-Essay-

GENEVA — It won't necessarily be carried out with a scalpel. Perhaps it'll be a syringe full of toxins. But over time, one way or another, there's a good chance you'll resort to cosmetic medicine — especially if you're a woman. That's because today's social codes make taking care of one's appearance, well, the least you can do.

Are social networks and the narcissistic society they produced to blame? Yes. But those aren't the only reasons. Advances in medicine and the efforts linked to ageing prevention are also behind this evolution. Not to mention that plastic surgery itself has changed, with easier and less invasive procedures.

Another contributing factor is that information about cosmetic medicine, thanks to the sharing of stories online, circulates better and contributes to making it less stigmatizing and taboo: A 50-year-old woman today, in the eyes of society, doesn't look at all like a 50-year-old woman from 50 years ago. Hence increased social pressure on the women who don't resort to it.

A matter of good manners

To understand these changes, let's start by remembering how, well before liftings and Botox, our collective ideas about makeup and hair dyeing also evolved. As Marie-Thérèse Duflos-Priot explains in her article "Le maquillage, séduction protocolaire et artifice normalisé" (Makeup, formal seduction and standardized artifice), cosmetics were codified along moral lines and associated with superficiality, seduction and sexuality. As such, makeup was strictly forbidden for "pure" young girls, tolerated for virtuous women on the condition that it was discrete, and seen as a sign of easy virture when applied conspicuously.

Nowadays, a woman of any age who goes makeup-free, without hiding her acne or her wrinkles, is seen as careless. And women who don't cover their gray hair, even after the age of retirement, are rare. Why? Because cosmetics have gone from being sexual to something akin to good manners, a form of politeness that consists of appearing young, in good health and at ease.

This social evolution is deeply linked to that of medicine itself, and to health policies that made prevention one of the field's central dimensions. "As soon as certain individual behaviors were identified as public health problems, they became singled out," says Vincent Barras, a medical historian from the Lausanne University Hospital.

"Tobacco prevention opened the way. Then, obesity prevention became a priority," he adds. "Feeling comfortable is also feeling attractive. We have moved from a paternalistic medicine to an era where each individual is held accountable, in the eyes of society, for the upkeep of his own health."

"Harmonizing" images

Today, with the demographic ageing of industrialized societies, age prevention itself seems to have become a priority. The problem is that living longer and enjoying good health later into life isn't sufficient anymore. Besides feeling good, people are also expected to look it.

"With age, there's an increasing gap between the image we have of ourselves and the image others or our mirror reflect back to us," says Pierre Quinodoz, head of the Swiss Society for Plastic, Reconstructive and Cosmetic Surgery. "Who hasn't woken up in great form, only to be told by others that they looked tired or in poor shape? Our work contributes to the better-being of patients, because it aims to harmonize the inside image with the outside image."

At the same time, the permanent display of ourselves through social networks largely contributes to the confusion between reality and appearances. Working on one's own image, whether it's through putting on makeup or resorting to plastic surgery, then becomes legitimate insofar as it directly contributes to psychological well-being.

"In a society where each individual is brought to watch, look at and take care of himself, appearance has become the measure of his own value," says Hélène Martin, a gender studies professor at the School for Advanced Studies in Social Work and Health.

Biological injustice

Does cosmetic surgery now serve self-confidence? Psychological studies support this idea. And some even say that the cause of women, the main customers for this type of medicine, could even benefit from this. "The biological injustice is that, in the course of their lives, women go through hormonal changes that do a lot more damage compared to what men go through," says Quinodoz. "Our work enables them to regain confidence at an age where their social life used to be considered over."

Hélène Martin sees things as being more relative. "Women don't age in a worse way, but their ageing is seen as uglier than for men," she says. "At the same biological age, they are socially older than men and suffer more pressure regarding their appearance. Besides, aesthetic standards, ideal and unattainable, to which they are bound, are racist, sexist and classist. In other words, the female ideal remains young, white and upper-class."

The gender studies professor notes that some feminists think resorting to plastic surgery means surrendering to the patriarchy. Others, however, "choose to see in cosmetic practices, makeup and surgery, a possible liberator — in the sense that it would be a way to gain more control over their bodies and, deep down, get by in a context that, unfortunately, is still misogynistic." So, if even feminism allows it …