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

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

2. 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

3. “Ugly” • Common first name in Ancient Greece, parts of sub-Saharan Africa • Idea: give children bad names so demons won’t find them • Other favorites: “Disagreeable,” “Crippled”

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

5. Historical Ideals of Beauty • Ancient Roman women colored their lips with red cinnabar stone, a type of mercury ore, lined their faces with white lead, and rouged their cheeks with red lead • Ancient Egyptians/Roman/Persians: antimony for conjunctival sparkle • Rome to medieval Europe: paleness preferred

6. Historical Ideals of Beauty • Renaissance women used leeches on their ears to drain blood from their faces for a fashionably pale complexion • Elizabethan hair plucking, ceruse makeup • Elizabethans used lard to set wigs, which could result in rat infestations

7. Historical Ideals of Beauty • Court of Louis XVI: blue veins drawn on neck and shoulders to emphasize noble blood • 16th & 17th century: belladona eye drops

8. 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)

9. Historical Ideals of Beauty • Unibrow: • Sign of criminal tendencies in Victorian England; mark of beauty in contemporary Iran • 19th Century: Vacuum pumps and vibration therapy for baldness/”flabby skin”; mercury-based freckle remover • Breast implants (since 1903 - Charles Miller, MD) • First silicone breast enlargement 1962

10. Contemporary Ideals of Beauty • “Better Baby Contests” – Eugenic Movement / Social Darwinism • Tapeworms (Maria Callas) • Rib removal (Cher?) • Prostitutes using diuretics (for weight loss), child sex workers forced to take dexamethasone (to look older, “curvier”)

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

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

14. Ideals ofBeauty • Wonderbra, Brava Bra ($2500, suction device worn overnight for 10 weeks, promises 1 cup increase (actual increase ½ cup size), can cause broken blood vessels, skin rash, discomfort) • Wonderbum pantyhose (DuPont Lycra) – promises a “perfectly peachy, pert bottom” • Music industry depictions of beauty

15. 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

16. The Perks of Beauty • The good-looking are more likely to get married, be hired, get paid more (including tips), and be promoted sooner • Lifetime earnings difference between the typical “good-looking” and “below average-looking” worker = $230,000

17. The Perks of Beauty • Height is associated with income and leadership positions • Ironically, 50 years ago some women were treated with estrogen to prevent them from growing too tall and becoming un-marriable • This impaired their fertility, among other consequences • Strangers are more likely to assist good-looking people in distress

18. 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

19. The Adonis Complex • 38% of men want bigger pectorals; 34% of women want bigger breasts • Each year, men spend over $2 billion on health club memberships and $2 billion for home exercise equipment • Tommy John surgery • To enhance elbow strength and improve pitching velocity

20. Anabolic Steroid Abuse • Supplement industry booming • 3 million American men have swallowed or injected anabolic steroids since they became widely available in the 1960s

21. Anabolic Steroid Abuse • 5.9% of current middle and high school students have used anabolic steroids (100% increase over last 6 years); rates higher among boys • Use associated with violent behavior • 35% use protein powders/shakes to build muscle

22. Adonis Complex of the Middle Aged and Elderly • “Low T (testosterone) Syndrome” • Hypogonadism is a real disorder, but “Low T Syndrome” manufactured by drug companies to treat those with stunted libidos and depressed mood • Carries risks of BPH, prostate cancer

23. 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)

24. Cosmetics • Worldwide annual spending around $19 billion ($8 billion in US) • 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 reproductive healthcare for all women in developing countries

25. 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

26. Cosmetics • Most contain carcinogens and/or endocrine disruptors (see http://www.cosmeticsdatabase.com/) • Unusual/dangerous ingredients include: • Mercury – skin creams • Lead – lipstick and kohl (decorative black eyeliner) • Arsenic, Cadmium, Copper • Bacteria – mascara • Mica (lung-damaging particles) • Cow colostrum • Gold • Foreskin • Placenta/Fetal cells • Paint stripper and varnish - eyeliner

27. 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

28. Hair Care Products • African-American “hair relaxers” contain endocrine disruptors • Use increases risk of uterine fibroids, cancers • Brazilian Blowout hair straightening products contain formaldehyde (possible carcinogen)

29. Cosmetics • 2013: EU bans sale of all cosmetics tested on animals

30. 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.

31. Tanning • UVA and UVB dangerous • Ozone damage allows greater UV radiation exposure • Estimated lifetime risk of melanoma 1/70 • Clouds filter out only 20% of sun’s UV rays • Snow reflects up to 80% of UV rays (sand 17%) • White T-shirt has SPF 7 (min 15 recommended); darker shirts have higher SPFs

32. 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 (melanoma and basal cell) • WHO: tanning beds cause cancer • Skin cancers of all types rising: 1/5 Americans will get during their lifetimes

33. Tanning Facilities • Over 50,000 in US (more than the number of Starbucks or McDonalds) • Generate revenues of over $5 billion/yr • 1 million use daily; 30 million annually • Most users are women • 18% of women and 6% of men visited at least once in past year

34. Tanning Facilities • Most countries do not limit access of youths to tanning parlors • Most US states limit access of youths (bans; parental consent) • FDA advisory panel has recommended increased regulation, including restricting use to adults • Indoor 10% tanning tax implemented in 2010 as part of PPACA (Obama Health Care Plan)

35. Tanning • Tanning as a substance abuse-like disorder • Associated with other addictions • Tanning produces endorphins • some contain fragrances – can cause allergic reactions • Sprays may damage lungs

36. Tanning • Mineral sunscreens best (Zn or Titanium); lotions and creams do not necessarily protect against UVA) • Use SPF of at least 15 and re-apply frequently • Avoid benzophenone (aka oxybenzone, estrogenic); avobenzone is safer

37. Artificial Tanning • Many lotions, creams, and sprays available • Most contain dihydroxyacetone (DHA) – can damage DNA and lungs and cause allergic reactions • Burgeoning industry • “Natural” does not necessarily mean safe • See EWG database

38. Artificial Tanning • Increased (but not excessive) carotenoid-containing fruit and vegetable consumption can improve skin color • Tanning pills (not approved for use) containing canthaxanthin dangerous • Skin lightening creams may contain mercury

39. Tattooing • Roman Empire used to brand convicts, slaves, and army deserters • Tattoo from Tahitian word “tatau” (“to mark”) • Reached apogee among Maori • Popularized in West by sailors returning from Polynesia

40. 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)

41. Tattooing • 30 million Americans have tattoos • 40% of Americans between 26 and 40 • Ancient practice: Maori tribesmen, Thracian women of 5th Century Greece, Moors) • Tattooing still illegal in South Carolina and Oklahoma

42. Tattooing • More than 50 different pigments and shades employed • Many contain heavy metals, phthalates, other endocrine disruptors and carcinogens • Some contain industrial grade printer’s ink or automobile paint

43. Tattooing • FDA considers inks to be cosmetics (premarketing safety evaluation required) • FDA considers pigments to be “color additives” (no premarketing safety evaluation required)

44. Risks of Tattooing • Tattooing associated with risky behaviors in adolescents • Infection • e.g., Staph, Strep, Mycobacteria, hepatitis B, C, and HIV (HIV risk theoretical – no cases identified to date) • Am Assn Blood Banks requires one-year wait between getting tattoo and donating blood • Allergic reactions

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

46. The Most Common Problem:Dissatisfaction • > 1/3 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

47. 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

48. Tattoo Removal Techniques • Laser treatments (photothermolysis) • Requires multiple treatments • Dermabrasion • Salabrasion • Scarification • Surgical Removal • Camouflaging

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

50. 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” • Color can last for more than a week