Plastic surgery will never make you feel beautiful

The fashion industry is calculated to locate the gap in our self-esteem and crowbar it wide open

This is an unofficial Plastic Surgery Week. Heat magazine's front page boasts: "The shocking truth about our youngest stars ... Plastic surgery under 30!" Michael Jackson's "face" has been flickering across our screens constantly. And - the plastic cherry on this plastic cake - ITV's Tonight With Trevor MacDonald on Monday night gave us Britain's first "extreme makeover".

Fran Rabin, a normal-looking teacher from Surrey, was shipped off to Hollywood to receive £50,000-worth of surgical reconstruction. The doctors broke her nose, implanted gortex in her chin, sculpted her face and remade her breasts. She was, MacDonald said with a straight face, given "a brand new face for the future ... you can get more information about plastic surgery on our website".

Fran emerged from hospital looking like she had been savagely beaten. Her bruised, swollen face was bound in bandages and she could only breathe through one nostril. In the run-up to the operation, Fran had been given "advice" by Eve Michaels, a Hollywood image consultant. Given that Eve herself would fit very neatly into the X-Men (Marvel Comics' team of mutant superheroes), it was surprising that anybody would pay to listen to her warped judgement. Eve's face didn't look sculpted; it looked scooped-out, stretched and sucked dry of life and expression.

And then, after four weeks of healing, Eve unveiled Fran's new face. She introduced it to Fran's gathered relatives by saying, "All she wanted was to look in the mirror and be truly beautiful." She paused. "Not only on the inside." The teacher then emerged, looking remarkably similar, if a little more - well, plastic. She embraced her surgeon, and said, "Thank you. Thank you for making me a beautiful person." It was hard not to think of the singer Dory Previn's line, "I hope the Hollywood sign weeps for the town it watches."

I hope ITV revisit Fran in five years. Her problems seem to be much deeper than her once-pleasant face. Her husband died in 1989, and since then she has found it very difficult to find another man. Dating, she said, was "traumatic ... you always come home disappointed". She had always "hated my looks, ever since I was a teenager", and envied her older sister. She had wildly unrealistic expectations. Her mother summarised the collective view when she said, "I hope everything will be OK after the surgery." The idea that a new nose and some lifted breasts will make her life perfect seemed flawed, to say the least. There was no evidence of pre- or post-operation therapy; presumably, after such a massive lay-out apparently not funded by ITV, she can't afford it.

Fran's case raises much wider questions about our culture. She is just one of two million people who had cosmetic surgery in the United States this year, and more than 50,000 people in Britain. The numbers are expected to continue to grow rapidly over the next decade. This seems like a good moment to ask: how did we end up like this, and is it healthy? The feminist author Kathy Davis argues it is a sign that women are taking charge of their lives, maximising their chances in a culture that privileges the attractive. Can this possibly be true?

Virginia Blum, in her new book Flesh Wounds: The Culture of Cosmetic Surgery, attributes the huge boom in the plastic surgery industry to three different cultural trends which began to emerge at the end of the 19th century. The first and most significant is, obviously, the development of medical technologies that make it possible to safely slice open and alter flesh. The second is a celebrity-worshipping culture. Hollywood established an international standard of beauty with which women began to compare themselves for the first time. Instead of comparing her looks with attractive people she might know, the standard for a normal woman (and, much later, men) was suddenly raised astronomically high - and so drastic solutions began to be considered.

The third contributing factor is psychoanalysis. There has been a growing belief in a wounded inner self that needs to be cured. Most plastic surgery recipients believe that they are changing their bodies to bring them into line with their true, quasi-Freudian self. "I wanted my body to look as young as I feel," they say, or, "That nose just wasn't me." In fact, these individuals are responding to extremely powerful cultural forces which suppress individuality and bring them into line with a rigidly policed cultural norm. Far from being "empowered" and expressing the self, they are being battered into line.

This can be seen most clearly in the case of Jews, Asians and black people who have their noses altered to resemble the "white" norm. Blum has identified a near-epidemic among American Jewish women to have their "hook" noses altered. (Fran, who was Jewish herself, shows how this has spread to the UK, consciously or not.) "The nose-job of the teenage middle-class Jewish girl became a rite of passage in the 1960s," Blum explains.

Similarly, among Asian Americans there is a widely documented phenomenon of mothers taking their teenage daughters for double-lid surgery, which gives the effect of a Caucasian eyelid and large, round Disney-style eyes. Michael Jackson is a very extreme example - but his "whitening" (which he claims is due to a very rare skin disease) may become more common too.

Far from being empowering, plastic surgery is another painful symptom of what the feminist academic Sandra Lee Bartky has dubbed the "fashion-beauty complex". President Eisenhower warned in the 1950s of a "military-industrial complex" - a dense network of vested interests that would always find wars to fight in order to justify their vast budgets. Bartky is playing on this concept, warning of a vast network of industries that will always make us feel ugly and fat, no matter how healthy, thin or beautiful we become. Of course, wanting to look good is a natural human instinct, and it will never go away. But the fashion and cosmetics industries are carefully calculated to locate the gap in our self-esteem and crowbar it wide open. They create a bleeding, pus-spewing wound that needs to be constantly treated with a balm provided exclusively (and expensively) by them. Our expectations of attractiveness are, thanks to them, forever escalating. No matter what you do, you will never feel beautiful.

We perpetuate this world ourselves. Women buy the magazines that are calculated to make them feel repulsive. They are dependent on our treatments (and so are most men now), and many women already feel old and in need of a lift by the time they reach their fifties. Once the virus is released, it is extremely hard to contain.

We can, however, look for alternative ways to contain our neuroses. Body Dismorphic Disorder (BDD) is a mental condition which compels its victims to feel that they are in the wrong bodies, and that only surgery can help them to realise their true selves. Can anybody seriously doubt now that we are, as Germaine Greer argues, living through an epidemic of BDD? The cognitive behaviourist Katherine Phillips claims to have found proof that BDD has a biological cause, and that brain scans will eventually find the exact location of the pathology. She says that it should not be treated with surgery - which will never be enough, and just leads to ever-greater and more extreme operations - but with antidepressants. Prozac, Seroxat and family have downsides to be sure, but I would recommend them over a facelift every time. Wouldn't a country of Prozac-poppers be healthier than a nation of women volunteering to have their faces and breasts sliced open?

j.hari@independent.co.uk