-prescription colored contacts are a form of enhancement, since they do not improve poor eyesight, only appearance. But depending on the context of each case, “normal” can have very different meanings.
One case study of a perceived lack of beauty focused on port wine stains, birthmarks in which swollen blood vessels create a reddish-purplish discoloration of the skin. Cosmetic surgery may restore a person to a “normal” appearance given that only 3 out of 1,000 people have this discoloration. An individual with this discoloration easily stands out in society, especially if the marks are on their face, and may be a provocation for teasing or embarrassment. But despite such discomforts, port wine stains do not harm an individual’s health. Proponents of the enhancement perspective would argue this, and perhaps go so far as to state that the discoloration is normal for the individual. Cosmetic surgery would then enhance that particular individual by changing their own natural biological makeup.
Another example pertains to the 65 years or older demographic. Thanks to modern medicine, more people are able to live longer in their senior years and remain physically active. Though cosmetic surgery can impact any age group, I am particularly interested in the older generation because of their changing image in society. We expect seniors to be warm, amiable, and content towards the end of life. The thought of Granny Smith going for breast augmentation after baking her pies is somehow uncomfortable. Yet more and more seniors are turning to cosmetic ‘corrective procedures’ for saggy jowls or wrinkled hands. According to the American Society for Aesthetic Plastic Surgery, in 2010 there were 84,685 surgical procedures among patients age 65 and older, and the numbers continue to rise.
Cosmetic surgery could act as therapy by helping seniors return to an ideal state. Most seniors feel that their aged appearance separates them from their young, energetic spirit. By allowing them to look as they feel, cosmetic surgery would act as therapy. Another issue is that some seniors feel increasingly alienated from a world which places strong emphasis on youth. Marie Kolstad, a grandmother at age 83, has undergone a breast lift so that her children and grandchildren would “be proud of what [she looks] like”. She feels that cosmetic surgery has enabled her to look like the rest of society by shedding a few years from her appearance.
To the enhancement perspective, cosmetic surgery does not restore normalcy but instead fights a natural process. Trying to eliminate wrinkles which normally develop during one’s life is an attempt to bring a normal biological process under the control of medical science. To the many like Kolstad who believe cosmetic surgery can rejuvenate them, proponents of the enhancement perspective may say that the changes that come with aging, both external and internal, are inevitable; the body will still age regardless of any face lift. How could cosmetic surgery act as therapy if it does not cure anything from aging, save for looks? How long can seniors “keep up appearances” with cosmetic surgery as their body continues to grow old and worn? For these reasons, cosmetic surgery is an enhancement for the elderly.
From these two different examples of normalcy, I propose that the most common detriment from a perceived lack of beauty lies in the creation of neuroses. In both cases, a perceived lack of beauty impairs mental well-being by causing low self-esteem or unhappiness. If we are upset over our appearances, wouldn’t cosmetic surgery act as a cure for our discontentment? From the therapy standpoint, surgery would restore the afflicted individual’s quality of life; remember that to be healthy is not only to be well physically but also mentally. In serious cases, anxiety over a perceived lack of beauty could lead to a mental disorder, affecting the individual’s daily life with ongoing feelings of depression, frustration, or anguish. By “fixing” one’s appearance, cosmetic surgery would help the individual achieve a healthy mental state and would generally ameliorate poor self-image.
But isn’t it normal to be often discontent with one’s looks? Those who see cosmetic surgery as an enhancement would agree that unhappiness is an illegitimate reason to require cosmetic surgery. There is a fine line between low self-confidence or insecurities and a serious impairment from a perceived lack of beauty – we should not assume that all who experience anxiety have a mental disorder. But even if an individual is mentally troubled, it must be considered that mental disorders have many causes; there may be many other factors which contribute to mental torment besides an obsession over a perceived lack of beauty. This could lead to even greater disappointment if surgery does not produce the results one had hoped for. Furthermore, one could argue that cosmetic surgery is unhealthy if a person has to permanently reshape their natural body in order to regain their esteem. Perhaps a better means toward a cure would be a visit to a psychiatrist rather than a surgeon.
Considering the many perspectives and opinions, it is difficult to judge whether cosmetic surgery is crucial for one’s health. I believe its necessity is determined by the circumstances of each case, and that it would be a challenge for insurance companies to properly insure cosmetic surgery. But the fact that a growing number of seniors feel separated from society, or that most people are unhappy with their bodies, signifies the growing pressure of beauty norms. Regardless of how it affects our health, cosmetic surgery may become necessary to attain such norms.
It is important to realize how our society may change if cosmetic surgery were to be insured. What are the benefits and the consequences? Would the benefits outweigh these consequences? The main purpose of health insurance is to give patients access to high costing medical care. As I have stated before, I will not be dealing with the financial effect of insuring cosmetic surgery; to be blunt, there will be no debates about the Affordable Healthcare Act here. However, I will assume that all American citizens would have access to insurance. My focus is if insurances companies, by covering cosmetic surgery, would create a need instead of offering a service. How would we feel if certain appearances were considered an illness?
History has shown that when services are covered by insurance, they gain the connotation of being fundamental, especially in the world of medicine. Why would insurance cover something if we didn’t need it? Not to pick on dentists again, but dental insurance affords a good example. Many insurance companies cover two annual exams and cleanings. Though such check ups have become a part of good dental hygiene, it may be argued that, unless one’s teeth are rotting or are causing violent pain, these visits may not be essential to our well-being. Do we need to visit the dentist to have our teeth professionally flossed and cleaned? I do not believe so; as much as I love my dentist, I trust that the majority of people can maintain a regimen of good dental health on their own. It is uncertain whether insurance companies or the dentistry field had a greater role, but it is an example of where a need may have been invented instead of found.
If cosmetic surgery becomes a practice as common as visiting the dentist, it may be normalized. What would this entail? We can look to South Korea as an example, which has the world’s highest per capita rate of plastic surgery. One in every five women in Seoul has undergone some form of cosmetic surgery to meet their beauty standard (“A Cut Above”). Even more alarming is how adolescents face tremendous pressure to be beautiful. In an all-girls high school in the city of Gwangju, there are full-length mirrors as well as a scale on every floor; students casually weigh themselves as they go from class to class. Cosmetic surgery is offered as a reward to successful students, oftentimes with the purpose of westernizing their features; one of the most popular procedures is double eye lid surgery, or blepharoplasty, which creates a crease in the upper eyelid that is common among Caucasians but lacking among Asians. Most universities or employees require applicants to send a photo of themselves in addition to their résumé; if you are not pretty enough, you may lose the position to another who is (“Self Improvement Kick”). It could be argued that in today’s South Korea, appearance and beauty have become synonymous with success. In the midst of a culture obsessed with looks, students do not question such activities; they are simply considered normal.
Though such obsessions may seem extreme to us, I believe it is wise to consider the possibility of this occurring in the States. Do we as a society want such changes? Would all people try to look the same? Society may place an even greater emphasis on appearance; as with Korea, our values could revolve around how we look. People may be constantly concerned about their appearance to the point where vanity overtakes society. This would not only affect how we view ourselves but our interactions with others as well. If the majority had cosmetic surgery, those who did not wish to might be mocked or rejected; to be accepted by society, they must have cosmetic surgery.
But could beauty exist without ugliness? Beauty seems to be one of the few unattainable qualities of life; one is naturally beautiful only by a stroke of luck in their genetic makeup. If we could all use cosmetic surgery to achieve a standard of beauty, would that standard remain beautiful if everyone looked attained it? Is beauty the golden treasure that is always out of our reach? If everyone looked the same, a new definition of beauty may arise. We might become entangled in a never-ending cycle of cosmetic improvement as we constantly reach for some new ideal.
We can spend days hypothesizing the meaning of beauty, or the many changes that might come with normalizing cosmetic surgery.. If cosmetic surgery was insured, people might believe that they must have it to be healthy. But whether insurance companies would be providing a service or creating a need cannot exactly be determined. However, the changes that may come if cosmetic surgery is insured may be too radical to support such insurance.
To restate my original question: should cosmetic surgery be covered by insurance? Insurance normally covers medical services which are deemed necessary for health. Medical necessity could be determined either by the medicalization of a perceived lack of beauty or by the declaration of cosmetic surgery as a necessity. Cosmetic surgery is currently considered an elective aesthetic surgery, but if insured, it would appear to be fundamental for one’s health. As a result, significantly more people might have cosmetic surgery. This increase could have a range of effects on society: everyone may strive to achieve a certain standard of beauty; more emphasis may be placed on appearance; or cosmetic surgery could be normalized.
If in the futurewe do agree to insure cosmetic surgery, then the future could be similar to South Korea’s current state. Cosmetic surgery would no longer be a personal choice but a societal and medical expectation. Everyone could achieve new self confidence or societal acceptance by eliminating any trace of perceived ugliness. But if cosmetic surgery becomes extremely popular, those who do not want cosmetic surgery may be pressured to have it; employers may only accept “beautiful” workers, or hospitals may encourage regular Botox injections. The standard of beauty may be raised to impossible heights if everyone could use cosmetic surgery to attain it. (How much cosmetic surgery would be enough? What new health problems would widespread usage of cosmetic surgery pose?)
Some others may say that the idea of insuring cosmetic surgery should be avoided completely. Our society would become vain if everyone was concerned with their appearance. If an individual has abnormal physical features, say an overly large nose, they could apply for reconstructive surgery. If an individual is suffering from neuroses over a perceived lack of beauty, then they should visit a psychiatrist, which is often covered partially by insurance. Above all, medicine should not become further involved with superficial physical appearance. People should not resort to cosmetic surgery for the sake of reaching societal beauty standards. (But then how should the average person achieve beauty? Should we be content to stay average?)
In either side of the issue, key problem remain unaddressed and certain values are ignored; people should not be pressured to undergo cosmetic surgery, yet people should be allowed to attain beauty as they wish. Therefore, I believe cosmetic surgery should generally not be insured, with exceptions; though self-acceptance is an important part to one’s health, there may be cases where severe mental anxiety over a perceived lack of beauty may only be cured by having cosmetic surgery, not just by visits to the psychiatrist. Insurance companies should definitely be open in cases where one’s mental health is in jeopardy.
But in all honesty, I am not overly concerned about the ramifications of insurance for cosmetic surgery. I only used this question to provide a framework and to act as a guide to the heart of the matter: one’s own personal feelings towards their body image. I am concerned about the desperate measures our society is taking to reach this idea of beauty; an idea of beauty found in magazines and advertisements. The increase in cosmetic surgery is a barometer of how beauty is becoming synonymous with health. We must learn to balance what is necessity and what is enhancement. Though there will always be societal standards, there is an importance to letting certain irritations in life, like not having the perfect figure or flawless skin, remain as life problems. When aspiring to a beauty standard, we must be comfortable with who we are. Though I have my own conclusion, the decision of how to face societal pressures is up to the individuals who comprise society.
I do not mean to condemn cosmetic surgery or cosmetic products; I confess to using makeup on a daily basis. I merely believe that society would be taking a radical and extreme approach to pursuing beauty by insuring cosmetic surgery. If you do want cosmetic surgery and can afford it, by all means do – I’m not against such procedures. However, I believe that there is a virtue to be gained in learning how to accept natural variation. It is normal to not exactly match beauty standards; as a society we should learn how to live, and live comfortably, with our differences.
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Veronica Child is a junior of the Class of 2014 at Kent Place School. Veronica researched the ethical implications of society’s vigorous pursuit of beauty. She decided to participate in The Bioethics Project because of her interest in advances in medicine and the benefits, as well as the consequences, that each discovery brings. Veronica joined Kent Place School at 6th grade and has enjoyed the many opportunities the school has to offer.