When less painful but equally effective variations on existing beauty treatments enter the market, they quickly assume a position of dominance. Women and men who want to enhance their physical appearance do not automatically seek out the most painful way of doing so.  The proposition conflates a means of achieving sexual gratification with the gratifying act itself. A masochist finds erotic pleasure in being subjected to pain, irrespective of the ultimate purpose of that pain. Likewise, a sadist will inflict pain to achieve pleasure, without feeling that his actions require further justification or purpose.  A surgeon will design his procedures so that a patient will suffer an absolute minimum of pain and discomfort. A medical professional would likely be subjected to professional disciplinary measures if it were to become apparent that he derived gratification from the unavoidable pain sometimes endured by his patients. The consequences of a medical intervention sometimes mean that a patient will experience pain, but this is not evidence for the existence of underlying sadomasochistic motives.  Put simply, individuals with more typical sets of sexual desires regard cosmetic treatments as a means of achieving gratification, not the end in itself. Pain and infirmity take on great significance when an individual decides whether he wants to undergo cosmetic enhancement. The psychological screening that cosmetic surgeons employ is likely to detect individuals for whom pain and sexual pleasure have become interchangeable.  As side opposition’s third point will demonstrate, states permit individuals to consent to dangerous cosmetic procedures precisely because the risks inherent in these practices can easily be subjected to third party scrutiny.  Cosmetic surgery and beauty products exist in public, and are open to regulation and oversight. The bedroom, the basement and the private members club are, by contrast, concealed and secretive.