Defining cosmetic surgery

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Nicola R Dean
Kristen Foley
Paul Ward


plastic surgery, healthcare, ethics, patient safety, medical economics


An agreed definition for cosmetic surgery would be helpful for the purposes of discourse on ethics, patient safety, healthcare policy and health economics.  One of the problems with previous attempts at developing a definition is the narrow frame of reference and lack of engagement with the full spectrum of academics and stakeholders.  This review brings together the sociological as well as the surgical literature on the topic of cosmetic surgery and examines societal, ethical and healthcare aspects.  It outlines principles of constructing a definition and presents a provisional definition for further debate, namely:  Cosmetic surgery is defined, for the purposes of a healthcare payer, as any invasive procedure where the primary intention is to achieve what the patient perceives to be a more desirable appearance and where the procedure involves changes to bodily features that have a normal appearance on presentation to the doctor. In contrast, surgery performed with the goal of achieving a normal appearance, where bodily features have an abnormal appearance on presentation due to congenital defects, developmental abnormalities, trauma, infections, tumours or disease does not fall under the definition of cosmetic surgery.  It is a given that “normal appearance” is a subjective notion.  Determining whether patients have a normal or abnormal appearance on presentation will rely on the clinical assessment of the treating doctor.


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1. American Society of Plastic Surgeons. Plastic Surgery Statistics Report - 2016 Cosmetic Plastic Surgery Statistics. Chicago, 2016. [Cited 1 October 2017.] Available from URL:
2. ISAPS International Survey on Aesthetic / Cosmetic Procedures Performed in 2015. Hanover, New Hampshire, 2015.
3. Khoo C. Towards the Regulation of Cosmetic Surgery. In: Green AR (ed). BAPS to BAPRAS: The History of the Association 1986-2016. London: The British Association of Plastic, Reconstructive and Aesthetic Surgeons, 2016.
4. Australian Health Ministers' Advisory Council, Inter-jurisdictional Cosmetic Surgery Working Group, Clinical, Technical and Ethical Principal Committee. Cosmetic Medical and Surgical Procedures - A National Framework. New South Wales: Australian Health Ministers' Conference, 2011.
5. Parker R. Women, Doctors and Cosmetic Surgery. London: Palgrave Macmillan, 2009.
6. Gilman SL. Making the Body Beautiful: A Cultural History of Aesthetic Surgery. New Jersey: Princeton University Press, 1999.
7. Elliott A. Making the Cut: How Cosmetic Surgery is Transforming Our Lives. London: Reaktion Books Ltd., 2008.
8. Morgan KP. Women and the knife: cosmetic surgery and the colonization of women's bodies. Hypatia. 1991; 6: 25-53.
9. Bordo S. Unbearable Weight, Feminism, Western Culture and the Body. London: University of California Press, 1993.
10. Davis K. Reshaping the Female Body: The Dilemma of Cosmetic Surgery. New York: Routledge, 1995.
11. Gimlin D. Cosmetic surgery: beauty as commodity. Qualitative Sociology 2000; 23: 77-98.
12. Negrin L. Cosmetic surgery and the eclipse of identity. Body & Society. 2002; 8: 21-42.
13. Blum V. Flesh Wounds: The Culture of Cosmetic Surgery. Berkeley: University of California Press, 2003.
14. Soest T, Kvalem I, Wichstrom L. Predictors of cosmetic surgery and its effects on psychological factors and mental health: a population based follow-up study among Norwegian females. Psychological Medicine 2012; 42: 617-626. PMid:21781375
15. Davis K. Dubious Equalities and Embodied Differences: Cultural Studies on Cosmetic Surgery. Lanham: Rowman and Littlefield Publishers, 2003.
16. Kaw E. Steven Polgar Prize Essay (1991). Medicalization of racial features: Asian American women and cosmetic surgery. Medical Anthropology Quarterly 1993; 7: 74-89.
17. Australian Society of Plastic Surgeons. Unregulated office-based cosmetic surgery a risk to patient safety. Media Release, 2015: 2.
18. De Vries DA, Peter J, Nikken P, de Graaf H. The effect of social network site use on appearance investment and desire for cosmetic surgery among adolescent boys and girls. Sex Roles 2014; 71: 283-295.
19. Ashikali E-M, Dittmar H, Ayers S. The impact of cosmetic surgery advertising on Swiss women's body image and attitudes toward cosmetic surgery. Swiss Journal of Psychology 2017; 76: 13-21.
20. Halliwell E, Diedrichs PC. Influence of the media. In: Rumsey N, Harcourt D (eds). The Oxford Handbook of the Psychology of Appearance. Oxford: Oxford University Press, 2012: 217-238.
21. Cano SJ, Klassen A, Pusic AL. The science behind quality-of-life measurement: a primer for plastic surgeons. Plast Reconstr Surg. 2009; 123: 98e-106e.
22. Honigman RJ, Phillips KA, Castle DJ. A review of psychosocial outcomes for patients seeking cosmetic surgery. Plast Reconstr Surg. 2004; 113: 1229-1237. PMid:15083026 PMCid:PMC1762095
23. Cook SA, Rosser R, Salmon P. Is cosmetic surgery an effective psychotherapeutic intervention? A systematic review of the evidence. J Plast Reconstr Aesthet Surg. 2006; 59: 1133-1151. PMid:17046622
24. Kosowski TR, McCarthy C, Reavey PL et al. A systematic review of patient-reported outcome measures after facial cosmetic surgery and/or nonsurgical facial rejuvenation. Plast Reconstr Surg. 2009; 123: 1819-1827. PMid:19483584
25. Cohen WA, Mundy LR, Ballard TN et al. The BREAST-Q in surgical research: a review of the literature 2009-2015. J Plast Reconstr Aesthet Surg. 2016; 69(2): 149-162. PMid:26740288 PMCid:PMC4995882
26. Klassen AF, Cano SJ, Schwitzer JA, Scott AM, Pusic AL. FACE-Q scales for health-related quality of life, early life impact, satisfaction with outcomes, and decision to have treatment: development and validation. Plast Reconstr Surg. 2015; 135: 375-386. PMid:25626785
27. Alderman AK, Bauer J, Fardo D, Abrahamse P, Pusic A. Understanding the effect of breast augmentation on quality of life: prospective analysis using the BREAST-Q. Plast Reconstr Surg. 2014; 133: 787-795.
28. De Brito MJA, Nahas FX, Barbosa MVJ et al. Abdominoplasty and its effect on body image, self-esteem, and mental health. Annals of Plastic Surgery 2010; 65: 5-10. PMid:20467297
29. Bensoussan J-C, Bolton MA, Pi S, Powell-Hicks AL. Quality of life before and after cosmetic surgery. CNS Spectrums 2014; 19: 282-292. PMid:24354998
30. Kinnunen T. 'A second youth': pursuing happiness and respectability through cosmetic surgery in Finland. Sociology of Health & Illness 2010; 32: 258-271. PMid:20149153
31. Fraser S. The agent within: agency repertoires in medical discourse on cosmetic surgery. Australian Feminist Studies 2003; 18: 27-44.
32. Von Soest T, Kvalem IL, Wichstrøm L. Predictors of cosmetic surgery and its effects on psychological factors and mental health: a population-based follow-up study among Norwegian females. Psychological Medicine 2011; 42: 617-626. PMid:21781375
33. Pozarycki MM. Rising health care costs. Annals Health L. 2006; 15: 331.
34. Australian Institute of Health and Welfare. Health Expenditure Australia 2013-2014: Analysis by Sector. Health and Welfare Expenditure Series. Canberra: Australian Government, 2015.
35. Stabile M, Thomson S. The changing role of government in financing health care: an international perspective. Journal of Economic Literature 2014; 52: 480-518.
36. White J. Targets and systems of health care cost control. Journal of Health Politics, Policy and Law 1999; 24: 653-696.
37. Edmonds A. 'The poor have the right to be beautiful': cosmetic surgery in neoliberal Brazil. Journal of the Royal Anthropological Institute 2007; 13: 363-381.
38. ABC News, Woman dies after botched breast surgery at Sydney beauty salon. [Cited 1 October 2017.] Available from URL:
39. Mofid MM, Teitelbaum S, Suissa D et al. Report on mortality from gluteal fat grafting: recommendations from the ASERF Task Force. Aesthet Surg J. 2017
37(7): 796-806. Recommendations from the ASERF Task Force. Aesthetic Surgery Journal. 2017.
40. Sowislo JF, Orth U. Does low self-esteem predict depression and anxiety? A meta- analysis of longitudinal studies. Psychological Bulletin 2013; 139: 213-240. PMid:22730921
41. Lansdown R, Rumsey N, Bradbury E. Visibly Different: Coping with Disfigurement. Oxford: Butterworth-Heinemann, 1997.
42. Durkheim E. The Rules of Sociological Method. Paris: Librarie Felix Alcan, 1895.

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