Plastic Surgery's Double-Edged Scalpel

Last week, Health Minister Ulla Schmidt, made a renewed appeal to would-be plastic surgery patients to carefully consider their actions before signing up to go under the knife in the name of physical improvement.

"Of course individuals may decide whether they wish to change themselves or the way they look," she said. "There is nothing wrong with make-up, jewelry, dyed hair, muscle training or a controlled diet as they don't damage the body. But when it comes to plastic surgery, we're dealing with an ethical question."

The problem for Schmidt (photo) and her fellow lobbyists is the discrepancy between sick people who would like to be healthy but have to undergo surgery and healthy people who are prepared to risk their health in a bid to get closer to becoming body perfect.

Changing advertising standards

In an effort to slacken the growing trend, the cabinet has passed a draft which if sanctioned by parliament, would change the way in which plastic surgery clinics and doctors are allowed to advertise for patients. The greatest changes would be the outlawing of "before and after" pictures and "as recommended by" statements, currently both popular methods for luring the physically flawed.

Medical Association Berlin spokeswoman Sybille Golkowski welcomed any advertising restrictions, but said that those proposed by the government would have minimal impact.

"It's just a small piece in a mosaic," she said. "What we are talking about here is a zeitgeist and if we are to reverse the trend, we have to get the media to stop making such an issue of it."

An aged issue

But has it really ever been very different? Although cosmetic surgery is relatively new on the medical menu, the shifting desire for a particular body shape can be traced back through the centuries. In the 17th century, the corset defined and deformed European women seeking to keep up with the images being sold to them by those in high places.

Eras come, eras go and shapes change accordingly and to entirely blame the increase in nip and tuck culture on today's media is a little facile. Firstly, the voluptuous 1950s were not without their own media coverage and secondly it is highly likely that body conscious women would have chosen to make occasional improvements decades if not centuries ago, had the world of medicine been advanced enough to offer it.

The fact is that there is indeed a clear desire -- particularly among women -- to make the most of themselves, and if that means resorting to surgical incisions, can that really be deemed an ethical issue? Opinion is clearly divided.

Please continue reading for the opposing argument

Heiner Kirchkamp, who runs a foundation offering advice to patients wishing to undergo plastic surgery, passionately believes that Ulla Schmidt's approach is wrong.

"It is not the job of the government to protect us from social development or to tell patients what they are or aren't allowed to want," he said. Politicians should focus their attention on changing the behavior of charlatan doctors within Germany's medical ranks," he said.

He argued that a ban on before and after pictures would restrict the flow of information, but would not ultimately prevent people who want surgery from going ahead and giving themselves what is often a much-needed boost.

"I have seen cases where women have liposuction and dare to strip off on the beach for the first time," Kirchkamp said. "They are suddenly very happy with themselves."

Is it such a bad thing to have happy people running about the beach smiling for Germany? Sybille Golkowski argued that there are other ways of accessing that smile, just as there are other ways of shedding excess pounds and feeling good about oneself.

"Before people sign up to go under the knife, they should ask themselves if the pressure to be successful is really such that surgery is justifiable," she said. "We know that success ultimately has little to do with physical appearance. People over estimate the effects of plastic surgery."

The crux of the problem

But Kirchkamp countered the real problem with cosmetic surgery is that the unregulated nature of the industry makes for fertile breeding ground for charlatans with dollar signs in their eyes.

As it stands the only doctors allowed to perform cosmetic surgery are throat, nose and ear doctors, mouth and jaw specialists and trained plastic surgeons. In the case of the first two, they are officially restricted to performing surgery on the area of the body relevant to their area of expertise.

But this is not controlled, and opportunist doctors can set themselves up as general plastic surgeons, offering the full palette of perfectionisms from liposuction to breast enlargements to facelifts and beyond.

Disguised by semantics

Both categories of doctor can legitimately write "plastic surgery" on their signs and can give themselves out as specialists.

"I always tell people who come to me for advice to ask the doctor what his specialist field is, whether he specialized in cosmetic surgery, where he studied and what his qualifications are," Kirchkamp said. "People have to be informed."

The fact is, however, that many people would never dream of considering the possibility of illegitimate doctors. And that means heightened health risks.

"Patients should always go to a doctor with a 'plastic surgery specialist' title," Golkowski said. "Too many people are too gullible, but they have to learn to protect themselves, they have to know there are risks, and they have to accept that if something goes wrong, they can't ask why the world wasn't protecting them."