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Ideals of Beauty and Body Modification Martin T Donohoe, MD, FACP. Outline. Historical and contemporary ideals of beauty and methods of body modification The obesity epidemic Ethical and policy questions. Historical Ideals of Beauty. Ancient Greeks valued symmetry

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Ideals of Beauty

and Body Modification

Martin T Donohoe, MD, FACP


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Outline

  • Historical and contemporary ideals of beauty and methods of body modification

  • The obesity epidemic

  • Ethical and policy questions


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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


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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


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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


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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)


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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?)


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Contemporary Ideals of Beauty

  • Botox injections

  • Plastic surgery

  • Abusive subjugation of women through body modification – female genital mutilation

    • Cultural components


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Ideals of Beauty

  • Brass neck rings (Paduang people of Burma)

  • Lip and earlobe expanders (certain African tribes)

  • Tattoos, body piercings, wings


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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


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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


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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


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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


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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)


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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


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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


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Cosmetics

  • Unusual ingredients include:

    • Cow colostrum

    • Gold

    • Foreskin

    • Placenta

    • Fetal cells


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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


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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.


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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


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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)


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Artificial Tanning

  • Many lotions and creams available

  • Burgeoning industry

  • “Natural” does not necessarily mean safe


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Tattooing

  • Tattoo from Tahitian word “tatau” (“to mark”)

  • Reached apogee among Maori

  • Popularized in West by sailors returning from Polynesia


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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)


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Tattooing

  • 30 million Americans have tattoos

  • Ancient practice: Maori tribesmen, Thracian women of 5th Century Greece

  • Tattooing still illegal in South Carolina and Oklahoma


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Tattooing

  • More than 50 different pigments and shades employed

    • None approved for skin injection

    • Some industrial grade printer’s ink or automobile paint


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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


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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


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Risks of Tattooing

  • Granulomas

  • Keloid formation

  • MRI complications

  • Swellings/burns

  • Image quality suffers (particularly with permanent mascara)


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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


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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


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Tattoo Removal Techniques

  • Laser treatments

  • Dermabrasion

  • Salabrasion

  • Scarification

  • Surgical Removal

  • Camouflaging


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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


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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”


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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


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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.)


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Botox

  • Most users white, age 35-50

  • 12% are men

  • In-home Botox parties; Botox scams

  • Hollywood actors


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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


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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)


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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


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Conclusions

  • Ideals of beauty: some relatively constant, others change

  • Multiple methods of body modification: some dangerous, even abusive


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Covered in Other Slide Shows

  • Cosmetic surgery

  • Female genital cutting

  • Body weight and the obesity epidemic

  • Ethical and policy issues


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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


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Re Tanning

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


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Contact Information

Public Health and Social Justice Website

http://www.phsj.org

martindonohoe@phsj.org


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