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
• 2.5-6.0% 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)
Scented Products
• Many cosmetics, perfumes, colognes, air
freshener sprays, candles, oils, and gels
contain fragrances
– Some fragrances toxic
– Many contain allergens
• 30% of Americans report skin irritation
or headaches with at least some
scented products
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
Tanning
• High sun exposure during childhood
increases risk of melanoma
• High sun exposures during adulthood
increases risk for nonmelanoma skin
cancers (squamous and basal cell)
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
–450,000 cases of basal and
squamous cell skin cancer and
11,000 cases of melanoma each
year attributable to indoor tanning in
the U.S., Australia, and Europe
–Melanoma rate up 200% 1973-2014
Skin Cancers – Other Estimates
• Skin cancers of all types rising: 1/5
Americans will get during their lifetimes
• Increased lifetime melanoma risk
–1/1500 - 1930
–1/68 – today
–Due mostly to ozone destruction, which
is reversing due to Montreal Protocol
(phaseout of CFCs)
Tanning Facilities
• Over 50,000 in US (more than the
number of Starbucks or McDonalds)
• Found at 50% of colleges
• Generate revenues of over $5
billion/yr
Tanning Facilities
• Most countries do not limit access of youths to
tanning parlors (Australia and Brazil have
banned them altogether)
• Most US states limit access of youths (bans;
parental consent)
• FDA regulates as moderate risk devices,
requires black box warning for minors (but does
not outlaw or restrict use by minors)
• 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
• Excessive indoor tanning associated with
depression, suicide attempts
• 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
• International Smart Tan Network– PR campaign
opposing the “sun scare 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, hydrocortisone, vitamin A, and
hydroquinine (used to develop
photographs)
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
• 80 million Americans have permanent
tattoos
• Ancient practice: Egyptian mummies,
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
– Red dyes most allergenic
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, syphilis, leprosy, 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
• 10% of those getting tattoo experience
adverse reactions (infections, allergies, etc.)
• > 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 (Acquired by
Actavis in 2014)
– 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
• Cold thermal injury
• 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)
• Deoxycholic acid (Kybella) – destroys
fat cell membranes (can also destroy
skin cells, if injected into them)
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