15. 7. 2020

English version | The skin I live in

by Ana Murcho

 

In the last six months, in Portugal alone, the surgery to increase the buttocks grew by 400%. This means that, despite the pandemic, women - because they are mostly women - remain concerned about their physical appearance. But that is just the tip of the iceberg. Because if the rub of the issue was in the obsession with the rear tail, we would be fine. The last decade has brought a widespread craze for interventions that way beyond the simple correction, or enhancement, of the image. 

Jordan James Parke had a dream: to be like Kim Kardashian. And he didn’t rest until… Well, we couldn’t write “until he did it” because, obviously, Jordan James Parke wasn’t able to fulfill his great life goal. Despite the countless surgeries he has undergone, the boy from Manchester, England, also known as “the king of aesthetics” (this is how he presents himself on his Instagram profile, where he has close to 100 thousand followers), still has a look that has nothing to do with the American reality show star. In 2016, in an appearance on The Morning Show, Jordan revealed having spent more than 140 thousand euros, out of his own pocket, on the more than 50 interventions he underwent in the space of six years. “Plastic surgery is 100 percent like sex. You cannot do it just once. You have to do it over and over, over and over again”, he admitted at the time. It’s probably something like this that has crossed the mind of Valeria Lukyanova, the Ukrainian that the world identifies as Human Barbie when, as a teenager, she realized the similarities that linked her to the doll of Mattel brand. From there to starting a path of no return in terms of “modifications” was a small step. Let's go straight to the point because, in Valeria's case, the giant breast implants and the ultra-skinny nose are yesterdays’ news: to achieve, and maintain, the “wasp belt” effect, the one that in times gone by women exhibited with corsets that were confused with instruments of torture, the girl (who meanwhile reinvented herself as a medium) decided to extract several ribs. In the middle of the nineteenth century, when we thought that the rag "suffering to be beautiful" had been discontinued once and for all, here are echoes of its reissues.

“Many of the aesthetic surgeries are performed so that the patient feels good about himself, confident with his image, because emotional well-being - self-esteem - has a great impact on his daily life, both in love and friendship relationships, as in family and professional relationships. When we are confident, we have another attitude towards life, another availability. However, in the case of extreme surgeries, I believe it goes beyond that. On the one hand, beauty is abstract and highly influenced by the society in which we operate and, individually, we can also have different views of what is beautiful and attractive. On the other hand, this search for more extreme procedures is often a way of drawing attention or escape to situations of emotional imbalance or disturbances in identification.” João Martins is specialist in plastic, aesthetic and reconstructive surgery. He is used to dealing with all kinds of cases, the good and the less good, those with happy endings and those who need a “second hand.” For him, the demand for cosmetic surgery, namely for these extreme procedures, is justified because, in the first instance, “the body image is both rational and emotional and often has an important weight in the value we attribute to ourselves. I think that self-esteem and the appearance of the body are linked and influence each other. If we don't like our body, it will be more difficult to feel good about ourselves and, if we don't feel good about who we are, we will hardly appreciate the image we have.”

It is an opinion shared by Paul S. Nassif, a Lebanese-American plastic surgeon and one of the protagonists of the Botched TV show, where mistakes made in past interventions are corrected. “Plastic surgery is becoming something more and more accepted. People do not expose themselves thinking they’re going to get botched - it just happens. Now some patients, like you see on Botched, are into body modification - and you know they’re very smart and know exactly what’s going on but they really want to modify their body, just like if someone wants to get tattoos or piercings, but this is more extreme. And they do search from all over the world to find the best doctors to do this, and that’s why they expose themselves. They don’t really lack self-esteem - some of these patients want the perfect body or the perfect something, or they’re plastic surgery addicts maybe, that might be one issue. But I think that in this situation it’s more that obviously there are patients that have body dysmorphic disorder, and they do go for something they see as imperfect and try to make it perfect.”

One-million-euro question: how does anyone decide to become a slave to the knife? Two-million-euro question: why does anyone decide to undergo constant surgeries, which involve large amounts of money and a very tough post-op, when often the final result is only the distortion of the traits with which they came into the world? In the last few years, what we call extreme procedures - and here the surreal breast implant fits in as well as the almost superhuman attempt to grow a few centimeters - has skyrocketed. Should we point the finger at the so-called celebrity culture or, on the other hand, are social networks, which celebrate a filtered version of people, the big culprits? João Martins has no doubts: “The cult of beauty and the idea of a perfect life and a perfect body that proliferates on social networks can, in fact, justify this increase. These procedures, said to be extreme, continue to be more frequent in societies like the American one, but it is true that, due to natural influence or evolution, they begin to appear in Portugal. With filters and other image manipulation tools, we no longer understand what is real or not and, when in doubt, we all believe in what we see, we believe in filtered versions even without knowing what these people's lives really are. There ends up being an abstract form of competition for life that certain people, whom we end up idolizing, have. On the other hand, new ‘beauty standards’ have emerged with celebrities like Kim Kardashian or Nicki Minaj who, whether we like it or not, have come to define new trends, often based on exaggeration. The fact that these models become references and draw attention, can lead someone to feel that they will have more appreciation from their peers if they manage to be more like these idols. People come to believe that what they see is the way their body or face should be.” Once again, it’s a position that finds an echo in Dr. Nassif. “I think it’s more social media – I don’t think it’s the celebrity culture anymore. I think what happens is they look at social media and they start filtering themselves, and they keep doing it a little bit more, a little bit more… and they end up basically thinking that they really look like that, a very over-filtered version of themselves which doesn’t exist. Then they go to the doctor and they try to recreate that, and some doctors will do it, and that’s when you get these extreme procedures.

It's here, too, that ethics and morals come into play. The two doctors have already refused to operate. More than once. When it came to health, physical and mental, more than a supposed beauty - which is never total, nor perfect, no matter how fine and experienced the hands that orchestrate the change are. “It is customary for patients to come to the consultation with an idea of what they want to be out of alignment with their reality. In these cases, in addition to talking about the pros and cons, I show them why I do not find it viable and, most of the time, the patient changes his mind and we end up choosing a result more in line with his structure”, explains João Martins. And he goes on: “Today, with so much technology available, it is even possible to simulate the image of what it will look like and then, facing its altered image, the patient understands better why it is appropriate or not. It is often not just a question of proportions, but of security. With the advancement of medicine and surgery, almost everything has become virtually possible, however the health risks may not justify what we are asked for. In addition to the short-term risks inherent to surgery, we must consider the long-term physical and psychological consequences and have a lot of respect for points of no return. That is, it may not be possible to reverse certain procedures. In surgery, there is no rubber that allows us to erase what we have modified in the body when certain characteristics are no longer in fashion or when they do not meet the expectations that a certain extreme physical change would solve all our problems and allow that filtered life that we tried to copy.” 

In Dr. Nassif’s case, we can watch his firm standings in any episode of one of Botched's six seasons. “You see me talk to patients all the time, especially in my office. I try to get them to change their mind, I even talk to them about if they have a psychological issue and try to get them to see the right mental health physician for it. I tell them why it’s dangerous what they’re going to do, and what it can do to them. Part of my job is being a psychiatrist, therapist and psychologist, and to find out why do they really want it? What is the reason, what is the obsession? And I have to dive deep into it, whether it’s obsessive-compulsive disorder, plastic surgery addiction, body dysmorphic disorder, low self-esteem, depression. What really is causing it? And so this happens all the time, some patients do listen to me, some patients sometimes don’t and they go see another doctor, and they eventually get the procedure.” Do you remember Jordan James Parke, with which we opened this text? He has already tried his luck twice in the program conducted by Dr. Nassif and his colleague, Terry Dubrow. Twice, his intentions were denied. A higher value was at stake - his health.

But, after all, what is being done in these offices outside? Or rather, what is being corrected? Because if we all know that lip filling started to be trendy-to-a-certain-point in the late 2000s, we’re a bit east when it comes to how to fix some of those lip fillers gone wrong. The same is to ask, what is the top of the interventions that are botched? The word to João Martins: “The most performed surgeries end up being the ones with the most corrections. Changing breast implants is the most frequent correction: removing implants that are too large and artificial (a look that was most sought after in the 1990s) and reassembling the breast without any implants or with smaller implants and with a more organic result. In recent years, there has been a very marked growth in lip growth. Due to the trivialization of fillers with hyaluronic acid and the lack of legislation on who can perform these procedures, it has been more and more frequent to have to correct lips, either because the product was placed in the wrong way and deformed the lip or because the proportions with the remaining elements of the face - such as the nose and chin - were not respected. Another area of correction is the gluteus, not only due to the improper use of methacrylate [a permanent substance, like cement, with a high potential for volumization], but also due to the attempt to obtain excessive increases through the abusive insertion of fat (which ends up for forming cysts, necrotizing or infecting), or the use of prostheses placed too excessively and which, years later, bring complications mainly to the visibility of the implant and deformation of the gluteus.”

That is why these stories, or part of these stories, do not always have a happy ending. People who practice extreme procedures, those who “can't stop at the first time”, are looking for a better version of themselves, a version that looks more like this utopia that they discover in a virtual world, only that they often end up for getting little more than a more fake, almost messy, version of the original. It is a certain amount of madness that implies (many) risks, as the Portuguese expert explains. “In addition to the risks inherent in the complexity of the procedures and the individual comorbidities of each patient, which can endanger physical integrity and life, the greatest risk is, in fact, that the person will lose his identity, that he/she stop being who he/she is, cease to have the features that are characteristic of he/she and that make he/she recognized. In my opinion, plastic surgery should be seen as an improvement of our image and not as a drastic alteration - except for some exceptions, such as reconstruction (be it breast, hand or other part of the body), in which the plastic serves, precisely, to ensure greater naturalness. We only have one body and, therefore, it is important to care for and preserve it, because an excessive change can cause many complications. We have to keep in mind that the tastes and trends also change and, therefore, what the person likes to see today, may no longer like to see in five years and, at that point, will be dissatisfied, frustrated and this will have an impact in your self-esteem, resulting in emotional problems.” The next time you think about lying down on a table to get JLo butt, remember all this. If you still decide to go ahead with the surgery, find a doctor for whom ethics is as important as the end result. Those are the ones who never fail.

*Originally published on Vogue Portugal's The Madness Issue.