What people do for looks

By Katherine Nichols
Advertiser Staff Writer

Flamenco music plays softly in the background, interrupted only by an occasional beep from the machine monitoring the patient's vital signs. Her body is draped; only her breasts are exposed.

Plastic surgeon Don Parsa marks up Lety Gilo's face. The markings aid during a face-lift. Deborah Booker • The Honolulu Advertiser

"One ... two ... three ... four ... " The nurse counts aloud. Each number equals an injection of 50cc of saline solution into the tube connected to the implant. In a matter of minutes, the patient's breasts are transformed, as she requested, from an A to a C cup.

It's a scene repeated hundreds of times a day across America: a patient choosing surgery for no other reason than improved appearance. Some find the idea distasteful; psychologists and culture watchers ponder what it says about us. But an increasing number of Islanders say the outcome is worth the suffering.

"You're going to feel some pressure, so please bear with me," says Parsa, his French-Persian accent soothing and confident. His fingers go in through the areola, pushing and pulling the implant, a movement that causes discomfort even through the anaesthetic. The patient whimpers.

"You're doing really good, sweetheart," says the ungloved nurse. "Hold my hand."

"Sorry," says Parsa. "I'm adjusting the implant to give you as much cleavage as possible."

"Does it look OK?" asks the patient, who remains awake and coherent in what Parsa called "a safe state of sedation" throughout the 90-minute surgery.

Parsa eases his lean, tanned frame around the table to survey his work from various angles. "It looks really pretty."

The nurse conveys the patient's reaction to Parsa's evaluation: "She's smiling."

Everybody wants to look attractive. And, for many, spending thousands of dollars is just the beginning. Some are willing to let a surgeon fracture their nose and reshape it. Or cut through their mouth and hollow a pocket in their cheeks to insert an implant. Or separate the skin of the face from muscle and bone, pull it tighter, and hold it in place with stitches along the hairline. Or insert human cadaver skin into lips to make them more pouty. Or repeatedly inject collagen or poisonous substances such as Botox into their faces to erase lines by temporarily paralyzing muscles.

Why are we so eager to confront the risks associated with putting foreign substances into our bodies? And embrace the dangers of surgery itself?

One of the reasons we take such drastic measures, say some experts, is because we can.

"This was my 60th birthday present to myself," said Dudley Wood, 63, of San Diego, Calif., who spent about $8,000 on a face-lift and a "tummy tuck." Wood, a travel consultant who frequently visits Hawai'i to compete in open-water swims, said she feels "terrific" about her surgeries because "it's something that's going to last forever, and it's something that's given me a great deal of pleasure. And it's something I didn't do for anyone else — just for myself."

Her sentiments are not restricted to the modern era.

Ancient practice

Surgical implements help perfecting the body. Deborah Booker • The Honolulu Advertiser

That knowledge, however, was not passed to the Western world until the 14th and 15th centuries through contact with invading Muslims.

Even today, Parsa admitted, "there is a fine line between what is considered cosmetic, and what is considered reconstructive." Plastic surgery started as reconstructive — for a desire to look "normal" — and evolved into a desire to look better.

"The need for improvement of one's image has always existed because people compare themselves to other people," said Parsa. "It's really part of human nature's competitiveness to look better, because of position of power and selection of a companion of the opposite sex. Animals do it instinctively, and humans have been programmed to be attracted to a more attractive mate."

There is more to it than the desire to find a mate, though. "Our culture is very youth-oriented," continued Parsa. "Aging has become a dreaded prospect. The job market has become very competitive. Most businesses are seeking younger, better looking people."

Pictures have effect

Another factor is the role the media has played in fueling the sexual revolution. Parsa cited television shows like "Friends," which did not exist 30 years ago and "expose the public to very perfected, nicely toned, beautiful actors and actresses." In fact, people often come into his office with a picture of an actress or model, which causes reputable doctors to become "very cautious," he said. "This is a sign of unrealistic expectations, and they are denied surgery" until they demonstrate a more realistic attitude.

Repeated advertisements for liposuction using slim models are examples of how "the media can be dangerous in creating a need that never existed in the individual's mind," Parsa explained. "Repeated exposure brings about a reduction in self-esteem and mental heath to the point" where people seek surgery.

Clinical psychologist Robert DavŽ goes a step further: "The proliferation of images is 100-fold compared with what we saw in the 1950s. There is a tremendous amount of image-making that we are exposed to; I think that's one of the primary influences behind the preoccupation and sometimes obsession" about the way we look.

"I think our society has become hypersexualized," DavŽ continued. "We use sex to sell everything: soap, beer, football . . . even motor oil! The message is that it's important to be sexy, and not just in the bedroom, but 24/7."

Why? "Being sexy is very powerful. It gets attention. It opens doors. It sells."

The problem is that few of the images we see in advertising are authentic. Breasts are augmented, corsets control tummies, and in almost all cases, photo imaging vaporizes inches and flaws from top models. "People look at this and think it's real and attainable," he said. "This mythology is created that leads people to believe they can do it. So they try. It's all about looking good, feeling good, being accepted. We're all suckers for that."

It's normal behavior

Forty years ago, findings indicated that any man wanting rhinoplasty had a psychiatric problem, said Parsa. Now, experts regard the majority of people seeking surgery as normal, healthy individuals who want to improve their appearance.

While DavŽ feels that Americans generally are too comfortable with their lives, he finds no fault with people choosing to have a surgery because it makes them feel better. "I hardly see that as a pathological problem," he said.

Dentist Jonathan Cross, who performs laser teeth whitening procedures, agreed: "We can take quite a few years off people. They want to look good." He said that the "me" generation has grown up and now has disposable income. "Since there are things that can be done, why not?"

Francis Chong concurred. "I was happy then; I'm happier now," said Chong, 55, who put away $100 every month to save $7,000 to have the bags under his eyes eliminated. "I'd been wanting them removed for 40 years. Now the face matches the rest of the body."

A 66-year-old Hawai'i resident, who spent more than $10,000 on a face-lift, forehead lift, derma-brasian and cheek implants, said it was "worth two or three times the price." But to her, one key element in cosmetic surgery is, quite simply, "vanity." She said, "I believe in looking as good as you can."

Yet for a 30-year-old local woman who paid almost $6,000 for breast implants, the issues went deeper than vanity. "I couldn't think of anything I would rather spend my money on," she said. To others considering the procedure (for years, as she did), she offered this testimonial:

"I would say, pain is not forever, and self-confidence is forever. I did it just for myself. And I feel more outgoing now, not as shy."

Some overdo it

Most doctors agree that these attitudes toward a single procedure do not create problems. The difficulties begin with body dysmorphic disorder and ensuing polysurgery. Described in plastic surgery and psychological literature for 100 years, body dysmorphic disorder essentially is beauty hypochondria, explained Parsa.

It occurs when someone who is beautiful by all standards wants to change everything about her appearance, and becomes markedly obsessed with a slight anomaly to the point where it creates significant distress and impairment in social and occupational functions that can lead to mental disorders. These include people in their early 30s requesting face-lifts, and teens seeking liposuction because they want to look like models.

The majority, however, have more basic motivations. "Now we're seeing younger people (who can afford surgery), and older patients because they live longer and they're healthier at an older age," said Parsa. "In the past, people basically retired from life at age 65; now that theory is absolutely discarded. They're dating, thinking of going on a trip with a future spouse. They are not giving up life."

Because many find it difficult or impossible to find happiness without looking their best, they will do whatever they can to improve their appearance — or at least their own perception of their appearance.