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UNDER the skin
The Scotsman, UK
... We can make breasts bigger with implants, thighs smaller with liposuction
and skin smoother with Botox. Nature no longer has the last word. ...

Catherine Deveney Scottish feature writer of the year

Ten days before he was due to have minor cosmetic surgery, Brian Jackson spotted the man in the blue jacket outside the airport. Jackson had just returned from a modelling assignment in Bilbao. Even at the age of 72 he was still working; but if the wattle on his neck was removed, and his drooping eyelids were raised, and the minor bags under his eyes disappeared, he might win another five years doing a job he enjoyed. The man in the blue jacket was directing people out of the airport. Jackson must have stared at him a second too long. "Just up there, sir," the man told him cheerfully, assuming he wanted a coach. But Jackson wasn’t thinking about coaches. He was looking at the growth that covered the whole side of the man’s face.

"I knew I was going in for this surgery and I felt immoral at that point," he says quietly. "I was going in for this privileged operation, this expensive procedure, and I really had a strong feeling that what I was doing was wrong, related to what I saw on the side of this man’s face. I had the feeling that I should have said to him, ‘Look, how do you fancy this?’"

Jackson, who appears in a new series of documentaries about cosmetic surgery on the Discovery Health channel, has had a long and varied career. He was an RAF photographer before becoming a successful actor, working at the Old Vic and the RSC. He also owned photographic and recording studios. He has done numerous voiceovers and spent five years travelling the world as "the man from Del Monte" in the famous television adverts, before turning to modelling. Even now, the elegance and fine features are still in evidence. Jackson didn’t need to change his appearance, just maintain it. "I’ve never been self-satisfied but I’ve always thanked God for making me what I am," he says.

But, increasingly, we have the potential to be not just what we are, but what we want to be. Basic cosmetic surgery has been around since the 16th century to correct deformity. Techniques improved rapidly after the First World War as surgeons found new ways to rebuild the shattered faces of injured soldiers. But it was in the Thatcherite ’80s, the era of individualism and self-motivation, that the emphasis moved from corrective to cosmetic surgery. Despite his misgivings, Jackson ultimately decided his cosmetic repair was morally justifiable. "If you can have surgery, and you want it, and it will help you in some way, then I don’t think God would argue with that. It’s like the parable of the talents. One buried it; one wasted it."

Peter Ashby, a Harley Street cosmetic surgeon, has noticed a change in attitude in the last 15 years. "There is now a greater public acceptance of this sort of surgery," he says. "More people are doing it." Ashby even has a patient in his mid-80s. A man who is bright, articulate and angry - angry because he feels his life experiences count for nothing against the lines on his face. Inside, he feels just as he did when he was 25, except wiser. But no one sees the wisdom for the wrinkles. He has booked cosmetic surgery to iron them out.

Perhaps this 85-year-old is a symptom of our youth-obsessed society; we have so little respect for the elderly that we all scramble around desperately trying not to look our age for fear we will be thrown on the scrapheap. Are we forcing narcissism to triumph over necessity, submitting to the surgeon’s knife to save our pride rather than our lives? Or are we merely embracing the potential to be everything we can be? What is the psychology of cosmetic surgery?

AS A TEENAGER, Tailia Santo used to ask her mother to break her nose while she was asleep. She had heard that if you broke your nose twice you would get a free nose operation. Sometimes she would sit and knock it with her fist in the hope that she could alter the shape. "As long as I can remember I’ve wanted my nose done. Everyone used to say I wouldn’t be the same without my nose but my heart would sink when I looked at it. Sometimes I could sense my boyfriend looking at me from the side and I’d say, ‘Stop looking at me.’ I remember overhearing an argument he was having with a friend and his friend said, ‘She’s just a big-nosed bitch.’ I thought, ‘My God, it is noticeable.’"

Santo is 24 and wants to be an actress. Strikingly tall and model-thin, her hair is scraped back from her face and hangs down her back in a thick, dark, waist-length plait. It’s the kind of severe hairstyle you don’t wear if you are self-conscious about your nose. But Santo isn’t any more. Rhinoplasty fixed it a few months ago. She no longer worries that someone might be looking at her side on. She no longer worries about photographs at auditions. She has appeared as an extra in Footballers’ Wives and Bad Girls and it used to kill her when she was told to turn in profile. "I’d be dying inside. Now I feel great," she says. After her operation, a friend told her that her old nose had made her hard-faced. "I tell people, ‘Say what you like about my old nose. It’s gone.’"

Clearly something happened in between Brian Jackson and Tailia Santo’s generations. One sees a moral dimension to surgery; the other considers it as no more than a lifestyle option. Life used to be a fixed-price, set-menu affair. You ate what was dished up on life’s plate, like it or lump it. Now we expect something more. Our lives are individually prepared and tailored. Now we pay our money and we want more than one crummy dish of the day.

We have become the ultimate consumers. Houses, cars, electrical goods. Clothes, shoes, jewellery. Endless choices, and no longer confined just to mere things. We are sold concepts too. Peace of mind in the form of insurance. Adventure in the form of foreign travel. Now we can even try buying physical perfection. Cosmetic surgery can change the size of our nose, the line of our teeth, the shape of our bodies. We can make breasts bigger with implants, thighs smaller with liposuction and skin smoother with Botox. Nature no longer has the last word.

As a single mother with a three-year-old son, Santo can only attend drama college part-time. But, long-term, life is a menu and she’ll eat the best she can afford. Perhaps a move abroad to a warmer climate. Perhaps running her own business one day. She keeps her money in envelopes. One for car insurance. One for rent. She even had one for her nose. It was like a new dress or a pair of shoes: a commodity to be bought. "If I want something," she says, "I’ll go to any length to get it."

Her mother had the same nose but chose a different path. "My mum once went for an appointment with a surgeon and put a deposit down but she bottled it. She decided, ‘If people can’t love for me who I am, then don’t love me.’ I think that’s great, but I got to the stage where I wanted to get it fixed. I wanted it done for me." After the operation, her mother told her how worried she’d been. "I can understand that. She’s looked at me for 24 years, I suppose. It’s like my son - I think he’s gorgeous. If he said in years to come he wanted plastic surgery, I’d say, ‘Why? You’re perfect the way you are.’ I suppose for my mum it’s a bit like me saying, ‘What you made isn’t good enough.’"

The idea of a creator frequently surfaces in discussions about cosmetic surgery. "Not so long ago, people went to great lengths to disguise the fact that they’d had surgery. It was seen as interference with God’s will to change the way we look," explains Peter Ashby. Santo talks of her mother’s creation, Jackson of God’s. And then there’s Mother Nature. Whether influenced by religious belief or not, many people in the past had doubts about interfering with what had been doled out at the gooseberry bush.

But we think differently now about our bodies. Women, for example, expect their post-pregnancy shape to match their pre-pregnancy figure, a feat their grandmothers rarely aspired to, and our idea of style and beauty, thanks to the mass media, is perhaps more uniform than in previous generations.

The beauty police still prefer a white aesthetic: black and Jewish noses don’t fit. Most importantly of all, the beauty police are young. The result is that we have gradually come to expect every minor bump, blemish or age line to be nipped, tucked or ironed flat. The top layer of motivation for cosmetic surgery is about freedom and self-confidence. The bottom layer is about fear and insecurity. Peter Ashby and Brian Jackson’s surgeon, Simon Withey, have noticed an increase in middle-aged executives trying to hold on to their youth and their jobs. "I feel sympathy, actually," says Withey. "We see women trying to keep up with others. And men are increasingly coming to us from the media industry or industries where young people are aggressive in their determination to get to the top."

For Tailia Santo, the rhinoplasty that changed her nose wasn’t her first surgery; she had already had breast implants. "I had breastfed for two years and my boobs were horrible. They were so saggy I couldn’t wear anything. They’d literally had the life sucked out of them."

Despite submitting to the surgery, however, Santo insists she would breastfeed again. "I didn’t want them to be huge, like Jordan’s. I just wanted them to look normal." What if she has to renew them? She waves her hand dismissively. Oh, that’s ten years away. No need to worry yet.

"All my friends have had their boobs done," she says. How many? She rattles off three names without trying. And a fourth had her ears pinned back. In her generation, cosmetic surgery is empowering, giving her and her friends the bodies they want. And if they don’t get it first time, they’ll keep trying. "You can’t think of all the negative things. All I thought was, ‘If it doesn’t work out the way I want, I’ll just have to have it done again.’"

Her new nose brought new confidence. "The boyfriend I had before surgery was a complete idiot. It gave me the confidence to get rid of him."

But confidence, argues Ashby, is a by-product. "I spend my time trying to bring people’s expectations down to earth. Someone might say, ‘I want rhinoplasty because I’m a timid person and I want to increase my confidence with women.’ But rhinoplasty isn’t an operation for self-confidence. It’s an operation that changes the shape of your nose. No operation on God’s earth will give you self-confidence."

Dee Rogers, an attractive hairdresser from Essex, went to Ashby for a facelift and necklift. "I would describe myself as a 58-year-old woman who’d lived a good life, and it showed on my face. It was partly the smoking - you can always tell the skin of a smoker. It’s dry and sallow and there are lines around the mouth." It was explained to her before surgery that a facelift would do nothing for the mouth lines. Now she’s having isolagen, a treatment that injects the body’s own cells into the lined area. It is working slowly - partly because Dee’s cells, like the rest of her, are 58 years old.

But why undergo surgery? "Vanity," she admits. "I didn’t want to look like an old lady." We think younger for longer than previous generations and that can cause a schism between our self-image and the image in the mirror. "My face just didn’t go with the feeling inside," she agrees. "I still feel 30 inside; I’m still running around like a headless chicken. I wanted to look the way I feel inside." She’s happy with the result. "My neck got lifted so it is all very tight. It was wrinkly, and the jowls were hanging down a bit." Now she looks good for her years.

"If people say they want to look ten years younger," says Peter Ashby, "I tell them they will be the same age after the operation as before it. If they are 55, I can make them look a good 55."

Ashby says Dee Rogers’ results were good partly because her expectations were realistic. "She looks fresher and more rested, like she’s had a damn good holiday, which is the way I like a facelift to look. The analogy I make is that it’s like a bed that’s well slept in. We are remaking that bed and straightening out the undersheet - but we’re not putting new bed linen on. The skin you have on your face is exactly the same skin you had before the operation."

The dangers of cosmetic surgery are well documented. "You’ve got to do your homework very carefully," warns Ashby. "The outcome is very surgeon-dependent." The horror stories prove it: the near-tragedy of footballer Colin Hendry’s wife, Denise, who went in for a routine tummy tuck and almost died after contracting septicaemia, for example. But there are psychological dangers too - the Michael Jackson scenario where perfection is never reached because the quest is fuelled by self-loathing. Or where happiness becomes a state of body and not a state of mind. You get women who have breast implants and are so delighted they think that if they increase them again, they will be even happier, says Ashby. "When people start thinking like that you have to tell them to slow down. Double the size is not double the magic."

Women still seem to feel more pressure to be physically perfect than men do, and men account for only around 30% of Ashby’s surgical load. It’s difficult not to be influenced by that pressure, says Dee Rogers. "I listen to my girlfriends and they are all talking the same way." Her husband said he would support her, but told her he thought she was mad. Even Tailia Santo’s "idiot" boyfriend said she didn’t need implants, and she admits that had she been securely married, she might not have done it.

Simon Withey believes it is vital that if someone has surgery it’s because they want it for themselves. He won’t operate, for example, if a woman says she wants to increase her breast size to win back her husband. "There are external and internal motives and what you are looking for is internal motive. It has to be them that’s driven."

Dee Rogers was. "If someone said, ‘Why did you bother? It doesn’t show,’ I’d say, ‘Well, it does for me.’ I’m happy with it."

Brian Jackson is happy too, though it took him a while. He liked Simon Withey immensely and the surgeon’s credentials are impeccable. But the operation still had complications. He picked up an MRSA infection and also suffered nerve damage when he had to be placed on his side during the operation. He felt "dreadful" when he came round and he is sombre when describing the first time he picked up a spoon and heard it clatter as it slipped from his grip. "That’s when I realised this was all numb," he says, indicating his hand. "It was moving but lifeless." The area behind his ears was tender, sore and refused to heal properly. "I’ve really been a bit poorly. It’s actually been 13 weeks since the procedure and it’s only this last week that I have felt reasonably like me."

At first he regretted the surgery. "Now that it’s more or less all gone, I’m not sorry. I’ve gone through the transition but, yes, there was a time when I thought there is nothing so foolish as an old fool."

The surgeons involved in the Discovery Channel documentaries paid for, or subsidised, patients’ operations for the series. Peter Ashby says part of the thrill of being a cosmetic surgeon is making patients feel happy within themselves. It is easy to imagine how satisfying that would be. Yet you can’t help but feel uneasy about some of the attitudes that drive people to surgery in the first place. Brian Jackson has 72 years crammed with experiences. He is richly entertaining to talk to. So it is discomfiting when he says, "I’ve questioned it a lot over recent years, why so many people barge into me." Younger people seem to literally push him out of the way as if he no longer matters. "It’s either my magnetic personality," he says drolly, "or I’m invisible."
http://www.news.scotsman.com/features.cfm?id=25882004