1. Ideals of Beauty and Body Modification Martin T Donohoe, MD, FACP

2. Historical Ideals of Beauty Ancient Greeks valued symmetry Contemporary definitions similar: –“Ideal woman”: small chin, delicate jaws, full lips, small nose, high cheek bones, large and widely spaced eyes, and waist:hip ratio of 0.7 –“Ideal man”: taller, waist:hip ratio of 0.9, dominant/rectangular face/chin, deep-set eyes, heavy brow Suggests strong supply of testosterone

3. “Ugly” Common first name in Ancient Greece, parts of sub-Saharan Africa Idea: give children bad names so demons won’t find them Other favorites: “Disagreeable,” “Crippled”

4. Historical Ideals of Beauty Chinese foot binding –pain, osteoporosis, falls/imbalance –Surgery to reshape women’s feet for stiletto heels increasingly popular Ancient Greek newborn female baby wrapping

5. Historical Ideals of Beauty Ancient Roman women colored their lips with red cinnabar stone, a type of mercury ore, lined their faces with white lead, and rouged their cheeks with red lead Ancient Egyptians/Roman/Persians: antimony for conjunctival sparkle Rome to medieval Europe: paleness preferred

6. Historical Ideals of Beauty Elizabethan hair plucking, ceruse makeupElizabethan hair plucking, ceruse makeup Court of Louis XVI: blue veins drawn on neck and shoulders to emphasize noble bloodCourt of Louis XVI: blue veins drawn on neck and shoulders to emphasize noble blood 16th & 17th century: belladona eye drops16th & 17th century: belladona eye drops

7. Historical Ideals of Beauty 18 th Century: vermillion makeup (sulfur and mercury) 14th - 19th century: corsetting (whalebone and steel) – precursor to the girdle –Making a comeback at both high- and low- end retailers (takes up to 30 minutes to lace up; requires an extra set of hands)

8. Historical Ideals of Beauty Unibrow: –Sign of criminal tendencies in Victorian England –Mark of beauty in contemporary Iran Breast implants (since 1903 - Charles Miller, MD) –First silicone breast enlargement 1962

9. Contemporary Ideals of Beauty “Better Baby Contests” – Eugenic Movement / Social Darwinism Tapeworms (Maria Callas) Rib removal (Cher?)

10. Contemporary Ideals of Beauty Botox injections Plastic surgery Abusive subjugation of women through body modification – female genital mutilation –Cultural components

11. Ideals of Beauty Brass neck rings (Paduang people of Burma)Brass neck rings (Paduang people of Burma) Lip and earlobe expanders (certain African tribes) Tattoos, body piercings, wingsTattoos, body piercings, wings

12. Ideals of Beauty Wonderbra, Brava Bra ($2500, suction device worn overnight for 10 weeks, promises 1 cup increase (actual increase ½ cup size), can cause broken blood vessels, skin rash, discomfort) Wonderbum pantyhose (DuPont Lycra) – promises a “perfectly peachy, pert bottom” Music industry depictions of beauty

13. Ideals of Beauty Ancient Greeks – symmetry –Remains true –Familiarity, personality traits also important Evolutionary adaptation for survival of human species –Size, muscle power, pathogen-free status, fertility

14. The Perks of Beauty The good-looking are more likely to get married, be hired, get paid more, and be promoted sooner Height is associated with income and leadership positions Strangers are more likely to assist good-looking people in distress

15. The Perks of Beauty The pretty/handsome are less likely to be reported, caught, accused, or punished for a minor or major crime Role of ageism (more important for women) The responsibility: –Attractiveness is recognized as a special gift, and its misuse is not tolerated

16. Cosmetics Concocted at home prior to 20 th Century Industry spawned by: –“Allure” of prostitutes/sexuality –Mass popularity of anti-aging products in 1920s –Women entering workforce –Migrations to cities Food, Drug and Cosmetic Act (1938)

17. Cosmetics 2004 spending = $12 billion –33% more than the amount needed each year (in addition to current expenditures) to provide water and sanitation for all people in developing nations –Slightly more than the amount needed each year (in addition to current expenditures) to provide reporductive healthcare for all women in developing countries

18. Cosmetics Average American adult uses 9 personal care products/day (with 126 unique chemical ingredients) –89% of the over 10,500 ingredients used in personal care products never tested for toxicity –Little FDA oversight

19. Cosmetics Unusual ingredients include: –Cow colostrum –Gold –Foreskin –Placenta –Fetal cells

20. Cosmetics and Hair Coloring Women devote average of 19 minutes per day to treating and altering their faces 55% of American women between 13 and 70 color their hair –1/8 American men between 16 and 60

21. Tanning The skin’s response to ultraviolet light injury No such thing as a “safe tan” 95% of Americans understand that sunburns are dangerous, but 81% still think they look better with a tan.

22. Artificial Tanning 47% of college students use a tanning lamp each year (females more than males) 39% have never used a tanning lamp More than 90% of users are aware that premature aging and skin cancer are possible complications of tanning lamp use WHO: tanning beds cause cancer

23. Tanning Tanning as a substance abuse-like disorder Tanning produces endorphins Most countries do not limit access of youths to tanning parlors SPF of at least 15 should be worn when outdoors (and re-applied frequently)

24. Artificial Tanning Many lotions and creams available Burgeoning industry “Natural” does not necessarily mean safe

25. Tattooing Tattoo from Tahitian word “tatau” (“to mark”) Reached apogee among Maori Popularized in West by sailors returning from Polynesia

26. Tattooing Aesthetic choice Initiation rite Time-saving way for disabled to overcome difficulties of applying makeup Adjuvant to reconstructive surgery (particularly face and breast, to simulate natural pigmentation)

27. Tattooing 30 million Americans have tattoos Ancient practice: Maori tribesmen, Thracian women of 5 th Century Greece Tattooing still illegal in South Carolina and Oklahoma

28. Tattooing More than 50 different pigments and shades employed –None approved for skin injection –Some industrial grade printer’s ink or automobile paint

29. The Fringes Anal bleaching –Initially porn stars and sex workers –Now available to general public for $75/treatment –Can cause eczema Money: Jim Nelson auctioned off his head on eBay for a corporate logo tattoo in 2003

30. Risks of Tattooing Tattooing associated with risky behaviors in adolescents Infection –e.g., hepatitis B, C, and HIV –Am Assn Blood Banks requires one-year wait between getting tattoo and donating blood Removal problems Allergic reactions

31. Risks of Tattooing Granulomas Keloid formation MRI complications Swellings/burns Image quality suffers (particularly with permanent mascara)

32. The Most Common Problem: Dissatisfaction 17% of those tattooed later regret it –Chief reason = the person’s name in the tattoo Practitioners’ skill levels vary widely Fading with time Blurring when injections too deep

33. The Most Common Problem: Dissatisfaction Human body changes with time Styles come and go With facial cosmetic surgery, appearance of tattoos and permanent makeup may become distorted

34. Tattoo Removal Techniques Laser treatments Dermabrasion Salabrasion Scarification Surgical Removal Camouflaging

35. Temporary Tattoos Fade after several days Allergic reactions FDA alert re risks with foreign-made products Freedom-2 Ink: Biodegradable dye capsules – when zapped by laser, dyes absorbed by body and tattoo disappears

36. Risks of Henna Tattoos Henna products risky –Henna approved for use as a hair dye, not for injection into the skin –Produces a reddish-brown tint, raising questions about what ingredients are added to produce the varieties of colors labeled as henna (e.g., “black henna,” “blue henna”

37. Botox Botulinum toxin: –Cause of botulism –potential biowarfare/bioterror agent Medical Uses: blepharospasm, spasmodic torticollis, migraines, back spasms, chronic pain, axillary hyperhidrosis, wrinkles due to normal aging Unlikely to work on sun- or smoking-induced wrinkles

38. Botox Manufacturer = Allergan –Allergan also markets Latisse (bimatoprost, the same ingredient in the glaucoma treatment Lumigan) for topical “treatment” of “hypertrichosis of the eyelashes” –Myobloc (Solstice Neurosciences – not yet FDA-approved)

39. Botox 2.5 million procedures in 2008 (costing $1.1 billion) Large direct-to-consumer ad campaign –Olympians Mark Spitz, Nadia Comanici involved $80/dose + physician’s fee ($443 avg.)

40. Botox Most users white, age 35-50 12% are men In-home Botox parties; Botox scams Hollywood actors

41. Botox Retreatments required q 3-4 months Side effects: muscle weakness, masklike facies, drooling, slurred speech, aspiration, dysphagia, dysnpnea, rare allergic reactions; may spread via neurons back to spinal cord or even CNS –87 hospitalizations, 16 deaths reported 1997-2006 –FDA boxed warning 2009

42. Rivals to Botox Collagen injections (from cows, possible allergic responses) Perlane (“natural” collagen alternative from human tissue) Fat injections Face lift/eyelid surgery

43. Dermal Fillers Alternative to botox Cow collagen, liquid silicone, plastic microbeads, synthetic bone and ground-up human cadaver skin (association with for-profit tissue banks)

44. Dermal Fillers $700-$900 per treatment (lasts a few months) –Compare with $4000-$6000 for a facelift, which lasts 10-15 yrs before requiring touch-ups Side effects –Include renal failure

45. Conclusions Ideals of beauty: some relatively constant, others change Multiple methods of body modification: some dangerous, even abusive

46. Covered in Other Slide Shows Cosmetic surgery Female genital cutting Body weight and the obesity epidemic Ethical and policy issues

47. References Donohoe MT. Beauty and body modification. Medscape Ob/Gyn and Women’s Health 2006;11(1): posted 4/19/06. Available at http://www.medscape.com/viewarticle/529442 http://www.medscape.com/viewarticle/529442 Donohoe MT. Cosmetic surgery past, present, and future: scope, ethics and policy. Medscape Ob/Gyn and Women’s Health 2006;11(2): posted 8/28/06. Available at http://www.medscape.com/viewarticle/542448 http://www.medscape.com/viewarticle/542448

48. Re Tanning See slide show by Anuru and Salmon on risks and regulations related to indoor tanning at http://phsj.org/?page_id=10http://phsj.org/?page_id=10

49. Contact Information Public Health and Social Justice Website http://www.phsj.org martindonohoe@phsj.org