Psychological effects of Cosmetic Surgery Breast Augmentation
ACKNOWLEDGMENTS
I would like to express my special appreciation and thanks to my boyfriend Emmunel and my sister Christine Tafeni, for the sacrifices they made in order for me to achieve and to strive towards my goal. My appreciation also goes to my dissertation supervisors Steve woods and Mark Allenby. I am extremely grateful for your invaluable source of guidance. Above all my sincere gratitude goes to Almighty God, the source of my strength and wisdom especially when the going got tough. Finally I would like to dedicate my project to my Family for their never ending support.
ABSTRACT
Learning objectives: To have a clear understanding of the psychological issues that propagates or contributes to the growing tendency of women going out for breast augmentation and other cosmetic surgical procedures. The study should further look into the psychological benefits enjoyed by the patient undergoing through the cosmetic surgery process.
Background: Breast augmentation and other cosmetic surgical processes started in 1960 and have continued to grow in demand over the past years. Such move is a sign of increased number of people have low body image and self esteem.
Methods:
Result:
Conclusion:
CHAPTER I: INTRODUCTION AND BACKROUND INFORMATION
1.1 Introduction
According to Crerand and Magee (2013),an increasing number of people are becoming dissatisfied with their physical appearance in the world. A good percentage of people have the problem with their physical appearance something studies suggest may be related to psychological issues. Cosmetic surgery provides an opportunity for women to improve their breast appearance. Studies show that that the people involved in carrying out cosmetic surgery are on the rise.
In certain age bracket, the physical look can affect ones self-esteem and affect their ability to perform. Crerand and Magee (2013) confirm that physical appearance is one of the largest if not the largest contributor to self-esteem and selfconcept amongst children and adolescents. Globally, the urge to change body image has been found to induce self-improvement behaviours such as exercising, dieting and carry out plastic surgery.
Swami et al., (2009) define cosmetic surgery as a process aimed at enhancement, maintenance and restoration of the person involved physical appearance through either medical or surgical procedure. The concept of improving general appearance is common in the western world with the United States recording as high as 11.7 million cosmetic surgeries in 2007 alone according to report released by America Society for Aesthetic Plastic surgery in 2008.
Various policies allow cosmetic surgery such as FDA policy that allows medical products to be used as long as they are considered safe and effective. Even many teenagers have undergone through the processes with silicone gel breast allowed for women above 22 and saline breast implant allowed for women above 18 years. However, there is a loophole in the system and teenagers aged much younger can undergo breast augmentation as long as their parents give consent.
1.2 Problem Statement
The rapid rise in the number of people doing surgery is on the increase especially in the western world. Unfortunately the increase is a result of psychological relationship where the person involved has low self-esteem and resolve to cosmetic surgery to improve their physical attributes. The research paper, therefore, should point out why increasing number of people in the modern society resolve to cosmetic surgery.
1.3 Objective
1.3.1 General Objective
? To understand the psychological benefit of cosmetic surgery breast augmentation
1.3.2 Specific objective
? To understand why people have cosmetic surgery (breast augmentation).
? To understand the relation of psychology and cosmetic surgery (breast augmentation).
? To understand the factors that stimulates the increase in number of people carrying out cosmetic surgery (breast augmentation).
? To understand if there are negative psychological effect of cosmetic surgery (breast augmentation).
? To understand the social factors that motivates a person to have cosmetic surgery (breast augmentation)?
1.4Research Questions
? Is their psychological benefit of cosmetic surgery breast augmentation?
? Why do people have cosmetic surgery (breast augmentation)?
? What is the relation of psychology and cosmetic surgery (breast augmentation)?
? What factors stimulates the increase in the number of people carrying out cosmetic surgery (breast augmentation)?
? Is their negative psychological effect of cosmetic surgery (breast augmentation)?
? Are their social factors that motivate a person to undergo cosmetic surgery (breast augmentation)?
1.5 Research risks
Various risks are possible in research and the examples of such research risk are:
? Physical threat or abuse especially during data collection
? Risk of emotional breakdown due to complexity of research.
? Social relationship breakdown
? Legal risk of violation of various rights
CHAPTER II: LITERATURE REVIEW
2.1 Introduction
The number of women undergoing breast augmentation for reconstructive or cosmetic reasons has been increasing steadily in the past decades.Breast augmentation is the most commonly carried out cosmetic surgical procedure across the globe, with more than 290,000 women undergoing breast augmentation procedures in the year 2013 in the United States (US) (American Society of Plastic Surgeons, 2014, pp.5). The British Association of Aesthetic Plastic Surgeons (BAAPS) estimates that 50,122 cosmetic procedures were carried out in the year 2013 in Britain, which was an increase of more than 17% from the previous year. Out of these procedures, 22% (11,135) involved breast implants (BAAPS, 2014, para.3).
The demand for breast augmentation across the globe is increasing, despite the fact that there are complications associated with the process and studies reporting potential adverse health effects of the implants. From the year 1961 when the first case of successful breast augmentation was performed by Cronin, and Gerow using silicone implants, breast augmentation has become a popular procedure since then (Melissa, Naikhoba and Munabi, 2013, pp.1). There are an increasing number of people who are not comfortable with their appearance since it does not measure up to the socially set standards. This literature review aims at examining what is driving women to undergo breast augmentation procedures and to create an understanding of the psychological effects of breast augmentation.
2.2 Types of breast implants
Breast augmentation, also referred to as augmentation mammoplasty or breast enlargement, is a procedure that mostly involves placing a synthetic implant either below the chest muscle or the breast tissuewith an objective of increasing the size of the breast or restoring the breast following pregnancy or weight reduction programs. There are two types of breast augmentation, namely silicone gel and saline solution implants. The two types of implants are enclosed by a strong, but a flexible silicone shell that assists in preventing rupture of the implants (Hedén et al. 2015, pp.264). There are specific advantages associated with each type of breast implant, thus the most appropriate type of implant depends on personal preferences or circumstances.
Silicone gels are the most common type of implants in the US and the United Kingdom (UK). Melissa, Naikhoba and Munabi (2013, pp.1) report that of all breast augmentation procedures carried out in the US in the year 2012, 60% involved silicone gel implants while 38% involved saline solutions. The popularity of the silicone gel implants in the past years indicates a shift in paradigm fromthe 1990s, when the US Food and Drug Administration (FDA) imposed a moratorium on silicone implants due to the association of the breast implants with various systemic diseases (Balk et al., 2016, pp.2).
After their return to the market in the year 2006, silicone gel implants have become more popular due to various advantages associated with them. To start with, silicone gel implants are less susceptible to wrinkling, are relatively safe, are available in contoured or round shapes, and they are soft and flexible, thus giving the breast a natural feel (NHS, 2016, para.4; (Balk et al., 2016, pp.2).
However, silicone breast implants have various disadvantages associated with them, for instance, if the implant splits, the liquid silicone might leak out and spread out into the breast.As a result, small lumps may develop a condition referred to as siliconomas. According to Adams and Mallucci (2012, pp.607), silicone implants have more chances of causing capsular contracture (13.2%) in comparison to the saline implants (7.2%). This is attributed to the silicone leakage, commonly referred to as silicone bleed, which has been labelled as a major cause of capsular contracture.
The leakage of silicone fluid does not lead to a reduction in breast volume due to the confinement of silicone in the fibrous capsule. As a result, it is challenging to detect silicone based bleed and the finding is made incidentally, making it hard to ascertain its occurrence across the globe. On the other hand, though saline implants have a long history of safety, they are more likely to rupture or fold earlier in comparison to the silicone implants. In addition, they feel less natural and their size may reduce with leakage. It has been established that saline implants leak in about 5% of patients (Albornoz et al., 2013, pp.15-18; NHS, 2016, para.1-8).
2.3 Motivation for Breast Augmentation
The decision to carry out breast augmentation is a challenging one to take especially if the reason for undergoing the cosmetic procedure is not medicinal. The motivational factors to undertake cosmetic surgery can either be internal or external. Internal factors are factors such as to improve the self-esteem of the patient while external involve secondary gain such as pleasing a boyfriend. In a clinical setup, it is very difficult to assess if a patient is internally or externally motivated to undergo the cosmetic surgery process. However, experience shows that patients that have internal factors as their motivation perform better in their medication process.
Women can also be motivated by the need to reshape their psychological status and improvement in other social relationships. This is in line with the report that most improve the quality of life, body image, improved self-esteem, increase marital happiness as well as improved sexual satisfaction. The decision to undergo through the cosmetic surgery process is enhanced by the awareness (information) and medical reasons. Many women going through breast augmentation and other cosmetic surgery report having information on the benefits and risk mostly from the mass media. Candidates suffering from body image dissatisfaction are prone to breast augmentation and other cosmetic surgery procedures, and this is common with big breast women compared to women having small boobs.
2.4 Cost of Breast Augmentation
Cosmetic surgery is a relatively expensive process. According to research done by America society of plastic surgeons, the breast augmentation process cost averagely $3,708 as represented by America cost of breast augmentation surgery. The cost normally includes the cost for anaesthesia, fee for the surgical facility, medical test fee, post-surgery insurance garments, medical prescription and surgeon fee (Plasticsurgery.org, 2015). Normally health insurance plan doesnt account for any medical bill paid for the cosmetic surgery.
WebMD (2015) approximate that the cost of surgery ranges from $5,000 to $10,000 and the variation depend on the place where the surgery took place, the doctor carrying out the surgery and the implant type. Breast implants are categorised into two namely saline and silicone. Most breast augmentation candidates prefer silicone due to more real look, but it is riskier especially if it leak. The difference is that saline implants are silicone shell filled sterile salt water while silicone implants are filled with plastic gel.
2.4 Breast Augmentation before and after pictures
Source: (londonessays.com
The figure above shows two set of pictures of two different women before and after the breast augmentation. The difference in the physical appearance of the pictures taken before surgery and the pictures taken after the surgery is noticeable and one can clearly point out an improvement in the physical beauty of the two patients who underwent through the breast augmentation process. The difference noticeable from the visual appearance is thickness, size and shape which are key appearance vital in improving the patient self esteem.
It is advisable that patients requesting for breast augmentation realize that Medicare does not cover some cost and a clear plan of how to pay for the services is necessary. However patients with private medical insurance may get more cover such as the cost of the actual implant, the cost of surgery or reconstructive surgery and finally the cost health screening services such as ultrasound, mammography and magnetic resonance imaging (Zuckerman and Abraham, 2008).
2.5 Reasons for breast augmentation
Breast enlargement procedures are commonly carried for cosmetic and reconstructive surgery reasons. Cosmetic procedures are aimed at enhancing the shape and the size of the breast while reconstructive procedures are aimed at reconstructing the breast mound following a mastectomy (the operation aimed at removing one or both breasts,mostlyin the treatment of breast cancers) (Somogy and Brown, 2015, pp. 89). In most cases, cosmetic procedures are not funded through the national insurance systems, though they may be covered through private insurance firms.
Some of the reasons highlighted for cosmetic breast surgery include improving the contour of the breast in a woman,who for subjective reasons is not comfortable with the size of their breasts (Singh, 2015, pp.2). Another possible reason for breast augmentation procedures is to reinstate the volume of the breasts which may have been lost after pregnancy or as a result of weight reduction programs. Another viable argument for cosmetic breast surgery is to enhance the contour of breasts that have begun losing their fullness and firmness (usually described as sagging breasts), and this is commonly done using breast lift techniques. In addition, some women seek breast augmentation services with an objective of enhancing the appearance of their breasts, which may have been disfigured due to birth abnormalities, genetic disorders or trauma (Jávo, 2012, pp. 8).
Reasons for undergoing cosmetic breast surgery (CBS) can be classified as intrinsic (internal) and extrinsic (external). Examples of intrinsic reasons are to enhance self-confidence, while pleasing a partner is an example of an extrinsic factor. Jávo (2012, pp.11) suggests that women undergoing CBS for intrinsic reasons have higher chances of being satisfied with the surgical outcomes, in comparison to those who are compelled by extrinsic factors.
There are no definite medical benefits of having breast implants but there are reports indicating that breast augmentation procedures can have positive psychological benefits in women who go through the procedures. For instance, if a woman, for various reasons, constantly feels that her breasts are extremely small or unwomanly. Dowling, Jackson, and Honigman (2013, pp.3) suggest that breast implants may help in improving her self-esteem and level of confidence in the society. Nevertheless, it should be noted that breast implants are not always a quick fix to womens perception about their breasts, thus individuals should take their time before deciding to have the breast implants.
Castle, Honigman, and Phillips (2002, pp.1) assert that if a woman has substantial body image concerns or feelings such as depression or anxiety due to their breasts, the implants may not necessarily enhance their self-esteem. As a result, most surgeons encourage their clients to request for breast enhancement for sensible reasons, and most of them reject those requests made on the grounds of pleasing a third party. On the other hand, a psychometr
ic test can be carried out to determine their cognitive health and ability to make such decisions for them without succumbing to influence of any syndrome.
2.6 Breast augmentation and psychological issues
Breast augmentation is a procedure that is commonly performed in the developed world with the rising number of individuals having issues with their physical appearance. According to Sarwer (2007, pp.112), if the process is not handled well, it can be a source of psychological issues such as depression. Rohrich, Adams and Potter (2007, pp.404) report that breast augmentation is commonly carried out on individuals who are unhappy with their appearance, and in most cases the patients may have unrealistic expectations such as undergoing through cosmetic breast surgery to find a new job or to have progress in their career path.
Sarwer et al. (2008, pp.425) acknowledges that there are some patients who go for breast implants with unrealistic expectations, and only prefers carrying out the surgical procedures on women who are doing it for themselves, rather than to please their spouse. Shridharani et al. (2010, pp.2246)adds that, even if patients with unrealistic expectations achieve technically acceptable outcomes, they can experience substantial distress after the surgical procedures and high levels of dissatisfaction with the procedures if the psychosocial benefits they were anticipating are not forthcoming. As a result, American Society of Plastic Surgeons recommends that patients be tested for self-esteem and any signs of body dysmorphic disorder before going through the procedure (Paraskeva, Clarke, and Rumsey, 2014, pp.29).
2.7 Body dysmorphic disorder and cosmetic breast surgery
Body dysmorphic Disorder (BDD) is described as a psychiatric disorder that is marked by a persons strong obsession with a perceived defect in physical appearance that may cause substantial distress (Sansone and Sansone, 2007, pp.3). If a physical defect is actually visible, the persons preoccupation with herself is intense. The occurrence of BDD is 1% in the general population, though it is higher in patients seeking cosmetic surgical procedures such as breast augmentation (Tadisina, Chopra, and Singh, 2013). For instance, a research conducted by Glaser and Kaminer reported that the occurrence of BDD ranged from 7 to 15% in patients seeking cosmetic surgery (Glaser and Kaminer, 2005, pp.560). In an Italian study, Altamura et al. (2011, pp.106) reported that the occurrence of formal BDD was 6.3%; though the subclinical threshold of the disorder was 18.4%.
2.6 Theoretical literature: Effects of breast augmentation
2.6.1 Social effects
There are numerous social risks that are associated with failed cosmetic breast surgical procedures which in most cases are immediate. The contemporary ideals of feminine beauty requires females to have or strive to attain an ideal type of body; in the modern-day world, beautiful women should appear to be young, slim, sexy, yet full breasted (Whitney, 2013, pp.121).
Realising these standards is a daunting task for women from lesser socioeconomic upbringings, considering that most of breast augmentation procedures are in most cases costly (Shannon, 2012, pp. 332). Therefore, it is clear that the ideal feminine appearance evidently disadvantages some groups of women, in comparison to others. Nevertheless, the beauty ideals are challenging for any women to maintain irrespective of their socio-economic status, particularly the childbearing women and the aged.
In spite of the challenges women go through in order to realise the beauty ideals, there some benefits that are associated with effective femininity. Adams (2014, pp.2) notes that women meeting the beauty standards are considered to be attractive, intelligent and enjoy social benefits such as having many friends and high chances of being in a romantic relationship. The appearance benefits extend to the workplace, with some reports indicating that women who meet the set beauty standards have more chances of being hired, earning more or being promoted. It is important to highlight that there are some women who have sought cosmetic breast surgical procedures with an objective of pleasing their partners or saving their marriage.
Therefore, the presumably perky or pathological decisions that some women make with regards to their bodies and appearances are as a consequence of conditional or unconditional reaction to a society that grants those who are compliant substantial rewards. On the other hand, women who fail to conform to the set ideal feminine beauty standards can experience substantial social censure. Nelson (2006, p.17) notes that women who fail to comply with the socially set beauty standards may be perceived as uninviting, unfriendly, less intellectual or sexually unavailable. As a result, these women experience substantial negative social outcomes on the basis of their appearance.
Similarly, Figueroa-Haas (2009, p.379) argue that in any society, individuals interact with each other and can directly or indirectly influence each other in the process. At times, the socially constructed values and anticipations about certain individuals can be rigid and extremely hard for them to achieve or to sustain in the long run. For those individuals whose level of confidence in their appearance is dictated by the defined feminine beauty ideal standards, and those who are constantly doing the best they can to fit within the socially set beauty standards, the outcomes of failing to meet the standards can be devastating.
In the contemporary world, models with certain looks are commonly used in the mass media advertisements. In some cases, their appearance has to be manipulated using the modern technology for them to meet the narrow normative feminine beauty ideals (Brown and Knight, 2015, pp.76). As a result, the image of women with an ideal look, which can be rare, if not non-existent, is created. The beauty ideals promoted by the mass media have an effect on women, and this motivates them to go for some procedures which can be life threatening to reduce the feeling of emptiness creeping inside them.
Breast augmentation is an example of a cosmetic potentially harmful procedure that women go for, with the anticipation that their appearance will be in line with the societys dictionary definition of the term beauty. In the process of doing so, these women go to an extent of putting their lives into risks by going through the cosmetic procedures in the hope of finding happiness and enjoying the social benefits associated with physical beauty.
On the contrary, some women end up more depressed, hopeless and having less feelings of self-worth with some of them committing or contemplating suicide (Rohrich, Adams and Potter, 2007, pp.404; Figueroa-Haas, 2009, p. 379). The irony in this case is that what was being seen as a source of happiness and value in the society (breast augmentation) eventually throws these women into a world of loneliness and despair.
A systematic review carried out by Manoloudakis et al. (2015) correlated breast augmentation with a higher risk of committing suicide in women undergoing CBS. The review also reported that some women who seek breast implants to improve their self -esteem and happiness do not attain the positive outcomes. However, most of the studies associating CBS and increased risk for suicide in women are not reliable because they have not clearly depicted a cause- and- effect correlation between CBS and high suicide rates. In addition, most of the studies reviewed in the systematic review did not determine the presence of pre-surgical risk factors that would have placed the patients at a high risk of suicide.
Von Soest, Kvalem, and Wichstrøm (2012, pp.619) is concerned that some patients requesting CBS may be having underlying psychological illnesses, considering that a huge volume of past studies have reported positive psychological effects of breast augmentation. Likewise, Solvi et al. (2010, pp.675) argue that most of the patients who go through breast augmentation procedures report satisfaction and a subsequent improvement in the quality of life indicators. However, Von Soest et al. (2009, pp.1239) observes that the satisfaction fades away with time, for reasons that are not well documented in the existing literature.
Lipworth and McLaughlin (2010, pp.234) argue that the so called social benefits of complying with the societal definition of the term beauty are short-lived, if at all they are not non-existent. On the other, the scholars highlight that most advocates of breast enhancement procedures only examine the immediate period right after going through the surgery. However, in order to have a clear understanding of the effects of breast enhancement, one has to carefully examine the entire post-surgical life. In essence, the main reason for having breast implants is to improve psychological wellbeing of women for the rest of their lives.
Using the Dynamics of Faith theory, Slevec and Tiggemann (2010, pp.67) argues that most women go for breast augmentation for unrealistic ultimate concerns only to find real disappointment which may force them to commit suicide or haunt them for the rest of their lives. This argument has been supported by findings presented by Fang, Balneaves, and Shu (2010, pp.2) who found that the sacrifices made by women going through breast augmentation procedures did not assist them in realising their long term goals. Years after undergoing reconstructive breast surgery, the patients began wondering whether the procedure was worth it. This is because the expected benefits of breast augmentation were not forthcoming and they experienced substantial health effects as a result of the breast enhancement procedures.
2.6.2 Liberal moral theory and breast augmentation
The liberal moral theory has been used to explain the circumstances at which women make decisions to have cosmetic breast surgical procedures and the psychological effects of such decisions. There are various debates about the theory and it has been classified into various versions. However, it is important to highlight that the theory largely reflects on the state or another individual intervention against another persons will, if it is proved that the individual was coerced to make the decision or the intervention is aimed at protecting the individual from harm (Laimann, 2013, pp.2).
The assumption in this case is that an individuals autonomy should be respected- unless there is a justifiable reason that they are harming themselves as a result of their decisions, which may be due to mental challenges among other factors(Laimann, 2013, pp.2;Chambers, 2008, p.11). The decision of not interfering with their choices is aimed at encouraging people to practice their own good.
Chambers, (2008, p.12)agrees with the general liberal stance against paternalism. The scholar observes that there are some decisions that are made by an individual as a result of discriminatory social norms. Such customs force the individuals to impose some form of injury on their bodies in order to become acceptable in the society or not be socially censured. This means that individuals who engage in the risky practices successful are likely to enjoy the social benefits (Latour, B., 2004, pp.206).
Laimann (2013, pp.2) observes that some groups can enjoy the socially regulated benefits without having to pay the cost of self-harm. This undermines not only the social equity, but also political equity. Boulton and Malacrid (2012, pp.516) observes that such norms can be a source of trouble, if they are allowed to have an influence on the prevailing social inequalities, for example, those related tosex, appearance or ethnicity. Chambers (2008, p.15) argues that the CBS practice is as a result of destructive and unfair social norms in the society. The prevailing norms expect women to have breasts that are of a particular size and contour, for them to enjoy social benefits such as being esteemed and admired (in the context of being viewed as sexually available or attractive).
They have to satisfy these beauty ideals for them to be successful in various occupations, such as model or actress, or to be famous like most television show celebrities. In some cases, they have to satisfy the standards for them to be in a romantic relationship. As a consequence, these norms facilitate discrimination of women who do not conform to the set beauty standards (Blum, 2003, pp.23). This indicates that breast augmentation does not increase womens power in the society: indeed it diminishes their power by forcing them to comply with the ideal beauty for them to enjoy social benefits.
Cosmetic breast procedures are painful and can unnecessary complications, which are in some cases life threatening. Boulton and Malacrida (2012, pp.516) argue that CBS procedures inflict status harm on women by casting them as objects to satisfy men sexual desires. Consequently, womens power in the society and the right to have absolute autonomy in controlling their own appearance is reduced. In addition to that, the surgeries and the additional medical treatments that are required to maintain the breast shape and the size require significant monetary investments, and consequently inflict financial harm besides the status harm. Mellican (2005, pp.11) maintains that the decision of women to have CBS is as a result of a womans social context which expects her to conform to the beauty standards which are rewarded through social appreciation.
2.6.3 Lifestyle risks
Besides the social risks that are related to the non-compliance with ideal feminine beauty, there are lifestyle risks that are related to the use of cosmetic breast procedures as the means of realising or meeting the ideal feminine beauty. Adams (2010, pp.756) suggests that the lifestyle risks are linked with the consumption of substances such as drugs or some types of foods or the cosmetic operation procedures that are believed to be harmful. Boulton and Malacrida (2012, pp.516) argue that in a consumer world, a person has the right to choose everyday life risks, but it is expected that they have the ability to act as prudent customers and impartially evaluate the risks so as to make informed consumer decisions. This means that lifestyle risks are viewed as intrinsically imposed considering that they individuals made the decisions to take part in the practices, particularly those that are related to consumerism.
Adams (2010, pp.757) maintains that, if there are negative effects as a result of their own choices, the individuals are blamed for making imprudent consumer decisions. Considering that cosmetic breast surgery is to a huge extent viewed as an individual choice, when the procedure fails to achieve the desired outcomes, there are higher chances that the patient, rather than the beauty system or the procedure, is held responsible for the undesirable effects. This is a major source of distress and dissatisfaction in some women who have undergone cosmetic breast surgery.
2.6.4 Medical risks
There are various medical risks associated with breast augmentation procedures, although patients are expected to make informed decisions and know how to manage the symptoms. It is surprising that small but entirely functional breasts are perceived as deformities or diseases, and a constantly increasing number of women are going through the surgical procedures just to fit in the society. Slevec and Tiggemann (2010, pp.69) highlight that it is important for women to be adequately informed and to take rational decisions considering that there are various complications associated with breast implants.
However, this presents a challenge to women, considering that the health care sector consists of closed information systems, thus it can be hard for the women to fully assess the risks. As highlighted in this paper, it indisputable fact womens decisions to have breast implants can be swayed by social factors, and this can outweigh even the medical risks. With regards to the dynamics of faith theory, it can be argued that the society has imprinted the feminine ideal beauty as the ultimate concern for every woman and thus have deteriorated the goals and the standards of healt