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A thought experiment: let’s abolish cosmetic surgery

By John Hubbard

John Hubbard is a retired English teacher and currently a U3A lecturer in English and Drama. High on John's list of desirable legislation is the complete abolition of cosmetic plastic surgery because of its wasteful and psychologically pernicious effects.

As the woman walked towards me on the street I felt a certain concern. She appeared to have been struck in the mouth and her face had a stiff and startled expression. The human face is a very strong and immediate communicator between us as a species, but the signals I was getting, although they initially appeared to be the result of a disturbing incident, were in fact the result of visual interference caused by dermal fillers in the lips and botox in significant areas around the face – procedures willingly undergone by her in one of rhe more than 940 such places licensed in the UK.

A few days later I explored the website on a well-known London clinic also providing these services, furnished with “before” and “after” images, and I was struck by the comparative subtlety of effect that their treatments generated, and it made me all the more anxious about the clearly variable levels of technical expertise in people providing such services. Services which, to maintain the changes to appearance, require renewal every four to six months. Very reassuring for income generation. It is also reassuring, however, to realise that this shows that such abuse of the body can right itself fairly swiftly and completely naturally in a comparatively short period. I did wonder why, if faced with a choice of looking my age or looking, frankly, alarming, I would choose to look alarming. Maybe it’s just a matter of choosing the right clinic. These two repeating non-surgical procedures are, however, immensely popular and increasingly normalised, and probably the mental gateway to much more serious interventions requiring a general anaesthetic and fortnights off work.

The field of cosmetic plastic surgery is a large one, and it generates £3.6 billion for the economy. It is almost never available on the National Health, which makes the distinction between plastic surgery and cosmetic surgery, the former being used for reconstructive purposes with people who have suffered remediable genetic abnormalities like a cleft palate, major injuries or burns or the results of radical interventions for cancer – in other words, people who have been very seriously ill or who suffer from disabling malformation.

It was the tragedy of injuries in modern warfare in the first and second world wars that led to the developments in the arts of plastic surgery that we now benefit from. Its necessity arose because of other advances in medicine which were able to tackle infection and blood loss so that many who suffered maiming injuries through shell, shrapnel, or fire survived them. This was surgery refined to give people who were prepared to make heroic personal sacrifice a tolerable life, to rebuild precious damaged faces so that they would shock less and function better. If you are interested in the story of these dedicated pioneers in surgery, I would suggest three books: The Facemaker by Lindsey Fitzharris, Faces from the Front by Andrew Bamji and The Guinea Pig Club by Emily Mayhew.

“Cosmetic surgery is a major medical intervention on people who are perfectly well, diverting highly trained individuals from caring for people who are genuinely sick.”

I mention these distinctions and this history because they are contexts that are too easily forgotten. To put it bluntly, cosmetic surgery is a major medical intervention on people who are perfectly well, diverting highly trained individuals from caring for people who are genuinely sick and acutely in need of their help. It is driven by a perverse social pressure which appears frightened by the appearance of age or imperfection and one which is monstrous in its sexist effects; annual statistics show that 93% of procedures are undergone by women. That is why I have been reluctant to bandy about the catch-all explanation of “vanity”, because if it were that simple, uptake across the genders would be closer to 50:50 rather than 93:07. One needs also to consider the very obvious fact that if cosmetic surgery is only available privately, it also becomes a marker of wealth and social status. Not appearing to age can become an ostentatious marker of privilege, although It’s obvious that a facelift has never done anything for arthritis or osteoporosis or any of the sundry other effects of the entirely natural processes of ageing.

Yet it isn’t all about age. In exploring attitudes, I was astonished to find that the age group most interested in cosmetic procedures was in fact young adults, a time when you might be considered to be at the height of your natural attractiveness and hardly in need of artificial help. Without reverting to another long whine about social media, one does, though, need to acknowledge the impact of it on the self-consciousness of a generation that seems to have been persuaded into thinking that nothing but a dull uniform perfection will do. 34% of those aged 18-24 have considered getting facial cosmetic surgery, a percentage that then, perhaps surprisingly, declines with age.

Given that we are a rather more phlegmatic nation than the Americans and have a less rapaciously developed private medical culture, I think it unlikely that cosmetic surgery will attain the grotesqueries achieved across the Atlantic, where some folk have their faces made to look like someone else, and then market themselves on that notoriety (and oh, I forgot – have ribs removed so they look more like a plastic doll). In this country it is still considered unethical to accede to the instructions of patients who are clearly seriously deluded, although it is not considered unethical to share and affirm the adventures in cosmetic surgery of one self-publicising D list celebrity after another. I also appreciate that such extremes are not typical of much of the rejuvenating re-styling that takes place, often repeatedly. Yet one of the problems of the extensive practice of cosmetic surgery is that the unnatural becomes so prevalent it normalises as a new identifiable aesthetic, and thus places more and more pressure on perfectly healthy women to accede to slicing, bleeding, bruising and stitching on an operating table. Would it be too much of a stretch of definition to see cosmetic surgery as a particularly brutal expression of misogyny; of a society in which women are persuaded that they are never good enough?

Sometimes I play a game – if you wish to be grand you can call it a “thought experiment” – in which contributors are asked what five pieces of legislation they would bring forward if they were in power tomorrow. High on my list is invariably the complete abolition of cosmetic plastic surgery because it is wasteful and psychologically pernicious. It would be no bad thing to then support the re-training of its practitioners in relation to the real needs of an NHS facing shortages of medically skilled personnel. Imagine how helpful those tens of thousands of annual operations might be if used to help those that are ill. There would of course be a counter-argument that one was robbing the economy of a good income-generator, that people would travel abroad to far less safe wielders of the scalpel. I don’t generally accept, though, that if sufficiently large amounts of money are involved something magically becomes right. I do feel that strong legislative indicators of the unacceptability of cosmetic surgery might give people pause and help change a damaging cultural attitude. A man with a knife (and it is rather often male surgeons) shouldn’t be coming anywhere near healthy women's faces, breasts, stomachs and legs.

Yet in play at the back of my mind is the case of the daughter of some friends who grew up with bundles of personality and her mother’s elegance, but who inherited from her father a nose that looked all very well on a male face but rather less so on her own, and it troubled her and made her unhappy. In my brave new world, to whom could she turn? And what about non-surgical interventions, the ones in which people trained to administer life-saving vaccines and inoculations turn their skills to promoting nerve damage with poison or making the owner of a mouth look as if they’ve just engaged in oral sex with a whole platoon of soldiers? In the first instance I would hope that in the long run we might have a more mature society in which people are supported in being happy in their own healthy skin, but in the short term perhaps allow some fairly strictly-controlled exceptions. In the second instance the general principle of forbidding the use of medical skills for non-medical purposes might reasonably extend to these practices too.

But… if 93% of the users of these services are women wouldn’t rendering them illegal be a misogynistic act in the face of perceived need? That could be an argument in itself, although it might turn on the rightness and interpretation of the word “perceived”. And of course, all of this is just a thought experiment, although its central justification at a time of a personnel crisis in the NHS is entirely serious. Maybe we should just take heart from the two-thirds of the population who say they would never consider a cosmetic procedure, and salute those who age elegantly and without fear of the skin they have lived in.

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