Ugly Beauty

by Ruth Brandon

  Forty years later, however, the daughters of those Victorian wives had become lipsticked suffrage marchers who, as everyone knew, would sooner rather than later have their way. And Helena Rubinstein, rich, independent, self-made, eye-poppingly chic, and sheathed in a seamless shell of creams, powders, and paints, both offered an image of what was possible and provided the means of getting there—or at least of taking a step along the way.

  The problem, however, with products that are of a particular moment is that they tend to date. Economically, today’s women have never been freer. In that sense we are still living in Rubinstein’s world. But cosmetics have moved on dramatically since Madame, in her heyday, was the constantly visible face of Helena Rubinstein. It was Eugène Schueller’s scientific laboratory, not Helena Rubinstein’s kitchen, that would hold the key to the cosmetics future.

  II

  During the twentieth century, dreams that had for centuries been the stuff of fairy tales one after another became reality. Airplanes gave us magic carpets; automobiles, seven-league boots. The telephone let us speak across continents; radio and television showed us all that was happening in the world, often at the moment it happened. Most recently, the Internet has granted us instant, universal knowledge. And although immortality is still beyond us, the beauty business offers a consolation prize. What (Freud famously inquired) do women want? Madame Rachel could have told him: to be beautiful forever. And today, beautiful forever is, up to a point, ours. When, in 1935, a reader wrote to the author of Skin Deep inquiring about Helena Rubinstein’s “Herbal Tissue” cream, retailing at $1.25 and supposed to “prevent or heal lines, crepy eyelids and crows around the eyes,”9 the answer was: “There is, alas, no cosmetic known capable of doing the things described.” Today, however, that is no longer true.

  Skin creams are still most people’s first line of defense. And these days, they can have some slight effect. In April 2007, research carried out for the BBC television program Horizon, investigating the antiaging industry, found that although most creams left wrinkles wholly unsmoothed, one did, over time, make a slight, but measurable, difference: No. 7 Protect and Perfect Serum, a proprietary brand of the British pharmacy chain Boots, and at £16.75 ($27) for a 30ml jar, one of the cheapest products in the survey. Within twenty-four hours of the program being broadcast, sales jumped 2,000 percent. Customers queued outside branches of Boots at five the next morning. In Yorkshire, there was a near-riot when one woman bought a store’s entire stock. Within two weeks what had been a year’s supply of the lotion was bought up, and single jars sold on eBay for up to £100. Today, in time-honored style, the Protect and Perfect family has expanded to include day cream, night cream, beauty serum, intense beauty serum, and a range of products for men. Why stop at one product when twelve will do?

  The secret of Boots’ cream is a vitamin A compound called retinol, which increases the production of two important components of the skin, glycosaminoglycan and procollagen. Creams today also use hyaluronic acid, or hyaluronan, a component of connective tissue that cushions and lubricates, and their advertising heavily emphasizes scientific certainty. Thus, L’Oréal’s Youth Code skin cream is “Inspired by the Science of Genes.” But the scientifically active ingredients in such creams, although present, are a vanishingly small proportion of the whole—far less than the quantity required to produce any noticeable effect. As Liz Walker, proprietor of the House of Beauty in Barnsley, Yorkshire, put it, “A pampering facial or a nice cream is all very well, but it’s not going to make those wrinkles completely disappear, is it?”10

  If the cream doesn’t do the trick, however, new and effective resources are now available. We can either go deeper, with plastic surgery, or iron out wrinkles with “cosmoceuticals.” In 2006, the number of cosmetic procedures, both surgical and noninvasive, was estimated at well over 21 million worldwide. By 2015, the American Society of Plastic Surgeons expects its members to carry out 55 million such procedures annually in the United States alone.11 The market, valued at nearly $14 billion in 2007, is growing at $1 billion a year.12 On-demand shape-shifting has become one of the passions of the new millennium.

  Plastic surgery is not new. As long ago as 2000 B.C., doctors in India repaired noses disfigured by disease or punishment. But until antiseptics and anesthesia made operations relatively painless and safe, it was used only in extreme cases. Toward the end of the nineteenth century, it gained ground: plastic surgery was one of the treatments Helena Rubinstein investigated on her whirlwind tour of European skin specialists in 1905, along with chemical skin peels and other such scientific innovations. But these treatments were expensive and often risky. In 1921, the American heiress Gladys Deacon, whom the press dubbed the world’s loveliest woman, and who was certainly one of the richest, had paraffin wax injected into her face to correct a small indentation at the bridge of her nose. She hoped to achieve the profile of a Greek statue, but unfortunately for her the wax slipped, leaving her with an incipient horn on her forehead and a swollen neck where the wax had run down under the skin. It was a catastrophe from which neither she nor paraffin-wax treatments ever recovered.

  As so often, military requirements nudged the science forward. Wars destroy many faces, and doctors such as Jacques Joseph in Germany during World War I and Archibald McIndoe in Britain during World War II were both made famous by their pioneering techniques in reconstructive surgery. Inevitably, these were soon co-opted by the beauty business. After World War I, another pioneering plastic surgeon, Sir Harold Gillies, wondered if it might be possible to make a living out of private plastic surgery. The answer, as he soon found, was yes. He neatly summed up the difference between his new field and his old: “Reconstructive surgery is an attempt to return to normal; cosmetic surgery is an attempt to surpass the normal.”13 But while comparatively few people, at least in peacetime, need reconstructive surgery, almost everybody would like to look better than they do, and many are happy to pay for the privilege.

  Today, surpassing the normal has become so run-of-the-mill that to age unretouched seems almost a form of obstinacy. The website of one London cosmetic-surgery practice offers a body map: click on the appropriate part to choose your preferred procedure. Face, ears, arms, hands, breasts, abdomen, genitalia, hips, legs, skin—all can be altered, and, hopefully, improved. You can indulge in medical tourism: see Prague (or Warsaw, or Rio) and get your tummy tucked while you’re there. The New York Times even published a restaurant-type guide to Rio doctors, giving prices, specialties, booking advice, and handy hints: “Dr. Müller is known for, among other things, sculpturing beautifully shaped breasts and performing body liposuction. If you’re looking for an aggressive makeover this is not the place for you: Dr. Müller specializes in the natural look. . . .”14 Doctors tout themselves online, publishing testimonials from grateful patients and employing media consultants to promote their public image—not only in America, where this kind of thing has always been allowed, but in Britain, where it very much has not. An old-school plastic and cosmetic surgeon I spoke to—he didn’t want to be named, I’ll call him Peter—thought advertising for cosmetic surgery “the pits: you used to get struck off by the General Medical Council for that kind of thing.” However, even where there is a prohibition, doctors get around it: all they need do is belong to a clinic, which does the advertising for them.

  So fundamental, indeed, has body altering become to our lives, and so fascinating are the possibilities, that watching it in action has become a compon
ent of prime-time television. In programs such as Extreme Makeover, Nip/Tuck, and Ten Years Younger, unreconstructed subjects undergo transformation by a team of experts—the dentist, the hairdresser, the boob man, the nose man, the stylist-cum-cheerleader—into another person altogether. The original subject—the clay, so to speak—exists only as raw material: the Before. The wizards do their stuff, and—shazam!—a new woman or man is born, all their own work. Pygmalion and Frankenstein live!

  I asked Peter if he felt like a sculptor when remolding people’s faces and bodies. He said he did. A lot of his colleagues, he said, are (as he is) painters or sculptors in their spare time—that was often what first attracted them to this branch of surgery. Indeed, he feels artistic skills so necessary to plastic surgeons that he set up a course called “Sculpture for Surgeons.” In it, seven or eight plastic surgeons are given a ball of clay and told to model the head of a sitter—something they do not, at first, find easy even though, or perhaps because, they are so familiar with facial anatomy. One typical participant produced, in the words of Luke Shepherd, the sculptor who teaches the course, “what turned out to be an anatomical model, very hollow-looking, more like a skull. He said he didn’t know how to fill in the soft tissue around the bone structure.” That is, the shape of the end of the nose, or the eyelids—the details, in fact, that concern potential patients. “We try to give them a basic grounding in the language of form—what symmetry is, how the eye balances things,” Shepherd said. “It’s training the eye to ask questions of the form so when they come to surgery the eye is able to make those sort of decisions.” He aims to teach the surgeons on his course to “see 3-D.” It is also important that they see each patient as an individual problem. Plastic surgeons get known for a particular specialty, but with facial work this specialization can be dangerous: patients don’t want a “signature” job, they want the nose, or chin, they themselves feel they need.

  Plastic surgery is still not cheap. But easy terms are available, and the customers are happy to pay up. Fifty-four percent of the interviewees in the Grazia survey intended to have cosmetic surgery, expecting to spend on average $5,650 (£3,500). If they didn’t have the necessary money available, they were happy to spend less on clothes and going out. If necessary they would take out a loan—many practices offer low-interest financing to their customers. And the market is not confined to women: a 2007 survey by the market-reseach organization YouGov found that a quarter of all men in the United Kingdom. would consider cosmetic intervention.

  However, the great majority of cosmetic procedures these days do not involve surgery. On the contrary, the American Society of Plastic Surgeons predicts that 88 percent of the 55 million procedures anticipated in 2015 will be noninvasive. “You can do a lot of things with a needle now—you can compete with a knife,” said Dr. Lucy Glancey, a specialist in cosmetic and antiaging treatments.15 You can either plump out your face with collagen fillers, “redistributing volume,” as Dr. Glancey put it, so that firmness returns without the deadly “windswept” look that can result from a face-lift; or you can simply smooth those wrinkles away with Botox, the registered name for an injectable solution of the botulinum toxin, which blocks the signals telling your muscles to contract. If you eat meat containing this poison, it attacks the muscles in your chest: you can’t breathe and it kills you. But if a small amount is injected into your face, the facial muscles can’t move—and so, can’t wrinkle.

  First used medicinally in the 1970s to relieve uncontrollable muscle spasms, Botox’s possible cosmetic application was first recognized in 1987. Since then, its popularity has increased exponentially. In 2000, about 800,000 Americans had Botox injections, while nearly 2 million had cosmetic surgery; in 2008, 5.5 million chose Botox (one in eleven of whom were men), and 1.7 million surgery. L’Oréal, already part of the injectables market through its part ownership of the pharmaceuticals firm Sanofi-Aventis and its share of Galderma, a joint venture with Nestlé, in 2009 introduced its own botulinum toxin treatment, to be marketed under the name Azzalure in Europe, and Reloxin in the States. The market for these treatments, worth $1.2 billion in 2009, is expected to grow by 13 percent per year between 2009 and 2012—a tempting prospect, especially given that both 2008 and 2009 saw L’Oréal’s profits fall: in 2008 by 27 percent, in 2009 by a further 3.2 percent.

  Injections of Botox (as the treatment has become generically known, though in fact the name is a proprietary trademark owned by Allergan) are quick and virtually painless. The effects are almost instantaneous and involve no ugly scarring. And if you don’t like the result, no problem: it wears off. Since it works because of its paralyzing effect, it makes your face less mobile, producing a curious masklike look. But some users actively prefer this. Just as in eighteenth-century France, the cosmetic mask represents something so desirable—membership in the king’s set, the defeat of time—that its very artificiality becomes a mark of status. “As the Botox wears off towards the end of three months, the movement returns to my face and I get really impatient for my next fix,” said Jay Nicholls, a thirty-two-year-old model and dancer.16 Jay has her Botox renewed every three months at £500 (about $700) a time. That’s the financial equivalent of a face-lift every two years, on and on, into the foreseeable future.

  Fillers are more dubious—or that, at any rate, is Peter’s view. In fact, he thought they could sometimes be quite dangerous. Gladys Deacon–type disasters are by no means inconceivable even now. The “trout pout” that can result from having your lips plumped is a notorious risk. But, as with Botox, these treatments are not permanent, and since they are both cheaper, per treatment, than surgery, as well as far less time-consuming and daunting, more and more people want to try them. “Supermarket workers, dinner ladies, they’re all saving up for [Botox],” says Liz Walker. “And there are no holds barred as to how far they’ll go for all the other stuff, either. We’re now using machines they don’t even use in London in order to get more immediate results.”

  I asked Dr. Glancey if she had tried out her own treatments. She admitted that she had: several of them, in fact. “We’re in a sweetie shop here—you can’t resist,” she said. And it’s easy to see what she means. Once you take the first step—iron out your frown lines, whiten your teeth, plump out your cheeks or the backs of your hands—your body becomes a blank sheet. What about those crow’s-feet, those baggy upper arms . . . ? If something goes wrong, perhaps some further tweaking may improve it. Once you begin, the possibilities for discontent are infinite, perfection always somewhere around the next corner. And soon, in the excitement of redesign, you’ve forgotten what you looked like in the first place. Before-and-after photographs of surgery addicts show a terrifying disjunction between the presurgery face and the end result of serial adjustments. “Most surgeons have to convince people to have less,” said Luke Shepherd.

  For some, the procedure rather than the result is the important thing. In an extreme form, this pattern can be pathological: the feeling of constant discontent with one’s body, and compulsion to change it, is a syndrome known as body dysmorphic disorder. But even for nondysmorphics, cosmetic procedures can be addictive. “I’m here for a wound check to make sure I’m healing properly,” Lauren, forty-five, said as she waited for her appointment at a large London practice.

  I had a tummy tuck, had my implants changed and I had a breast uplift. I had my first breast implants done 17 years ago after I had my son. My boobs went from a C to an A and I thought, “I don’t like that, they look like pita
breads.” I was considering having a tummy tuck so I thought while I’m there I might as well have my breasts done.17

  Mostly, though, the treatments are a means to an end: feeling better about yourself. “I have completely re-invented myself and Botox has played a big part in that,” said Lisa, thirty-seven, while Victoria, a widow, age forty-five, said Botox “has given me the confidence to restart my life after [my husband’s] death.”18

  Workplace issues are also important. Particularly when times are hard, people feel that if they begin to look old they may lose their job to someone younger. When the beauty business began, this fear was not a woman’s concern, as men were the principal wage earners and most women’s chief preoccupation was to catch a husband—as in a typical L’Oréal ad from 1923, which showed a pretty girl sitting between two admirers: “The young are life’s favorites. . . . Gray hairs don’t attract admiring looks. And happy youth lasts longer for those who use L’Oréal.”

  But priorities soon changed—and the letters written by readers to the author of Skin Deep in 1935 and 1936, during the Depression, pinpoint the moment. These women’s principal worry was no longer that they would fail to catch a man, but that they might lose their job. Their earnings, formerly, like their bright-red lipstick, a badge of newly gained freedom and independence, had become a vital part of the family budget; and cosmetics and hair dye (once carefree banners for emancipation) were now essential tools in the grim fight for employment. In those circumstances, cosmetics played a vital role—whether by preserving the illusion of youth, so that an employer would be less inclined to “let you go,” or because the wearer felt—and so worked—better. Skin Deep’s researches revealed that all the synthetic hair dyes on the market in America during the 1930s were more or less allergenic, some seriously so; but the ensuing correspondence made it clear that many women felt they had to risk them, or else face unemployment. “Due to the fact that my hair is prematurely grey, and even more important, that if such a fact were known it would jeopardize my job, I have in desperation and with much fear and trembling been using Inecto Hair Dye,” confessed a worried reader in 1935. Inecto had been found to cause acute dermatitis of the face, inflammation and irritation of the scalp, face, and nose, dermatitis of the scalp, sores on scalp and face, swelling of the eyelids and closing of the eyes, and “many other unpleasant consequences, including toxic absorption extending down over the face, back and arms, followed by acute nephritis, Bright’s disease and anaemia.”19 Another wanted to know “if there is certain proof of injury to persons who have used Grayban for a long period. My work makes it important that I look as well as possible, and gray hair is not flattering to me, as many try to make me fancy.”20 Grayban was based on a salt of bismuth, and poisonous when absorbed. But many users would tolerate any discomfort to avoid being sacked.