15 November 2018Last updated

How should we feel about cosmetic surgery?

Cosmetic surgery is more popular, attainable and socially acceptable than ever, but is the ability to transform our appearance with the slice of a knife a double-edged scalpel?

Tabitha Barda
20 Oct 2015 | 12:00 am
  • We are constantly urged by the media to ‘be the best that we can be.

    Source:Corbis Images Image 1 of 5
  • Tess Holliday, the largest plus-size model to be signed with a mainstream agency.

    Source:Supplied Image 2 of 5
  • Blogger Rachel Hollis’s picture of her post-baby bikini body, which went viral.

    Source:Supplied Image 3 of 5
  • Lizzie Velásquez, motivational speaker who suffers from a genetic disorder that prevents her from putting on any body fat.

    Source:Corbis Images Image 4 of 5
  • Newly launched UAE-based modelling agency Recto Verso is the first of its kind to have plus-size models on its books.

    Source:Supplied Image 5 of 5

How far would you go in the pursuit of beauty? Face cream, hair colour, make-up? Yes, obviously. Whiten your teeth? Sure, it’s practically basic dental care nowadays. What about a spot of Botox, maybe a cheeky bit of filler? Hmm, well, everyone else seems to be doing it... So then, how about a facelift? Liposuction? A little scrape with the scalpel? A quiet nip and tuck?

We’ve all got our limits when it comes to chasing perfection, but there’s no doubt they have shifted in recent years. In fact, if you haven’t already had one of these more invasive procedures, it’s almost inevitable that you will at some point. Not because you’re excessively vain, or because you hate yourself the way you are. But for the same reason that you might use concealer or colour your grey hairs: because almost every other woman will be doing it (and no one wants to have the saggiest face on the school playground).

The new normal

There’s no getting away from it: plastic surgery has gone mainstream. More than 22 million surgical and nonsurgical procedures were performed worldwide in 2013, according to the most recent figures from the International Society of Aesthetic Plastic Surgery, and the number of nips and tucks we underwent increased by a whopping 197 per cent over the past 15 years, say 2012 stats from the American Society for Aesthetic Plastic Surgery (ASAPS). The UAE is paving the way in the Middle East, fast becoming a plastic surgery hub: an estimated billion dirhams was spent on cosmetic surgery in the country last year, according to the Emirates Plastic Surgery Society (EPSS), and it now boasts more plastic surgeons per capita than any other country in the world. And this looks set to grow – the Dubai Health Authority has announced that the emirate is looking to attract some half a million medical tourists per year by 2020.

Globally, our attitude to plastic surgery has transformed too. Where women once would do anything to hide the fact they’d ‘had work done’, the taboo associated with even the most drastic of procedures has diminished dramatically, with reality TV shows like Extreme Makeover demystifying and normalising the process. Plus, the refinement of surgical techniques (no more bolt-on breasts or one-size-fits-all noses) and new post-payment credit plans mean that what used to be the domain of the Beverly Hills brigade has become more desirable and attainable than ever.

We’re also nothing like as judgemental as we used to be about those who opt to go under the knife. In a 2011 study by ASAPS almost 53 per cent of women said they approve of cosmetic surgery, and 67 per cent of people said they would not
be embarrassed if their friends and family knew they’d had something done – stats that would be unimaginable just 10 to 20 years earlier, when our only popular frame of reference for such surgery was the poignant plasticity of Michael Jackson’s face.

In the same way that using hair dye or make-up used to have negative associations until the mid-to-latter 20th century, the stigma that used to be attached to anyone ‘shallow’ enough to get cosmetic surgery has evaporated, and celebrities are now more likely to come under fire on social media for ‘letting themselves go’ than for having lipo.

But perhaps most significant of all is the fact that cosmetic surgery is not just the domain of the super-rich, the super-famous or the superficial any more. We are – all of us – constantly urged by the media to ‘be the best that we can be’, and plastic surgery has become something that we ‘deserve’ on this never-ending quest, whether we’re a supermodel, a CEO, or a stay-at-home mum.

“Newer generations [of women] feel they have earned the right to be successful and look their best,” says New York therapist Vivian Diller, quoted in an article for The Atlantic that outlines how plastic surgery is no longer incompatible with being seen as intelligent or worthy of respect.

It seems that in our hyper image-aware, Instagram-obsessed world, we all now feel entitled to a surgeon-given right to what must be the modern-day definition of success and happiness: perfect selfies, every time, from every angle.

Plastic-fantastic world

Plastic fantastic?

So how should we feel about this new plastic-fantastic world? Is it empowering that we can take control of our appearance and overrule the plans that time or our genes had in store for us?
Or are we feeding the beast – colluding with those who perpetuate the sense that we aren’t good enough as we are, in order to peddle medically unnecessary operations?

A preoccupation with our outer appearance is nothing new, explains Dr Nic Isse, plastic surgeon at The American Surgecenter in Dubai. “An obsession with beauty is not unique to modern Western culture but can be found around the world in almost all societies that have been studied,” he says. “Every culture in the history of mankind has had its own standard of beauty, from the civilisations of ancient Egypt and the Han Dynasty, to the Italian Renaissance and Victorian England, right up until the present day. Several studies have shown that members of different ethnic groups share common attractiveness standards, suggesting that the constituents of beauty are neither arbitrary nor culture-bound.”

Indeed, many scientists believe that there is an objective formula for the ‘perfect’ face, to do with symmetry, averageness and measurements between the features. Meanwhile, countless other studies show that beauty pays dividends in every aspect of life: good-looking people have been shown time and time again to get better jobs, to be paid more, be better regarded by their peers, the list goes on… So it should stand to reason then that the modern ability to fix our noses or enhance our chests – and therefore reap the benefits of being beautiful – will make us happier and more successful, right? Not necessarily, says Dina Zalami, a counsellor at The LightHouse Arabia in Dubai. “It is a fact that the more you ‘fix’, the less confident and attractive you will feel,” she says.

Around one fifth of patients leave the operating table unhappy with the results, says a poll by, while a Swedish study found that women with breast implants are three times more likely to commit suicide than those without – suggesting not only that those undergoing the procedure are more likely to have psychiatric problems, but also that having such surgery is not the self-esteem remedy many may imagine.

Even plastic surgeons themselves are calling a halt to the flippant way in which we now view what are, after all, life-threatening procedures (and let’s just make clear that all the way through we are referring to elective, medically unnecessary cosmetic surgery, rather than surgery to correct abnormalities or to address injuries, etc). The British Association of Plastic Reconstructive and Aesthetic Surgeons has launched the Think Over Before You Make Over campaign to educate the public on safe cosmetic surgery. It has identified a number of worrying trends – including a tendency to rush into surgery without thorough consideration, and a preoccupation with keeping costs down – which have been found to leave patients less confident about their appearance after their procedure than they were before it. “One of the things we have to do is give people a reality check on what are normal human behaviours and values, and what is social pressure,” says campaign supporter and plastic surgeon Dr Mark Henley. “Not everyone is suitable for cosmetic surgery and ethical surgeons will either decline to treat, or at least recommend that a person has psychological counselling first. This is to ensure that a desire to change appearance is not part of an existing emotional problem that no amount of surgery can correct.”

Plastic Surgery 

Unrealistic ideals

The helpful-versus-damaging impact of cosmetic surgery is all down to the patient’s state of mind, says Dr Saliha Afridi, managing director of The LightHouse Arabia. “There are many people who use plastic surgery or non-invasive measures to enhance their beauty. They do this to boost their self-image; however, their self-esteem is not solely linked to beauty and image. It is when self-esteem and self-worth are linked to their body or their image that it becomes a problem.”

Plastic surgery is not the enemy, says Dr Afridi. Rather, it is a symptom of a larger issue. “Our sense of self is not at threat because of plastic surgery, our sense of self is at threat because we have a very narrow and unrealistic idea of beauty being communicated in all forms of media,” she says.

Which brings us to the real villain of the piece: the media. “We are operating in a global culture that tells us that almost no bodies are acceptable in their natural, unadorned state,” says Sherri Irvin, presidential research professor of philosophy and gender studies at the University of Oklahoma, and a member of the worldwide academic Beauty Demands network, which assesses the pressures of beauty ideals in society.

“The message that we should constantly be viewing our bodies as a project, rather than simply inhabiting them comfortably and enjoying them, comes from the media, from advertising, and from our parents, teachers, bosses and friends.

“Standards of bodily acceptability are racialised; in the United States, for instance, physical features associated with blackness tend to be devalued by a white-dominated culture.
Signs of ageing are regarded as ugly. And, of course, people with ‘unusual embodiment,’ are constantly subjected to stares, rude remarks, and other forms of dehumanising treatment.

“In this context, most cosmetic surgery is of course connected to self-esteem or body image rather than simply being an uncoerced form of creative self-fashioning. But the individual mental states that motivate the surgery are merely symptoms of the core problem; they are not the problem itself. As for the surgery, it is an individual solution to a problem it contributes to on a systemic level: when people – especially celebrities – seek surgery to comply with standards of bodily acceptability, they contribute to the impression that bodies that don’t comply with these standards are aberrant.”

The LightHouse Arabia’s Dina agrees: “We are inundated with images of ageless beauties who have been nipped, tucked, lifted and injected in all places to maintain their youthful appearance. The media is not kind to the ageing, and so many women will find themselves feeling very insecure, undesired and unattractive at the sight of their first wrinkle or grey hair. This insecurity is observed by our children, and perpetuates the message that ‘thin and young is beautiful’.”

The impact this warped attitude to beauty is having on the young is perhaps the most worrying aspect of all of this. “Girls as young as seven are starting to be conscious of their image and one study revealed that the number-one wish for girls aged 11-17 is to be thinner,” says Dina. “In our clinic we see girls from all backgrounds, ages, religions, and cultures reporting with self-esteem problems, leading to eating disorders at worst, and disordered eating at best. When asked where they learned about such ideas, they say ‘Instagram.’ Websites that are ‘pro-Ana’ (pro-anorexia) and ‘pro-Mia’ (pro-bulimia) give long lists of tips and support-group chat rooms where young girls are teaching and encouraging each other to starve or purge. With all this unfiltered and uncensored information at their fingertips, young impressionable girls are falling into the trap of wanting to achieve an unrealistic version of beauty.”


While all of us, young and older, seem to have been whipped up into a frenzy of image-obsession that’s enabling us to justify more and more extreme behaviour, there is a small but insistent voice of dissent from ‘body positive’ bloggers and social-media users who are sticking their fingers up at our modern-day beauty standards. They are using hashtags for good rather than bad, calling for a celebration of different ethnicities, body sizes and ages.

They are people like Tess Holliday, the plus-size model and founder of the #EffYourBeautyStandards movement, which encourages people to share their images and messages of size positivity.
 They are mummy bloggers like Rachel Hollis, whose proud picture of her post-baby bikini body – with its stretchmarks and “saggy bellybutton” – went viral, with hoards of supporters applauding her refusal to feel body-shamed just because she doesn’t fit the ‘perfect’ ideal.

They are photographers like Rick Guidotti, who traded in his New York fashion photographer job, where he shot the likes of Cindy Crawford, to start up his own non-profit called Positive Exposure, for which he shoots people with a range of visible genetic conditions such as albinism, Marfan’s syndrome, Down’s syndrome and dwarfism, as part of its campaign for diversity and acceptance.

“I loved the idea of aesthetic beauty but didn’t understand why there was only one standard,” says Guidotti, whose documentary film On Beauty was released this summer. “I decided to use what I know to show people something different.”

And they are motivational speakers like Lizzie Velásquez, who suffers from a rare genetic condition that prevents her from being able to put on any body fat. Her humbling TedX talk really puts our modern beauty neurosis into perspective. She describes how she found a YouTube video somebody posted of her while she was in high school, labelling her as ‘the ugliest woman in the world’. There were four million views and thousands of comments: “People saying, ‘Lizzie, please, please just do the world of favour, put a gun to your head and kill yourself’.” But rather than let it destroy her, Lizzie decided to harness the ambivalent power of the internet and to put it to good use, bravely starting up her own YouTube channel, on which she posts uplifting messages of positivity. “I thought, ‘Am I going to let the people who called me a monster, define me?’ No. I’m going to let my goals and my success and my accomplishments be the things that define me, not my outer appearance.”

They are words we could all heed.

Encouragingly, there are signs that in the UAE we are also becoming more open-minded when it comes to beauty, with the launch of new modelling agency Recto Verso, which has models who are either plus-size or less-conventional looking on the books. “The Curve section takes a healthy approach to body image, featuring models [UK]size 12 and above, whereas our Unique section focuses on finding models with an edgy look and striking features,” says agency managing director Claire Gilbody. “We feel that this is going to change people’s perspective on beauty in a positive way. Modern beauty comes in all shapes and sizes – it just needs to be recognised more.”

The idea of being happy with who you are and finding self-acceptance might sound like hippy-dippy claptrap, but there’s evidence to back up how helpful it can be; Katharine Wright, assistant director of the Nuffield Council on Bioethics in the UK, points to thought-provoking research on teenagers with and without cleft lips and palates, which has shown that those who have had to come to terms with disfigurement actually have greater confidence in their own appearance than teenagers without any such disfigurement.

“While initially counter-intuitive, this finding correlates well with psychological research showing that, in fact, happiness with the way we look is multi-factorial, and includes factors such as resilience, acceptance of self, and the value placed on aspects other than appearance,” says Katharine.

Which is a timely reminder that plastic surgery, while not the enemy, is also not always the answer.

Yes, the media and social media might be to blame for shredding our self-esteem. But, as Eleanor Roosevelt once said, no-one can make you feel inferior without your permission.

So the next time you look in the mirror and wonder how far you’d go in the name of beauty, remember this: no matter how hard it is to love ourselves when we’re being bombarded with images of airbrushed perfection left, right and centre, we can still take responsibility for how we react to them. And we may as well strive to react in a way that brings us genuine fulfilment, rather than a temporary or superficial ‘fix’. Because, although it might feel good to be conventionally beautiful, you know what feels better? Being happy. And unlike outer beauty, inner beauty isn’t subject to the forces of time and gravity.

As Lizzie Velasquez says, “You are the person in the front seat of your car. You are the one who decides whether your car goes down a bad path or a good path. You are the one who decides what defines you.”

Are you feeling the pressure?

Counselling psychologist at The LightHouse Arabia Dina Zalami gives her advice to anyone feeling pressured by modern-day beauty standards:

Limit your exposure to all forms of media. Be around real and positive people and notice that there are lots of different shapes and sizes and looks all around you.

Find things about yourself that you like and write them down — too often we can become hyper-focused on things we do not like about ourselves or that we find more attractive in others. These things could include physical features or talents that you may have.

Instead of trying to take a fast way to beauty — put the time and effort into taking care of your body and face. The self-esteem you get from building a body in the gym cannot be attained by simply undergoing liposuction!

Don’t take it lightly, get help. If you feel you really struggle with your appearance or body weight, see a psychologist. You don’t have to suffer from poor self-image or low self-esteem,there are ways to treat these problems.

Body-positive social media accounts you should know about

Chantelle Winnie (@winnieharlow on Instagram)

Model who suffers with skin disorder vitiligo, proving that beauty comes in all shades. She believes that it is up to us as consumers of media to change what the media reflects. “If humans want to see the same types of people over and over, that’s what industries will give us. If we want to see something different that’s what they’ll have to give us.”


Lizzie Velasquez (

Author and motivational speaker who suffers from a rare congenital condition and has spoken out against bullying ever since she was dubbed “the world’s ugliest woman” by cyberbullies.


Tess Holliday (@TessHolliday and #EffYourBeautyStandards)

The largest plus-size model to be signed to a mainstream modelling agency (Milk Model Management) and a body-positive activist who campaigns for changing beauty standards.


Sarad Mahmoud and Yara Assadi (#TheHabitatiTag)

US-based Palestinian students who founded the #TheHabibatiTag movement, which hopes to promote the diverse beauty of
non-Western women and men.


The Beauty Demands network (@BeautyDemands #BeautyDemands)

Research network sharing views on beauty norms and practices, based in the UK at the University of Birmingham. 

Tabitha Barda

By Tabitha Barda

Deputy Editor