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Viewpoint: Freeze the Botax

By: Steven H. Dayan, MD, FACS
Posted: December 3, 2009

page 3 of 7

Besides the cosmetic improvement, patients were mentioning they received more favorable treatment from others after receiving Botox. This posed an interesting question: What was causing the perception of better treatment? Was it that after undergoing a cosmetic medical procedure, a person felt better and projected a better image, or was it that others perceived the treated person more favorably because they were physically more attractive?

It is well-known and researched that the subtleties humans find attractive in one another are often perceived at a subconscious level. Evolutionary biologists have done extensive studies validating the importance of certain physical characteristics, such as symmetry, youthfulness and body proportions, as important indicators of beauty and maximum fertility. Moreover, for hundreds of thousands of years, humans have been enhancing gender-specific character traits, whether it’s with clothes, makeup, perfumes or adornments, attempting to appear more fertile and attractive to potential mates. To the unknowing observer, people who get cosmetic medical treatments are thought to be more attractive, successful at dating and even better athletes.2

Perhaps the perceived improved treatment from others is not solely due to a physically improved appearance, but is a result of an invigorated self-esteem, resulting in the projection of a more favorable attitude thus reciprocated. A report published early this year indicated that cosmetic treatments alleviated symptoms of depression, and although this study was small and uncontrolled, it launched an interesting dilemma for further discussion.3 In a double-blind randomized placebo controlled study, patients who received Botox showed an improved quality of life at two weeks and up to three months after their treatment.4 It is easy to speculate that a person who feels better about the way she looks experiences an improved self-esteem, acts more confidently and enjoys a better quality of life. Furthermore, Botox has been shown to correlate with a positive increase in mood.5 In which case, would treating a disease that affects 9.5% percent of our population6 with cosmetic treatments or plastic surgery still be subjected to a cosmetic tax? Conversely, perhaps the 10 million Americans treated this year with cosmetic procedures1 can apply for a cosmetic tax exemption believing they suffer from a mood disorder. As the benefits of cosmetic surgery are beginning to be studied and objectively quantified, the definition of what is cosmetic becomes even more blurred.

Cosmetic quandaries

Although cosmetic medical treatments had been initially labeled as vain luxuries for the rich and famous to discuss while sipping champagne on their yachts, a closer look reveals that these treatments have a much bigger role for many individuals from all backgrounds. Yes, Botox can reduce wrinkles, but it also can provide facial symmetry to stroke victims, reduce migraine headaches and prevent excessive sweating. Once the theme of sci-fi movies, surgical facial transplants are now a reality, allowing hope to the severely disfigured society. Breast implants can effectively rescue an inherent feminine trait for the one in 26 women who will undergo cancer-curing mastectomies.7 Does a 50-year-old postmenopausal breast cancer survivor need her breast? No, not for survival, but certainly it is a critical quality of life and cosmetic issue. Will this be subjected to a cosmetic tax? Where do we draw the line between what is and what isn’t cosmetic? What about the 57% of females who suffer from balding8 or the 1.1 million HIV victims who experience facial wasting?9

These patients undergo treatments to alleviate the cosmetic effects of these conditions, none of which are medically necessary for survival, but all of which are cosmetic and quality of life issues.