Ideals of Beauty
and Body Modification
Martin T Donohoe, MD, FACP
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
“Ugly”
• Common first name in Ancient Greece,
parts of sub-Saharan Africa
• Idea: give children bad names so demons
won’t find them
• Other favorites: “Disagreeable,” “Crippled”
Historical Ideals of Beauty
• Scarification – dates back at least 4,000
years
• Chinese foot binding
– pain, osteoporosis, falls/imbalance
– Surgery to reshape women’s feet for
stiletto heels increasingly popular
• Ancient Greek newborn female baby
wrapping
Historical Ideals of Beauty
• Ancient Roman women colored their lips
with red cinnabar stone, a type of mercury
ore, lined their faces with white lead, and
rouged their cheeks with red lead
• Ancient Egyptians/Roman/Persians:
antimony for conjunctival sparkle
• Rome to medieval Europe: paleness
preferred
Historical Ideals of Beauty
• Renaissance women used leeches on
their ears to drain blood from their
faces for a fashionably pale complexion
• Elizabethan hair plucking, ceruse
makeup
• Elizabethans used lard to set wigs,
which could result in rat infestations
Historical Ideals of Beauty
• 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/Spanx
– Making a comeback at both high- and lowend retailers (takes up to 30 minutes to
lace up; requires an extra set of hands)
Historical Ideals of Beauty
• Unibrow:
– Sign of criminal tendencies in
Victorian England; mark of beauty in
contemporary Iran
• 19th Century: Vacuum pumps and
vibration therapy for baldness/”flabby
skin”; mercury-based freckle remover
Historical Ideals of Beauty
• Efik people of the Nigerian coast,
others: fattening rituals
• Breast implants (since 1903 Charles Miller, MD)
–First silicone breast enlargement
1962
Contemporary Ideals of Beauty
• “Better Baby Contests” – Eugenic Movement
/ Social Darwinism
– Today – “Baby Bangs”
• Tapeworms (Maria Callas)
• Rib removal (Cher?)
• Prostitutes using diuretics (for weight loss),
child sex workers forced to take
dexamethasone (to look older, “curvier”)
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 (actual
increase ½ cup size), can cause
broken blood vessels, 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
have higher self-esteem, date more, get
higher grades, graduate from college,
get married, be hired, get paid more
(including tips), and be promoted
sooner
• Lifetime earnings difference between
the typical “good-looking” and “below
average-looking” worker = $230,000
The Perks of Beauty
• Height is associated with income and
leadership positions
– Ironically, 50 years ago some women were
treated with estrogen to prevent them from
growing too tall and becoming unmarriable
– This impaired their fertility, among other
consequences
• 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
The Adonis Complex
• 38% of men want bigger pectorals; 34%
of women want bigger breasts
• Each year, men spend over $2 billion
on health club memberships and $2
billion for home exercise equipment
• Tommy John surgery
– To enhance elbow strength and improve
pitching velocity
Anabolic Steroid Abuse
• Supplement industry booming
• 3 million American men have
swallowed or injected anabolic steroids
since they became widely available in
the 1960s
Anabolic Steroid Abuse
• 5.9% of current middle and high school
students have used anabolic steroids (100%
increase over last 6 years); rates higher
among boys
– Use associated with violent behavior
• 35% use protein powders/shakes to build
muscle
Adonis Complex of the Middle
Aged and Elderly
• “Low T (testosterone) Syndrome”
• Hypogonadism is a real disorder, but “Low
T Syndrome” manufactured by drug
companies to treat those with stunted
libidos and depressed mood
– “Treatment” carries increased risk of
cardiovascular disease, BPH, prostate cancer
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
• Worldwide annual spending around $19
billion ($8 billion in US)
– 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 reproductive
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
• Most contain carcinogens and/or endocrine disruptors
(see http://www.cosmeticsdatabase.com/)
• Unusual/dangerous ingredients include:
– Mercury – skin creams
– Lead – lipstick and kohl (decorative black eyeliner,
alleged to help children’s eyes develop and protect
them against curses)
– Arsenic, Cadmium, Copper, aluminum
– Bacteria – mascara
Cosmetics
• Unusual/dangerous ingredients include:
– Mica (lung-damaging particles)
– Cow colostrum
– Gold
– Foreskin
– Placenta/Fetal cells
– Paint stripper and varnish - eyeliner
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
Hair Care Products
• African-American “hair relaxers”
contain endocrine disruptors
– Use increases risk of uterine fibroids,
cancers
• Brazilian Blowout hair straightening
products contain formaldehyde
(possible carcinogen)
Cosmetics
• 2013: EU bans sale of all
cosmetics tested on animals
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.
Tanning
• UVA and UVB dangerous
• Ozone damage allows greater UV radiation
exposure
– Estimated lifetime risk of melanoma 1/70
• Clouds filter out only 20% of sun’s UV rays
• Snow reflects up to 80% of UV rays (sand 17%)
• White T-shirt has SPF 7 (min 15 recommended);
darker shirts have higher SPFs
Artificial Tanning
• 36% of adults, 25% of teens, and 55% of
college students use a tanning lamp each
year (females more than males)
• More than 90% of users are aware that
premature aging and skin cancer are
possible complications of tanning lamp
use (melanoma and basal cell)
Artificial Tanning
• WHO: tanning beds cause cancer
– 419,000 cases of basal and squamous
cell skin cancer and 11,000 cases of
melanoma each year attributable to
indoor tanning
• Skin cancers of all types rising: 1/5
Americans will get during their lifetimes
Tanning Facilities
• Over 50,000 in US (more than the
number of Starbucks or McDonalds)
• Generate revenues of over $5
billion/yr
Tanning Facilities
• Most countries do not limit access of youths to
tanning parlors
• Most US states limit access of youths (bans;
parental consent)
• FDA advisory panel has recommended
increased regulation, including restricting use to
adults
• Indoor 10% tanning tax implemented in 2010 as
part of PPACA (Obama Health Care Plan)
Tanning
• Tanning as a substance abuse-like
disorder
– Associated with other addictions
• Tanning produces endorphins
– some contain fragrances – can cause
allergic reactions
– Sprays may damage lungs
Tanning
• Mineral sunscreens best (Zn or Titanium);
lotions and creams do not necessarily
protect against UVA)
• Use SPF of at least 15 and re-apply
frequently
– Avoid benzophenone (aka oxybenzone,
estrogenic); avobenzone is safer
Artificial Tanning
• Many lotions, creams, and sprays
available
– Most contain dihydroxyacetone (DHA) – can
damage DNA and lungs and cause allergic
reactions
• Burgeoning industry
• “Natural” does not necessarily mean safe
• See EWG database
Artificial Tanning
• Increased (but not excessive) carotenoidcontaining fruit and vegetable
consumption can improve skin color
• Tanning pills (not approved for use)
containing canthaxanthin dangerous
• Skin lightening creams may contain
mercury
Tattooing
• Roman Empire used to brand
convicts, slaves, and army deserters
• 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
– 40% of Americans between 26 and 40
• Ancient practice: Maori tribesmen,
Thracian women of 5th Century
Greece, Moors)
• Tattooing still illegal in South Carolina
and Oklahoma
Tattooing
• More than 50 different pigments and
inks employed
– Many contain heavy metals,
phthalates, other endocrine
disruptors and carcinogens
– Some contain industrial grade
printer’s ink or automobile paint
Tattooing
• FDA considers inks to be cosmetics
(premarketing safety evaluation
required)
• FDA considers pigments to be “color
additives” (no premarketing safety
evaluation required)
Risks of Tattooing
• Tattooing associated with risky
behaviors in adolescents
• Infection
– e.g., Staph, Strep, Mycobacteria, hepatitis
B, C, and HIV (HIV risk theoretical – no
cases identified to date)
– Am Assn Blood Banks requires one-year
wait between getting tattoo and donating
blood
• Allergic reactions
Risks of Tattooing
•
•
•
•
•
Granulomas
Keloid formation
MRI complications
Swellings/burns
Image quality suffers (particularly with
permanent mascara)
• Removal problems
The Most Common Problem:
Dissatisfaction
• > 1/3 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 (photothermolysis)
– Requires multiple treatments
•
•
•
•
•
Dermabrasion
Salabrasion
Scarification
Surgical Removal
Camouflaging
Temporary Tattoos
• Fade after several days
• Allergic reactions
• FDA alert re risks with foreign-made
products
• Freedom-2 Ink, Infinitink: Biodegradable dye
capsules – when zapped by laser, dyes
absorbed by body and tattoo disappears
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”
– Color can last for more than a week
Body Piercing
• 36% of Americans
• Women > Men
• Complications: 20-40%
– Skin irritation and infections most common
Body Piercing Complications
• Other complications include auricular
chondritis, nasal cartilage destruction,
abscesses, contact dermatitis, bleeding, bladder
infections, dental trauma, and other secondary
trauma
• Death rare
• Avoid shopping mall kiosks
• Unclear if prophylactic antibiotics helpful
The Fringes
• Snail slime facials to make skin soft (South
America)
• Nightingale dung facials to bleach and
brighten skin (Japan, “The Geisha Facial”)
• “Vampire Facelift”: patient’s own blood
injected into face to smooth out wrinkles
• Face slapping by massueses
The Fringes
• Merkins (pubic hair wigs – used
throughout history – allow male actors
to play females; hide STDs; decorative;
etc.)
• Pubic hair implants (abundant pubic
hair associated with fertility in South
Korea)
The Fringes
• Anal bleaching
– Initially porn stars and sex workers
– Now available to general public for
$75/treatment
– Can cause eczema
• Red labial dye (“My New Pink Button”)
The Fringes
• Money: Jim Nelson auctioned off his
head on eBay for a corporate logo
tattoo in 2003
• Others sell tattoo space on their bodies
Botox
• Botulinum toxin:
– Cause of botulism
– potential biowarfare/bioterror agent
• Medical Uses: blepharospasm, spasmodic
torticollis, migraines, back spasms, chronic
pain, axillary hyperhidrosis, BPH, autonomic
disorders, wrinkles due to normal aging
• Unlikely to work on sun- or smoking-induced
wrinkles
Botox
• Manufacturer = Allergan
– Allergan also markets Latisse
(bimatoprost, the same ingredient in the
glaucoma treatment Lumigan) for topical
“treatment” of “hypertrichosis of the
eyelashes” (eyelash transplant alternative)
– Myobloc, Dysport, and Xeomin (other
botulinum neurotoxins)
– -Limited standardization
Botox
• 4.8 million procedures in 2009
• Large direct-to-consumer ad campaign
– Olympians Mark Spitz, Nadia Comanici
involved
• $80/dose + physician’s fee ($443 avg.)
Botox
• Most users white, age 35-50
• 12% are men
• In-home Botox parties; Botox
scams; counterfeit Botox
(ineffective and/or dangerous)
• Hollywood actors
Botox
• Retreatments required q 3-4 months
• Side effects: muscle weakness, masklike
facies, drooling, slurred speech, aspiration,
dysphagia, dysnpnea, rare allergic reactions;
may spread via neurons back to spinal cord
or even CNS
– 87 hospitalizations, 16 deaths reported
1997-2006
– FDA boxed warning 2009
Rivals to Botox
• Collagen injections (from cows,
possible allergic responses)
• Perlane (“natural” collagen alternative
from human tissue)
• Fat injections
• Face lift/eyelid surgery
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)
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
• Risks
– Include renal failure, retinal artery
occlusion
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
Re Tanning
• See slide show by Anuru and Salmon on
risks and regulations related to indoor
tanning at http://phsj.org/?page_id=10
Contact Information
Public Health and Social Justice
Website
http://www.phsj.org
martindonohoe@phsj.org