DIFFICULT MORAL QUESTIONS

Question 57: May a woman have a face-lift to gain a more youthful appearance?

I am a woman in my fifties. A little over a year ago, a checkup showed that my cholesterol had risen dramatically, and, since I no longer am ovulating, my doctor recommended I go on estrogen therapy. After looking into it, however, I decided not to, and instead took up a regular exercise program. My husband and I also changed our diet by drastically reducing saturated fats, so that now we are virtually vegetarians. As a result, my cholesterol has come down, and both of us have lost a lot of weight.

My husband feels and looks better than he has in years, and I feel five years younger. But, unlike him, I look ten years older, especially in the face. Careful makeup helps, but it cannot hide the pouches and wrinkles, and I am thinking of having a face-lift. A friend of mine had one a few months ago and looks years younger. She was very pleased with the surgeon who did it and with the hospital, where it was done on an outpatient basis. She needed only two or three weeks to recover, though she does have a couple of permanently numb spots where nerves were cut.

My husband, agreeable and supportive as always, says he will be happy with whatever I decide. He also told me he will love me just as much without as with a new face, since I still seem beautiful to him. Though I don’t still seem beautiful to me, I know he meant it; he does not waste words and always means what he says. Then too, while I have a job outside our home, my appearance has no effect on my work. In short, I cannot say I need the face-lift. The total cost would be around ten thousand dollars, and my health insurance would not cover any of it. Still, I would like to look younger, and wonder whether that is a good enough reason to go ahead.

Analysis:

The questioner asks whether she may spend ten thousand dollars for a face-lift. If necessary to fulfill one’s responsibilities, one could have a moral obligation to have such surgery. The questioner, however, is considering a face-lift simply to conceal the evidences of aging. Prizing youthful appearance for itself reflects conventional secularist values rather than sound human and Christian ones; it also manifests the wish to relate to others on the basis of a deceptive appearance. Rather than using ten thousand dollars for a face-lift, the questioner has an obligation, which in my judgment is grave, to use the money to meet genuine needs—if not her and her dependents’ needs, then those of others.

The reply could be along the following lines:

While it is not quite true that beauty is in the eye of the beholder, perceptible beauty is relative to the perceptual capacities of those who perceive it. In some respects, these capacities are determined by nature, and to that extent people tend to agree in their judgments about beauty. For example, since bright, clear colors and regular, balanced shapes provide a good visual stimulus and are easily taken in, they are agreeable to anyone with normal visual perception, and so are regarded as beautiful by just about everyone. In other respects, however, perceptual capacities are determined by experience, which varies and whose shaping is influenced by emotions, and to that extent people disagree about what is beautiful. For example, those who lack experience of people belonging to other races or are prejudiced against them often find members of other races ugly, since they look so different from the way people “should” look. At the same time, individuals always look like themselves, and so they seem to appear just as they should to those who know them well, love them, and perceive them as the unique persons they are rather than as more or less good instances of some type. Since your husband perceives you in this way, you still seem beautiful to him.

Cosmetic measures, such as beauty treatments and makeup, serve at least four diverse purposes.

First, every culture develops certain conventions of personal appearance, some applying generally and others only to people in certain roles or on certain special occasions. These conventions usually involve wearing certain sorts of clothing and/or jewelry, and often involve cosmetic measures by either men or women, or both. Second, cosmetic measures can be used to enhance already satisfactory appearance in accord with either an individual’s personal taste or commonly accepted esthetic standards, or both. Styling the hair and using cosmetics to highlight attractive facial features are examples. Since I do not think either of these purposes is among your motives for considering a face-lift, I shall not discuss them further.

Third, both makeup and cosmetic surgery can be used to correct or conceal abnormalities or blemishes. Since these can be repugnant to others, correcting or concealing them can facilitate interpersonal relations. It also can reduce feelings of embarrassment and increase self-confidence, thus improving a person’s ability to function well. Cosmetic measures appropriate for such purposes are justified in themselves, though their use should be limited by other responsibilities. While cosmetic surgery often is used for this purpose, you do not say your appearance is abnormal for your age, and so I set this purpose aside.

That leaves only the fourth purpose: to conceal the evidences of the normal aging process, which are felt to be undesirable for two reasons. First, since aging causes deterioration and ends in death, its signs are repugnant; thus, appearing to be elderly is undesirable to both men and women, and people who appear to be older than sixty or sixty-five tend to be seen as diverging from the person-in-the-prime-of-life type. Second, since a woman’s capacity and opportunity to mate is greatest shortly after she sexually matures, evolution has made the nubile young woman erotically appealing to men, with the result that many men see every woman who might be considered a possible sexual partner in terms of the nubile-young-woman type. By these ideals, beauty fades with age, and even middle-aged women who no longer appear youthful are more or less ugly.²⁰⁴

Thus, face-lifts often are used to conceal the evidences of aging and restore a youthful appearance, and this seems to be your motive. You say that, after losing weight, you “look ten years older” and your friend, after a face-lift, “looks years younger.” Perceiving yourself as neither in the prime of life nor a nubile young woman, you no longer seem beautiful to yourself, and “would like to look younger.” For several reasons, I do not think you should act on this motive.

In the first place, we Christians should both hope for everlasting life and habitually regard others and ourselves as complete, unique persons rather than mere instances of types such as healthy adult and sexually attractive female (male). Our sense of self-worth should be based on those things in us that we know God values highly. The reasons that cause many people to feel that signs of aging are unattractive should not affect our self-esteem as Christians. Still, they do affect it because our perceptual standards are skewed by our corrupt culture—with its prejudice against the aged and obsession with sex—and our virtues of hope and modesty are imperfect. On this score, I suggest that, instead of getting a face-lift, you should resist the biases of our culture, bear in mind the gifts that accompany growing old, and try to see and value yourself as your husband does—as the unique person you are—rather than as an aging woman (see Prv 31.25–30). After all, you have no need to attract a mate or impress people with youthful vitality.

In the second place, people who get face-lifts, wishing to seem younger than they are, generally prefer that others not know about the operation. If others know, they do not regard the more youthful appearance as natural but are likely to see the renovated face as a mask, perhaps faintly ludicrous, perhaps pitiful. Concealment is necessary, both for effective deception and to forestall seeming vain. In this matter as in others, however, honesty is the best policy. Avoiding all deception and vanity, and allowing others to know one’s true self enables one to live with them in more authentic communion.

The questionable purpose aside, getting a face-lift probably also would be more or less ineffective and perhaps even self-defeating for you. Facial pouches and wrinkles are not the only signs of aging; in their absence, other telltale signs sometimes become even more noticeable, and the discrepancy between a youthful face and other aspects of one’s behavior and appearance can seem ugly. The apparent effectiveness of cosmetic surgery for entertainers and certain other public figures is somewhat misleading; makeup applied by experts and careful photography complement the surgeon’s work and conceal any telltale signs and other incongruities. Moreover, a person’s skin continues to age, so that after a few years the face no longer seems so youthful. And, like any surgery, a face-lift involves risks; you might suffer more serious consequences than your friend’s couple of numb spots.

Does it follow that you also should avoid using makeup, as you have been, to mitigate the appearance of aging? No. Though makeup sometimes is a sign of vanity, its judicious use serves legitimate purposes other than trying to hide the signs of aging. You lost a good deal of weight suddenly, and your present appearance also is not normal for you. But this “abnormality” will be corrected naturally as time passes, for you and the people who know you will become accustomed to the new you. Meanwhile, inasmuch as you are justifiably using makeup for other reasons, you may use it insofar as you can to subtly mitigate your suddenly changed appearance.

Someone might say that, if you may rightly hide some abnormal signs of aging with makeup, you may regard all such signs as abnormal, so that you would be justified in getting a face-lift to correct or conceal them to the fullest possible extent.²⁰⁵ That argument would be unsound, however, since not all signs of aging are abnormal. Moreover, your stated purpose in considering a face-lift was to gain a more youthful appearance. So, you should resist any tempting suggestion to let considerations about correcting or concealing abnormalities play a role in your deliberations. Bringing in such fresh considerations at this point would be mere rationalization.

Suppose you were widowed or changing jobs, and thought a more youthful appearance would help you remarry suitably or find a satisfactory job. Would getting a face-lift then be justifiable? Perhaps. Since a face-lift for the sake of appearing more youthful is not intrinsically evil, it can reasonably be chosen as a means to an ulterior good end. Still, even with such an end, one is surrendering to cultural pressures and reinforcing the biases that underlie them in trying to appear more youthful than one is. Therefore, it seems to me, only those whose personal vocation requires it are justified in having a face-lift to gain a more youthful appearance. In other words, getting a face-lift never is morally optional; either it is appropriate to fulfill one’s responsibilities or it is morally excluded.

Finally, one factor makes your obligation not to get a face-lift be, in my judgment, a grave matter: the ten thousand dollars it would cost. Perhaps this money should be used to meet some of your own or your dependents’ current or predictable needs. If so, you should not use it for a face-lift, which you really do not need. If not, though, you should use this money to meet others’ needs (see LCL, 780–82, 789–92, 800–806, 811–14). For instance, you might donate it to an organization that would use it to fund plastic surgery for some poor child born with serious facial deformities. Jesus teaches that, on the day of judgment, he will say to those who failed to meet others’ needs: “‘Truly I tell you, just as you did not do it to one of the least of these, you did not do it to me.’ And these will go away into eternal punishment” (Mt 25.45–46). Instead of investing in a face-lift for yourself, invest in the kingdom of heaven, where alone we can hope to remain forever youthful.

204. Linda A. Jackson, Physical Appearance and Gender: Sociobiological and Sociocultural Perspectives (Albany, N.Y.: State University of New York Press, 1992), 65–67, supports this point and summarizes research showing that middle-aged men are considered more attractive than younger ones while middle-aged women are considered less attractive than younger ones.

205. This line of argument is a common rationalization of cosmetic surgeons and their patients; see Diana Dull and Candace West, “Accounting for Cosmetic Surgery: The Accomplishment of Gender,” Social Problems, 38 (1991): 54–70.