# Issues in Interdisciplinarity 2020-21/Power in Plastic Surgery
## Introduction

Cosmetic surgery is a speciality of Plastic surgery that focuses on improving or rejuvenating one's external appearance. In the last couple of decades, the percentage of people undergoing plastic surgery has grown significantly, with an increase of 446% in the United States in only one decade. This Wikibooks Chapter will scrutinize several power dynamics that can help us understand this growing phenomenon and examine the interdisciplinary tensions, inherent to the controversial nature of this practice. Currently, disagreements regarding the social and psychological implications, hinder communication between disciplines. However, an interdisciplinary perspective may be the best approach to understanding its increasing popularity and the power dynamics involved.

## Disciplines
### Medicine

Western beauty standards play a crucial role in the plastic surgery industry. Recently, some surgical cosmetic interventions have drawn the attention of sociologists because of the racial implications they carry, as they seem focused on pursuing western beauty standards by erasing physical characteristics typical to a certain racial group. The main procedures include:
Double fold eyelid surgery: Often referred to as “Asian blepharoplasty”, this surgery consists in creating a fold in the upper eyelid to form a slight furrow, making the eye seem wider. This surgery could be interpreted as a way to appear more caucasian, proving the racial alienation exercised by western influence.
Whitening treatments: In most eastern countries there is a considerable link between beauty and pale skin. There is a wide variety of products which aim to reduce the skin colour, such as makeup, whitening creams, and melanin-reducing injections. While some argue there is no correlation between the desire for pale skin and western beauty standards and relate this to skin colour reflecting social status, it can be interpreted as a manifestation of the hegemony of European beauty ideals nowadays. Lastly, there are some surgeries which, although not directly related to western body traits, can be interpreted as a pursuit of western beauty standards. For example, nose reshaping surgery, where Asian women look for a high-bridged narrow nose, which strands further from the average Asian nose, with a flatter nose bridge and wider nostrils. Other examples are breast augmentation or jawline reduction.

### Psychology

Psychology can shed light on the motivators behind the desire to transform one's body, such as low self-esteem and an amplified perception of the interconnectedness between one's body and identity. These characteristics often surface as body dissatisfaction, which can start developing during childhood. Puberty related body transformations, appear to particularly influence young girls, as studies suggest, girls who start menstruating earlier are more likely to develop and maintain a negative body image. The speed at which these changes take place, make the new features seem more prominent, resulting in self-consciousness increasing, and all body-related comments having a greater impact on the subject.
Body dissatisfaction, in itself, is becoming more prevalent, to such an extent that it is being accepted as a normative discontent. This has made recognising body image disturbance, a more serious form of body dissatisfaction, increasingly challenging. This often appears as a symptom of psychiatric disorders, such as body dysmorphic disorder, narcissistic personality disorder and histrionic personality disorder.
People suffering from such disorders, perceive cosmetic surgery as a tangible solution to an intangible problem, yet such unrealistic expectations can result in cosmetic procedures causing more harm than good. Further psychiatric symptoms may arise after surgery, such as depression, anxiety and self-destructive behaviour, and studies have even suggested, undergoing breast augmentation is correlated to increased suicide rates.

### Sociology

The sociological perspective observes that people associate beauty with positive traits. Thus, cosmetic surgery is increasing in popularity in countries with both low and high income as a powerful tool for increasing social mobility and employability opportunities.
In South Korea, for instance, some job applications require information such as weight and height accompanied by a photo, and reports suggest about one-third of human resources managers employ workers based on their appearance despite them not being the best fit for the job. Conversely, suitable candidates are rejected solely due to their appearance. Considering these consequences, cosmetic surgery may no longer be a 'want' but instead regarded as a 'need' and a pivotal investment.
Further, an "ethnical market" for cosmetic surgery has grown into existence, driven by immigrants, determined to adjust to the beauty standards of the society they live in. Understood to help with avoiding prejudices and exoticization, ethnic surgery is about inclusion, rather than purely aesthetics. People may not negate their origins but invest in social and economic opportunities that cosmetic enhancements can provide.
With the normalization of cosmetic surgery discrimination against the ones despite their age and gender avoiding it might become a new social problem.

## Power Dynamics

As recognised medical practitioners, cosmetic surgeons carry authority, making their suggestions, alongside personal, non-verbalised attitudes towards the practice, immensely powerful. Interviews with surgeons have shown age related features, are usually considered subjective issues, while ethnicity related features are seen as objectively problematic, yet only when discussing non-white individuals. Increasing demand for such procedures, often described as “ethnic corrections", demonstrates a prejudice for western features, but surgeons do not necessarily interpret these as embodiments of racial inequalities. They argue, while there may be a western ideal, this is not standardized across all races and that, for example asian patients, do not desire double eyelid surgery because it removes their stereotypical features, but because they want to appear more “alert and bright-eyed”.
Surgeons further have distinct views related to gender. While cosmetic surgery is considered “normal” for women and compared to wearing makeup, similar parallels are not drawn in regards to men. Appearance related concerns are only perceived inherent to women, thus when males formulate similar worries, surgeons expect more justification. Due to a lack of understanding, the preconception that men are less effective in communicating their wishes and the fear of a malpractice claim if the results do not match expectations, cosmetic surgeons are therefore inclined to reject male patients. This perpetuates a cycle of cosmetic surgery remaining scarce for male patients, and thus the industry provides institutionalised support for defining gender. Aware of these power dynamics, cosmetic surgery companies, nevertheless choose to profit from them. Advertisements are directed at women, and focus on making these procedures appear empowering, as women are considered more perceptible targets, as well as more suitable patients.
Patients are found and created, but because patients are increasingly given control over every procedural detail, women believe their decision is self motivated, resulting in blind contribution to the reproduction of larger structural inequalities.

## Interdisciplinary tensions

Every discipline approaches cosmetic surgery differently. While, sociology emphasizes the social opportunities surgery provides, suggesting they fabricate a new consumer market enabling individuals to present themselves as desired. Psychology sees surgery as a strategy to gain control over feelings of inadequacy. In practice, psychology is overlooked with surgeons not trained or required to complete psychological analyses of their patients. Increasing demand for cosmetic surgery, and the corresponding economic wealth generated are compelling motivators that have led psychological risks, to be ignored to prevent decelerating this growth.
Absence of interdisciplinary communication prevents understanding the increasing craze about cosmetic surgery and its potential threats. Cooperation between disciplines could help solve problems associated with cosmetic surgery.

## References

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* ↑ The Countries With the Largest Number of Cosmetic Surgeries. 10/07/2020. Cosmetic Sugery Solicitors. Available from: https://www.cosmeticsurgerysolicitors.co.uk/news/countries-largest-number-cosmetic-surgeries
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* ↑ Wei, L., Ge, C., Xiao, W., Zhang, X. and Xu, J., Cross-sectional investigation and analysis of anxiety and depression in preoperative patients in the outpatient department of aesthetic plastic surgery in a general hospital in China. Journal of Plastic, Reconstructive & Aesthetic Surgery, 2018. 71(11), pp.1539-1546. Available from: https://doi.org/10.1016/j.bjps.2018.07.015
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