In an ideal world, people would base their sense of self-esteem only on the content of their character and not their outward appearance; there would be no discernible disparity in hiring rates among those considered attractive and those deemed unattractive; and the cultural emphasis on or obsession with beauty would be relegated to a level of focus much closer to its actual importance. Needless to say, we do not live in an ideal world. Certainly, there is ample evidence to suggest that across a wide swathe of the population, one’s own appearance is important on the individual level and has wider social implications. The American Society of Plastic Surgery reports that nearly 11 million cosmetic procedures (comprising cosmetic surgery and minimally-invasive but not reconstructive procedures) were performed by board-certified physicians in the United States in 2006, which represented a 7% increase over the previous year, and a 48% increase from 2000. In turn, the 2005 total represented a 151% increase from 2000 and a 775% increase from 1992 (the first year for which the 76-year-old organization has detailed statistics). In 2006, Botox injections, chemical peels, laser hair removal, microdermabrasion, and hyaluronic acid, in descending order, were the five most popular procedures.1 In total, soft tissue filler procedures (also including calcium hydroxylapatite, collagen, fat, and polylactic acid) collectively represented the second most popular type of procedure. The top five cosmetic surgical procedures, also in descending order, were breast augmentation, nose reshaping, liposuction, eyelid surgery, and tummy tuck. According to psychiatric studies, the number of “healthy” people seeking aesthetic surgery has increased steadily since 1980, indicating greater public acceptance, wider diversity in those seeking the procedures, and an evolution in the psychiatric definition of “healthy.”2
As with most of the topics covered in this text, a full book could be devoted to the psychosocial aspects of cosmetic dermatology and, in particular, the billion-dollar beauty industry as well as the historic, philosophic, and theoretical investigation of beauty itself. This chapter will discuss some of the underlying reasons for the ever-increasing incidence of elective aesthetic procedures in the developed world and what motivates people to undergo these procedures. Specifically, this chapter will focus on the influence and significance of beauty in society and its implications for the field of cosmetic dermatology. The significant social and psychic consequences that disorders such as psoriasis, alopecia, hirsutism, melasma, rosacea, vitiligo, and others have on individual’s health-related quality of life are generally beyond the scope of this chapter, though such effects related to acne are briefly considered as is the role of stress as an initiating or mediating factor in cutaneous conditions that may, in turn, induce anxiety over the effects on one’s skin, fostering the desire for remedial cosmetic treatment.
THE VIEW OF EVOLUTIONARY PSYCHOLOGY: PULCHRITUDE TO THE MULTITUDE
In the United States, more than twice as much money is spent on personal care than ...