Despite the ubiquity of cosmetic procedures, the associated physical and psychological risks can be significant, as Insight discovers.
Every year, Australians spend around $1 billion on cosmetic procedures. Approximately 8,000 people undergo breast augmentation surgeries, while 30,000 will opt to have excess deposits of fat removed with liposuction procedures.
Anti-wrinkle injections, dermal fillers, and procedures are also among the most sought-after methods for Australians to change the way they look.
But the quest for perfection is not without risks – both physical, and psychological.
As Insight looks at whether cosmetic procedures are becoming normalised for young people, what emotional and bodily toll can these surgeries have?
“The infatuation or the desire with beauty is not something new, it's not something that's special to our society,” says Dr Gazi Hussain, a plastic surgeon and Vice President of the Australian Society of Plastic Surgeons.
What is new, however, is the availability of procedures to achieve these desires. Dr Hussain says for the most part, minor practices have become increasingly safer: “I'm not talking about major surgical interventions but I'm talking about injectable treatments are by and large relatively safe,” he tells Insight’s Jenny Brockie.
Botox injections have been used for around 50 years, and while mishaps are rare, the injections do contain botulinum – a bacterial neurotoxin that can cause botulism-like symptoms (muscle weakness, vision, speaking, breathing and swallowing problems) if it spreads to other parts of the body when incorrectly administered.
Every year, Australians spend $350 million on such anti-wrinkle reduction procedures that contain botulinum.
Dermal fillers, another injectable, have been around for about 15 years and are used to change the shape and size of lips, jaw lines, cheeks and other facial features. The non-permanent ones, lasting around 12 months, are usually low-risk. “Most of them are made from a substance called Hyaluronic acid,” says Dr Hussain, “which basically is a substance found in our bodies so this filler does get broken down.”
Permanent fillers, however, are more prone to long-term side effects and problems can also be caused if filler is accidentally injected into a blood vessel.
These relatively safe alterations can give way to more major surgical interventions.
“It's a slippery slope,” says Sarah McMahon, a clinical psychologist specialising in issues around body image. “In that you can start with one procedure, which is easy and accessible, and that can snowball and become more and more invasive because we become more immune to what we're actually doing to ourselves.”
It's a slippery slope, in that you can start with one procedure ... and that can snowball and become more and more invasive.
The Medical Board of Australia defines major cosmetic and surgical procedures as ones that “involve cutting beneath the skin.” They give examples of breast augmentation, breast reduction, rhinoplasty, face-lifts and liposuction.
The Board has recognised the safety risks associated with these treatments, recently introducing new guidelines that mandate a mandatory seven-day cooling off period for all adults considering a major cosmetic procedure, and a three-month cooling off period with psychological counselling for under-18 year-olds considering one. These come into effect on the 1st October 2016.
Despite the ubiquity of cosmetic surgery, deaths and life-threatening complications linked to procedures are not uncommon.
Last year, two women in their early twenties went into cardiac arrest during breast augmentation surgeries in NSW. In 2008, a South Australian woman died from multiple organ failure after contracting gangrene during a liposuction treatment.
In 2016, a Victorian man died from complications after multiple procedures in Malaysia, and the previous year a Gold Coast woman died undergoing a Brazilian butt lift in Mexico. The Australian Society of Plastic Surgeons warns against overseas cosmetic tourism, and notes many experiences require further corrective surgery upon return to Australia.
"There are risks associated with any form of cosmetic surgery and before someone undertakes that, they need to be satisfied that those risks are as low as possible,” says Dr Hussain. “And that they're having it done in the best possible environment for themselves."
A psychological toll?
Sarah McMahon is concerned about the mental health impact cosmetic surgery can have, particularly for young people.
“I do wonder in years to come if we'll look back at this generation and liken it to other periods of history when we had beauty ideals that were harmful for people,” she says.
“I think one of the issues here is the fact that if surgery is being sought for reassurance seeking, we can't fix an internal issue, a psychological issue, with a physical intervention,” she says. “So a physical intervention may result in increased self-esteem … but for a lot of people that may not necessarily be the case.”
Dr Meredith Jones, a sociologist specialising in body modification, is less worried about the impact of cosmetic alterations.
“As a culture we do many things to children under the age of 18 that permanently change their bodies, [such as] orthodontics,” she notes on Insight.
“No child who rocks up to an orthodontist and says I want my wonky teeth fixed is then sent off to a psychiatrist or to a psychologist for assessment. Our culture just accepts that it's better not to have crooked teeth.”
But McMahon points out that the normalisation of major procedures put young peoples’ right to childhood in jeopardy.
She worries physical alterations may provide short-term relief, but will ultimately feed into existing or further anxieties but reinforcing the fact those physical features were a real problem in need of fixing.
The emotional risks will always vary according to personality and experience, and Gemma Sharp, a psychologist from Flinders University who researches the motivations behind women’s choices to have labiaplasty, says the question is more about who is best suited to surgery.
“I'm all about identifying who is a good candidate for surgery, who's likely to be satisfied and who isn't,” she says. “And I think that's where we need to focus our attention because I think we've got some very satisfied candidates ... so they would be good candidates for surgery, but those people who keep going back for more surgeries, [who may] have body dysmorphia, they should be picked up at the consultation stage and given psychological referrals.”
She says initial psychological consultations before any procedures are crucial.