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Does God want you to have a nose job?
Americans are spending more money than ever on cosmetic surgery and procedures. But what are the ethics of nose jobs and buttock augmentation? Are they procedures people of faith should have? - photo by Jennifer Graham
Doctors can't cure the common cold yet, but they can give you a wrinkle-free face and a Hollywood body if you've got the money and don't mind needles.

And plenty of people are able to pay and put up with the temporary discomfort. Americans spent a record $13.5 billion on plastic surgery and aesthetic procedures in 2015, up $1.5 billion from the previous year, according to the American Society for Aesthetic Plastic Surgery.

Doctors suctioned Americans' fat, lifted their breasts and padded their buttocks, when not augmenting their chins, smoothing their brows and streamlining their noses.

Plastic surgery is no longer hush-hush. We are immersed with it on magazine covers and on television," said Dr. Norman Rowe, a New York City plastic surgeon. "Why not look and feel the best that we can?

For people of faith, however, the answer to Rowes question can be complicated. Few dare to suggest that getting plastic surgery is a sin, but many wrestle with the dilemmas it presents, such as whether altering one Gods-given body insults its creator and whether the resources of time and money could be better spent.

The passage that comes to mind is Psalm 139, I am fearfully and wonderfully made,' said Amy Laura Hall, associate professor of Christian ethics at Duke University Divinity School in Durham, North Carolina.

But the message modern culture gives to people women in particular is that they are flawed and need to be fixed, Hall said.

And I would ask, how does the church fail to offer a significant witness against this anxiety and fear in American culture," she said. "Why isnt the church saying something different than the secular culture?

God and beauty

Personal aesthetics is an industry that has registered growth every year since 1997, including the Great Recession. Cosmetic procedures, both surgical and nonsurgical, numbered over 1.6 million in 1997. By 2015, that number had jumped to nearly 13 million.

Women are the biggest consumers of aesthetic procedures, accounting for 90 percent of the business in 2015.

And the market is geographically diverse. Los Angeles and New York City, the capitals of entertainment and fashion, are among the top 10 metro areas with the most plastic surgeons per 100,000 residents (Nos. 3 and 8, respectively), according to RealSelf, an online plastic-surgery forum.

But Salt Lake City is No. 2, and Grand Rapids, Michigan, Tampa, Florida, and Baltimore, also make the top 10, giving credence to Rowes assertion that cosmetic procedures have become mainstream and are popular all over the country.

The growth of the industry, Rowe said, is due in large part to improved techniques that provide lasting results with little or no recovery time.

As the methods improve and results become more noticeable and easier to obtain, I see only a continued increase in the publics desire to look and feel better, he said.

That desire is sometimes attributed to God. In an essay for Christianity Today's Her-meneutics blog in 2010, Christian author Shelly Beach suggested the desire for beauty originates with God and said, "decisions for or against cosmetic surgery are ultimately theological decisions."

"Beauty is important to God and reflects spiritual significance, as evidenced in the rainbow, creation and the God-ordained design of the Tabernacle and priestly robes," Beach wrote, but added, "Yet that which delights the eye may be unbeautiful because our concepts of beauty can be derived from faulty human perception."

When perfect isn't good enough

The perception of beauty is one part of the ethical conundrums plastic surgeons face. Many refuse to operate on women diagnosed with body dysmorphic disorder, a psychiatric condition in which people become obsessed with perceived flaws or defects in their bodies.

Dr. Kian Karimi, a Los Angeles physician who is board-certified in two specialties head and neck, and facial plastic surgery said he interviews potential clients before agreeing to take them on, asking about their motivations for seeking a procedure.

Typically, he asks the patient why she wants the procedure, what makes this a good time in her life to do it, what her fears and hesitations are and what she hopes to accomplish by having the procedure.

Red flags, he says, someone saying, 'I am expecting my relationship with my significant other to improve after this' thats an unrealistic expectation or 'Im hoping to get a better job.'

A healthy response to the question about fear, he said, is Im afraid of looking operating on, or having a done appearance.

That patient has reasonable expectations," he said. "Shes someone who wants to look better, but wants to look natural."

In 2012, Karimi published a paper on ethical considerations of aesthetic rhinoplasty, colloquially known as a nose job. In examining previous literature on the procedure, he found that just 110 out of 100,000 papers addressed the ethics of the profession, even though the field is rife with potential violations. For example, a woman suffering from body dysmorphia might seek to have multiple operations in search of a perfect nose, even though each time an operation is performed on the nose, it becomes increasingly more difficult to achieve a perfect result.

Rhinoplasty is a procedure of improvement. Its not a procedure of perfection, Karimi said. Id rather them be unhappy with their nose as it is, rather than have yet another operation. I turn patients away, but I know if they knock on enough doors, theyre going to find someone to do the procedure.

He is also inclined to turn away patients if they dont have the support of their family, Karimi said.

Drawing the line

Hall, the Duke Divinity School professor, is 47 years old, and says many of her friends are approaching 50 and are wrestling with how much they should do to combat the physical calling cards of aging.

She has an internal battle when a dermatologist looked at a line between her eyes and said he could take care of that for her.

I started thinking about, thinking, 'well, maybe I should put some money aside each month for that,' Hall said. The procedure her doctor proposed would have cost about $2,000.

But then, a male friend said, Your face shows your character. It shows the wisdom you have gained. And I thought that was the sexiest thing a man has ever said to me. But then I thought, Why didnt I already know that?

Hall said women should be affirming each others natural beauty to counter the relentless youre not good enough message that they get from womens magazines and other forms of media.

We dont know how to affirm that. There is no place in the Bible where women are saying to each other, you are beautiful,'" she said. "We have to find that within the cracks and crevices of our scriptures, if we are fearfully and wonderfully made."

But, Hall said, no one should criticize a person for spending money on a cosmetic procedure, if it is undertaken thoughtfully and for a good reason: "Guilt and self-criticism is already part of the problem," she said.
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