Introduction
One of the most critical developments in the field of medical tourism is the increase in the number of people who seek for medical services that can enhance their physical appearance. Therefore, research denotes a lot of advances in plastic and reconstructive surgery.
Also referred to as aesthetic surgery, plastic surgery is used to improve the physical image of the people who are suffering from burns, skin cancers, as well as people who suffer from congenital abnormalities. The demand for aesthetic surgery keep rising, raising the question of ethics and considerations on the side medical plastic surgeons and the people seeking for such services.
Among the questions that are asked revolve around the possibility of limiting the number of people who seek for such services through the process of screening and ascertaining those who seek for such services. Also, there are a lot of health risks that are associated with such practices on the patients. This raises questions about the ethical principles in plastic surgery.
From a broad perspective, the cosmetic surgery industry seems to attract more customers, raising the question of whether there should be controls and referrals for people who seek for such medical services or whether people should seek for the services at their will. This paper argues that cosmetic surgery presents a lot of risks for the patients.
The other question that comes up at this point concerns the amount of information that should be relayed to the people who seek for plastic surgery services, especially the information on the risks and benefits that accrue from cosmetic surgery (Mousavi 38).
More people continue to spend billions of dollars on aesthetic surgery even as others continue to raise questions about the ethical stance in plastic surgery. Therefore, this paper explores the issue of the growing concern about the ethical principles and considerations in cosmetic surgery.
Historical overview of reconstructive surgery and the shift to cosmetic surgery
It is apparent that reconstructive surgery as a medical practice is shifting to cosmetic, also known as aesthetic surgery. A deeper look into the medical practice of reconstructive surgery reveals that it was part of surgery, which was meant to improve the health of patients who had complex medical conditions that required reconstructive surgical operations.
The advancement of complex medical ailments, like cancer, in the 20th century resulted in the growth in the number of complex medical conditions requiring intense surgical practices on certain organs of individual patients. The effects of war in the 20th century saw the widening of the scale of reconstructive surgery due to the increase in the number of people with intense injuries that required intense reconstructive practices.
Therefore, the methods of repairing the wounds that were disfigured were developed by surgeons like Harold Gillies and Archibald McIndoe during the 20th century. However, it is important to note that reconstructive surgery as a practice in the field of medicine and surgery can be traced back to the 16th century. During this time, the practice was used as a means of reducing injury and deformity.
However, the modern day practice of cosmetic surgery, which is mostly confused with reconstructive surgery, is more elective and dwells on the aesthetic reasons rather than the real medical reasons. This is spearheaded by the extreme transformation in the global culture and the intense emphasis on improvement of appearance through surgery and medicine (“Reconstructive Surgery” par. 1-4).
Understanding cosmetic surgery
According to Scott, plastic surgery can be defined as, “a subspecialty of medicine and surgery that uniquely restricts itself to the enhancement of appearance through surgical and medical techniques” (1).
Plastic and reconstructive surgery is a field in the medical industry that is gaining prominence, especially in the contemporary society where people value innovation in almost every industry. Plastic surgery entails two groups of customers. The first groups of people who seek for reconstructive surgery are people with health problems whose conditions can be managed by virtue of undergoing reconstructive surgery.
According to Panfilov (3), plastic surgery is an old field in the healthcare and medical industry. The practice can be traced back to the sixth and seventh century in India. However, plastic surgery has changed in scope and practice, especially in the 19th century where most people discovered the possibility of changing their physical make through medical help.
Most of the ground work for the growth and development of cosmetic surgery was laid down in the 20th century where professional groups in the medical field were developed, with most surgeons specializing in specific aspects of reconstructive surgery. “The oldest, largest, and most famous national professional associations in the world is the American Society for the Aesthetic plastic surgery, founded in 1967” (Panfilov 6).
To a large extent, the broadening and intense commercialization of reconstructive surgery into cosmetic and aesthetic surgery comes from the continued embrace of the culture of beauty in the contemporary society (Blum 2). McInnes et al. (163) observed that the development of reconstructive surgery has set the ground for the development and intense embrace of cosmetic surgery. This reiterates the change in the scope of plastic surgery.
Cosmetic surgery is largely portrayed as a powerful magic that can transform the physical look of people. “Most surgeons tell me about the technical aspects and the logical desire to improve your appearance…” (Blum 4).
This is a comment from one of the people who have sought for cosmetic service. From the statement, it can be concluded that a lot of details are not presented to people who seek for such services. Moreover, the rationality that is often presented by the surgeons cannot be ascertained by people who are looking for the services.
Also, the people who seek for these services often close up their minds because much of their focus dwells on their hope to improve their physical image (Blum 4). Cosmetic surgery goes behind the aesthetic value and may pose negative expectations for people who value such cosmetic plastic surgery practices such as breast augmentation. “Women who undergo breast augmentation surgery have a greater incidence of lactation insufficiency” (Michalopoulos 62).
Therefore, there is a wide range of practices in the contemporary cosmetic surgery in the United States and other countries around the world. “More than 8.7 million people underwent cosmetic surgery in 2003, up 33 percent from the year before, according to the American Society of Plastic Surgeons” (Shute 52).
The high number of people who demand for cosmetic surgery denotes the wide range of practices and variations in the services that are sought for by the population. This makes it difficult to differentiate between people who seek for such services on medical grounds and those who purely seek for such services for aesthetic purposes.
However, from the trends in medical tourism, it is clear that a large number of people seek for services on the grounds of beauty rather than on the health grounds. The future concerns in the field of plastic surgery revolve around the possibility of altering the genetic composition of individuals, besides the physical characteristics. In a similar sense, a substantial number of people continue to raise concerns about the sustainability of cosmetic surgery, especially when the future of the human generation is put into picture (Mousavi 39).
It is not clear whether the costs that are incurred by the people in the medical surgery can be vindicated by the outcomes of plastic surgery when put on the long-term scale.
In his research, Scott (8) concluded that the practice of plastic surgery is bound to be subjected to a lot of criticisms in the near future and possible resentments that come from the extended social effects of the practice on the individuals and the society in general. Already, there are a lot of conflicts in the modern times about the nature and generational attributes of people where the physical beauty that is attained through cosmetic surgery cannot be vindicated across generations (Scott 8).
The scope of cosmetic surgery in the United States
According to McInnes et al. (163), there is a change of identity in the specialty of plastic surgery. The change has been necessitated by an increase in competition and the resultant change in the reconstructive procedures. The trends in the plastic surgery industry in the United States denote the emphasis and concentration of the plastic surgeons on cosmetic practices rather than the reconstructive practices as embraced in other countries like Canada. This brings up the fact that plastic surgery is a specialty that is undergoing transformation.
Most of the pointers show that the profession is moving from the intense focus on the procedures of reconstruction to the focus on cosmetic or aesthetic procedures. It can be argued that this shift is necessitated by two forces. These include the intense marketing of plastic surgery, on the one hand and the increase in the diversity of cases of plastic surgery, on the other hand. “While the future of plastic surgery hinges on both systems of clinical practice, an optimal workforce balance has yet to be elucidated” (McInnes et al. 163).
A substantial number of surgeons in the United States have moved away from the observance of clinical and hospital practices that are based on reconstructive procedures. They now dwell on private practices that focus on cosmetic procedures for people rather than the reconstructive procedures for patients with complex health problems.
Several concerns are raised over the embrace of these trends. Among the concerns is the question of standardization of surgical practices and the possibility of malpractices in the field of plastic surgery due to the growth in demand for plastic surgery among the global population (McInnes et al. 164). Third, “in many countries physicians who are not trained as board-certified plastic surgeons routinely perform cosmetic surgery procedure” (Turner 28).
Turner made this observation out of the intense exploration of the cases where patients who had undergone plastic surgery developed complexities that led to their deaths. Also, Turner (29) ascertains the difficulty of determining whether the information that is given to the customers by the plastic surgeons is adequate enough for them to make a fair judgment about the risks and benefits of plastic surgery.
Turner (21) observes that a substantial number of people from the developed and developing world travel in search for cosmetic surgery services in countries where these services are offered. However, doubts are raised about the potential of these people to attain the best services and care bearing in mind how delicate the practice of plastic surgery is and the inability of these people to sustain long stays that can enhance the duration and quality of care.
The implication here is that patient safety and the quality of care are issues of priority as far as the better positioning of plastic surgery as a practice in the medical field is concerned. From the cases presented in his research, it is evident that people travel in search for places where particular services are offered. Also, cost is a factor as denoted by the number of people who travel from the developed world to the developing world in search for surgical services (Turner 25).
Cosmetic surgery and the natural appearance
One of the most debated issues when it comes to cosmetic surgery concerns the use of cosmetic surgery for aesthetic purposes, which sometimes makes a lot of people to refer to it as aesthetic purposes. There are a lot of relational and genetic factors that are often bypassed by people who engage in plastic surgery. Research denotes that most people decide to undergo plastic surgery for aesthetic purposes rather than for medical purposes.
The decisions preceding cosmetic surgery are important because the resultant change in the natural appearance comes with a lot of psychosocial and health issues. “Emerging cosmetic plastic surgeries allow us to bypass our genetic code and cheat our naturally predetermined appearance…” (Scott 1).
The genetic code of human beings is very important in the procreation and continuity of evolution and existence. However, as the quote denotes, most of the changes that are embraced in cosmetic surgery dwell on the physical attributes, while largely ignoring the genetic attributes (Scott 1).
According to Scott (1), genetic attributes are quite important in the recreation and the evolution of human beings. But as it is in medial surgery, the perceived internal code is overlooked at the expense of the external flaws. A lot of people pay a lot of attention to the external characteristics when making choices, while largely forgetting that the continuity of generations is built on the internal features.
These are genetic in nature and they are exemplified in the generations that are procreated from the present generation. At this juncture, the question that comes into the mind of researchers concerns the level at which the unwanted physical attributes make people to seek for cosmetic surgery. In other words, cosmetic surgery results in dramatic or abnormal presentation of people rather than presenting people according to their real genome (Scott 1).
Plastic surgery has been intensely commercialized to an extent that it is seen as an extension of the beauty industry. A content analysis of advertisements appearing between 1986 and 2007 in large city magazines reveals that, “advertisements position surgery as a means of boosting sex-esteem, and enhancing one’s sexual attractiveness…” (Hennink-Kaminski and Reichert 41).
There are many television programs and shows in the United States and the entire world dedicated to publicizing advances in plastic surgery. Arguing about the increased commercialization of plastic surgery, Scott notes that, “What we see on the outside is not necessarily what we are going to get on the inside, genetically speaking” (1).
The physical makeup of people plays a critical role in the choice and development of relationships within circles of connected relationships between individuals in the society. A concern is raised on whether the relationships established by individuals are affected after they undergo plastic surgery.
This is a social perspective of the issue of ethics in plastic surgery, which comes from the change in the physical attributes and the maintenance of these attributes within the social context of the society. The implication here is that the use of cosmetic surgery has been extended and is more common in the developed world, with the United States leading in terms of the number of people who undergo plastic surgery for different reasons every year.
The effects of engaging in cosmetic surgery are intense, particularly when it comes to the complexities of sustaining the physical image of individuals.
From the genetic perspective, the genetic attributes of an individual remain unaltered in most cases, meaning that these attributes feature in procreation where greater variations between the physical attributes of individuals and their genetic makeup come out. Arguing about the dangers of cosmetic surgery, De Cuyper (30) observed that, “Risks and complications include infections, allergic reactions, scarring, fanning, fading, and dissatisfaction about color and shape.”
Ethical dilemma in plastic surgery
According to Cain, Cheryl, Bernard and Owen (169), the number of women who go for plastic surgery is far much higher than the number of males. “According to the American Society for Aesthetic Plastic Surgery, in 2009, over 90% of cosmetic surgery procedures in the U.S. were performed on women” (Turner 28).
Borrowing from the earlier observation about the change from constructive surgery and emphasis on cosmetic surgery, it can be argued that the statement is a true reflection of the changing landscape in the field of reconstructive surgery.
The more women continue to embrace cosmetic surgery, the more the controversies are raised about the entire practice and its impacts on the wellbeing of women in the society. The controversies revolve around the issue of rights, ethics, and vulnerability. “It is a source of conflict and controversy globally because the benefit and harm of offering these procedures raise concerns about harmful cultural views, education, and social vulnerability of women with regard to both ethics and human rights” (Cain, Cheryl, Bernard and Owen 169).
The developments in the field of plastic surgery denote the involvement and embrace of the practice by a large number of people without the possession of complete information about the real implications of the practice, both positive and negative. This is one of the reasons why a lot of critics of the exercise point to the need for the development of principles that can help guide the practice.
People who assent to these practices undergo immense procedures that can result in psychological disorders if adequate care is not embraced by the practitioners (McInnes 169). Whether this kind of care can be achieved remains to be a rhetorical question, especially now that research points to a higher level of demand for cosmetic surgery practices than the number of professionals or surgeons.
Also, the issue of the capacity of training and the development of the medical professionals in the field of plastic and reconstructive surgery come out strongly. There are only a few opportunities that are presented for training in such field because of the needs for training for such practices. This, in turn, indicates the continued vacuum between the demand and supply of care for people undergoing plastic and reconstructive surgery (McInnes et al. 163).
Shute (52) is one of the researchers who have brought out the immense dangers of cosmetic surgery. Through a psychosocial stance, Shute highlights a number of factors that push people to cosmetic surgery without an evaluation of the effects of the surgical practices in the long-term. According to her, the number of people who seek for such services in the United States keeps rising. However, the level of awareness about the risks of cosmetic surgery among the population has remained constant.
This deviation is quite critical because cosmetic surgery has immense effects on individuals. Such surgical practices result in the death and long term health complexities in some cases. Through an exploration of media reports, Turner (22) documents a number of cases of medical surgery that resulted in the deaths of the respective patients.
Most of the reported deaths in the cases result from the complexities that follow the surgeries. While a lot of people have positive perceptions about cosmetic surgery, it is evident that the perceptions are immensely shaped by the testimonials that mostly feature in shows on plastic surgery and extreme makeover. This makes people keep looking for the perfection that is portrayed in the television shows on extreme makeover.
However, it is also important to note that a substantial number of people portray negative perception about cosmetic surgery (Shute 52). “…many also fear that shows like The Swan may be making people unrealistic, both about what surgery can accomplish and about the very real dangers of going under the knife” (Shute 53). The more the number of people who seek for perfection rises, the more the number of people who are negatively affected by cosmetic surgery.
There are a lot of health risks for individuals who undergo cosmetic surgery. “A 2001 survey of surgeons found that the death rate from liposuction alone was about 2 per 100,000 procedures” (Shute 53). However, this observation does not apply to people who undergo multiple surgical procedures.
For such people, the risk of death is more than twice. Furthermore, injuries are quite common in medical facilities that do not have qualified providers of anesthesia. Contrary to the perceptions of most people, cosmetic surgery is just surgery, which means that all dangers that are associated with other forms of surgery are also inherent in cosmetic surgery (Shute 52).
As observed earlier, the nature of practices in the field of cosmetic surgery keeps changing. Some of the changes that are being embraced in the industry is the reconstruction through the use of chemical compounds, rather that the real surgery. Invasive surgical techniques are being minimized through the embrace of non-invasive techniques, such as the use of chemicals (Shute 52).
Protection of patients
Can the patients who demand and go for cosmetic surgery be fully protected. This is the question that is raised by most researchers who are exploring the ethical basis in reconstructive and plastic surgery. One of the most important considerations when it comes to demand and supply for plastic and reconstructive surgery services is the issue of the need for such services.
It is apparent that most people seek for plastic surgery not out of need, but out of the desire to boost their self-esteem through the improvement of their physical looks. However, it should not be forgotten that there are cases of reconstructive surgery that are necessitated by the health problems affecting the patient. Therefore, the diversity prevails in terms of the views on the need to protect the people who undergo surgery.
Looking at it from the normal lens, people seeking for plastic surgery services because of the health problems need protection more than the people who seek for such services for cosmetic purposes. Again, this necessitates the debate about the questions of needs and rights, particularly when it is looked at from the perspective of the contemporary society where the value of beauty far much supersedes the considerations of risks associated with the procedures of attaining the desired beauty (Turner 29).
According to turner (29), there should be a thorough assessment of medical facilities before a decision to use the facilities is reached. Most of the complexities that are witnessed in the field of cosmetic surgery come from low quality services in the given facilities.
Practitioners in the field should be put in the spotlight as more people continue to travel in search for cosmetic surgery services. The reason for this is that the demand is bound to overshadow the capacity, thereby giving a chance for the plastic surgeons to lower the quality of care as they seek to meet the demand and make huge profits.
A substantial number of deaths from cosmetic surgery result from the lack of acute care for the patients, something that may as well be far beyond the control of the plastic surgeons because of the expenses of such care.
In most cases, patients leave the foreign countries when they have not fully recovered from the injuries, an aspect that causes further complications. Therefore, government participation in the control of medical tourism is important to offer support to their citizens in the foreign destinations. However, the support and participation of government is not definitive.
Most researchers are of the opinion that the support of the government should focus on genuine patients seeking for reconstructive surgery rather than the people seeking for surgical services for aesthetic purposes. According to Opel and Wilfond (19), the question of choice and decision is also critical in plastic surgery, especially when it comes to children with cognitive disabilities. “The impact of the surgery on the child’s quality of life must be balanced with the risks of the proposed procedure” (Opel and Wilfond 19).
Conclusion
It is evident from the information presented in this paper that there is a deep division among scholars when it comes to the subject of cosmetic surgery. Most of the variation in opinions comes from the risks and benefit of cosmetic surgery. Also, there is a wide variation of arguments about the nature of controls that ought to be imposed on the field of cosmetic surgery considering the fact that most people make individual choices when it comes to aesthetic surgery.
Individual choices are rights in their own sense, implying that the risks that accrue from the acceptance and engagement in cosmetic surgery are acceptable to most people in the society. However, the developments in the field, especially the question of risks and the increased demand for the cosmetic surgery services, point to the desire for control and considerations, as well as the disbursement of a lot of information so that people can make decisions based on knowledge rather than desire.
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