Nichola Rumsey PhD, OBE
Centre for Appearance Research, UWE, Bristol
We are social beings, predisposed to seek people out and to communicate with them. In our first encounters with others, our physical appearance is our interface with the social world – the initial impressions we form of each other are ‘skin deep’. The way we present ourselves and the way we are perceived by others have a strong influence on the early stages of an initial meeting. Some people manage this process with confidence and skill, recognising that snap judgements made by others on the basis of our looks can quickly be modified through the use of alternative communication strategies, whereas others experience much more trepidation about this process, anxious that one particular physical feature or perhaps their overall ‘look’ will dominate the process of impression formation both initially and over time, making it impossible for them to project their ‘real self’ to others. This latter group may consider a range of strategies to alleviate their concerns and, for an increasing number, these strategies are likely to include cosmetic surgery.
In choosing to focus on studies of patients undergoing aesthetic surgery and by inviting the viewer to consider the price paid for the pursuit of appearance ideals, Jonathan Yeo is offering us the opportunity to explore a crucial contemporary social issue. The growing prevalence of dissatisfaction and anxiety about our looks is a major current concern for researchers, educators, policymakers and youth organisations. Body image (the thoughts, feelings and behaviours associated with the appearance and functionality of a person’s body) was voted as one of the top ten issues affecting the lives of just under a million young British people in a ballot organised by The British Youth Council (BYC) in 2017 and was chosen as the focus for an inquiry by the BYC’s Youth Select Committee published in 2018. Research evidence suggests that more than two-thirds of young people and adults in the UK and many other countries experience significant levels of appearance dissatisfaction with prevalence rates increasing year on year.
Why is this a cause for concern? A substantial amount of evidence collected over the past three decades links poor body image with a range of damaging impacts on psychological well-being, including low self-esteem, depression and anxiety – particularly in social situations and with negative consequences for key areas of living, such as relationships, physical health, performance in educational settings and work.
Crucial influences in this ‘epidemic’ of appearance concerns include the sharing of appearance ideals on the internet and through social media, the growing culture of the celebrity, and the images and messages used in advertising and the media. Although, at some level, many people understand that celebrity culture and the tinted, filtered and photoshopped images in advertising, broadcast and social media are more artifice than truth, there is evidence that significant numbers of consumers of these images are buying in to the ‘beauty myths’ implicit in this imagery. Despite research to the contrary, the message we are being sold is that beauty is associated with happiness, success and quality of life. Furthermore, alongside the stream of images depicting current ideals, a variety of ‘solutions’ are offered to correct our own ‘faults’ in appearance, along with encouragement to ‘improve’ the way we look. Among these solutions, cosmetic surgery is portrayed as the most effective (and thus desirable) way of achieving an appearance closer to current ideals.
Much debate surrounds the increasing uptake of cosmetic surgery in the context of society’s growing levels of dissatisfaction with appearance – is aesthetic surgery part of the solution or part of the problem? Some patients clearly derive considerable benefit. Most surgeons operating in this sector can describe improvements in the confidence and self-esteem of some patients, following the alteration of a particular feature that has been a focus of discontent for many years. Yet, fuelled by the ‘beauty myths’, other potential consumers have more ambitious expectations of the likely psychological and social gains that might result from aesthetic enhancement. The evidence to support the likelihood of these broader gains is lacking. What are the motivations of those who choose to have cosmetic surgery? What are their expectations of outcome? How much do patients expect their lives to change if they can achieve an appearance that they believe is closer to a particular ideal? Are their perceptions of the risks and potential side effects of surgery accurate? How are these reconciled with the perceived benefits? What proportion is satisfied with the outcome and how many are disappointed? How long do any benefits last? How many patients return for more procedures? For those who do return, are the impacts less significant each time?
In addition to calls for more research to understand the effects of undergoing cosmetic surgery on individual patients, many commentators have also expressed concern about the broader societal impacts of the increasing drive for appearance enhancement, in particular the consequences of ever-narrowing definitions of what is a ‘desirable’ appearance and also what is ‘normal’. As both categories become harder to attain, more people fall outside the ‘norm’. Some argue that the rising pressure to look a particular way is ageist (as current ideals promote the benefits of a youthful appearance), racist (for example, by emphasising the desirability of lighter skin colour) and sexist (as although boys and men are affected by body image dissatisfaction, appearance ideals are more prescriptive for girls and women). The ideals also discriminate against those whose bodies deviate from current appearance ideals in relation to their weight and shape and those whose appearance is unusual in some way (for example, as the result of birth anomalies, trauma or disease).
Clearly, in the context of these debates, the Skin Deep exhibition is particularly timely. In contrast to the glamorised view of cosmetic surgery offered in magazines and other forms of media, often using ‘before’ and ‘after’ pictures to headline the aesthetic outcomes and omitting the detail of the process and immediate aftermath of surgery, the paintings in this exhibition offer us a very different perspective – a reminder of the ‘small print’. By including the lines drawn on the patient’s body to guide the surgeon’s incisions, the pictures encourage us to reflect on the invasive nature of the surgical process – a glimpse of the lengths patients are prepared to go to in the pursuit of aesthetic gain – inviting us instead to consider the ‘costs’ as well as the potential ‘benefits’ of choosing to undergo surgery for aesthetic reasons.
In addition, this collection also provides a stimulus for viewers to contemplate a range of broader ethical and social issues. As levels of appearance dissatisfaction increase, should everyone have a free choice to undergo cosmetic surgery if they wish? If so, how ‘free’ is a choice made in response to unrelenting messages from advertisers and the media about the benefits of attractiveness? Does the pressure experienced by those who are particularly susceptible to these messages cloud their ability to accurately assess the risks and potential side effects of surgery? How likely is it that their aspirations for psychological and social gains will be met? Should there be safeguards in place for those who are vulnerable to unrealistic expectations of outcome?
A growing number of people are engaging in appearance-altering cosmetic procedures and this is a social trend that is unlikely to change any time soon. Is this simply a benign sign of the times or a cause for concern? People coming to this exhibition will have the opportunity to consider cosmetic surgery in a different light.