A look at beauty

Is beauty skin deep?

by Jim Clarke

Beauty they say is in the eye of the beholder. However, it is becoming increasingly evident that being perceived as ugly can seriously detract from one's quality of life, while being attractive can bring a whole raft of benefits. It seems clear that beauty or the lack of it is no longer merely about aesthetics, but is now a health issue.

Increasingly the techniques of craniofacial surgery are being applied to the vain. Each time a new facial surgery technique is developed to deal with a deformity, it is quickly adapted by cosmetic surgeons. Craniofacial surgery is now used to implant high cheek bones in women, to strengthen the jaw line in men and to advance receding or low chins.

Of course, plastic surgery is also used to help patients who have undergone major surgery.

Mr Anthony Ryan is a plastic surgeon working at the Blackrock Clinic. In the course of his work, he removes cancers from some patients, which may leave them with a disfiguring scar.

"With my cancer patients, I try to make the surgery as least deforming as possible", he explains. "But the first principle is to cure the patient. Only after that can you think of dealing with the effect of removing the tumour".

Saves lives

As the surgery saves the lives of these patients, patients are thankful for it. Patients with clefts and facial deformities due to rare syndromes also have their lives transformed by craniofacial surgery.

People with Apert's syndrome and similar rare diseases find that their faces become physically deformed. Being stared at in the street is often the least of their concerns. It is the sense of being differentiated from 'normal' looking people that hurts the most.

"There have been a lot of advances recently in craniofacial surgery and it is amazing what can be done today", says Mr Ryan. "This surgery literally changes these patients' lives. People with physical deformity or gross malformations of the face can now be given a normal face shape. Even huge clefts, where the nose is split, can be repaired and we can correct hypertelism, where eyes are too far apart, by splitting the skull and bringing the orbits together".

Clearly there are many people who do not require facial surgery in the way that a cancer patient or person with a cleft palate requires it. Yet many healthy people are seeking to have surgical procedures performed on the delicate tissues of their face. Our faces, in some ways symbolise our identity. If people are seeking unnecessary surgery on their face, perhaps it reveals an underlying unhappiness with themselves?

Catherine Zeta Jones - recently voted the world's most beautiful face.

irishhealth.com recently launched the 'Your View' facility, which allows all our registered site visitors to comment on material on the site and raise health issues for debate with each other. One of the most interesting debates has been one initiated by 'Duckling', on the issue of being ugly. Her statement that being ugly was the 'single, central fact' of her life has provoked a flood of responses from site users.

"My daughter is so unhappy about her appearance that she is virtually a recluse in our home", wrote one contributor. "She is regarded as plain, but she's a nice girl if only she could see that. I'm afraid she is going to become totally depressed. She doesn't want to talk about it, she doesn't really want to do anything at all these days".


Another contributor believed she was unattractive and worthless. "I avoided any personal contact", she wrote. "I became a recluse and even though I had a good job I looked at myself as a failure which made me feel worse. I embraced my pain and it became my friend".

In fact, depression and low self-esteem can be only the tip of an iceberg of difficulties that unattractive people have to face. People with facial scars or burns have reported symptoms ranging from social withdrawal to body dysmorphia, agoraphobia to anxiety, sleeping difficulties to suicidal impulses.

Facial scarring, whether as a result of acne, burns, surgery, illness or wounding, cannot be removed by medical treatment, leaving many to feel ugly and wounded for a long time. Cosmetic surgery techniques such as dermabrasion may be effective at improving the appearance of facial scars in some cases. Generally, however, scars on the face will remain prominent, as they tend to be exposed to sunlight which dries out and discolours the keloid or hypertrophic tissue.

Dr Scott Frank, of Case Western Reserve University in Cleveland, is a well-known specialist in the treatment of facial scarring. He believes that it is necessary to recognise that the process of healing neither causes damage to tissue nor restores it to its previous state. He recommends that patients with facial scarring be given sustained counselling so that they can come to accept and love their new appearance.

"To become wounded is an inevitable consequence of human existence", he explains. "To scar is an inevitable consequence of having been wounded. While it is necessary to scar in order to heal, scarring is not healing. Healing is defined by revising the scar, so that the patient can accept that who they are is how they have healed."

With very few exceptions, people with facial scars are self-conscious about them. Some people may also experience diminished functioning of the eyes, mouth, or nose due to tightening of scars or the scarring itself. In the case of severe burns that destroy a large area of the epidermis, the skin will tend to heal in a red and puckered fashion. As the skin heals, muscles and tendons may be affected in this contracting movement.


Keloid scars are a result of the skin's overproduction of collagen after a wound has healed. These scars generally appear as growths in the scar site. Hypertrophic scars, unlike keloids, do not grow out of the boundaries of the scar area, but because of their thick, raised texture, they can be unsightly and may also restrict the natural movement of muscles and tendons. Some facial scars are considered unattractive simply because of where they appear on the face, while others affect facial expressions.

One person who has refused to let facial scarring get in the way of pursuing his dream is the pop singer Seal. Born in Nigeria, he suffered in his early twenties from a form of Lupus that left him with virulent scarring on his upper cheeks. Though many might have felt this to be a particular disfigurement in the music world, where beauty is considered so important, Seal has consistently refused to allow how others perceive his appearance to affect his career as a singer and musician.

His religious faith - he is a fervent Buddhist - has enabled him to overcome allegations that his scars were the result of membership of a gang or involvement in a Nigerian voodoo ceremony. Nevertheless, he believes that many people with facial scarring are subjected to similar insults, ridicule and suspicion. He has refused plastic surgery to reduce their visibility on the grounds that he has accepted them as part of himself and does not wish to mask who he is from the world.

Seal, who suffers from facial scarring due to Lupus.

"People used to say that I'd been involved with gangs, that I got scarred to join a gang", he explained. "Because I grew up in Africa, a lot of people thought it was some kind of religious thing. Actually, my religion has helped me to deal with my scars, to accept them as part of me. True beauty is internal and eternal - it doesn't matter what's only skin deep".

Clearly, there is no innate problem in being 'aesthetically challenged'. Many people have achieved success, happiness and even fame without the assistance of classic good looks. Rather, problems arise when people perceive themselves as ugly and judge themselves on the basis of looks alone.


Everyone dislikes some aspect about their own appearance, increasingly so when the outrageously beautiful are promoted as the norm in advertising, television, music and cinema. However, when people become obsessed with a physical imperfection, they can fall victim to body dysmorphic disorder (BDD).

Typically, someone with BDD looks perfectly normal to others, or at most has a slight physical abnormality. However, to the sufferer, their fear of ugliness can manifest in delusions that they are freakish or hideous in their appearance. Patients with BDD have attempted to isolate themselves, wounded themselves and even attempted suicide.

We may all agree that to judge people purely on the basis of their physical attractiveness is shallow and stupid. Yet, though most of the planet by definition have average looks, psychological study after study has revealed just how innate our pro-looks prejudice really is.

The modern conception of beauty and ugliness arose in the middle ages, claims Arthur Marwick, history professor and aesthetician with the Open University. He believes that the medieval Church interpreted the ancient Greek philosopher Plato as saying that all good was beautiful and all ugliness evil. From this, our modern preference for the physically attractive was born.

"We now value beauty unreservedly", he explains, "and men today tend to be rated on beauty in the way women have always been. Both genders can now profit from their beauty without having to concede sexual favours. Many attempts have been made to lay down, scientifically, the measurements which account for a beautiful face. All have laid themselves open to ridicule. There is no one model, no one set of proportions".

There are many types of beauty, he says. "With modern travel and the mass media we have become increasingly flexible in our taste. We can now recognise that there is Chinese beauty, African beauty, Latin beauty, Nordic beauty and so on. Only a tiny minority within each type are actually beautiful. Beauty is what the overwhelming majority, on sight, recognise as beautiful".

Modern travel and mass media have widened our conception of beauty.

Beauty even overrides our principles, it seems. In 1979, male and female experimenters approached students on a college campus and tried to get them to sign a petition. The more attractive the experimenters were, the more signatures they were able to get. In Texas, 16 years later, it was discovered that judges set lower bail and imposed smaller fines on suspects who were rated as attractive rather than unattractive.

Salaries and job prospects

Even economists have examined the beauty factor as it relates to career success and high remuneration. In 1994, Daniel Hammermesh and Jeff Biddle, two academic economists, embarked on the widest ranging study into the impact of aesthetics on the labour market. They used three separate surveys to rate the looks of the workers they tracked in their study. They discovered that not only are beautiful people paid a premium for their work, but that there is a wage penalty for ugliness.

In the Hammermesh and Biddle study, people classified as 'homely looking' earned between 5% and 10% less than average for their job. In contrast, those classified as better looking took home between 5% and 10% more than average in wages for their work. As the authors wryly noted, this wage differential is the equivalent of three extra years of education.

Last year the producers of the US television programme '20/20' attempted to recreate the experiment with their own staff. They paired members of their crew with professional models and then dressed them identically. Each pair were subsequently sent to interview for random jobs and told to claim identical qualifications. Though the TV programme can hardly claim the academic rigour of Hammermesh and Biddle's study, it is still interesting to note that all the models were hired and given salaries at the upper limit of their pay brackets.

This is not only an American phenomenon. In Britain, The Industrial Society published the results of their latest study of recruitment practices in March of this year. Entitled 'Looking Good, Sounding Right', it made for interesting reading.

Employers in the UK ranked technical skills 23rd in importance out of 24 employment criteria. Even qualifications were considered less important than the aesthetic appeal of the candidate, leading the report's author Chris Warhurst to wonder whether young people were wasting their time obtaining degrees.

Warhurst gave the example of one hotel chain which specified that it only hired staff who were 'stylish, confident, tasty and successful', all euphemisms for attractive. "We haven't actually looked for people with experience", stated a spokesperson for the chain, "because we felt that was not important. We want staff who fit a look - nice smile, nice teeth, neat hair and in decent proportion - quite plain, but neat and stylish".


Could such blatant discrimination be common practice in Ireland too? With the current labour shortage in many sectors, employers probably do not have the freedom to discriminate on grounds of appearance.

Last November, the Equal Status Act 2000 entered legislation with a large publicity campaign, aimed at educating the public to dispense with prejudice. It is no longer legal to discriminate against anyone on grounds of gender, age, religion, disability, sexual orientation, race, family or marital status. Appearance was not included in the list.

Obviously there are certain jobs where physical attractiveness is a legitimate job requirement, such as modelling. One could also argue that jobs which involve dealing with the public or appearing in public might be better suited to those whose physicality will make a favourable impression on the people who encounter them.

Nevertheless, while we all might protest that to prefer a candidate on looks alone is desperately unfair, it seems to be inbred into humanity. Studies have shown that infants given photographs of adults will spend longer looking at those rated more physically attractive. Scientists suggest that our preference for beauty is related to the biological search for a healthy mate. It may be that we are biologically driven to prefer attractive people.

The simple fact of life is that beautiful people will receive more opportunities than their less well-looking peers. However, the benefits of beauty can be exaggerated. Beautiful women often find it harder to make female friends and one study found that good looking men are considered to be less intelligent by their peers.

Everybody feels ugly sometimes and equally everyone deserves to feel beautiful too. When some people are placing themselves at risk of depression, eating disorders and BDD because of their body self-image, it is especially important for all of us to keep in mind that beauty really is only skin deep.

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