The Cosmetic Surgery Stigma

Abstract

Sir: Although over 15.1 million cosmetic procedures (compared with 5.7 million reconstructive procedures) were performed in the United States in 2013,1 there is, without question, a stigma in American culture attached to cosmetic surgery and a hidden condescension toward patients undergoing these procedures. Steps should be taken to address and resolve this issue. Perhaps the first step is to admit its existence. There is some resistance to accept this view in academic circles, and one possible factor is that plastic surgeons are reluctant to admit that their work may be controversial and stigmatized. Individuals who choose to undergo these procedures often find themselves condescended to or shamed, and even accused of having psychological problems, which in turn influences them to hide or deny that they have gone under the knife. Many celebrities, considered cultural icons of natural beauty, are “outed” later in their careers in a demeaning and salacious manner by the media as if surgery is a shameful secret of their past. Beauty is not skin deep, and cosmetic surgery is not superficial in terms of its impact on patients’ lives: it often addresses psychosocial issues that are deeper and more complex than pure aesthetics. Evidence has shown that patients who undergo these procedures enjoy benefits such as improved sex lives, self-confidence, and self-image.2,3 The reasons for the discomfort with plastic surgery in American culture—one that prides itself in more liberal views—remain unclear. Maybe this is a cultural phenomenon. The media often describes Iran as the rhinoplasty capital of the world, perhaps because of the Persian cultural acceptance and endorsement of the pursuit of a higher aesthetic ideal. Brazil is the country in which the second largest number of cosmetic surgery procedures are performed4; there, the public perception is that plastic surgery improves one’s self-image and quality of life.5 Perhaps the stigma in American culture has to do with disrupting antiquated, classicist ideals that beauty is something with which one is born. The compelling slogan “Maybe she’s born with it?” (Maybelline, New York, N.Y.) comes to mind. If beauty is bought or assisted with surgery, does that somehow cheapen it and devalue its luster? As advocates for our patients, intervening steps should be taken to address this problem. The media are in part responsible for perpetuating this stigma. Rather than stigmatizing plastic surgery, media messages can foster acceptance and more realistic views about individuals who make this choice. If patients and the celebrities serving as culture’s tastemakers and role models are more confident and transparent about their decisions, we may experience a paradigm shift in the field. From an academic standpoint, more education needs to be provided to explain the potential psychosocial benefits of plastic surgery in patients’ lives. Academics from both surgery and psychology backgrounds can collaborate to change harmful public perceptions. Until we can recognize the stigma plaguing our field and pursue means of reversing the detrimental perceptions about plastic surgery, the empowerment inherent in the choice to enhance self-image is muddled with the shame that can haunt our patients. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. Saba Motakef, M.D. Department of Plastic Surgery Loma Linda University Loma Linda, Calif. Sahar Motakef, M.A. Graduate School of Education and Psychology Pepperdine University Malibu, Calif. Michael T. Chung, M.D. Department of Surgery Division of Plastic, Maxillofacial, and Oral Surgery Duke University Durham, N.C. Michael J. Ingargiola, M.D. Department of Surgery Division of Plastic and Reconstructive Surgery Mount Sinai Hospital New York, N.Y. Jose Rodriguez-Feliz, M.D. Department of Surgery Division of Plastic Surgery Albany Medical Center Albany, N.Y.