Home Facial Treatments the rise of medicalised treatments in the beauty industry

the rise of medicalised treatments in the beauty industry

the rise of medicalised treatments in the beauty industry


When I was a teenager, beauty was low-tech. It was also DIY. Nobody I knew ever went to a salon for anything other than a haircut or colour (or, in the ’90s, god forbid, a perm). Instead, we attempted to live our best beauty-therapy lives at home: waxing, bleaching, masking (the mud pack variety, rather than the global pandemic one), French manicuring. Oh, the French manicure, the pink-polished nail, finished with a fine white line painted along its tip: surely the very definition of the pointless, impossible beauty task. We must have been mad.

Today, beauty norms have little to do with home-made manicures and much to do with things like microneedling. To be a woman now – or, increasingly, a teenage girl (although a growing number of men engage with beauty treatments, the industry is still overwhelmingly female-centric) – is to be exposed to a world in which no one has hairy legs or short blonde eyelashes or bad skin or frown lines; in which going to a beauty salon is not an occasional treat but an essential routine; in which no one stops at a relaxing facial or an occasional manicure, but regards Botox and dermabrasion and fillers and tattoos and microneedling and laser as standard maintenance.

Even the humble eyelash is permed, curled, extended, filled and volumised. Consider the thread facelift: suture thread is inserted beneath our skin to literally pull it tight. Or the “vampire facial”, à la Kim Kardashian, in which – wait for it – our own blood plasma is rubbed into microneedled holes all over our faces? (For Kim’s own experience, see Instagram, circa 2013. Note the blood – and also the full eye make-up. Since then she’s apparently sworn off the treatment because it’s “too painful”. No kidding.)

As the French would say (when not doing French manicures), il faut souffrir pour être beau (“one must suffer to be beautiful”). One must indeed, but even the French could never have envisioned anything like this. All these treatments are classed as “minimally invasive” yet they’re painful enough to require local anaesthetic or numbing creams, and have side effects which, though rare, can include drooling, infection, scarring and “difficulties breathing”. (In 2019, research published in the journal Plastic and Reconstructive Surgery found that in the previous year, close to 200 people globally had suffered blindness as a result of receiving dermal filler injections.) Nonetheless, they’re marketed as simple, no-downtime, routine maintenance procedures. They even have a cute nickname: “tweakments” – as if they’re simply tiny, insignificant adjustments on an evermore attainable path to physical perfection.

This is not to say they don’t work. One of the reasons for the international success of anti-wrinkle injections (Botox is one of several brands but no one remembers the others) is because they’re supremely successful at their main job: paralysing various muscles in your face to temporarily eliminate the dynamic wrinkles we all develop while living, you know, life. Though the effects only last a few months, the average forehead costs around $300 to de-wrinkle – about the same as a pot of exclusive face cream. This success, along with decades of intense marketing by Allergan, Botox’s parent company, has managed to reposition Botox away from the scary-mad-woman-plastic-surgery end of the beauty spectrum and right into the mainstream, hitched to the mega-wagon of wellness and self-care.

Long-term Botox users can trace this evolution –from dangerous to everyday – in their own lives. This is why, US sociologist Dana Berkowitz explains, “I talk about Botox as a gateway drug.” Berkowitz, who has long dark hair and a beautiful new baby who waves her hands at the screen while we talk, is the author of the 2017 bestseller, Botox Nation: Changing the Face of America. “It used to be, you know, you want a beauty treatment, you get a manicure. Now you get Botox, and a filler, and needling. Botox was the tip of the spear. In the three years since the book was published, there’s been an explosion of treatments.”

Compared to a decade ago, these treatments are more expensive, more intense, and more aggressively marketed – and we’re having them in greater numbers, starting at a younger age. And according to experts, we’re doing so because, in cultural terms at least, we have less choice about our physical image now than at any point in human history.

Today, industry sources estimate that Australian women have one of the highest per capita spends on beauty products and procedures in the world – more than 40 per cent higher than the US. In 2015, according to some reports, we spent $1 billion on cosmetic treatments. In 2018, the top three procedures were all tweakments: anti-wrinkle injections, dermal fillers, and laser and IPL (intense pulsed light) treatments. And though it seems almost impossible to believe, the Cosmetic Physicians College of Australasia industry group estimates that Australians spend as much $350 million on anti-wrinkle injections alone each year.

We’re having treatments in greater numbers because, in cultural terms at least, we have less choice about our physical image now than at any point in human history.

This trend echoes older data from overseas. In 2012, a survey commissioned by German pharma giant Merz Aesthetics of 3000 women across Europe and Russia found 80 per cent thought it was “the norm” to spend money on procedures like fillers, Botox and laser.

In some ways, of course, none of this is a shock. In every age, right back to prehistoric Anatolia, where the first man-made mirror was made from obsidian glass around 6000BC, humans have been obsessed with the way we look, and with the attempt to improve on what nature has given us. And whether it be lead, arsenic, mercury or radium (all toxic, all historically used as complexion aids) or things like X-rays (carcinogenic in high doses, and used for hair removal from the 1920s until after World War II), we’ve always been prepared to use whatever tools are available to us.

Dana Berkowitz had her first Botox injection in 2012. She was 33 years old, living in the US, and researching Botox Nation. Initially resistant to the idea of being injected, she was persuaded by her interview subjects, who told her she couldn’t understand it until she’d done it herself. Within a week of her first procedure, she wrote, “I was in awe of the results. I was surprised at how refreshed, awake, and yes, a little bit younger I looked.” But by her second treatment two years later, she felt “increasingly self-conscious, even terrified, that my students and colleagues would notice … I felt like a fraud, a failure.”

This is apparently a familiar reaction for Baby Boomers and Gen Xers, reared on the ideal of “natural beauty”. For them, the goal of treatment is to look better, but also to look like they haven’t actually “done” anything. Added to which, for those of us raised on nothing more invasive than Clearasil face wash, the idea of, say, a vampire facial takes some getting used to. As Berkowitz – who is now in her early 40s – explains, “My god! I had one of those a few years ago and it’s just crazy. You have the laser on your face and then the plasma: they get your blood and your blood is all over your face!” She grimaces. “I remember in my book, sometimes women would say some of these procedures were enjoyable; but I can promise you that none of them actually feels good. Getting your face burnt off, peeled off, needles stuck into your face? It doesn’t feel good!

“But it’s complicated. For women, physical appearance translates to professional power, economic power. Some women talked to me about it as a democratisation of beauty: ‘I wasn’t born beautiful, but I can make myself beautiful.’ They have an opportunity to control, to change, to improve.”

The new arsenal of treatments increases this opportunity, but also raises the pressure to act on it. “It’s not just an opportunity, it’s an imperative. It’s not ‘we can’, it’s ‘we should’. It’s becoming harder and harder and harder for women to reject that beauty imperative. And yet, of course it is the case that when you are treated better, and you make more money, and you have all of these interactive and structural consequences in your life because of how you look, then you are going to feel better.”

“For women, physical appearance translates to professional power, economic power. Some women talked to me about it as a democratisation of beauty.”

Sarina is a beauty therapist in Sydney’s inner west. A former model from Prague, she not only performs but receives many modern beauty treatments. She was an enthusiastic solarium user in her teens and early 20s, which means she shares a common Australian problem of sun-damaged skin. She treats it – in herself and others – with laser therapy and microneedling. The laser burns away dark pigment in the skin; microneedling causes thousands of tiny holes in the skin, which the body must then heal. The broad principle of both treatments is that the new skin is fresher, smoother and more even in colour and texture than the old.

“Women come in for the first time and they say ‘Just a little, not too much,’ ” she explains. Does it hurt? “Of course! And your skin is very red afterwards – it feels rough, like a nail file. Then it peels off, which looks very strange.” Despite all this, “the second time they come, women are like, ‘Do more, more: go harder!’ For the money [treatments start at about $200 a session], you want to get value.” According to Sarina, the pay-off is clear. “You feel better. If you look good, you feel good. Nobody wants to have wrinkles. You look in the mirror and if you see wrinkles and dark patches it just makes you feel very down. Very shit, as a matter of fact.”

“We just don’t have role models of women who have not embraced the beauty imperative,” concludes Berkowitz. “Michelle Obama talks about this in her book [Becoming]: she has a stylist, she has a trainer, a hairdresser. She says, ‘I never thought I’d be the type of person to have all these things, but women in my position need them.’ ”

Once upon a time, beauty was not only in the eye of the beholder, but unique to individual cultures and communities. What was beautiful to a European was different to the view of an African, or to someone from Japan or India. Those distinctions, says British philosopher and author of Perfect Me: Beauty as an Ethical Ideal, Professor Heather Widdows, are disappearing. Today, she explains via email, there are four global beauty ideals that women are increasingly, and universally, expected to meet: thinness, firmness, youthfulness and smoothness.

“Hair removal is a good example,” she writes. “It is wholly a beauty practice, absolutely unnecessary for bodily functioning, and yet it is increasingly seen wholly as a health and hygiene practice: body hair is classed as abnormal and disgusting and showing a lack of self-care. This is beginning to happen with other practices, from teeth whitening, skin lightening, injectables, [to] nails, hair dye.”

These ideals cross countries and cultures, she argues: so much so that the modern beauty archetype is a rare example of a truly global concept. This ideal, wrote New Yorker journalist Jia Tolentino last year, includes “an overly tan skin tone, a South Asian influence with the brows and eye shape, an African-American influence with the lips, a Caucasian influence with the nose, a cheek structure that is predominantly Native American and Middle Eastern”.

“Once an idea becomes part of a moral framework, it stops being just a suggestion, or one of many options, and becomes the dominant means by which individuals judge themselves and each other.”

“There are different pressures in different places,” says Widdows, “but they’re all tracking in the same direction. More is required to meet minimal standards, to be ‘normal’. And there’s also an increasingly moral component involved. “People say things like, ‘I’ve been good, I’ve been to the gym today,’ or ‘I’m so bad, I’ve eaten that cake.’ Once an idea becomes part of a moral framework, it stops being just a suggestion, or one of many options, and becomes the dominant means by which individuals judge themselves and each other.”

Beauty trends are contributing to a debilitating “global epidemic of body image anxiety”,  says one expert.

Beauty trends are contributing to a debilitating “global epidemic of body image anxiety”, says one expert.Credit:Getty Images

Olivia Smith (not her real name) is 19 – and if there’s a universal beauty ideal being imposed on her, she’s not aware of it: she just wants to look good. She lives in Cronulla in Sydney’s south, and is studying accounting at UNSW. She works at a pizza restaurant on weekends, which pays for some, but by no means all of her beauty treatments. “Mum helps out,” she says. “We don’t tell Dad.”

Smith has olive skin and naturally thick dark brows, eyelashes and hair. Nonetheless, she has eyelash extensions (false lashes glued to existing ones), which cost $180, and $80 a fortnight to maintain. She has almost all her body hair – full legs, Brazilian, arms, armpits, chin, upper lip and cheeks – removed via monthly waxing and laser, which costs at least $100 a session for waxing (depending what she has done) and about double that for laser. She’s also had her eyebrows tattooed into a thick, defined swoop, which cost $700 and needs to be redone once a year. Then there’s the weekly maintenance: manicures, pedicures, facials – and products: cleansers, moisturisers, masks, serums, make-up.

Smith’s motivation for all this is hard to pin down. She loves Instagram, and spends hours a day examining her own and her friends’ feeds – but she also knows a lot of it “is filters, or people taking 50 photos for one good one”. Her friends spend at least as much on beauty as she does – in fact, she feels pretty restrained compared to them, several of whom have already had things like Botox or lip fillers. And her mum, while exerting some controlling influence (via holding the purse strings) is broadly enthusiastic. “She really takes care of herself,” says Smith. Her mother has regular Botox and microneedling, and often goes for treatments with her daughter. “We love having a mani-pedi
together,” says Smith. “It’s like our bonding time.”

Smith estimates she spends “close to $1000” on beauty a month – and though she’s never considered giving up treatments, she has thought about doing them herself – especially last year, when COVID-19 closed salons and, like many clients, she found herself home, alone, and increasingly self-conscious. “I’ve tried various waxing and hair removal stuff … but it really hurts when you do it yourself. You’d only do it if you absolutely had to.”


Nonetheless, the online beauty business has experienced a phenomenal boom in the past year, thanks to COVID. Standard beauty products, sold by companies like Mecca and Adore Beauty and espoused by influencers such as Zoë Foster Blake, Lauren Curtis and Chloe Morello, now sit alongside more and more extreme treatments: “peels, microneedling pens you can use at home, home lasers, crazy facial things”, as Berkowitz puts it. “These beauty boxes – especially all the things coming in from South Korea – are really DIY on steroids.”

Though both anti-wrinkle injections and dermal fillers must be administered by a doctor or registered nurse in Australia, you can of course buy all sorts of mind-boggling stuff online – including fillers and anti-wrinkle treatments, complete with needles. For Smith, these products have the advantage of being “super-cheap compared with going to a salon” but she’s not interested in them herself. “I had a friend who bought an eyebrow tattooing kit online, and it was a disaster,” she says. “It’s not worth it.”

Cosmetic tattooist Georgie Westley grits her teeth at the mention of DIY brow kits. Founder of Distinctive Features Cosmetic Tattoo and Beauty salon in Melbourne, where a new brow treatment costs from $700 (plus maintenance charges), Westley has been doing professional cosmetic tattooing for 20 years. “We’re seeing the brow boom of our lifetime,” she says.

But brow tattooing (there’s also eyeliner, lip and aureole tattooing) comes in all shapes and sizes, and Westley has some reservations about the current fashion for a “very sculptured, defined, dark brow – the Kim Kardashian brow” (and the Smith brow). “I actually disagree with it,” she says. “It means you need a lot of other treatments to balance things out in your face. You need the lips, the lashes, the whole thing.” Added to which, if a Kim Kardashian brow goes wrong, it goes really wrong. “Although cosmetic tattoos fade to a certain point, they never fully disappear. We can try to treat them with laser and saline, but it may take 10 treatments over two years to get it fixed.”

This is what happened to Smith’s friend. “She had all these scabs all over her eyebrows,” she recalls. But it hasn’t put Smith off. “I’d love to get my lips done … just a bit of filler. And some Botox, for prevention.”

Berkowitz rolls her eyes at this “preventative” idea. “Since I published the book, Allergan [the company that produces Botox] has initiated an extremely
aggressive ad campaign on social media, specifically targeting Millennials,” she explains. “It’s this whole idea of ‘preventative Botox’. And they’re doing a great job. My husband’s cousins, who are in their 20s, are always asking me, ‘Should I start Botox now? All my friends are.’ ”

Professor Heather Widdows: “There are different pressures in different places, but they’re all tracking in the same direction. More is required to meet minimal standards, to be ‘normal’.”

Professor Heather Widdows: “There are different pressures in different places, but they’re all tracking in the same direction. More is required to meet minimal standards, to be ‘normal’.”Credit:Getty Images

Lilliane Caron is the owner of the Smooth & Tan beauty salon in Geelong. She also owns and manufactures Caronlab waxes, which are exported to beauty therapists and home users worldwide. She started her business 41 years ago, during the waxing revolution (before that, people actually shaved their legs and armpits – a concept unimaginable to girls like Smith), so in beauty terms at least, Caron carries the wisdom of the ages. “I remember doing the very first Brazilians,” she recalls. “I had no idea what I was doing – people were just coming in and pulling their pants down and saying, ‘Can you take it all off?’ And I was only charging $10 a go!”

These days, she treats three generations of the same families at her 14-room salon, with up to 3000 clients a week in the Christmas rush period. “I still have 70-year-old women having bikini waxes,” she laughs. “Don’t ask me why! But it’s great!”

As well as waxing, Caron – who is gentle and charming, and holds her tiny golden dog on her lap throughout our on-screen interview – offers a big range of cosmetic treatments to an increasingly young clientele. “When the business started, most clients were 25, 30 years old,” she says, “but I’d say today it’s common from 15 onwards.” This concerns her. “I don’t encourage waxing – or any treatment – at a young age. Except perhaps if they’re doing gymnastics or something, or they’re being bullied; and we always chat to their mum. I certainly say if you can’t see the hair from two feet away, it doesn’t need to be removed. I have two foster children, twins, and they’re 15, and although one has had a tiny bit of eyebrow waxing, I feel quite protective about them not starting too young. I say, ‘Whatever you do, you’re going to have to keep doing it for the rest of your life! Baby steps is important, and getting your priorities right.’ ”

That said, she acknowledges that many young women regard their beauty regimen as a priority. “A lot of them are working, and their money is spent on this: the fake lashes, tattooing of the brow, and also injectables, which are very, very popular.”

It’s a snowball effect, she says, echoing Georgie Westley: “You might start with the volume lashes, then you might need the great brows, and then the fuller lips.” Indeed, sometimes one treatment ends up requiring another, in a sort of cascade of interventions. As Westley points out, lip tattooing is often done to correct the aftermath of repeated fillers, because “after people have filler for a few years, they can lose the outline of their lips due to scarring”.

“They are live-streaming their experience! They really want to share it with the world.”

Still, few women – and fewer young women – are interested in hearing words of warning. “Girls come in and they’re very aware of what they want,” says Caron. “They have their Instagram influencers – not Kim Kardashian so much any more, but lots of others. We also see a lot of anime: that very defined, pronounced facial look. They’ve seen a two-minute video on their phones on how someone’s managed to achieve this look, and that’s what they want. They have all the terminology: they’ve studied it. We try to influence them a little bit; we try to tell them the truth. But whether they listen is a different kettle of fish.”

Where Gen Xers and beyond are after anti-ageing effects – looking like themselves, only fresher – young women don’t necessarily want to look like themselves at all. “They like the treatments that are physically changing their look,” says Caron. “They want to look bold and strong. And they don’t care that they don’t look natural. If they can only afford a few treatments, they go for the ones with the biggest impact, that people can really see. They’re happy to be exaggerated. That’s the look they like: everything bigger, everything enhanced.”

Cosmetic surgeon Dr Vivek Eranki, founder of the Cosmétique chain (13 clinics nationally and counting), couldn’t agree more. “[What people want] is much more extreme these days,” he explains from his base in Perth. “Looking natural is not their priority.”

His company’s Facebook page is a case in point: image after image of bee-stung lips, inch-long lashes, brows like black knife blades and enormous boobs (Cosmétique also provides a range of surgical treatments.) Dr Eranki himself, who once worked in trauma surgery, sounds slightly bemused by the whole business. “In my own profession, I am one of the only people I know who hasn’t had any work done,” he says. “Not even a single injection, ever. Of course, I never have to see my own face! But I think it is a generational thing. The younger generation has grown up sharing everything. So you don’t have to limit what you do to very subtle changes because you don’t want anyone to know.

“Some years ago, patients viewed things like injectables as a taboo subject. They would say, ‘My husband doesn’t need to know I’m doing this; no one needs to know.’ But now, from the moment they enter the clinic they are live-streaming their experience! They really want to share it with the world. So then they feel comfortable doing something much more extreme, and being proud of that.”

Platforms like Instagram, he goes on, encourage extreme treatments because they offer users a highly visual, heavily idealised world, increasingly divorced from reality. (For anyone wanting a perfect example of this, try Sydney-based Lydia Barakat’s Instagram page, with its 1.3 million followers. It takes a while to realise what Barakat looks like: a cartoon Disney princess.) “Your car is shiny; your holiday is perfect; your lips are full,” as Dr Eranki puts it. “If that’s what you’ve grown up with, and that’s what your friends validate, then that’s what you aspire to. And that’s what you do treatment-wise.” And once you do it, and post it for others, the feedback loop is complete.

What does our beauty future hold? More of the same, it seems: more treatments as prices go down and technologies improve; more homogeneity as social media platforms proliferate; more acceptance of an increasingly altered version of a “normal” human face.

For some, this is an awful, even apocalyptic vision. “It’s catastrophic for all of us,” writes Professor Widdows, not mincing her words. “If trends continue and the highly modified body becomes the normal body, we will spend more of our time and effort and scarce resources seeking it. We already have a global epidemic of body image anxiety which is devastating and debilitating, and this is spreading across communities, cultures, genders, sexuality and all demographics. An obsession with the body beautiful as the way we value and judge ourselves and others won’t lead to happy lives!”

“Botulinum toxin, from which Botox is made, is the most toxic substance known to man.”

Practitioners like Westley and Eranki, meanwhile, are focused on the practical fall-outs from this trend. As more treatments become available to more people, there’s an even greater need for proper training and regulation. In Australia, a doctor – even one without any significant surgical training – can claim to be a surgeon and perform, say, breast augmentations. Even at the less dramatic end of the beauty spectrum, “people shouldn’t trivialise these treatments,” says Eranki. “From the patient’s perspective, an anti-wrinkle treatment is just a tiny little needle going in and out. But botulinum toxin, from which Botox is made, is the most toxic substance known to man. It’s very much diluted in treatment, of course, but it’s still extremely potent. People should be aware of things like that.”


Fundamentally, the beauty ideal is no different from any other goal in life. As Widdows says, we pursue it because we think it will make us happy. But on current evidence, the modern beauty paradigm – and the endless trials and tribulations we undertake to align ourselves with it – doesn’t seem to be creating a more joyful human race. Might Olivia Smith be happier if she spent $12,000 less on beauty treatments each year, and the equivalent time and money on other things: holidays, or friends, or just hanging out with her mum? “I have no idea,” she laughs. “Maybe.”

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