Scientific and Ethical Aspects of Beauty and Modifying Appearance

1. Scientific and Ethical Aspects of Beauty and Modifying Appearance Bernadette Moreno, Sundeep Srivastava and Sarah Wolf

2. Introduction • Cosmetic surgery or procedure including dental • Diet pills or other supplements • Hair products or make-up • Reasons why?

3. Science and Technology

4. Plastic Surgery • Rhinoplasty • Breast Augmentation • Liposuction • Chin and Cheek Implants • Blepharoplasty • Brow Lift • Abdominoplasty • Etc.

5. Rhinoplasty • One of the most common cosmetic surgery procedures • Reduce or increase nose size, change shape of tip or bridge, nostril size, angle between nose and lip, or correct breathing problems • Cost: $5,700 “Modern Rhinoplasty Techniques and Facial Plastic Surgery” <http://ent.pote.hu/course12.htm> 22 March 2006.

6. Breast Augmentation • Enhances the size of the breasts using inflatable saline or silicone implants • Implants placed behind breast or pectoral muscle tissue • Cost: $5,850 (saline) $7,050 (silicone) “Breast Augmentation Surgery in Los Angeles” Personal Image Center <http://www.plasticsurgerysource.com/plastic-surgery/breast-enlargement.cfm> 22 March 2006.

7. Breast Augmentation • Side Effects • Temporary soreness, swelling, change in nipple sensation, bruising, breast sensitivity to stimulation; lasting up to a few weeks • Scarring lasts from several months to a year or more • Risks • Implants may need removal or replacement for problems such as deflation or the formation of scar tissue around the implant

8. Liposuction • Sculpts the body by removing unwanted fat • Typically removed from abdomen, hips, buttocks, thighs, knees, upper arms, chin, cheeks and neck • Narrow tube inserted through tiny incision and suctioning out fat cells • Cost: $9,900 “Lipoplasty/Liposuction” American Society of Plastic Surgeons <http://www.plasticsurgery.org/public_education/procedures/Lipoplasty.cfm> 22 March 2006.

9. Facial Implants • Used to improve facial contours • Implants made from different materials including silicone • Implant inserted into small incision; often performed in conjunction with other facial surgery, i.e. face lift • Incision taped to reduce swelling and discomfort • Cost: $3,000-$5,000 “Facial Implants” American Society of Plastic Surgeons <http://www.plasticsurgery.org/public_education/procedures/FacialImplants.cfm> 22 March 2006.

10. Blepharoplasty and The Brow Lift • Blepharoplasty: the removal of fat, excess skin and muscle from upper and lower eyelids • Does not remove “crow’s feet”, wrinkles or dark circles • Brow/Forehead Lift: corrects drooping brows and smoothes forehead • Cost: $5,000 Left: “Blepharoplasty” and Right: “Brow Lift” American Society of Plastic Surgeons <http://www.plasticsurgery.org/public_education/procedures/Browlift.cfm> 22 March 2006.

11. Abdominoplasty • Removes excess skin and fat from middle and lower abdomen • Long incision from hipbone to hipbone above pubic area • Skin separated from abdominal wall and muscles stitched into new position • Extra skin removed and new hole cut for navel • Cost: $6,500 “Abdominoplasty” American Society of Plastic Surgeons <http://www.plasticsurgery.org/public_education/procedures/Abdominoplasty.cfm> 22 March 2006.

12. Plastic Surgery and Recovery • Scars may be pink for up to six months after surgery • Risk of post-operative infections and blood clots • Fluid loss • Nerve damage

13. Microdermabrasion • Sandblaster-like device used to spray high pressure stream of aluminum oxide or salt crystals across face and suction used to remove dead outer layer of skin. • Stimulates skin cell and collagen production. “Microdermabrasion” Skinet. <http://www.lasercare-clinics.co.uk/Treatments/Display.asp?ID=17> 22 March 2006.

14. Microdermabrasion • Affects only outer layer of skin • Used to reduce fine lines, “crow’s feet”, age spots, acne scars • Effective for all skin types • “Lunch hour procedure” • Multiple treatments required for visible results • 5 to 12 treatments 2 to 3 weeks apart

15. Microdermabrasion • Few complications • Treatment extends only to outermost layer of skin and so scarring is unlikely and recovery is rapid. • Use of eye protection during procedure prevents ocular complications such as redness, sensitivity to light, and crystals adhering to the cornea typical of early microdermabrasion treatments.

16. Chemical Peel • Uses a solution of phenol (deep peel), trichloroacetic acid (medium depth peel) and alphahydroxy acids (light peel) to remove damaged outer layers of skin • Wrinkles, blemishes, uneven pigmentation or sun damage “Chemical Peels” BGPMA Department of Aesthetic Medicine <http://www.bgpma.com/html/aesthetics/peels_main.htm> 22 March 2006.

17. Chemical Peel • Side Effects • Temporary throbbing, tingling, swelling, redness, sensitivity to sun, whiteheads • With Phenol peel: permanent lightening of skin and loss of ability to tan • Risks • Infection, scarring, flare-up of skin allergies, fever blisters, cold sores • In rare cases, heart irregularities with phenol peel • New wrinkles may form as skin ages

18. Collagen Injections • Plump creased, furrowed or sunken facial skin • Add fullness to lips and backs of hands • Risks and Side effects: • Stinging, throbbing, burning sensation, redness, swelling, excess fullness, allergic reaction, rash, hives, flu-like symptoms, infection, connective tissue or autoimmune diseases

19. Botox • Botulinum toxin is a product of the bacteria Clostridium Botulinum • Wrinkles caused when a muscle tightens. • Botox is injected through the skin into the muscle and keeps the muscle from tightening; when the muscle can't tighten, the wrinkle is less prominent • Effective for about 4 months, after which wrinkles may reappear

20. Botox • Side effects • Droopy eyelids, flu-like symptoms, headache, upset stomach, risk of botulism (a potentially fatal disease which often results in difficulty moving the arms and legs and difficulty breathing – risk is low if Botox is used properly)

21. Obesity Review • 300,000 to 400,000 obesity/overweight related deaths per year and climbing

22. Gastric Bypass • Performed when patient has BMI >40 or a life-threatening, weight-related condition and other weight loss treatments are unsuccessful • Makes stomach smaller and allows food to bypass part of the small intestine • Fewer calories are absorbed resulting in weight loss

23. Regular Digestion: Gastric Bypass: Gastric Bypass

24. Laser Eye Surgery • LASIK: Laser Assisted In Situ Keratomileusis • Reduce or eliminate dependency on contacts or glasses • Not strictly considered cosmetic, but still an elective procedure

25. LASIK Procedure • Anesthetic eye drops to numb eye • Suction ring applied to hold eye steady • Corneal flap-outermost 20% of cornea-raised and lifted to side • UV light and high-energy pulses reshape internal cornea • Flap returned to original position and observed for 3-5 minutes to ensure cornea bonds correctly

26. After LASIK • Burning, itching, discomfort, watery eyes, blurred vision, sensitivity to light and bloodshot appearance immediately afterward • 3 to 6 months for vision to stabilize • Glare, haloes, difficulty driving at night • Further correction may be necessary

27. Cosmetic Dentistry • Whiten teeth • Correct gum line • Seal gaps • Fix chips or cracks • Correct rotations • Replace worn down or discolored teeth

28. Cosmetic Dentistry • blends function with beauty by combining tooth reconstruction and plastic surgery procedures on the mouth tissues (gums, jawbones, facial muscles, lips, and skin) to result in a better-looking smile Before After

29. Cosmetic Dentistry • Crowns: artificial coverings for teeth made from ceramic/porcelain metal composite, gold, or a tin/aluminum mixture • Veneers: similar to crowns except they cover the forward part of the tooth only and are used exclusively for aesthetic purposes

30. Cosmetic Dental Costs • Orthodontics: $5,000 to $8,000 • Crowns: $700 to $1,300 • Whitening: $300 to $520 • Veneers: $250 to $2,500 per tooth

31. Hair Removal • Many cultures have an aesthetic "ideal" amount of hair for males and females. For some of us, unwanted hair that exceeds this arbitrary standard can cause real or perceived problems with social acceptance.

32. Hair Removal Methods • Depilation (removing part of the hair above the skin's surface) • Shaving or trimming • Depilatories (creams or shaving powders which chemically dissolve hair) • Friction (rough surfaces used to buff away hair) • Epilation (removing the entire hair) • Tweezing • Waxing • Sugaring (similar to waxing but with a sticky paste) • Threading (twisted thread catches hairs as it’s rolled across skin) • Rotary Epilators (devices which rapidly grasp hairs and pull them out by the root)

33. “Permanent” Removal Methods • Electrolysis: permanent for most • Laser: permanent reduction for some • Flashlamp: permanent reduction for some • Prescription oral or topical medications: requires continuous use

34. More “Extreme” Methods • X-Ray: banned in the United States • Photodynamic therapy: in the experimental stage • Other methods with doubtful promise • Electric tweezers, transdermal electrolysis, transcutaneous hair removal, photoepilators, microwaves, dietary supplements, nonprescription topical preparations

35. Pharmaceuticals and Appearance

36. Diet Pills • Many Diet Pills and Weight Loss Products are Fraudulent According to Fat - Exploding the Myths ( Lisa Colles), Americans are reported to spend between $30-50 billion each year on diet and weight loss programs, products and pills; $6 billion of this is said to be spent on weight loss products and pills that are fraudulent.

37. Diet Pills • Prescription diet pills regulated by the FDA • Meridia (Sibutramine), Xenical (Orlistat), Adipex, Bontril, Didrex, Phentermine and Tenuate • Over the Counter Pills and Supplements • Classified as “food supplements” instead of “weight loss drugs” and are unregulated (i.e. not subject to advertising, dosage or labelling requirements) • Some supplements have amphetamine-like properties or serious side effects including death • Others are just plain useless!

38. Side Effects • Pills that work on the brain, i.e. reduce appetite • raised blood pressure, chest pain, fever, hair loss, depression, impotence, heart damage • Pills that work in the gut, i.e. reduce calorie or fat absorption • diarrhea, unexpected fecal discharge and oily stools • Herbal diet pills • “Herbal” or “natural” do not equal “healthier” • Some associated with major health concerns

39. Cosmetics • Enhance beauty of the human body • Simulate appearance of health and youth as well as sexual arousal (wide eyes, flushed cheeks and red lips) • Types: • Lipstick, foundation, powder, rouge, mascara, eyeliner, eye shadow, nail polish, concealer, etc.

40. Cosmetic Ingredients • “Pearl essence” in lipstick: shimmery substance in fish scales and is a byproduct of large-scale commercial fishing industry • More commonly, pearlescent quality comes from mica coated with a thin layer of titanium dioxide • Red color of lipstick: iron oxide (rust) or organic pigments • Eye shadow: carmine dye which comes from crushed bodies of cochineal insect (though rarely)

41. Skin Care Products • Moisturizers • Sunblock • Protect skin from UV damage • Self-tanners • And other lotions • Hide imperfections such as acne, wrinkles, dark circles, etc.

42. Ethical Considerations Topics for Discussion

43. What is Beautiful? • What is beautiful? • Why do we find certain attributes beautiful? • How has the notion of beauty changed over time and what are some of the social implications?

44. Beauty and Morality • Certain images or ideas may be considered inherently immoral and hence do not create a valid aesthetic experience • Sexual content? • Politically motivated? (That which does not encourage adherence to dictates of the state)

45. Religious/Philosophical Views • What does it mean to worship your body or to view your body as a temple? • Taking care of your body, doing what is best for it • Treating your body with respect, compassion and care • Not the same as being obsessed with appearance

46. Cultural Considerations • What is acceptable fashion/use of cosmetics in one culture may be inappropriate or offensive to another • Implications for a multicultural society?

47. Botox • Many cases of botched Botox • Four cases of botulism poisoning occurred at a Fort Lauderdale Clinic and then expanded to California. • Doctors received their materials form a biological laboratory that supplied the botulinum toxin. • How can doctors know for sure that what they are providing to their patient does not harm them?

48. Plastic Surgery • Medical evidence shows no correlation between cancer and breast implants • Should we be concerned about long term health risks that we are not aware of for other procedures?

49. Gastric Bypass • Surgical and long term health risks associated with gastric bypass surgery • University of Washington study found that 1 in 50 people die within one month of having gastric bypass surgery

50. Another Question: • The holiday season brings an increasing number of people giving plastic surgery as a gift, i.e. $15,000 face lifts, $500 Botox treatments, and $40,000 porcelain tooth veneers • Some doctors and social critics have raised ethical andpsychological questions about the consequences of amending someone else's appearance, especially if the gift was not requested. Patients may alsooverlook the medical risks of the procedures if they receive them as gifts. • What are your thoughts?