No Really, It's for My Health

Cosmetic surgery can help people look younger, but youthful looks alone might not improve longevity.

A century ago, senior citizens could only pine for their lost youthful looks. Today anyone willing to fork over enough cash can lift a falling chin, surgically implant new hair into a bald spot, raise saggy breasts, or suck away a decade's worth of fat. Botulinum toxin, a potent poison once famous as the culprit behind a deadly form of food poisoning, is now injected into more than a million Americans’ faces each year to smooth out crow's feet and frown lines. With the launch of a magazine devoted to cosmetic surgery and the production of reality television shows that revolve entirely around assessing the before-and-after appearance of contestants who undergo cosmetic enhancements, outward signs of aging might soon become passé. As enhancement procedures gain popularity--the number of people opting for cosmetic surgery has nearly tripled since the 1990s--some experts wonder whether such techniques are just smoke and mirrors or whether a baby face, and a body to match, can make a person healthier.

At least one study suggests that youthful looks might be more than skin deep. Epidemiologist Kaare Christensen of the University of Southern Denmark was searching for markers that could reveal people's biological age--as opposed to their age in years--when he remembered something from his medical school days. "In Denmark when people are admitted to the hospital, you note whether they look younger or older than their chronological age," he says. That got him wondering if someone's appearance conveys vital information. To find out, he asked 20 nurses to guess the age of 387 pairs of twins, 175 of them identical. Each nurse looked at individual photos of the twins on two separate occasions and assigned an age to each person. When the researchers examined the assessed ages of the 49 twins who had died, they found that in 73% of the cases, the older-looking twin succumbed first. "Perceived age actually works as a biomarker of aging," Christensen says.

Even so, the finding doesn't mean that youthful looks achieved via surgery can turn back the clock. A report published in the New England Journal of Medicine (NEJM) last June concluded that liposuction does not confer the same health benefits that regular weight loss does. Study after study has shown that people who lose weight the old-fashioned way, through diet and exercise, improve their risk factors for heart disease, for instance, by lowering cholesterol concentrations and reducing blood pressure. Normal weight loss also cuts the risk of the most common form of diabetes by improving the body's ability to regulate blood sugar. But in the NEJM study, which tracked 15 obese women for 3 months after they'd had body fat sucked away, liposuction failed to lower cholesterol, improve glucose metabolism, or produce the other payoffs normally seen with weight loss.

Still, looking more youthful could present other benefits. "The whole idea of cosmetic surgery took off in the 1930s and '40s when it was seen as a way of improving a person's psychological well-being," says bioethicist Carl Elliott of the University of Minnesota, Twin Cities, author of Better Than Well: American Medicine Meets the American Dream. At one time, researchers even toyed with the notion that they might rehabilitate criminals through cosmetic surgery. "The idea was that if you fixed the causes of their low self-esteem, like a bad physical appearance, you might improve their psychological state and improve their behavior," says Elliott. The plan never quite caught on, as evidenced by the widespread lack of prison-based plastic surgeons.

Yet in broader society the cosmetic surgery fad has ballooned. One of the consequences is a shift in the standards of beauty, says Elliott: "These things make you look better, but they also change your idea of what looks good." He points to a 1940 film called The Shop Around the Corner to illustrate his argument. "In the film, Jimmy Stewart is in his 20s and always wearing a suit and hat. The aesthetic of the day was that young people wanted to look older. Now you have just the reverse. Even grandmothers walk around in sweatpants like college students." Elliott worries that the more people turn to quick fixes such as Botox, the more such cosmetically altered looks will become the norm.

The spreading use of artificial enhancement is similar to the use of performance-boosting drugs in sport, he says. "The more people use [enhancement techniques], the more people who would rather not be using them feel pressured to use them just to keep up," Elliott says. But bioethicist Arthur Caplan of the University of Pennsylvania in Philadelphia argues that beauty has always been culturally driven, even before the advent of cosmetic surgery. "I can't argue it's unnatural to change ourselves when as soon as we stood up we developed fashion," he says.

What's more, Caplan says that our attraction to youthful appearance has biological roots. "There are very few people in any society who would argue that in terms of appearance and beauty, older is better. Younger has so much power over us because it's associated with vigor and health," says Caplan. Looking young gives people an edge in finding jobs and attracting mates, and that advantage will exist regardless of whether a person is born with good looks or attains them with a doctor's help, he says.

But some enhancements are not necessarily the shortcut to good looks that they purport to be, and doctors and the media should say so, Caplan says. For instance, people who undergo liposuction must limit their calories if they want to keep the weight off. "But there are quick fixes out there that work," he adds. "And I don't feel bad about it." If some people want to get LASIK eye surgery to free themselves from unwieldy glasses, Caplan asks, who are the people with 20/20 vision to say they shouldn't do it?

Genetics plays a large part in how we look. The study that showed a longevity benefit from looking young also found that genetics explained 60% of the perceived variation in age between twins. Cosmetic surgery's biggest allure might be that it brings losers in the genetic lottery closer in appearance to the wrinkle-free seniors with full heads of hair who were lucky enough to hit the jackpot. But whether looks alone can boost longevity remains a matter of debate.

Christie Aschwanden is a freelance writer who thinks of her smile lines and crow's-feet as proof of her propensity toward laughter.