UNHAPPY with your body? Join the club. And I don t mean the gym or health club. Exercise and diet, it seems, are too much like hard work. These days, cosmetic surgery is the way to go.
In the US, surgeons carried out 1.8 million cosmetic procedures in 2003, the largest number ever recorded and nearly double the 1997 figure. The numbers considering surgery were also at record levels--not just among adult women but also men and teenagers. And as acceptance of cosmetic surgery grows, costs fall and techniques improve, the chances are that having our bodies tweaked to make them more to our liking will become increasingly common.
The list of body alterations we can choose from is growing ever more extensive and radical. A few years ago, it was all about fixing one or two irregular features with a nose job or facelift. These days, it focuses on "harmonising" the "aesthetic units" of your face and body by working on them all at the same time. Some surgeons are happy to perform four or five procedures at once. At the extreme end of this trend is a controversial practice known as the total body overhaul.
In the past such radical reshaping would have taken months or years. Now cosmetic surgeons are getting the job done in weeks. Two American TV networks ran reality shows this year about cosmetic surgery, both promoting the idea of rapid, radical transformation. Fox Broadcasting's The Swan took 17 "average girls"--"ugly ducklings" presumably being a bit too near the knuckle--and turned them into beauty queens in six weeks. ABC's Extreme Makeovers transformed 24 men and women in a similar time.
Thirty-two-year-old Cindy from San Diego in California was a typical Swan contestant. At school she was teased because of her droopy nose; as a grown-up with two children she felt unattractive and frumpy. Sex happened with the light off. Not any more. For the first time Cindy feels beautiful. She has a new nose, built from cartilage that used to be in her ear, plus a facelift, chin refinement, breast implants, tummy tuck, liposuction, lip augmentation, a brow lift and laser surgery on her eyes, not to mention non-surgical treatments including laser hair removal and cosmetic dentistry, all in the space of a few weeks. If you were an old friend of Cindy's, you might be forgiven for not recognising her in the street. And that, presumably, is the point.
Cindy is clearly happy with her new look, as are the majority of people who have cosmetic surgery. But the extent of the TV makeovers has whipped up a controversy. The shows' producers claim they are only reflecting what many people and their cosmetic surgeons are already doing, but many other surgeons are horrified. The very idea of a total body overhaul is wild exaggeration, they warn. In fact, it is positively dangerous. "Someone will die," warns Norman Waterhouse, a London-based surgeon and former president of the British Association of Aesthetic Plastic Surgeons (BAAPS).
But is there really a trend towards this sort of radical makeover, or is it just a TV phenomenon? It's hard to be certain. Statistics compiled by the American Society for Aesthetic Plastic Surgery (ASAPS) and other professional bodies record only the number of operations performed, not on whom and in what combination. But anecdotally, some practitioners in the US confirm that combination surgeries are on the increase. "There is a trend towards multiple procedures," says Michael McGuire, associate professor of plastic surgery at the University of California, Los Angeles. "There's an increasing realisation that it's not just one aspect of your appearance that is inadequate. Unattractive teeth will still ruin your face even if you have a nose job."
The watchword is "harmony". A facelift that improves matters above the chin might make a sagging neck more obvious, so many surgeons now do a neck lift at the same time. Another popular combination is facelift, brow lift and eyelid surgery. And for new mothers who want to get back into shape quickly, tummy tuck plus breast lift is the must-have combo. Some surgeons have even taken to working in pairs, one taking on the face while the other handles the body. And with big improvements in the safety of anaesthesia over the past 10 years, surgeons are increasingly prepared to keep patients under for longer in order to make time for extra procedures.
"In 7 hours you could get a facelift, eyelid surgery and an eyebrow lift plus a chemical peel, collagen injection or Botox," McGuire says. With a second surgeon working on your body at the same time, you are looking at a sizeable alteration in appearance. It's not exactly a total body overhaul. And it's not quite overnight; even the most minor cosmetic surgery takes days to heal. But it will be a noticeable and rapid change nonetheless.
So what is the limit? "I wouldn't exceed 7 or 8 hours," McGuire says. "After that you are not getting the surgeon's best work." Some surgeons go longer, he says, driven by competition or patients' demands. "It's not emergency surgery," McGuire points out, "but some people think it is."
Despite the increasing popularity of multiple procedures, most surgeons dispute the idea that a patient can walk into a clinic as an ugly ducking and walk out as a swan. "It's not possible, it's not safe and it's misleading," McGuire says. Waterhouse is more forthright. "I feel strongly that this trivialises and sensationalises surgery. It grotesquely distorts perceptions of what aesthetic surgery is about." He also considers it potentially dangerous. If you prolong operation time there is a massive increase in the risk of deep vein thrombosis and blot clots in the lungs, which can be life-threatening, he says.
Surgeons also worry that the promise of an as-seen-on-TV makeover distorts people's expectations. According to Stanley Klatsky, editor-in-chief of Aesthetic Surgery Journal, increasing numbers of would-be patients are turning up at clinics asking to be made over from head to toe overnight. Adam Searle, current president of the BAAPS, says the same is happening in the UK. People are starting to see cosmetic surgery as equivalent to a trip to the salon. "This is a major surgical procedure, not a hairdo," he points out.
According to an ASAPS survey this year, 34 per cent of women in the US and 14 per cent of men were considering having cosmetic surgery. If the rest of us are tempted to sneer at such vanity, it is also important to remember that cosmetic surgery can have real benefits. Ted Grossbart, a psychologist at Harvard Medical School, says the majority of patients are pleased with the results and consequently feel happier and more self-confident. "It can change lives," Searle says.
Nips and tucks Most popular cosmetic surgery procedures in the US in 2003 Number of operations (thousands) Average cost Women Liposuction $2578 Breast implants $3360 Eyelid surgery $2599 Breast reduction $5351 Nose job $3869 Men Liposuction $2578 Nose job $3869 Eyelid surgery $2599 Breast reduction $3124 Hair transplant $3084 Note: Table made from bar graph. SOURCE: AMERICAN SOCIETY FOR AESTHETIC PLASTIC SURGERY
The surgical way to standing tall
IT can put you in a wheelchair for a up to a year, but if you want it desperately enough there is a way to add 10 centimetres to your height.
Here's how it's done. A surgeon breaks both the patient's lower legs in two places--below the knee and above the ankle--and rigs up a traction device that pulls the broken ends apart by about 1 millimetre a day. The healing process does the rest.
Leg-lengthening surgery was invented in the 1950s for treating childhood deformities and short stature arising from genetic abnormalities. But an increasing number of people who just happen to want to be taller are choosing to pay up to $75,000 for the procedure in the belief that it will change their lives. "Many people feel inadequate due to their height," says Dror Paley, co-director of the International Center for Limb Lengthening in Baltimore, Maryland. "Lengthening surgery cures them." Paley receives some 50 enquires each year about the procedure, and he operates on about 12 people.
The Baltimore centre is among 25 or so worldwide that will perform cosmetic leg lengthening. One of the busiest is the Beijing Institute of External Skeletal Fixation Technology in China. It claims to have carried out more than 2000 operations, many of them on people who see gaining an extra few centimetres as the key to career success.
Don't try this at home
HERE'S how to split your tongue in two. One: have it pierced. Two: put a piece of fishing line through the hole. Three: pull.
That, at least, is how 20-year-old Dustin Allor of Menlo Park, California, did it in 1997, when tongue splitting was becoming popular. Nowadays it's more usual to find a dentist or surgeon to do it for you. The results, though, are the same--a forked tongue with tips you can move independently.
As extreme as it sounds, tongue splitting is just one of dozens of types of body modification practised in the west today. The spectrum runs from the commonplace tattooing and piercing to savage "heavy roods" such as nipple removal, genital mutilation and amputation, often self-inflicted. Think of any part of the human body that can be stretched, pierced, mutilated or removed altogether, and someone, somewhere has done it.
Last year Shannon Larratt, founder and editor of the respected online fanzine BMEzine, posted an exhaustive questionnaire about body modification on a members-only section. Of more than 4700 people who responded, most were only pierced or tattooed (iam.bmezine.com/megasurvey.html), but 870 of the respondents reported having had some form of heavy modification.
The most common heavy mods revealed in the survey were genital modifications ranging from circumcision--female as well as male--to scrotal and labial stretching, glans splitting and relocation of the urethra. Decorative implants of various sorts are also popular, including some which are inserted under the skin. Branding, scarification and tongue splitting score highly. At the extreme, 30 people reported that they had been castrated, had their penis cut off or had voluntarily amputated an extremity such as a toe, hand or limb. Amputees are known on the scene as "nullos".
What might motivate someone to do such a thing? Whatever it is, it is strongly felt. According to Mark Benecke, a psychologist at the University of Cologne in Germany, many of those involved will operate on themselves if they cannot get a professional surgeon to do the job. And finding help can be difficult: in the US it is illegal for surgeons to perform procedures that alter people's bodies beyond what is deemed socially acceptable. In the BME survey, the majority of people with heavy roods reported doing it themselves.
"Some do it for aesthetic reasons, as a spiritual quest, or out of recklessness," says psychologist Armando Favazza of the University of Missouri in Columbia, who studies self-mutilation in all its forms. But he suspects that many are probably mentally ill. "In the absence of a proper examination I can't really speculate about what is wrong with them," he says. One obvious possibility is that they suffer from body dysmorphic disorder, a personality disorder characterised by extreme body dissatisfaction which has driven some people to seek medically sanctioned amputations.
Nearly 30 per cent of the respondents to the BMEzine survey rated their mental health as worse than average or very poor, and 17 per cent reported that they were taking prescription drugs for a mental health problem. However, there is no evidence that people with heavy modifications have worse mental health than the soft mod crowd; if anything, the opposite is true. And the majority of heavy modifiers said they were happier people as a result of their body modifications.
Sex can play a big part. Split tongues have an obvious utility and many of the genital modifications supposedly enhance sensation, in much the same way that piercings do. Even ultra-heavy modifications can have a sexual motivation. This year a team led by Richard Wassersug of Dalhousie University in Halifax, Nova Scotia, surveyed 134 men who wanted to be castrated, or already were. Around 30 per cent said they found the idea of castration sexually exciting, while a similar number said they liked the cosmetic appearance it would achieve. Only 40 per cent said they wanted to be castrated to free themselves from uncontrollable sexual urges, which is the orthodox explanation for castration fantasies (Archives of Sexual Behavior, vol 3), p 433).
Having studied the scene and met many of its adherents, Benecke has come to the conclusion that body modification is often simply a lifestyle choice. In 1999, he published the first, and still apparently the only, case study. The subject was a 28-year-old New York woman who had a split tongue, extensive scarification, branding, tattoos and piercings. Her social circle consisted of other members of the body modification scene, but in other respects she was utterly normal. She had had a regular childhood, was psychologically stable and had an ordinary office job.
Eric Sprague, also known as Lizardman, is another disarmingly normal body modifier. Sprague is one of the world's most heavily modified people and, unusually, he is willing to talk about it. He is tattooed all over his body and face, has a split tongue, multiple piercings, horn-shaped implants on his forehead, and sharpened teeth--all directed towards making him look like a lizard. He sees his motivations as unremarkable. "First and foremost it is an internal drive towards self-satisfaction," he says. "The same thing that makes people exercise or style their hair a certain way." The lizard thing is a "pure, personal, aesthetic choice", he says. "I chose a lizard for the same reason you chose the colour of your suit or car."