Youth, beauty, and an obsession with looks

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By Alyssa Giacobbe
Globe Correspondent / January 21, 2010

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In her groundbreaking 1999 book, “Survival of the Prettiest,’’ Harvard Medical School psychologist Nancy Etcoff argued that beauty is not a social construct but a built-in ideal. Scientific studies have proven that human beings are hard-wired to respond more positively to beautiful people; we like, trust, and value them more. Good-looking people, Etcoff wrote, get better jobs, are better paid, and have an easier time in life. Evolutionarily speaking, pretty people win.

More than a decade later, Etcoff’s premise is as relevant as ever, if by now fairly obvious. Recently, British archeologists at the University of Bristol published a report in a UK medical journal that Neanderthals wore makeup as long as 50,000 years ago. These days, beauty is a multibillion dollar industry. In the United States, Etcoff wrote, more money is spent on aesthetic pursuits than on education or social services.

As science progresses, and achieving physical “perfection’’ becomes more accessible to those with the money and inclination, the line between the desire for a bit of self-improvement and obsession has become increasingly blurred. Last week, People magazine put reality star Heidi Montag on the cover to promote her latest round of cosmetic surgery. Under the headline “Addicted to Plastic Surgery?’’ Montag talks about undergoing 10 procedures - including liposuction, breast augmentation (she’s now a DDD), and a brow lift - in a single day. She’s 23.

While both surgical and non-surgical procedures have been in decline during the recession, according to a 2008 report by the American Society for Aesthetic Plastic Surgery, 69 percent of 18- to 24-year-olds approved of cosmetic surgery, up from 62 percent just two years earlier. The report also notes that invasive procedures on those 18 and younger have nearly doubled over the last decade from 1 percent to 2 percent, and that of those who get Botox injections, 14 percent are between 19 and 34.

In People, Montag gives two reasons for her over-the-top transformation. For one, she was teased about her looks as a child; more recently, she was “disheartened’’ when she couldn’t fill out a bra at a shoot for Playboy. But more than that, she says, looking a certain way is a necessary part of succeeding as a pop star, her ultimate goal. Etcoff says there is evidence that kids who were bullied may never shake the ugly duckling feeling even if they grow into swans. Cambridge dermatologist Ranella Hirsch, past president of the American Society of Cosmetic Dermatology and Aesthetic Surgery, contends there are “very few people in Hollywood who haven’t had something nipped, tucked, or smoothed.’’

Still, Hirsch cautions against such extreme alterations so early on. “All of these procedures have a certain life span,’’ she says, adding that her office turns away half of all patients who come in for a consult for a variety of reasons, including being too young.

The fact is, however, that most people flirting with cosmetic enhancements are a bit older, and the weak economy may be playing a role.

“The recession’s had a huge effect on how we view beauty,’’ says Etcoff, pointing to a more competitive workplace and fewer overall jobs. On Tuesday, Etcoff, Brookline plastic surgeon Sumner Slavin, modeling agency director Jo Somers, eating disorder specialist Heather Thompson-Brenner, and the School of Fashion Design’s Jay Calderin were slated to take part in a forum on the science of beauty and just how much looks matter in 2010. The panel (which took place after deadline) was sponsored by

Etcoff says there’s no clear reason why one person becomes compelled to get more and more plastic surgery and another does not. “When someone goes that far, there are many motivations,’’ she says. “Some people can go in for a treatment and be satisfied. For others, it becomes a never-ending quest.’’ Etcoff specializes in treating Body Dysmorphic Disorder, a mental illness in which a person struggles with imagined ugliness, and says that many BDD sufferers seek out repeated cosmetic procedures. Conversely, a small percentage of people who have elective surgery later develop BDD. And like any addictive behavior, some people are simply predisposed to wanting more.

While the moralizing around cosmetic beauty has tapered off as more participants freely cop to it, Etcoff points out the enduring hypocrisy surrounding the subject.

“People will condemn those who elect to alter themselves physically as vain or deluded, and yet those same people will unconsciously judge against someone who is unattractive or overweight,’’ she says. “We’re judged if we’re unattractive, judged if we do something about it. The fact is that we do care about beauty, we do judge - the question should be, how can we live with it in a more productive and accepting way?’’

Many in the blogosphere blasted People for giving Montag the space, and for helping normalize extreme plastic surgery and Hollywood’s unrealistic standards of beauty. (People would not comment for this story.) “Heidi is basically allowed to spew comments about how surgery was the answer to all of her body image issues,’’ Margaret Hartmann wrote on (Hirsch, meanwhile, points out that, although on the high end, performing 10 related procedures in a single day isn’t unheard of when you consider that most doctors will elect to anesthetize a patient as few times as possible.) But both Hirsch and Etcoff agree that, while celebrities and the media are most often criticized for glorifying ideals of beauty, cosmetic contagion happens much closer to home.

“No one wants to be the oldest-looking woman in her social group,’’ Hirsch says. “It’s rarely the Heidi Montags of the world that compel you to change your looks. It’s your neighbor.’’