Professionals, practitioners and beauty norms

28 Bedford Square, London, London WC1B 3JS, Nuffield Council of Bioethics
Arts and Law, Lectures Talks and Workshops
03 - 04/06/2015

This workshop will explore how cosmetic surgery defines beauty norms and vice versa, and the role of medical professionals in developing, offering and carrying out aesthetic procedures. It will consider the extent to which deviation from the 'norm' becomes 'ill-health' and the extent to which medical professionals consider that such work is continuous with, or distinct from, medical work. The workshop will discuss the impact this has on the wider public perception of the role of the medical profession, understandings of 'patients as consumers' and what this means for consent, safety and regulation issues. The workshop will also begin to consider how 'routine' such procedures are considered to be by those using them for cosmetic reasons (for instance, different attitudes to the risks of breast implants).


‘I don’t like the way I look: the tyranny of normative discontent’
Nichola Rumsey
(Co-Director of the Centre for Appearance Research, University of the West of England)

Significant levels of dissatisfaction with appearance have been reported in more than 70% of the population.  This talk will offer a brief overview of the evidence relating to the impacts of this 'normative discontent' on the psychological wellbeing and physical health of those affected and of current understanding about the psychological factors motivating people to seek appearance enhancing surgery.  Recent research has shed some light on the short-term impacts of cosmetic surgery and on the psychological risk factors for poor post-operative satisfaction.  Ways of embedding effective pre-operative screening and postoperative follow-up into routine care will be discussed.

‘Towards the regulation of cosmetic practice’
Chris Khoo
(Cosmetic and Plastic Surgeon)

I would like to take you on a journey through my specialty of plastic, reconstructive and aesthetic surgery, and then focus on the present situation with regard to cosmetic provision.  How is an individual’s concept of personal beauty affected by the norms of society?  What are the current trends?   We’ll need to work through some definitions: for example, cosmetic and aesthetic.  Who provides treatments, and  how are practitioners trained and regulated?  Where does the law stand, and how can patients be best protected, (sometimes from themselves).  And what mechanisms are in place to control the provision of cosmetic services?  Our time will touch on  issues of  consent, safety and regulation, and I hope that we can share perceptions, and suggest ways of improving the patient experience.

‘The horror of imperfection: the web, aesthetic surgery and the perpetuation of deficient female bodies’
Rebecca Nash

Adhering to prevailing aesthetic standards is a central facet of contemporary consumer culture. How individuals do so has evolved with technologies and influence from media imagery. With growth of media and services, the latter half of the twentieth century saw aesthetic surgery procedures become both increasingly popular and largely normalised within societies. The emergence and growth of the Web has potentially altered how aesthetic surgery is researched, discussed, and pursued. The Web is the largest human information construct in history. Individuals have gone from mostly consuming various edited materials, to being producers and consumers of Web content. It is argued here that the web enables employment of what Wegenstein and Ruck (2011) term a cosmetic gaze, on a scale not previously seen.

This study employed multimodal critical discourse analysis (MMCDA) of multiple Web spaces - gauging a snapshot of how aesthetic surgery is represented online. Online news content, surgery provider websites, online discussion forums, and online video content were examined. Across a two-month period, 165 articles were retrieved from English language online news sources, along with 78 forum threads consisting of 1136 total posts, data from 10 aesthetic surgery provider websites - UK-based and international ‐ and 10 of the ‘most viewed’ videos from YouTube located using keywords ‘cosmetic surgery’.

It was found that the Web is visually and linguistically producing and eliciting responses from individuals and companies that denigrate female bodies in different ways. Altered bodies are positioned in contrast to unaltered bodies, judged unworthy of praise due to perceived lack of labour, such as exercise. Pre-surgery unaltered bodies are problematised through the construction of multiple physical flaws. Post-surgery bodies are critically discussed as either successes - usually when the results of surgery is invisible - or failures if the results look ‘fake’ or procedures have been botched. Bodies judged as excessively altered are turned into a spectacle of horror to be derided by users. Injuries sustained during botched procedures were often focused on - with photographic evidence playing a central role in sensationalising stories. Although there were some exceptions where individuals were praised as ‘natural beauties’, they remained a small minority.

Aesthetic surgery in some spaces is advocated as a solution to perceived imperfections and low body image; in others, it is driving low body image. Bodies that have undergone - or are perceived to have undergone - aesthetic surgery are variably applauded for being ‘improved’, criticised as ‘fake’, or derided as deservedly ‘grotesque’ if something goes wrong. Web users are faced with spaces that do not provide a cohesive or consistent representation of ideal bodies or aesthetic surgery, but perpetuate the notion that female bodies are aesthetically deficient altered or unaltered.

‘Beauty and the beast: exploring the relationship between childhood bullying and beauty values’
Kirsty Lee

In this paper, I will discuss what is known about the relationship between bullying by peers and attitudes towards cosmetic surgery. It is well known that messages about beauty in modern culture are pervasive. It is no surprise then that body dissatisfaction starts early. Body dissatisfaction is particularly prevalent in females, who are not only exposed to these omnipresent messages from a young age, but also receive more personal comments and judgements about their appearance. Despite these cultural influences, body satisfaction or esteem is distinctly damaged by another source –peers. Evidence suggests there is a bi-directional and long-lasting relationship between peer victimisation and negative body perceptions. For example, victimisation in adolescence predicts body shame in adults, and evidence is now highlighting a link between teasing and cosmetic treatments. The prevalence of teasing in patients undergoing a cosmetic treatment is approximately 40%. As females are much more likely to have a cosmetic treatment, the majority of research has thus focused on them and we know little about males. A point of interest is that generally males with actual or perceived lower body mass indexes (BMIs) are more likely to be victimised, and males with lower BMIs appear more accepting of cosmetic treatments. In an attempt to further explore the relationships between bullying, body esteem, and interest in cosmetic treatments, I am conducting a study on children aged 11-16 years. The key research questions are: Does bullying predict interest in cosmetic treatments in 11-16 year olds? Is the effect direct or is it mediated by perceived attractiveness or body esteem? Compared to victims, are bullies and bully-victims more or less interested in cosmetic treatments, and how do they differ from neutral children? What value do children involved in bullying place on beauty ideals (attractiveness and weight) for themselves, their friends and romantic partners? Do these values differ from neutral children? And does sex, age, or self-esteem moderate any of the relationships? I will discuss the existing research on these questions, where research exists. By examining these relationships more closely, we can better understand the extent to which bullying is a driving factor in a person’s interest in cosmetic treatments. It might then be possible to offer psychological interventions to individuals with treatable psychological disorders, rather than reinforcing the belief they are not good enough as they are.

‘Beauty in fashion’
Carolyn Mair
(Psychology, London College of Fashion)

Fashion is an important global economy, worth approximately 1.8 trillion US$ in 2013. It exerts a powerful and pervasive influence on individuals’ daily life and helps shape the expression of their identity for the better and for the worse. Exposure to fashion images in which idealised, and often digitally altered, female bodies of typically thin, young, “flawless” Caucasians has been linked with appearance dissatisfaction. This presentation will discuss the psychological implications of this situation and the attempts to alter body and face adopted by those influenced by such exposure.

Female genital cosmetic surgery (FGCS): A gynaecologist’s view’
Sarah Creighton
(Consultant Gynaecologist and Honorary Clinical Professor, University College London Hospitals)

Gynaecologists and plastic surgeons are increasingly likely to be consulted by women and girls seeking surgical treatment for perceived genital abnormalities. Most commonly requested is a labiaplasty where the labia minora are reduced in size by the removal of a strip or wedge of labial tissue. The primary motivation for women requesting labiaplasty is concern about genital appearance although practical difficulties with hygiene, discomfort during sex and tampon insertion as well as discomfort with exercise and tight clothing are often mentioned. Female genital appearance is variable and depends upon the relative sizes and shapes of the labia majora and minora, clitoris and vaginal introitus. There is limited scientific research on female genital anatomy but small studies have shown that most women seeking labiaplasty have labia minora that fall within normal limits

There are no accurate data on the total numbers of procedures performed. NHS labiaplasty figures rose five fold between 2000 and 2010. Recent numbers of NHS procedures have decreased although this is likely to be due to a change in commissioning health care rather than reduced requests for surgery. Labiaplasty is now listed as a “procedure of uncertain benefit” and requires specific justification from the surgeon for each individual case. Even prior to this designation the majority of labiaplasties were performed in the private sector.  The exact number of private cases performed is unknown as there is no requirement for surgeons in the private sector to record numbers performed. Widespread advertising by the large number of private clinics suggests that labiaplasty is easily accessible and frequently performed.

There are currently no controlled trials or prospective studies investigating the clinical effectiveness or risks of labiaplasty procedures. Available studies offer scant descriptions of methodology and are usually authored by the operating surgeons resulting in little independent evaluation. There are no data on the efficacy of treatment for functional problems, and pre- and post-surgical symptoms such as physical discomfort, appearance and sexual dissatisfaction are difficult to assess. Where labiaplasty is performed for cosmetic reasons, the evidence of efficacy comes mainly from responses to questions from the surgeons. Short-term satisfaction rates of up to 100% have been claimed, but there is no robust evidence to substantiate this conclusion.  Whilst short-term risks such as infection, bleeding and wound dehiscence are reported, there are no data on other potential physical and psychological risks such as revision operations for dissatisfaction with the initial result. Long-term impacts such as damage to genital sensitivity and sexual function and an increased risk of perineal trauma during vaginal delivery have been mooted but not explored

 Clinicians should provide women and girls with accurate information on the normal genital variation and also on the lack of data on the risks and outcomes of surgery. Simple measures to alleviate genital discomfort may be of benefit.  Counselling and short-term, focused psychological treatments for body image distress, sexual difficulties and low self esteem are available. Labiaplasty should not be performed in girls under the age of 18 years to allow completion of pubertal development. If adult women chose to undergo labiaplasty, fully informed consent is mandatory as is the case for all surgical procedures. Further research is required to establish normal variation for external genitalia and to set objective measures for the success and long-term risks of all FGCS procedures including labiaplasty.

‘It’s not what I need, it’s what I want’
James Partridge
(Chief Executive, Changing Faces)

Insights from 23 years of supporting people with disfigurements (including those whose cosmetic surgery produced undesired results) will underpin this talk. I will review the decision-making of patients (not consumers) seeking reconstructive surgery or other treatments which are intended to improve their face’s (or body’s) functioning or appearance and how that choice-making can be enhanced by clinical teams and professionals. I will then discuss whether the purchase of ‘retail cosmetic surgery’ alters the prerequisites for good and safe choice-making and consenting and what this means for the training, regulation and information-giving/advertising by the retailers. What are the implications for the next Government in taking forward the recent Keogh Review proposals to improve the safety of the beauty industry?

Join the network

We would like to encourage anyone interested in this area to join the BeautyDemands network. Our aim is to promote cross-disciplinary academic engagement in public and policy debate on topical beauty issues. We are interested in bringing together scholars, policy makers, practitioners, activists and others who work in the area of beauty norms, practices and body-image. We will be doing this by hosting four workshops, but also by promoting virtual discussion via Twitter (@beautydemands, #beautydemands) and the BeautyDemands blog. To express your interest in joining the network and writing a blog, please contact us on

Please note, while many of those in the network take a particular stand on beauty issues the network aims to facilitate open and respectful debate and discussion. It aims to welcome those with all views and to encourage exchange of views and does not endorse one single perspective.