April 2016

The Medicine

A fine line

By Karen Hitchcock
The effectiveness of plastic surgery is a matter of perception

I once worked with a doctor who spent six months preparing for her high school reunion. She went on a diet, joined a gym, had her boobs done, got her face resurfaced, filled and botoxed. She experimented with eyelash and hair extensions. She’d detail her endeavours to anyone who’d even half listen and wrap it up the same way every time: “I’m gonna show those bitches.” She was deaf to exhortations, blind to our looks of horror and discomfort. She’d entered some kind of mad alternative universe. Her party came and went and she was satisfied she’d shown them, those ageing horrors. She said she needn’t have bothered trying. I know, right? No one told her that that’s what everyone thinks.

Full-blown neurosis and benign protective delusions aside, it’s arguably getting tougher for the average woman to embrace her deepening wrinkles and slackening skin. We watch celebrity faces stay smooth as photoshopped cream, rich with the possibility that we too might escape the spoil. Aesthetic procedures are on the rise. In women’s magazines, plastic surgery has become the new cold cream. They say you should start young. Take Madonna: a ton of work, a bit of make-up and a pair of gloves have kept her sort of 35 for more than two decades.

I used to think plastic surgery was all boob and nose jobs, face lifts and tummy tucks. But in the public hospital, plastic surgeons treat burn victims, skin cancer sufferers and people with disfiguring, function-impairing injuries. They reconstruct, re-attach and graft.

In medical school interviews, prospective students are asked to explain why they want to become doctors. A friend of mine who grew up in rural New South Wales intended to return to his hometown and work as a general surgeon. Tough gig. Mending all those stoic late presenters and farm accident victims, working horrific hours, being constantly on call with little back-up. Declaring this ambition in his interview probably gained him instant admission to the course.

Midway through his training he fell in love with a beautiful GP, who wore icepick heels and emerald-green silk dresses to work. “As soon as I clapped eyes on her,” my friend said, his hand kneading his forehead as if divided loyalties could be massaged away, “I knew I’d be staying in the city.”

My friend married the GP, dropped out of surgical training and became a “cosmetic physician”, performing all the minimally invasive procedures: office-chair injectables and laser treatments, day-case fat removal and silicone implantation. This causes him terrible periodic guilt. He could have completed real plastics training and done stints in developing countries fixing cleft palates. I like him and always feel an urge to defend him against himself. It’s not like he’s performing labiaplasty on porn-normed young women. He’s just the product of our medical system and society: consumer-centred, fee-for-service and privatised.

Psychology and surgical journals are full of studies trying to measure the success of aesthetic procedures, with titles such as ‘Objective Assessment of Perceived Age Reversal and Improvement in Attractiveness After Aging Face Surgery’ and ‘The Effect of Incobotulinumtoxin A and Dermal Filler Treatment on Perception of Age, Health, and Attractiveness of Female Faces’. They tie themselves in knots trying to work out what they are measuring and how. Unknowingly they’re trying to reduce complex philosophical matters to empirical equations – beauty on a scale of one to ten – believing that human perception can be rendered objective. Researchers have groups of “raters” estimate the age or the level of attractiveness of people from pre- and post-surgery photographs. One study determined that a face lift “objectively” saves 3.1 years on average, but doesn’t improve scores of attractiveness. Another study found the average number of years saved to be 4.6.

My grandmother would have been an enthusiastic rater. When I was a teenager she’d tell me, at least once a week, “Remember, you never see yourself as others see you.” She usually said it in an attempt to get me to use less eyeliner or remove my leopard-skin coat. I thought it was her only dodgy aphorism: the last of the Victorians versus Gen X. But it turns out she was right. But wrong about what should follow.

What all the plastics research proves is that how you think you look has very little to do with what those others might think. Despite woefully modest improvements in how a group of strangers reckon you scrub up, studies pretty consistently show that when people have their face nipped and tucked, paralysed and filled, they experience major decreases in physical, emotional and social distress.

My friend feels guilty for saving skin-years rather than lives, for helping to promote a ludicrous and no doubt sexist aesthetic regime. But the aesthetic surgeons and cosmetic physicians are ultimately operating on their patients’ (or customers’) internal portraits, on their fantasies, on self-perception. The operations work in much the same way as placebos or luxury brands do. Big fantasies hinge on tiny things: sugar pills, wait-list handbags, heavy watches, three fewer wrinkles. And buyer beware: Michael Jackson’s slowly butchered face probably made him feel better and better.

Recently I was onstage with author Renata Singer and stand-up comedian Mandy Nolan. We were discussing societal attitudes to ageing and how unfortunate it is that we eschew its visible manifestations. Singer turned to Nolan and said, “Well, what about make-up? Where’s the line, Mandy?” Nolan raised her eyebrows. “Where’s the line? I know where the line is.” She struck her finger to her forehead. “The fucken line’s here.” A shallow crease on the forehead, a ravine in the mind.

Karen Hitchcock

Karen Hitchcock is a doctor and writer. She is the author of a collection of short fiction, Little White Slips, and the Quarterly Essay Dear Life: On Caring for the Elderly.

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