The medical and the cosmetic: reflections on ‘corrective’ surgery and the scientific use of animals
The medical and the cosmetic: reflections on ‘corrective’ surgery and the scientific use of animals
In my PhD work on societal views towards animal research, I’ve found that the area of cosmetics is often held up as an unambiguous example of the ethical limits of using animals in science, with cosmetic products and procedures providing an easy marker of where animal research is unnecessary and unjustifiable. Indeed, the use of animals for ‘cosmetic purposes’ is banned at both national and EU level (Directive 2010). In contrast to the ‘medical’, a category of research invested with expectations of life ‘-saving’ and '-prolonging’ interventions, the ‘cosmetic’ is commonly regarded as trivial and those who consume cosmetic products and procedures often depicted as shallow. However, is the distinction between the cosmetic and the medical as clear-cut as it seems (to some) on the surface?
In considering this, I have found myself thinking about the significance that ‘cosmetic’ matters have played and continue to play in my life. Undergoing ‘corrective’ surgery as a teenager the cosmetic explicitly became medical, and I know from my own experience that appearance is often felt as far from trivial in the everyday. Yet, how do such 'cosmedical' interventions align with conceptions of necessity mobilised in animal research? And what kinds of ethical problems do they present for human and non-human bodies? Below I offer some early musings.
Sticking out and blending in
As a teenager I had my ears surgically ‘pinned back’ via what is medically known as a pinnaplasty or otoplasty, ‘a unique procedure to aesthetically correct protruding ears’ (Niamtu 2011, 271). Though essentially medically benign, the presence of prominent or protruding ears (or ‘macrotia’, literally ‘big ear’) is shown to generate negative psychosocial impacts (Sheerin, Macleod and Kusumakar 1995) which successful otoplasty is seen to remedy (Gasques, Pereira de Godoy and Cruz 2008, Songu and Kutlu 2014a, Songu and Kutlu 2014b). In such studies, bullying is discussed as a common experience of school-age children with prominent ears and this propels the medical judgement that otoplasty is best performed on children between 5 and 7 years old (Niamtu 2011). The performance of otoplasty has even been reported on patients as young as 9 months (Gosain and Recinos 2002).
In their study of the psychosocial condition of patients before and after otoplasty, Gasques et al. (2008) observe that ‘[o]ften, children return home crying, asking for help from their parents because of nicknames, bullying, and teasing caused by their prominent ears, leading the children to despair’ (Gasques et al. 2008, 91). Interpreting such occurrences, they contend that the ‘feeling of being despised and persecuted contributes to making life hard, and children become cautious and reserved. In such cases, when the children do not become rebellious, they become anxious, aggressive, and violent individuals’ (ibid). In making this leap, the authors suggest a direct link between the childhood experiences of those with physical ‘abnormalities’, such as prominent ears, with problematic or even deviant futures, a link which justifies medical intervention at an early age. Indeed, historically, as Rogers (1968, 210) observes, such features were linked with criminal behaviour and Gilman (1999) has discussed the racialisation of large ears and noses in anti-Semitic literature and anthropology. Perhaps the prominence of such narratives goes some way to explaining why otoplasty has become ‘one of the most common paediatric [sic] otorhinolaryngological operations’ (Kajosaari, Pennanen and Klockars 2017, 52).
When I was in the infants half of primary school, my mum prompted me to think about having my ears pinned back but back then I wasn’t really that bothered about the way I looked. Having an operation seemed serious and scary and, at that point, I couldn’t see any need for it. From my mum’s perspective, I imagine that the surgery presented itself as a pre-emptive strike against the stigma that was expected to come. However, I wasn’t made aware of my ears as a meaningful ‘abnormality’ until secondary school, where I received the prompt lesson of my literal and metaphorical sticking out. Through my early teenage years I developed my own non-invasive ways of blending in. I wore elastic headbands that flattened my ears down, hair extensions which added volume and weight to cover them, and, probably the least effective technique, once spent a day at school with my ears sellotaped to my head under my hair. Each working to hide my problem ears, but not resolving them. Sometimes I glibly thought about supergluing my ears to my head. I’d grown to not only despise them but also feel disgusted by them and even started covering them at home. It was no longer just about hiding them from other people, I needed to hide them from myself.
Eventually I’d come to see not just the value in surgical intervention upon my ears, but the necessity of it. Expecting that once fixed, I would feel free and comfortable with my body and could move past the near constant self-regulation. Upon proving my need for elective surgery, demonstrating the negative impact that my problem ears were having on my wellbeing and the everyday steps I took to mitigate their existence, at 14 I was able to access an otoplasty free of charge through the UK National Healthcare Service. Once healed, I cut my hair short and ticked my ears off my list of bodily insecurities (though I still didn’t like them), having corrected what culture has defined and medicine diagnosed as a ‘deformity’ (Rogers 1968).
Having lived the effects and affects of a body judged as physically ‘abnormal’, I have often felt uncomfortable with the clear distinction made between the cosmetic and the medical, the necessary and the trivial, in discussions around the use of animals in research. For me, the experience of my own cosmetic intervention illustrates the lived borderlands between the two, in which the cosmetic is felt as far from superficial. Feminist understandings of the body have directed focus to the normalising powers that work to discipline women’s bodies in patriarchal culture, in ways structured differently along the lines of race, class, age, and so on, reinterpreting efforts spent on one’s appearance as attempts to physically perform a normative feminine body and gain the capital that such performances may accrue. As Bordo (2003) writes, ‘[p]eople know the routes to success in this culture—they are advertised widely enough and they are not "dopes" to pursue them. Often, given the racism, sexism, and narcissism of the culture, their personal happiness and economic security may depend on it’ (Bordo 2003, 34).
Given that the experience of embodiment for many women is structured by visibility (Bartky 1998), for spectators imagined or otherwise, Dolezal (2010) has claimed that cosmetic augmentation may represent the desire for societal invisibility, rather than hypervisibility. Similarly resonant with my own experience, Gimlin (2006) suggests that rather than simply making the body more visible, ‘cosmetic surgery is sometimes used to make the body less problematically central to consciousness, thereby allowing individuals a greater degree of volition in focusing on the body or beyond it’ (Gimlin 2006, 700).
Thinking back to how much my ear surgery meant to me at the time, the hopes I had instilled within it, characterisations of the cosmetic world as superfluous seem entirely at odds with my lived experience. But within the arena of animal research, an issue seemingly marked by moral conflict and dilemma, I can understand the tantalising comfort that clear ethical boundaries can present. Unfortunately, however, as this brief example suggests, the medical and the cosmetic do not exist separately. Both corporeally and institutionally, the cosmetic is medical. Yet, what does this mean for justifications of using animals in science?
Aesthetic medicine and animal research
Considering the medicalisation of cosmetic interventions when thinking about the scientific use of animals alerts us to the messiness of the cosmetic/medical distinction and troubles the ethical boundaries built upon this. In examining my own experience of cosmetic surgery in relation to animal research, I found that alternatives to the use of live animals exist, such as the use of animal cadavers (for instance, the heads of pigs (Loh et al. 2014) and sheep (Uygur et al. 2013)), and synthetic materials to replicate the ear (Schneider, Voigt and Rettinger 2016, Reis, Marim and Souto 2018). Yet, animals remain used as experimental models for developing and practicing surgical techniques involved in otoplasty (Rohrich, Friedman and Liland 1995, Oliaei et al. 2013, Yau et al. 2014, Taylor and Hong 2016), and are used throughout plastic and reconstructive surgical training more broadly (Loh et al. 2018).
In some of the studies cited above, photographs can be seen of rabbits with their ears sutured into folded positions. In looking, I remember how surprisingly painful my post-operative healing was, how I couldn’t rest my head on my pillow properly for weeks and would groan restlessly through the night. But I had my new and normal ears to give reason to the pain and process, the vision of myself once my head dressing could be removed hopefully making it all worth it. Being killed 8 weeks or less after their otoplasties, the rabbits of such studies didn’t have much time to experience their new auricle aesthetics and, anyway, their ears were the species-specific equivalent of normal in the first place.
Along with countless other children, I grew up with a body trait that bears no physiological impact but very often leads to ‘corrective’ surgery, an experience which demonstrates the practiced permeability of the medical/cosmetic divide. The situation of animals implicated like those above in a culture which defines the bodies of healthy children as ‘deformed’, the main symptoms of this being cruel jibes and the emotional turmoil they can inflict, reflects the multi-species suffering that cultural body norms can generate. Alongside emphasising the blurriness of the cosmetic and the medical, stressing that the ‘aesthetic’ is never merely that and that cosmetic interventions can of course promote wellbeing, the use of animals to reinforce normalising powers upon (mainly children’s) bodies raises urgent questions about the exceptional ethical status that the broad field of medicine receives.
In exploring patient engagement and involvement in animal research, Davies, Gorman and Crudgington (2020) found that alongside reassurance of their possibility ‘to gain from this research’ and the responsibility of ensuring that ‘what they encounter is acceptable care’, the entering of the animal research facility may also generate a felt personal responsibility between the patient and their animal model counterpart (Davies et al. 2020, 148). As they suggest, ‘the potential to understand their own condition through research and through animal’s bodies opens the potential for shared suffering’ (ibid). The personal reflections I have offered here, go some way to illustrating not only the affectual burdens that even distant encounters with the laboratory animals that model our ‘medical conditions’ can produce, but also the political and ethical accountabilities that emerge through such medical practices. In this case, such accountabilities ask if the harming and killing of non-human animals in order to reconstruct human bodies to fit cultural norms should ever be ethically acceptable?
Feminist care ethics calls for attention to shared vulnerabilities. Tronto (2012) captures this in the concept of ‘relational responsibility’, ‘where the fact of being alive and the nature of human vulnerability places one in relationships […] that produce responsibilities’ (Tronto 2012, 308). Such considerations are key to an ethics of care, as Bird Rose (2013) claims, ‘[t]o understand one’s self as part of a community of life is to accept responsibilities, and also to accept vulnerability’ (Bird Rose 2013, 311). In the context of animal research, the sharing of corporeal vulnerabilities between human and non-human animals plays out viscerally in their use as models for human ills. As this case shows, enacting ethical care towards such animals involves consideration and accountability not only for those caught up in our healthcare in the strictly clinical sense, but also in our aesthetic healthiness, the processes through which our bodily aesthetics are medicalised and subject to diagnostic lenses. The constructs that create aesthetic vulnerabilities and which can lead to psychosocial vulnerabilities are here demonstrated to affect both humans and non-humans. Despite the obvious aesthetic dissimilarities across animal species, cultural standards of ‘normal’ or ‘attractive’ faces and their medical transformation into healthy and unhealthy, not only come to bear on human bodies but also on those of other animals.
In thinking about the medical and cosmetic divide through personal experience, I hope to have offered a brief reflection on the practical implausibility of this distinction. As well as being complicated by the intersections of health as a physiological and relational phenomenon, with bodily insecurities and stigma contributing to poor mental health (and its physical manifestations), this example suggests that resting upon such dualisms and the judgements that accompany them to be ethically problematic. The role that medical interventions such as cosmetic surgery can play in physically reshaping bodies calls for continued critical attention not only because of the dangers it holds for reinforcing body fascism but also because of the ethical obligations we have to laboratory animals used in this area. Rather than simply adding to the scrutiny towards the aesthetic, focus here can work to unsettle the representation of the ‘medical’ as ethically exceptional and politically neutral in animal research practice (Blattner 2019).
Of course, much more attention is needed here to tease apart the entanglement of culture and science and their intervention upon human and non-human bodies in the name of medicine. For now, these reflections add to an evidencing of the leakiness of the barrier separating the medical and cosmetic and, in thinking about this with animal research, trouble the consequences that such a distinction and the status of medicine bears for animals in science. As this demonstrates, medicine is not a neutral category and is inevitability influenced by cultural and political notions of health and ‘healthy’ bodies. Indeed, as Clarke, Ghiara and Russo (2019) put it, ‘[h]ealth is more than the absence of disease. It is also more than a biological phenomenon. It is inherently social, psychological, cultural and historical’ (Clarke et al. 2019, 2).
Judging the worth of biomedical research is difficult and multifaceted, requiring vision oriented to the past, present, and future. However, time spent here, considering the specific and not the abstract, with our ears pricked up to the medically mundane, can be productive for all those whose bodies are caught up in the production of health.
Bartky, S. 1998. Skin Deep: Femininity as a disciplinary regime. In Daring to be Good: Essays in Feminist Ethico-politics, eds. B. A. B. On & A. Ferguson, 15-28. Routledge.
Bird Rose, D. 2013. Death and grief in a world of kin. In The Handbook of Contemporary Animism, ed. G. Harvey, 137-147. Acumen Publishing.
Blattner, C., E. . 2019. Rethinking the 3Rs: From Whitewashing to Rights. In Animal Experimentation: Working Towards a Paradigm Change, eds. K. Herrmann & K. Jayne, 168-193. Leiden, The Netherlands: Brill.
Bordo, S. 2003. Unbearable weight : feminism, Western culture, and the body. London : University of California Press.
Clarke, B., V. Ghiara & F. Russo (2019) Time to care: why the humanities and the social sciences belong in the science of health. BMJ Open, 9, e030286.
Davies, G. F., R. Gorman & B. Crudgington. 2020. Which patient takes centre stage? Placing patient voices in animal research. In Geohumanities and Health. Cham: Springer.
Directive, E. (2010) 63/EU of the European Parliament and of the Council of 22 September 2010 on the protection of animals used for scientific purposes. Official Journal of the European Union, 276.
Dolezal, L. (2010) The (In)Visible Body: Feminism, Phenomenology, and the Case of Cosmetic Surgery. Hypatia: A Journal of Feminist Philosophy, 25, 357-375.
Gasques, J. Á. L., J. M. Pereira de Godoy & E. M. T. N. Cruz (2008) Psychosocial Effects of Otoplasty in Children with Prominent Ears. Aesthetic Plastic Surgery, 32, 910.
Gilman, S. L. 1999. Making the body beautiful: a cultural history of aesthetic surgery. Princeton, N.J.: Princeton University Press.
Gimlin, D. (2006) The Absent Body Project: Cosmetic Surgery as a Response to Bodily Dys-appearance. Sociology, 40, 699-716.
Gosain, A. K. & R. F. Recinos (2002) Otoplasty in children less than four years of age: surgical technique. J Craniofac Surg, 13, 505-9.
Kajosaari, L., J. Pennanen & T. Klockars (2017) Otoplasty for prominent ears – demographics and surgical timing in different populations. International Journal of Pediatric Otorhinolaryngology, 100, 52-56.
Loh, C. Y. Y., E. Gunn, D. J. L. Pennell & T. Athanassopoulos (2014) Pinnaplasty: A porcine training model. Journal of Plastic, Reconstructive & Aesthetic Surgery, 67, 868-869.
Loh, C. Y. Y., A. Y. L. Wang, V. T. Y. Tiong, T. Athanassopoulos, M. Loh, P. Lim & H.-K. Kao (2018) Animal models in plastic and reconstructive surgery simulation—a review. Journal of Surgical Research, 221, 232-245.
Niamtu, J. (2011) Cosmetic Otoplasty. The American Journal of Cosmetic Surgery, 28, 261-272.
Oliaei, S., C. Manuel, B. Karam, S. F. Hussain, A. Hamamoto, D. E. Protsenko & B. J. F. Wong (2013) In Vivo Electromechanical Reshaping of Ear Cartilage in a Rabbit Model: A Minimally Invasive Approach for Otoplasty. Archives of facial plastic surgery, 15, 1-5.
Reis, M. G. A. d., R. G. Marim & L. R. M. Souto (2018) Pinna synthetic mold for otoplasty techniques application. Brazilian Journal of Otorhinolaryngology, 84, 159-165.
Rogers, B. O. (1968) Microtic, lop, cup and protruding ears: four directly inheritable deformities? Plast Reconstr Surg, 41, 208-31.
Rohrich, J. R., M. R. Friedman & L. D. Liland (1995) Comparison of Otoplasty Techniques in the Rabbit Model. Annals of Plastic Surgery, 34, 43-47.
Schneider, G., S. Voigt & G. Rettinger (2016) Computed tomography-based training model for otoplasty. European Archives of Oto-Rhino-Laryngology, 273, 2427-2432.
Sheerin, D., M. Macleod & V. Kusumakar (1995) Psychosocial Adjustment in Children with Port-Wine Stains and Prominent Ears. Journal of the American Academy of Child & Adolescent Psychiatry, 34, 1637-1647.
Songu, M. & A. Kutlu (2014a) Health-related quality of life outcome of children with prominent ears after otoplasty. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 271.
Songu, M. & A. Kutlu (2014b) Long-term psychosocial impact of otoplasty performed on children with prominent ears. The Journal of Laryngology & Otology, 128, 768-771.
Taylor, B. A. & P. Hong (2016) Otoplasty outcomes with different suture materials in a rabbit model. Journal of Craniofacial Surgery, 27, 477-479.
Tronto, J. C. (2012) Partiality Based on Relational Responsibilities: Another Approach to Global Ethics. Ethics and Social Welfare, 6, 303-316.
Uygur, S., C. Ozturk, G. Kwiecien & M. Z. Siemionow (2013) Sheep Head Model for Plastic Surgery Training. Plastic and Reconstructive Surgery, 132.
Yau, A. Y. Y., C. Manuel, S. F. Hussain, D. E. Protsenko & B. J. F. Wong (2014) In Vivo Needle-Based Electromechanical Reshaping of Pinnae. JAMA Facial Plastic Surgery, 16, 245-252.