Changing Ideals of Beauty and Body Modification

1. Ideals of Beauty and Body Modification Martin T Donohoe, MD, FACP

2. Outline • Historical and contemporary ideals of beauty and methods of body modification • The obesity epidemic • Ethical and policy questions

3. Historical Ideals of Beauty • Ancient Greeks valued symmetry • Contemporary definitions similar: • “Ideal woman”: small chin, delicate jaws, full lips, small nose, high cheek bones, large and widely spaced eyes, and waist:hip ratio of 0.7 • “Ideal man”: taller, waist:hip ratio of 0.9, dominant/rectangular face/chin, deep-set eyes, heavy brow • Suggests strong supply of testosterone

4. Historical Ideals of Beauty • Chinese foot binding • pain, osteoporosis, falls/imbalance • Surgery to reshape women’s feet for stiletto heels increasingly popular • Ancient Greek newborn female baby wrapping • Ancient Egyptians/Roman/Persians: antimony for conjunctival sparkle

5. Historical Ideals of Beauty • Elizabethan hair plucking, ceruse makeup • Court of Louis XVI: blue veins drawn on neck and shoulders to emphasize noble blood • 16th & 17th century: belladona eye drops

6. Historical Ideals of Beauty • 18th Century: vermillion makeup (sulfur and mercury) • 14th - 19th century: corsetting (whalebone and steel) – precursor to the girdle • Making a comeback at both high- and low-end retailers (takes up to 30 minutes to lace up; requires an extra set of hands)

7. Contemporary Ideals of Beauty • Breast implants (since 1903 - Charles Miller, MD) • First silicone breast enlargement 1962 • “Better Baby Contests” – Eugenic Movement / Social Darwinism • Tapeworms (Maria Callas) • Rib removal (Cher?)

8. Contemporary Ideals of Beauty • Botox injections • Plastic surgery • Abusive subjugation of women through body modification – female genital mutilation • Cultural components

9. Ideals of Beauty • Brass neck rings (Paduang people of Burma) • Lip and earlobe expanders (certain African tribes) • Tattoos, body piercings, wings

10. Ideals ofBeauty • Wonderbra, Brava Bra ($2500, suction device worn overnight for 10 weeks, promises 1 cup increase, can cause skin rash, discomfort) • Wonderbum pantyhose (DuPont Lycra) – promises a “perfectly peachy, pert bottom” • Music industry depictions of beauty

11. Ideals of Beauty • Ancient Greeks – symmetry • Remains true • Familiarity, personality traits also important • Evolutionary adaptation for survival of human species • Size, muscle power, pathogen-free status, fertility

12. The Perks of Beauty • The good-looking are more likely to get married, be hired, get paid more, and be promoted sooner • Height is associated with income and leadership positions • Strangers are more likely to assist good-looking people in distress

13. The Perks of Beauty • The pretty/handsome are less likely to be reported, caught, accused, or punished for a minor or major crime • Role of ageism (more important for women) • The responsibility: • Attractiveness is recognized as a special gift, and its misuse is not tolerated

14. Cosmetics • Concocted at home prior to 20th Century • Industry spawned by: • “Allure” of prostitutes/sexuality • Mass popularity of anti-aging products in 1920s • Women entering workforce • Migrations to cities • Food, Drug and Cosmetic Act (1938)

15. Cosmetics • 2004 spending = $12 billion • 33% more than the amount needed each year (in addition to current expenditures) to provide water and sanitation for all people in developing nations • Slightly more than the amount needed each year (in addition to current expenditures) to provide reporductive healthcare for all women in developing countries

16. Cosmetics • Average American adult uses 9 personal care products/day (with 126 unique chemical ingredients) • 89% of the over 10,500 ingredients used in personal care products never tested for toxicity • Little FDA oversight

17. Cosmetics • Unusual ingredients include: • Cow colostrum • Gold • Foreskin • Placenta • Fetal cells

18. Cosmetics and Hair Coloring • Women devote average of 19 minutes per day to treating and altering their faces • 55% of American women between 13 and 70 color their hair • 1/8 American men between 16 and 60

19. Tanning • The skin’s response to ultraviolet light injury • No such thing as a “safe tan” • 95% of Americans understand that sunburns are dangerous, but 81% still think they look better with a tan.

20. Artificial Tanning • 47% of college students use a tanning lamp each year (females more than males) • 39% have never used a tanning lamp • More than 90% of users are aware that premature aging and skin cancer are possible complications of tanning lamp use

21. Tanning • Tanning as a substance abuse-like disorder • Tanning produces endorphins • Most countries do not limit access of youths to tanning parlors • SPF of at least 15 should be worn when outdoors (and re-applied frequently)

22. Artificial Tanning • Many lotions and creams available • Burgeoning industry • “Natural” does not necessarily mean safe

23. Tattooing • Tattoo from Tahitian word “tatau” (“to mark”) • Reached apogee among Maori • Popularized in West by sailors returning from Polynesia

24. Tattooing • Aesthetic choice • Initiation rite • Time-saving way for disabled to overcome difficulties of applying makeup • Adjuvant to reconstructive surgery (particularly face and breast, to simulate natural pigmentation)

25. Tattooing • 30 million Americans have tattoos • Ancient practice: Maori tribesmen, Thracian women of 5th Century Greece • Tattooing still illegal in South Carolina and Oklahoma

26. Tattooing • More than 50 different pigments and shades employed • None approved for skin injection • Some industrial grade printer’s ink or automobile paint

27. The Fringes • Anal bleaching • Initially porn stars and sex workers • Now available to general public for $75/treatment • Can cause eczema • Money: Jim Nelson auctioned off his head on eBay for a corporate logo tattoo in 2003

28. Risks of Tattooing • Tattooing associated with risky behaviors in adolescents • Infection • e.g., hepatitis B, C, and HIV • Am Assn Blood Banks requires one-year wait between getting tattoo and donating blood • Removal problems • Allergic reactions

29. Risks of Tattooing • Granulomas • Keloid formation • MRI complications • Swellings/burns • Image quality suffers (particularly with permanent mascara)

30. The Most Common Problem:Dissatisfaction • 17% of those tattooed later regret it • Chief reason = the person’s name in the tattoo • Practitioners’ skill levels vary widely • Fading with time • Blurring when injections too deep

31. The Most Common Problem:Dissatisfaction • Human body changes with time • Styles come and go • With facial cosmetic surgery, appearance of tattoos and permanent makeup may become distorted

32. Tattoo Removal Techniques • Laser treatments • Dermabrasion • Salabrasion • Scarification • Surgical Removal • Camouflaging

33. Temporary Tattoos • Fade after several days • Allergic reactions • FDA alert re risks with foreign-made products • Freedom-2 Ink: Biodegradable dye capsules – when zapped by laser, dyes absorbed by body and tattoo disappears

34. Risks of Henna Tattoos • Henna products risky • Henna approved for use as a hair dye, not for injection into the skin • Produces a reddish-brown tint, raising questions about what ingredients are added to produce the varieties of colors labeled as henna (e.g., “black henna,” “blue henna”

35. Botox • Botulinum toxin: • Cause of botulism • potential biowarfare/bioterror agent • Medical Uses: blepharospasm, spasmodic torticollis, migraines, back spasms, chronic pain, axillary hyperhidrosis, wrinkles due to normal aging • Unlikely to work on sun- or smoking-induced wrinkles

36. Botox • Manufacturer = Allergan • Myobloc (Solstice Neurosciences – not yet FDA-approved) • 4.6 million treatments in 2007 (costing $2.3 billion) • Large direct-to-consumer ad campaign • Olympians Mark Spitz, Nadia Comanici involved • $80/dose + physician’s fee ($541 avg.)

37. Botox • Most users white, age 35-50 • 12% are men • In-home Botox parties; Botox scams • Hollywood actors

38. Botox • Retreatments required q 3-4 months • Side effects: muscle weakness, masklike facies, drooling, slurred speech, aspiration, rare allergic reactions; may spread via neurons back to spinal cord or even CNS • 87 hospitalizations, 16 deaths reported 1997-2006 • Rivals = collagen injections (from cows, possible allergic responses), Perlane (“natural” collagen alternative from human tissue), fat injections, face lift/eyelid surgery

39. Dermal Fillers • Alternative to botox • Cow collagen, liquid silicone, plastic microbeads, synthetic bone and ground-up human cadaver skin (association with for-profit tissue banks)

40. Dermal Fillers • $700-$900 per treatment (lasts a few months) • Compare with $4000-$6000 for a facelift, which lasts 10-15 yrs before requiring touch-ups • Side effects • Include renal failure

41. Conclusions • Ideals of beauty: some relatively constant, others change • Multiple methods of body modification: some dangerous, even abusive

42. Covered in Other Slide Shows • Cosmetic surgery • Female genital cutting • Body weight and the obesity epidemic • Ethical and policy issues

43. References • Donohoe MT. Beauty and body modification. Medscape Ob/Gyn and Women’s Health 2006;11(1): posted 4/19/06. Available at http://www.medscape.com/viewarticle/529442 • Donohoe MT. Cosmetic surgery past, present, and future: scope, ethics and policy. Medscape Ob/Gyn and Women’s Health 2006;11(2): posted 8/28/06. Available at http://www.medscape.com/viewarticle/542448

44. Re Tanning • See slide show by Anuru and Salmon on risks and regulations related to indoor tanning at http://phsj.org/?page_id=10

45. Contact Information Public Health and Social Justice Website http://www.phsj.org martindonohoe@phsj.org