The confidence trick of cosmetic surgery

I’m a troubled old feminist these days. Back in the ice age, when I read my first  Germaine Greer and chucked out Just 17 in favour of Spare Rib, cosmetic surgery was pretty straightforward. It was something you did if you were (a) horribly disfigured or (b) rich and vain.

Now it’s apparently a rite of passage, a confidence-booster, something you do for yourself, because you’re worth it. Last week, more! magazine said 70% of the 1000 young women they asked wanted to go under the knife, and as many as half were already planning to do so.

What struck me were the reasons. More than half said it was because they were unhappy with the way they look. And 35% said they thought it would improve their confidence.

So will it? Well, I work in evidence-based medicine, so I took a look at the literature. A quick PubMed search (the biggest database of published medical trials) threw up few studies even looking at this outcome.

There was one recent study, looking at 1500 Norwegian adolescents. About 5% of girls in the study had cosmetic surgery. The authors report: ‘…those who underwent surgery during the course of the study experienced a greater increase than other females in symptoms of depression and anxiety (t=2.07, p=0.04) and eating problems (t=2.71, p<0.01). ‘ In other words, those who had surgery got more depressed, more anxious, more likely to have an eating disorder. It’s an observational study, so we can’t prove that cosmetic surgery caused the problems. The girls who’d had surgery also had more anxiety, depression and self-harm before surgery. But surgery sure as hell didn’t seem to help.

I also found a small German study of women having breast implants. They were surveyed before, then six months after surgery. Perhaps not surprisingly, they said they felt more attractive and reported an improvement in their sex lives. However, the authors add: ‘The only topic that exhibited next to no change was the series of questions dealing with insecurity/anxiety’.

Now, from what I remember, just about all teenage girls are unhappy with the way they look. It’s a sad truth you only recognise when you’re knocking on a bit, that you probably looked your most lovely and fresh-faced in the years that you were most consumed with self-doubt. But back in those terrible days of worrying about my big nose and flat chest, the assumption was that you did your best with what you’d got. Some girls were pretty, some were bright, some were pant-wettingly funny. Che sera. I don’t remember anyone saving up for a boob job.

It’s this confidence business that really bothers me. Isn’t confidence something that you gain, over time, as you gain skills and experience and loving relationships? Doesn’t that sort of confidence – in your ability to speak fluent French, manage your bank account, earn your living or cook a decent risotto – have to be earned?

I struggle to see how having a couple of bags of silicone inserted under your nipples can do anything for your confidence. Who’s feeding young women this crap anyway? Who’s telling them that how they look matters more than what they can do, that their bodies are not good enough the way they are? And where did this insidious myth come from, that slicing up your body or injecting poison into your face is something you do for yourself? If women accept that their own faces or bodies need sculpting into an approved model, what the hell does that say to our daughters?

You’re right. I’m angry.  Lots of women worry about their looks. But where’s the evidence that cosmetic surgery helps build confidence in anyone’s appearance? As I found, there doesn’t seem to be any. If cosmetic surgery is so damn empowering, why do people start with one ‘procedure’ – then decide maybe to have something else ‘corrected’, and a little more to ‘maintain’ their increasingly artificial appearance? Learning to live with, look after, and even like our own bodies is a better bet for long-term body confidence.

I know whereof I speak. The big nose – still there. I love it; it gives my face a presence it wouldn’t have with some cute little button. The flat chest never did ‘fill out’, despite the school nurse’s promises. I’ve lived a life free of men talking to my chest instead of my face, and still managed to find plenty of congenial male company. (Actually one bloke did that once – I thought I’d spilt something down my top).

If I’d been offered a magic pill to ‘fix’ those things when I was 17, I might just have taken it. I might even have been happier for a while. But I wonder if I’d still be as happy now? I did consider a boob job once, fleetingly, when I was 29 and single and at a low ebb. I had the money; there was no-one to judge me. I decided to learn Spanish, instead.



  1. What about the desire for surgery as your laugh lines become deep as fjords, your lips shrink, you eyelids droop, you gain dewlaps, you have permanent dark circles under your eyes… when you look in the mirror you see your mother. There is a lot of age prejudice around and you are considered less capable as you age. And then there is ‘you are so wonderful…for your age’ If I wasnt so scared of possible surgical disasters I would seriously consider a face lift so that, in this society that values youth, I would be taken more seriously.

  2. But isn’t it awful that we need to look young to be taken seriously, that our fjord-deep lines can’t be worn as badges of wisdom and experience, that we feel the need to hide the evidence of all the times we laughed? I do understand, very much, what you say about feeling that the face looking back in the mirror is no longer the face you recognise (although yours is always lovely, Ingrid!), and maybe I will change my mind as that process goes on. But then where do we go? A society where those with the resources keep their lovely young faces, and those without become objects of horror, as in Huxley’s Brave New World?

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