It’s Not Just Vanity

Cosmetic surgery has been done for thousands of years, but only in the last decade has it become widely available. Like so many other fashions, it first became popular in Hollywood and then spread throughout the population. Now, it is common for everyone from children to the elderly to have surgical adjustments made to parts of the body. It is not cheap, however. Medical tourism is likely to change that. For the cost of a ski lift ticket, you can get minor surgery done overseas — and banish forever an annoying or unsightly feature of your body. Most people choose cosmetic surgery to reverse the signs of aging, such as wrinkly and sagging skin and pockets of fat. Others do so to enhance their appearance in order to meet the fashion of the day and place. In India, for example, a female plump face is considered attractive, whereas chin jowls are considered undesirable on American women. The same is true of noses — where Philippine women like the angular Western nose, women in the United States prefer the more petite nose. Dark people want lighter skin while light people tan and color their skin to look darker. It is not only an issue of vanity. Throughout history, physical appearance has been linked to moral worth. People who are considered goodlooking are more likely to get married or hired for a job. They get paid more and are promoted sooner. Strangers are more likely to assist goodlooking people in distress. Attractive people are less likely to be reported, caught, accused, or punished for minor and major crimes. Is it unfair? Absolutely. But it is human nature. Historically, physical appearance was a genetic lottery. Now, however, you can do something about it. The most common types of cosmetic surgery are:

• Blepharoplasty (eyelid reshaping)
• Liposuction (removing fat from under the skin)
• Breast augmentation (enlarging breasts)
• Breast reduction (reducing overly large breasts)
• Breast lift (perking up sagging breasts)
• Face lift (tightening up the face and neck)
• Forehead or brow lift (tightening up the forehead)
• Rhinoplasty (nose reshaping)
• Abdominoplasty (belly reshaping)
• Ear pinning (ears pulled back)

In addition to these are countless very minor procedures to remove blemishes, tattoos, or damaged skin. According to Time magazine, cosmetic surgery increased 444 percent in U.S. from 1997 to 2005. In 2004, according to the American Society for Aesthetic Plastic Surgery, 9.2 million cosmetic surgeries were performed in the U.S., with patients spending $12.4 billion for the procedures. An estimated 455,000 liposuctions were done in 2005. Females account for 88 percent and males 12 percent of cosmetic surgery, but men are catching up, especially for liposuction and nose and eyelid reshaping. These U.S. figures do not account for those who have the surgery done overseas — a number that is likely to grow far larger. Medical insurance has to pay for cosmetic surgery when it can be shown that the surgery is necessary for health reasons or as a consequence of illness or injury. However, there is a large gray area between “medically necessary” and “cosmetically preferable.” The result is that insurers are having to pay out ever higher amounts as more

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″I had a little roll of fat hanging over the back of my jeans, like a spare bicycle tire in the back,″ said Dana Conte, 34, a bartender in Manhattan. It was so obvious that her mother constantly came up behind her and pulled her shirt down over it, Ms. Conte said. ″When your mother is doing that, it means there′s a problem.″ She tried Weight Watchers and working out ″like a lunatic,″ but couldn’t get rid of her back fat. She ended up having liposuction on her lower back, and then again to remove ″bra fat″ — the bulges, she said, when her ″bra pushes lumps of fat down my back and up over the bra fastening and to the sides right near my arms.″ The total cost was $10,000, but she thought it was well worth it. Had she gone overseas, she might have paid just a fifth for the same procedures.

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people find sympathetic physicians and avail themselves of the opportunity to improve their appearance. Some health insurers are requiring prospective patients to view graphic videos of surgery to try to dissuade them from having surgery. However, television shows like Nip/Tuck are doing the opposite — cosmetic surgery is increasingly seen as normal, routine, and even a nice indulgence for already attractive people. A major benefit of medical tourism is privacy. With surgery done on vacation, out of sight of acquaintances and colleagues, the bandages are gone and the recovery well under way by the time you return. According to the International Society of Aesthetic Plastic Surgery (ISAPS), five countries account for 47 percent of all plastic surgery procedures worldwide: the U.S. does 16 percent, Mexico 10 percent, Brazil 9 percent, Canada 6 percent, and Argentina 6 percent. The vast majority of these are residents of the country — medical tourism is just starting to proliferate. Because most cosmetic procedures involve sameday surgery with just local anesthesia, the cost of building such a clinic is not high. Therefore, many countries are starting to offer lowcost surgery. Mexico, Brazil, and Argentina already have a long tradition of highquality care, so clinics in these countries are generally a safe bet. Newer on the horizon are hundreds of such clinics in Asia, particularly in Thailand. Many of them are associated with excellent hospitals and have doctors trained in the United States Eastern European countries also heavily advertise cosmetic surgery clinics, although most of their clientele appear to be from neighboring countries.