Tuesday, 9 August 2016

Cosmetic Surgery - Structuring the Argument

Advances in medical technology and surgical practices have revolutionized the field of cosmetic surgery. Cosmetic surgery seeks to alter the appearance of a person. The surgical procedures used are aimed at reconstructing the body by either reshaping body parts or through excision of specific deformed or unwanted tissue. Its medical utility is in managing birth defects, traumatic wounds, burns, and neoplastic growth as well as diseases which are associated with bodily deformation, for instance hydatid cyst growth. Nonetheless, cosmetic surgery is also used for improving the aesthetic appearance of a person, without any additional medical value (Shiffman & Di Giuseppe, 2012). This essay aims to argue that cosmetic surgery for purely aesthetic purposes is wrong.
The structure of the argument is described hereafter. To begin with, cosmetic surgery and its various forms are described briefly. Thereafter, the arguments against cosmetic surgery for purely cosmetic purposes are explained. Afterwards, the counter-arguments are discussed and refuted. Finally, a logical conclusion to the argument is provided.
Photo Credit: drtoddcase.com
Cosmetic Surgery
Cosmetic surgery is also referred to as aesthetic surgery, and is a subspecialty of plastic surgery. It uses reconstructive surgical techniques to alter the appearance of a person. The most common surgical procedure used is skin grafting. Skin grafting is the transfer of skin tissue from the donor to the recipient. The skin grafts are of three types; autografts, allografts and xenografts. Autograft are skin grafts from the body of the person undergoing cosmetic surgery. Allografts are skin grafts derived from other persons. Xenografts are grafting tissue derived from non-human sources. Cosmetic surgery places a lot of emphasis on incision, and usually mandates that incisions be made along tension lines. Well-placed incisions promote complete wound closure without formation of scar tissue. In fact, one of the reasons for performing cosmetic surgery is to remove unsightly scar tissue (Shiffman & Di Giuseppe, 2012).
There are different types of cosmetic surgery. These types can be broadly categorized into two forms which are described hereafter. The first category of cosmetic surgery is reconstructive aesthetic surgery which aims to correct defects that cause functional impairments. These defects include burn injuries, poorly healed bone fractures, congenital malformations, development deformations, and neoplastic tumors which have eroded the integrity of skin tissue. Thus, this form of surgery aims to not only improve the appearance of the individual, but it is also aimed at restoring his or her functional status. The main types of surgeries that fall under this category are breast reduction surgery, tumor removal, scar repair, mastectomy, breast reconstruction, hand surgery, contracture surgery, laceration repair, and ear surgery (Shiffman & Di Giuseppe, 2012). As it is discussed later, most of the arguments in favor of cosmetic surgery tend to conflate reconstructive aesthetic surgery to pure aesthetic surgery so as to use the justifications of reconstructive aesthetic surgery to rationalize and justify the need for pure aesthetic surgery. Thus, it is important to show the difference between these two broad categories of cosmetic surgery.
The second category of cosmetic surgery is pure aesthetic surgery which aims to only enhance the appearance of a person, and is usually devoid of any medical value; and for this reason it is an optional procedure. Recently, pure aesthetic surgery has also been used to obfuscate old age by removing signs of the aging process. According to statistics, over 90% of this form of cosmetic surgery is performed on women. The main types of surgeries that fall under this category are abdominoplasty, phalloplasty (reshaping the genitals), blepharoplasty (surgery of the eyelids), breast augmentation, mastopexy (also called breast lift), buttock augmentation, cryolipolysis, labiaplasty, cryoneuromodulation, rhinoplasty, lip enhancement, otoplasty, genioplasty, rhytidectomy (also called face lift), cheek augmentation, orthognathic surgery, brachioplasty, filler injections, laser skin rejuvenation, and liposuction (Shiffman & Di Giuseppe, 2012).
Supporting arguments
The focus of the essay is to rationalize the non-utility of using cosmetic surgery for purely aesthetic purposes. To begin with, the procedures used in pure aesthetic surgery are fraught with risks as explained hereafter. The procedures involve implantation, controlled bone fracturing, and skin grafting. A good example is orthognathic surgery which involves controlled fracturing of the facial bones along with skin manipulation to achieve the desired facial appearance.
The process of controlled bone fracturing risks fracturing sinuses and rupturing blood vessels, thus causing sinus infections and uncontrolled bleeding into both the nasal cavity and the oral cavity. Moreover, the procedure can lead to bone infections, most of which are resistant to treatment (Shiffman & Di Giuseppe, 2012). In a published study entitled The effect of tranexamic acid on blood loss in orthognathic surgery: a meta-analysis of randomized controlled trials, the extent of blood loss following inadvertent injury to blood vessels during orthognathic surgery was found to be too large to sometimes warrant the need for blood transfusion. Blood transfusion also has its adverse effects including spread of infections, and disseminated blood clotting which can lead to death. Additionally, the statistics used in the study also showed that a significant proportion of persons who seek orthognathic surgery do develop the aforementioned surgical complications (Song et al., 2013). Thus, the procedure of orthognathic surgery is best justified as a reconstructive surgery following an accident, burns or neoplastic erosion of the facial bones. Otherwise, orthognathic surgery for purely aesthetic reasons is unwarranted as the risks are too great to justify the benefits.
Secondly, pure aesthetic surgery sets precedence for future plastic surgeries as is explained hereafter. Breast surgery, especially insertion of breast implants, for purely aesthetic reasons is significantly associated with unacceptable risk. This is because a perfectly healthy body is subjected to the trauma of surgery, and the body responds by increasing its immune surveillance. If a blood vessel is ruptured during the procedure or if the implant impinges on any blood vessel, then the tissue of the affected blood vessel would react by recruiting immune cells to the area, and this process heightens the state of immune surveillance in the breast region. Breast implants are xenografts, and xenografts are recognized as foreign matter by the immune cells and an immune reaction occurs. The chemicals released by the immune cells cannot dissolve the breast implant, and thus the immune cells resort to using the mechanism of granulation to wall off the implant from the rest of body using granulation tissue [as the walling material]. Granulation tissue is unsightly, and some of it usually grows beyond the skin surface and thus forms a huge scar outgrowth. This scar outgrowth deforms the shape of the breast as well as reduces the functional range of the arms thus limiting the ability of the affected person to use her arms. This necessitates corrective surgery, and the most appropriate reconstructive surgical procedures are a combination of breast reconstruction, brachioplasty and scar removal. Thus, pure aesthetic surgery sometimes leads to functional impairments which require reconstructive surgery (Shiffman & Di Giuseppe, 2012). It also sets precedent for future surgical procedures. It is for this reason that pure aesthetic surgery is discouraged as the aesthetic value obtained from the procedure is negated by the un-aesthetic attributes of the resulting scar tissue or granulation tissue.
In a study done by Salzberg, Dunavant, and Nocera; and published in 2013, the post-surgical complications of breast surgery are shown to affect a significant proportion of women who seek the surgical procedure for purely aesthetic reasons. Thus, it is not recommended for one to seek the procedure for beautification purposes only.
Also, pure aesthetic surgery suppresses the immune system of an individual thus predisposing him or her to infections, chronic diseases and cancers. The procedure used in aesthetic surgery involves utilization of powerful immune-suppressants so that the allografts and the xenografts are not rejected by the body, and thus not subjected to walling off through formation of granulation tissue. These immune-suppressants reduce the capacity of the immune system to adequately protect the body, and this allows cells that have undergone neoplastic transformation to survive. These cells would otherwise have been destroyed by the immune system. Nonetheless, their persistence in the system also induces other cells to undergo neoplastic transformation, hence the development of neoplasia following aesthetic surgery (Shiffman & Di Giuseppe, 2012). 
In a study published in 2012, it was shown that cosmetic breast surgery led to the development of large-cell lymphoma (a cancer of the blood cells) (Aladily et al). It was also shown that a significant proportion of women who seek the surgical procedure for purely aesthetic reasons do end up developing a neoplastic condition (Aladily et al., 2012). Thus, cosmetic surgery for purely beautification purposes is not recommended.
One of the main arguments used to justify cosmetic surgery for purely aesthetic reasons is that appearance improves self-esteem. In the book Reshaping the Female Body: The Dilemma of Cosmetic Surgery, Davis (2013) analyzes the psychological value of cosmetic surgery. The book quotes and assesses the psychology studies which show that appearance enhances the sense of self-worth. According to these studies, improving the self-worth averts depression. These studies utilize liposuction as a good example of justifying their argument. Liposuction does improve the shape of the body, and this is quite valuable for a female model whose need for a shapely body cannot be understated. However, liposuction is associated with unacceptable post-surgical complications such as peritonitis, kidney failure and liver failure. Furthermore, one can build a good body shape by engaging in physical exercises (Davis, 2013). Thus, it is evident that there are better alternatives than pure aesthetic surgery, and these alternatives would still achieve the same psychological value as pure aesthetic surgery. For this reason, pure aesthetic surgery can be regarded as a superfluous exercise.
The second argument used to justify pure aesthetic surgery is that it manages body deformities. Pintaguy evaluates this argument in the book Aesthetic plastic surgery of head and body (2012)Cosmetic surgery is used on burn victims because there is need to restore the appearance of the affected person. Burnt tissue needs to be debrided, and tissue loss replaced by another tissue. Moreover, cosmetic surgery also alleviates contractures that result from burns. Nonetheless, this argument conflates pure aesthetic surgery with reconstructive aesthetic surgery. The surgical procedure done on a burn patient, such as reduction of a contracture, is aimed at restoring the function of the affected body part, and thus the procedure falls under the realm of reconstructive aesthetic surgery, which is a valuable surgical procedure (Pintaguy, 2012). Thus, management of burns does not involve pure aesthetic surgery, but it involves reconstructive aesthetic surgery. Hence, it is not valid to state that pure aesthetic surgery is used in the management of burns.
The surgical procedures used in cosmetic surgery are aimed at reconstructing the body by either reshaping body parts or through excision of specific deformed or unwanted tissue. There are two broad categories of cosmetic surgery; the reconstructive aesthetic surgery and the pure aesthetic surgery. Reconstructive aesthetic surgery has medical utility as it aims to manage functional impairments. On the other hand, pure aesthetic surgery has no medical utility and its only value is aesthetical. Pure aesthetic surgery is associated with unacceptable risk and debilitating post-surgical complications. Moreover, it sets precedence for future surgeries as well as suppresses the immune system of a person. Likewise, its psychological value does not justify the associated risks and complications. Thus, cosmetic surgery for purely aesthetic purposes is wrong.
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Aladily, T. N., Medeiros, L. J., Amin, M. B., Haideri, N., Ye, D., Azevedo, S. J., ... & You, M. J.
            (2012). Anaplastic large cell lymphoma associated with breast implants: a report of 13
cases. The American Journal of Surgical Pathology36(7), 1000-1008.
Davis, K. (2013). Reshaping the Female Body: The Dilemma of Cosmetic Surgery. Routledge.
Pitanguy, I. (2012). Aesthetic plastic surgery of head and body. Springer Science & Business
Salzberg, C. A., Dunavant, C., & Nocera, N. (2013). Immediate breast reconstruction using
porcine acellular dermal matrix (Strattice™): long-term outcomes and complications. Journal of Plastic, Reconstructive & Aesthetic Surgery66(3), 323-328.
Shiffman, M. A., & Di Giuseppe, A. (Eds.). (2012). Cosmetic Surgery: Art and Techniques.
            Springer Science & Business Media.
Song, G., Yang, P., Hu, J., Zhu, S., Li, Y., & Wang, Q. (2013). The effect of tranexamic acid on
            blood loss in orthognathic surgery: a meta-analysis of randomized controlled trials. Oral
            Surgery, Oral Medicine, Oral Pathology and Oral Radiology115(5), 595-600.

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