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					   Ideals of Beauty
and Body Modification

Martin T Donohoe, MD, FACP
   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
                  “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”
   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
   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
    Historical Ideals of Beauty

• Elizabethan hair plucking, ceruse
  makeup
• Court of Louis XVI: blue veins drawn on
  neck and shoulders to emphasize noble
  blood
• 16th & 17th century: belladona eye
  drops
    Historical Ideals of Beauty
• 18th 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)
  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
 Contemporary Ideals of Beauty

• “Better Baby Contests” – Eugenic
  Movement / Social Darwinism

• Tapeworms (Maria Callas)

• Rib removal (Cher?)
 Contemporary Ideals of Beauty

• Botox injections
• Plastic surgery

• Abusive subjugation of women
  through body modification – female
  genital mutilation
  – Cultural components
          Ideals of Beauty

• Brass neck rings (Paduang people of
  Burma)

• Lip and earlobe expanders (certain
  African tribes)

• Tattoos, body piercings, wings
       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
           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
      The Perks of Beauty
• The good-looking are more likely to get
  married, be hired, get paid more
  (including tips), and be promoted
  sooner
• Lifetime earnings difference between
  the typical “good-looking” and “below
  average-looking” worker = $230,000
       The Perks of Beauty
• Height is associated with income and
  leadership positions
  – Ironically, 50 years ago some women were
    treated with estrogen to prevent them from
    growing too tall and becoming un-
    marriable
  – This impaired their fertility, among other
    consequences
• Strangers are more likely to assist
  good-looking people in distress
       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
               Cosmetics
• Concocted at home prior to 20th 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)
               Cosmetics
• Worldwide annual spending around $19
  billion ($8 billion in US)
  – 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 reproductive
    healthcare for all women in developing
    countries
            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
                       Cosmetics
• Most contain carcinogens and/or endocrine disruptors
  (see http://www.cosmeticsdatabase.com/)
        • Kohl (decorative black eyeliner) contains lead; use increases
          risk for ADHD in offspring
•   Unusual ingredients include:
–   Cow colostrum
–   Gold
–   Foreskin
–   Placenta
–   Fetal cells
  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
         Hair Care Products
• African-American “hair relaxers”
  contain endocrine disruptors
  – Use increases risk of uterine fibroids,
    cancers
• Brazilian Blowout hair straightening
  products contain formaldehyde
  (possible carcinogen)
                 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.
           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 (melanoma
  and basal cell)
• WHO: tanning beds cause cancer
• Skin cancers of all types rising: 1/5 Americans
  will get during their lifetimes
          Tanning Facilities
• Over 50,000 in US (more than the number
  of Starbucks or McDonalds)
• Generate revenues of over $5 billion/yr
• 1 million use daily; 30 million annually
  – Most users are women
  – 18% of women and 6% of men visited at least
    once in past year
          Tanning Facilities
• Most countries do not limit access of
  youths to tanning parlors
• Most US states limit access of youths
• FDA advisory panel has recommended
  increased regulation, including restricting
  use to adults
         Tanning Facilities
• Indoor tanning tax implemented in 2010 as
  part of PPACA (Obama Health Care Plan)
   – Applies only to dedicated tanning-only
     facilities
   – Efforts underway to repeal
                 Tanning
• Tanning as a substance abuse-like
  disorder
  – Associated with other addictions
• Tanning produces endorphins
• SPF of at least 15, which provides
  protection against both UVA and UVB,
  should be worn when outdoors (and re-
  applied frequently)
         Artificial Tanning
• Many lotions, creams, and sprays
  available
  – Most contain dihydroxyacetone (DHA) – can
    cause allergic reactions
• Burgeoning industry
• “Natural” does not necessarily mean safe
         Artificial Tanning
• Increased (but not excessive) carotenoid-
  containing fruit and vegetable
  consumption can improve skin color
• Tanning pills (not approved for use)
  containing canthaxanthin dangerous
• Skin lightening creams may contain
  mercury
              Tattooing
• Roman Empire used to brand
  convicts, slaves, and army deserters
• Tattoo from Tahitian word “tatau” (“to
  mark”)
• Reached apogee among Maori
• Popularized in West by sailors
  returning from Polynesia
               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)
               Tattooing
• 30 million Americans have tattoos
  – 40% of Americans between 26 and 40
• Ancient practice: Maori tribesmen,
  Thracian women of 5th Century
  Greece, Moors)
• Tattooing still illegal in South Carolina
  and Oklahoma
              Tattooing
• More than 50 different pigments and
  shades employed
   – Many contain heavy metals,
     phthalates, other endocrine
     disruptors and carcinogens
   – Some contain industrial grade
     printer’s ink or automobile paint
   – None approved for skin injection
     (FDA considers “food additive”)
        Risks of Tattooing
• Tattooing associated with risky
  behaviors in adolescents
• Infection
  – e.g., hepatitis B, C, and HIV (HIV risk
    theoretical – no cases identified to date)
  – Am Assn Blood Banks requires one-year
    wait between getting tattoo and donating
    blood
• Removal problems
• Allergic reactions
          Risks of Tattooing
•   Granulomas
•   Keloid formation
•   MRI complications
•   Swellings/burns
•   Image quality suffers (particularly with
    permanent mascara)
   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
  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
    Tattoo Removal Techniques
• Laser treatments (photothermolysis)
    – Requires multiple treatments
•   Dermabrasion
•   Salabrasion
•   Scarification
•   Surgical Removal
•   Camouflaging
        Temporary Tattoos
• Fade after several days

• Allergic reactions

• FDA alert re risks with foreign-made
  products

• Freedom-2 Ink, Infinitink: Biodegradable dye
  capsules – when zapped by laser, dyes
  absorbed by body and tattoo disappears
    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”
  – Color can last for more than a week
               Body Piercing
• 36% of Americans

• Women > Men

• Complications: 20-40%
  – Skin irritation and infections most common
  Body Piercing Complications
• Other complications include auricular
  chondritis, nasal cartilage destruction,
  abscesses, contact dermatitis, bleeding, bladder
  infections, dental trauma, and other secondary
  trauma
• Death rare
• Avoid shopping mall kiosks
• Unclear if prophylactic antibiotics helpful
              The Fringes
• Anal bleaching
  – Initially porn stars and sex workers
  – Now available to general public for
    $75/treatment
  – Can cause eczema
• Red labial dye (“My New Pink Button”)
• Money: Jim Nelson auctioned off his
  head on eBay for a corporate logo
  tattoo in 2003
                     Botox
• Botulinum toxin:
  – Cause of botulism
  – potential biowarfare/bioterror agent
• Medical Uses: blepharospasm, spasmodic
  torticollis, migraines, back spasms, chronic
  pain, axillary hyperhidrosis, BPH, autonomic
  disorders, wrinkles due to normal aging
• Unlikely to work on sun- or smoking-induced
  wrinkles
                   Botox
• Manufacturer = Allergan
  – Allergan also markets Latisse
    (bimatoprost, the same ingredient in the
    glaucoma treatment Lumigan) for topical
    “treatment” of “hypertrichosis of the
    eyelashes” (eyelash transplant alternative)
  – Myobloc, Dysport, and Xeomin (other
    botulinum neurotoxins)
  – -Limited standardization
                 Botox
• 4.8 million procedures in 2009

• Large direct-to-consumer ad campaign
  – Olympians Mark Spitz, Nadia Comanici
    involved

• $80/dose + physician’s fee ($443 avg.)
               Botox
• Most users white, age 35-50
• 12% are men
• In-home Botox parties; Botox
  scams; counterfeit Botox
  (ineffective and/or dangerous)
• Hollywood actors
                   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
           Rivals to Botox
• Collagen injections (from cows,
  possible allergic responses)
• Perlane (“natural” collagen alternative
  from human tissue)
• Fat injections
• Face lift/eyelid surgery
           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)
            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
           Conclusions
• Ideals of beauty: some relatively
  constant, others change
• Multiple methods of body
  modification: some dangerous,
  even abusive
 Covered in Other Slide Shows
• Cosmetic surgery
• Female genital cutting
• Body weight and the obesity
  epidemic
• Ethical and policy issues
                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
• 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
             Re Tanning
• See slide show by Anuru and Salmon on
  risks and regulations related to indoor
  tanning at http://phsj.org/?page_id=10
     Contact Information
Public Health and Social Justice
             Website

     http://www.phsj.org
   martindonohoe@phsj.org

				
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