More and more Germans who are indeed not VIPs but do have relatively well-filled purses put themselves under the knife. The German Federal Republic ranks internationally in eighth place for number of cosmetic surgery jobs done behind the leaders U.S., Brazil and China. The estimated number of jobs done by plastic surgeons and their colleagues stands currently at no less than 300,000 to about one million procedures which have been done on healthy people who feel their bodies not to be flawless and in response want to do something about it.
Most often it is the bosom that is altered, eyelids streamlined and fat sucked out. Sometimes the doctors meet patients’ wishes which seem a little strange. In 2003 “Vogue” reported on a demand from New York women to have their feet reshaped more suitably for fashionable stilettos and flip-flops. “Snip and trim makes one happy” was the headline of an article from DocCheck a few months ago about the motives, but also on the satisfaction of the body shape optimisers’ clients.
An inadequate show under the panties
A particularly intense upswing in activity has been experienced in the area of surgery on the most intimate part of the female body, the labia. Surgeons from the German Society of Plastic Surgeons, Reconstructive and Aesthetic Surgeons (DGPRÄC) undertook 5440 operations in 2011. Surveys of patients show: only about half of the women complained of discomforts suffered while riding a bike or during sexual intercourse. The other half was simply not satisfied with its appearance and therefore simply had the labia reduced. Another study of 33 healthy women who’d made the decision for such a correction described the external anatomy of their reproductive organs in almost all cases as visibly normal. Even after the respective explanation by the doctor nearly half of the women stuck to their original intentions.
Exact figures on how often and where cosmetic surgeons in Germany do their scalpel work or liposuction do not exist, for nearly half a dozen professional societies in Germany make the claim to represent aesthetic medicine. Therefore, the number of complications and adverse effects of such operations is largely unknown. Since each licensed physician can without having special qualifications also adorn his wall with the title “plastic surgeon”, probably more commonly than with other interventions outcomes also occur which the patient had not imagined as such.
What does all this have to do with the professional ethics of the doctor? Should medicine not be responsible for the medical treatment of diseases and disabilities as opposed to involving “rebuilding processes” according to the whims and wishes of healthy people? Matthias Kettner of the University of Witten/Herdecke a few years ago coined the term “wish fulfillment medicine” which – thanks especially to the rising demand in recent years – has permitted outstanding earnings. The big money attracts many physicians more than do the many constraints under which more and more publicly funded doctors are suffering, in addition to their growing workload. No wonder that for instance Uwe Herrboldt of Medical One in Düsseldorf enthuses about his work in the private medical field: here you have the opportunity to enjoy life as a doctor and to devote more time to the patient. Critics of pure “aesthetic medicine” – seen quite separately from the use of plastic surgery after an accident or disability – accuse them however of “making healthy people sick”, as Adrien Daigeler, professor of plastic surgery at the clinic BG Bergmannsheil in Bochum, puts it.
Youthful beauty craze
Will the doctor then however merely become a service provider for dissatisfied people with an adequate health budget? A service which is advertised in a unabashed and extravagant way? The plastic surgeon is not sitting alone here in the dock. More and more so, people want an improvement in their physical and mental performance, or simply with the help of doctor and pharmacists to turn back the clock. Coated ideals of beauty also manifest themselves even where the youthful body has not yet matured. Therefore in 2005 the German Medical Association, together with politicians and churches, appealed in a “coalition against beauty madness” to the media, to at least not aim at youth as a target group. The number of operations is when compared to the total activity in this area quite small, a ban on cosmetic surgery without a medical indication has not been enforced mainly for legal reasons (self-determination of minors and the rights of parents).
Quality standards instead of advertising messages
Nearly a year ago the Central Ethics Commission of the German Medical Association published a statement on “medical treatment without indications of a related illness”. Before each treatment, therefore, an in-depth consultation should take place. The patient’s welfare should be of first priority followed only then by his wishes whereas neither the doctor’s nor his employer’s financial interests should matter. This means the inclusion of options other than those provided in the clinic’s own treatment programs and bringing them to the table – or the possiblity of coming to warmer terms with the patient’s present non-operated state. The doctor should offer only treatments for which he or she has the necessary skills. In general, the Ethics Commission has not turned against commercialism in cosmetic surgery – knowing well that the patient may upon experiencing rejection thus sometimes end up in the hands of lesser qualified “medical” people.
Certainly, the impression dare not be allowed to arise, simply on account of the often generously rewarded services of cosmetic surgery in the absence of an indicated illness or condition, that the doctor may be increasingly becoming more of a seller than caring therapist. This way, the medical profession as a whole would also continue to lose trust: trust that some overzealous IgeL [Germany’s IHS] sellers have already put at risk. In order to win a reputation in precisely this field, quality standards and codes of conduct should as soon as possible appear in place of advertising messages. Misconduct and botch ups ought to not remain without consequences and to be governed and punished, ideally by the appropriate chambers of self-management.
Death instead of big breasts
Such was the fatal outcome in 2011 in Hamburg during a breast augmentation. It was the fifth such operation for a porn star who wanted to attain a cup size “G”. The anesthesiologist was sentenced to probation, but the judge also seriously reproached the clinic: probably on account of profit motives there was a dearth of personnel and equipment. If, for example, the homepage of the renowned hospital chain already mentioned at the start of the article advertises its participation in the RTL-2 cosmetic surgery casting show “Extrem Schön”, it probably also arouses some desire among the less affluent to be more attractive. Some observers already see in this a dividing of society also in the area of health. Those who can afford attractiveness with the help of doctors and those who end up being denied this. And then there are those for whom it might just be ok to go to a discount plastic surgery – without quality management.
Cosmetic surgery = injury?
Does “nihil nocere” still play an important role in medical treatment of a healthy body? “Surgical procedures that seek to modify the human body without medical necessity” in the strict legal sense are to be considered physical injury, but without consequences by way of consent of the patients, infers Berlin lawyer Carsten Zabel on the topic of aesthetic surgery without a correlated medical condition. The question remains, however, whether the dissatisfaction of people with respect to their own body leads to a serious loss of quality of life – and perhaps to a need for correction by well trained professionals. The truth is likely to lie somewhere in the middle and probably looks somewhat different to each voluntary patient. Somebody who helps unhappy people to greater satisfaction and through this earns money can still be a good and respected doctor. However, someone who persuades persons without a flawed body that they could gain a competitive disadvantage in career and partnership should think about whether or not such a physician has been converted into a pure businessman.