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
• 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
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
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
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 lowend retailers (takes up to 30 minutes to
lace up; requires an extra set of hands)
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?)
Contemporary Ideals of Beauty
• Botox injections
• Plastic surgery
• Abusive subjugation of women
through body modification – female
genital mutilation
– Cultural components
Ideals of Beauty
• Brass neck rings (Paduang people of
Burma)
• Lip and earlobe expanders (certain
African tribes)
• Tattoos, body piercings, wings
Ideals of Beauty
• 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
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
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
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
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)
Cosmetics
• 2004 spending = $12 billion
– 33% more than the amount needed each
year (in addition to current expenditures)
to provide water and sanitation for all
people in developing nations
– Slightly more than the amount needed
each year (in addition to current
expenditures) to provide reporductive
healthcare for all women in developing
countries
Cosmetics
• Average American adult uses 9
personal care products/day (with 126
unique chemical ingredients)
–89$ of the over 10,500 ingredients
used in personal care products
never tested for toxicity
–Little FDA oversight
Cosmetics and Hair Coloring
• Women devote average of 19
minutes per day to treating and
altering their faces
• ½ of American women between 13
and 70 color their hair
–1/8 American men between 16 and
60
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.
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
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)
Artificial Tanning
• Many lotions and creams available
• Burgeoning industry
• “Natural” does not necessarily mean
safe
Tattooing
• Tattoo from Tahitian word “tatau” (“to
mark”)
• Reached apogee among Maori
• Popularized in West by sailors
returning from Polynesia
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)
Tattooing
• 30 million Americans have tattoos
• Ancient practice: Maori tribesmen,
Thracian women of 5th Century
Greece
• Tattooing still illegal in South Carolina
and Oklahoma
Tattooing
• More than 50 different pigments and
shades employed
– None approved for skin injection
– Some industrial grade printer’s ink or
automobile paint
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
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
Risks of Tattooing
•
•
•
•
•
Granulomas
Keloid formation
MRI complications
Swellings/burns
Image quality suffers (particularly with
permanent mascara)
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
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
Tattoo Removal Techniques
•
•
•
•
•
•
Laser treatments
Dermabrasion
Salabrasion
Scarification
Surgical Removal
Camouflaging
Temporary Tattoos
• Fade after several days
• Allergic reactions
• FDA alert re risks with foreign-made
products
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”
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
Botox
• Manufacturer = Allergan
• 3.8 million treatments in 2005 (costing
$1.4 billion)
• Large direct-to-consumer ad campaign
expected
• $80/dose + physician’s fee ($300 to
$1,000)
Botox
• Most users white, age 35-50
• 12% are men
• In-home Botox parties; Botox
scams
• Hollywood actors
Botox
• Retreatments required q 3-4 months
• Side effects: masklike facies, slackness
and drooling, rare allergic reactions
• Rivals = collagen injections (from cows,
possible allergic responses), Perlane
(“natural” collagen alternative from
human tissue), Myobloc, fat injections,
face lift/eyelid surgery
Dermal Fillers
• Alternative to botox
• 33% increase in use compared to 2001
• Cow collagen, liquid silicone, plastic
microbeads, synthetic bone and
ground-up human cadaver skin
(association with for-profit tissue
banks)
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
Conclusions
• Ideals of beauty: some relatively
constant, others change
• Multiple methods of body
modification: some dangerous,
even abusive
Covered in Other Slide Shows
• Cosmetic surgery
• Female genital cutting
• Body weight and the obesity
epidemic
• Ethical and policy issues
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
Contact Information
Public Health and Social Justice
Website
http://www.phsj.org
martindonohoe@phsj.org