But then, once Towlson was back in the UK, Green Park seemed less willing to offer aftercare support: with disastrous consequences. By 11 May, Towlson was dead, found decomposing in her home. Her tragic story is far from unique. Since 2019, some 28 Britons have died after cosmetic procedures carried out in Turkey. In truth, though, fatalities represent only the most extreme outcomes. For every death, hundreds more patients return to the UK with complications requiring urgent NHS treatment — treatment which the British Association of Aesthetic and Plastic Surgeons (BAAPS) estimates costs the NHS £15,000 per patient.

Combined with a rise in dangerous off-the-books procedures in Britain itself, and the beauty industry is having a profound impact on our health service. Part of the solution involves tightening up regulations, and clamping down on dodgy practitioners. But the problem ultimately stems from deeper societal issues — around beauty standards, mental health, and the immense power of imported US culture. Without addressing these root causes, the NHS will continue to bear the physical, psychological, and financial burden of beauty gone wrong.

Medical tourism is booming, with Turkey especially emerging as a primary destination for dental work and cosmetic procedures. Yet if BAAPS figures show the country is comfortably the most popular destination for Britons opting for cosmetic surgery abroad, everywhere from the Dominican Republic to Tunisia are represented too. All told, the ONS has found that the number of British residents leaving the country for medical treatment increased by over 100,000 from 2021-2.

Yet as the Towlson case so vividly shows, these expeditions can end in disaster. In a sense, this is unsurprising. Investigating Towlson’s death, the coroner expressed concern about the lack of coordination between international medical authorities, and the absence of clear warning systems for British patients considering procedures abroad.

Even when patients don’t die, they can still suffer, with symptoms ranging from post-operative wound infections to full-blown sepsis and pulmonary emboli. I see similar basket cases in A&E, from red raw peeling scalps that have been butchered by backstreet hair replacement clinics to faces so swollen by cheap collagen implants that the patient’s head takes on an eerie alien look.

More from this author

NHS fat cats have blood on their hands

By Dr Emma Jones

Yet far from crowing about the state of foreign cosmetics practitioners, cases like Susan McGowan’s highlight the deadly potential of procedures inside Britain itself. An NHS Scotland nurse, McGowan died on 4 September 2024, after receiving injections of tirzepatide (more commonly known as Mounjaro) from an unqualified practitioner here in the UK. McGowan’s colleagues at University Hospital Monklands in Airdrie fought to save her life, after she presented at A&E with severe stomach pain — but to no avail.

As with Anne Towlson, McGowan’s case is the sharp end of a far wider wedge. Weight loss drugs like Ozempic and Mounjaro may be celebrated on social media as miracle cures, and even trumpeted by Health Secretary Wes Streeting. But the numbers are worrying. Data submitted to the UK drugs regulator show that, as of January this year, dozens of deaths have been linked to these medications.

The side effects of these medications — primarily nausea and suppressed appetite — are often misunderstood or downplayed. As treatments go, indeed, this is Wizard of Oz stuff: pull back the curtain and you’ll lose weight not because of the wonders of modern medicine but simply because you feel sick all the time. I had a patient who thought her persistent stomach issues were simply side effects of Mounjaro. Actually, the drug was masking symptoms of potentially life-threatening bowel cancer.

At the same time, patients seem increasingly unwilling to accept clinical guidance. A dentist friend told me of a patient who wanted a dental bridge. My friend advised against it: the risk of complications and infections was far too high. The patient ignored my friend’s advice, went to Turkey, had the procedure — and the predicted complications duly appeared. My friend refused to fix the problem, advising the patient to return to Turkey for additional treatment. This may seem harsh, but a dentist or clinician who’s advised a patient against a risky procedure isn’t obliged to clean up another practitioner’s mess.

Yet when complications do arise, patients often find themselves in NHS emergency departments, creating a perverse system where private profit is internationalized while the costs of complications are socialized through the NHS. In other words, British taxpayers end up subsidizing both shoddy domestic and foreign cosmetic practices, and patients who haven’t thought carefully about the procedure they’re embarking on — all because they want to save a few bucks and be “Instagram ready”.

Telling, too, is how many people now arrive at A&E expecting comprehensive corrective procedures to their cosmetic nightmares, misunderstanding the fundamental mission of emergency medicine. Essentially, me and my colleagues are there to maximize a patient’s utility, not magically turn them into Scarlett Johansson. But, today, everyone has a bit of Gen Z about them. No one will wait for anything. Everyone thinks it’s their right to look young, attractive and desirable. When I try to give my oozing, bleeding, weeping patients a “teachable moment”, they don’t want the reality lecture. They want the fantasy outcome.

Nor is the problem going away. If anything, it’s getting worse, with untrained practitioners proliferating right across the country. It’s astounding how many and what sort of invasive procedures can be carried out by someone with zero clinical expertise. As researchers at UCL found, 68% of cosmetic practitioners administering injections such as Botox and dermal fillers are not qualified medical doctors. That’s even as the UK injectables market is predicted to reach a value of £11.7 billion by 2026.

NHS departments regularly treat patients suffering from infections after receiving dermal fillers from beauticians who may have only watched a handful of instructional YouTube videos. Many hairdressers branch out into doing cosmetics after doing a perfunctory online course, thinking they can go from hair extensions or pedicures to collagen implants and butt fillers that breach the skin and enter the body. Ironically, 16th-century barbers who combined cutting hair and trimming beards with pseudoscientific leeching are the progenitors of today’s NHS surgeons. To that extent, then, rogue beauticians are simply reclaiming their birthright.

And like in the Renaissance, unregulated procedures today flourish in a regulatory wild west. The legal specifics differ significantly between countries. In the US, for instance, the industry is considerably more controlled. Start pumping patients up with Polyfilla and not only will you wind up with a massive lawsuit, you’re also going to jail.

The UK, however, has developed a reputation for what one friend calls a distinctive “British style” of cosmetic surgery — one characterized by poor technique and overfilling thanks to looser regulations around who can perform procedures. The landscape is further complicated by dubious online marketplaces. Performance-enhancing steroids and supplements that would send the IOC into a spasm can be bought at the click of a button, from the same sources selling bootlegged weight-loss medicines, corrosive teeth whiteners, or self-administered collagen implants.

Given the shocking deaths of Towlson, McGowan and others, renewed and growing calls for stricter regulation of the beauty industry, from both the Royal College of Surgeons and the British Medical Association, represent the concerns of myself and colleagues who find the unabated rise of cosmetic quackery deeply worrying. But if the Government is incapable of legislating against backstreet practices here in the UK, what hope is there for people who find themselves ill-treated abroad? My advice to anyone contemplating cut-price cosmetic surgery, anywhere, is to take a good, hard look at yourself in the mirror — literally — and ask yourself: is it really worth the risk?

Anyway, even in well-regulated environments, financial incentives can distort clinical judgment. Some practitioners provide prescriptions with minimal oversight, driven by profit rather than patient welfare. There are plenty of unethical private doctors happy to leave a private prescription under the plant pot. These people, though highly trained, are not thinking about patient complications. They’re thinking about being able to buy a new tack for their daughter’s pony.

In the end, though, I think tightening up the rules is only half the answer. Behind every botched procedure lies a deeper psychological narrative. Body dysmorphia, unrealistic expectations, and a profound disconnect between self-perception and reality drive many towards the surgeon’s knife. Talking to my own patients, it’s clear there are vast mental health problems washing about in less-regulated corners of the cosmetics industry. The subtext: I don’t like who I am, I want to be someone else.

Unsurprisingly, social media is central here, revolutionizing how beauty standards are created, communicated and commodified. The “Instagram face” — characterized by inflated lips, sculpted cheekbones, and contoured features — has become a globalized aesthetic. That’s even as rapid cycling between extreme body types, from heroin chic (remember that one?) to Kardashian curves and back again, makes it impossible for punters to keep pace either physically or financially.

Perhaps all that’s an inevitable consequence of a culture that’s preoccupied with difference, individuality, identity politics and celebrity. Once upon a time, if you were some random person out of the limelight, you wouldn’t need to care about what you looked like. But today, if you’ve picked up a couple of thousand followers online, you feel like you have to look a certain way to keep up appearances.

Suggested reading

The male baldness industrial complex

By Nicholas Harris

All the while, platforms like TikTok accelerate these trends through filters that shrink noses and enlarge lips, creating a distorted self-image that patients then seek to make permanent through cosmetic procedures. This phenomenon drives people to show plastic surgeons their filtered face as their desired result — an inherently unattainable standard. And though traditionally associated with women, cosmetic enhancements have increasingly attracted male patients, particularly for hair transplants and dental work.

Some men also pursue more extreme interventions like bicep implants and chest enhancements, reflecting changing expectations around male physique. Class matters here too. We’re often talking about people who can’t afford treatments in the first place, then can’t afford to take time off work when something goes wrong. At the other end of the spectrum are people with too much money and not enough sense, who pursue extreme procedures without thinking them through.

I’d ultimately argue that whoever’s taking Mounjaro or having their teeth done is falling prey to an insidious form of American cultural imperialism, at odds with British self-perception. We like to think of ourselves as European, modern and sophisticated. The truth, though, is that we’ve got an obscene obsession with what’s happening over the Atlantic. This influence extends to the commercialization of procedures, with practitioners styled after American influencers, promoting not just beauty but a luxury lifestyle complete with private jets and pool parties in Dubai.

Rather than obsessing over miracle drugs, then, perhaps Streeting should encourage society to address the underlying factors driving such procedures. This includes media literacy education, particularly for young people, and more nuanced conversations about body image and self-worth. And it’s worth repeating: this is about more than patient safety. Just as eating disorders, self-harm and substance addiction drive the weak and the vulnerable toward A&E, the dark side of the cosmetics industry will invariably do the same, even if it seduces you with a smile on its face.

Deets wasn’t exactly deceiving her fans. She left older, less manipulated images available, and described her work as “art”. Even so, some accused her of “pedo-baiting”. But just last week, a story that seemed a perfect 21st-century blend of self-commodification and AI-assisted digital unreality took a darker note, when news broke that Deets had taken her own life.

The callous response by extremely online rubberneckers to someone’s obvious suffering exposes two recurring themes in current-day culture.

First, that we have wildly underestimated how completely the shift to a digital-first culture is unmooring us — or, at least, some of us — from material reality. And second, that this has accelerated a transformation that has been under way for over 50 years, in which commerce and innovation turn inward from exploring (and exploiting) the world towards doing the same in the human body, and the human soul: the transhumanist revolution, that began with the contraceptive pill.

In Feminism Against Progress, which is published today, I have argued that these revolutions take aim at aspects of embodied human experience that were previously treated as natural and immutable: for example that men and women exist, and can’t change sex; that most are heterosexual, and the point of sex is, ultimately, making more people. It even takes aim at the fact that only women can have babies, or that puberty is “natural”.

More from this author

Peter Thiel on the dangers of progress

By Mary Harrington

Instead, since the contraceptive revolution, “progress” increasingly entails waging war on human nature as such. And this is justified on the utopian basis that it is a fallacy to claim that anything about us is “natural”, and these claims mostly serve the patriarchy, or white supremacy, or some such boogeyman.

But doing so doesn’t actually free us from human nature, so much as open up aspects of that nature to the market. So, for example, in theory the sexual revolution freed women from pregnancy risk, liberating us to be as sexually voracious as men; but, in practice, men and women still approach mating differently. And if separating sex from its reproductive consequences enabled us to treat sexual behaviour as a purely private matter for the first time, so with that came the defence of pornography and prostitution on libertarian grounds.

We’ve been taught to view such changes as “progress”, and as inseparable from “feminism”, understood as the pursuit of ever greater freedom, underwritten by (usually for-profit) technology. I bought into that myself, until I had a child. But as I’ve set out to understand the under-counted costs of seeing women’s bodies, and women’s interests, in these terms, I’ve come to see the costs of setting out to emancipate ourselves from our own bodies as especially steep for women — especially women outside the elite.

More from this author

Why society still needs the family

By Mary Harrington

Feminism Against Progress looks at this through the prism of sex, a basic organismic pathway for many species as well humans, and yet now under all-out assault by those who would liberate us from it — such as trans activists, campaigners for “fertility equality” or scientists hunting for ways to create embryos without gametes. Meanwhile, male desire and female beauty haven’t gone away so much as been marketised; and in Deets’s tragic story, this marketisation fused with another irreducible fact of the human condition, also under all-out transhumanist assault, but also as yet immutable: ageing.

I was never more than average-looking, even in the flush of youth; even so, the ravages of time on my face still cause the odd pang now I’m middle aged. What is it like for someone whose face and body are their fortune, to see this happen? Here, too, the market wants to help: many celebrities with the money to do so respond by leaning into for-profit “freedom” and going under the knife — sometimes with eerie results. Further down the food chain, “tweakments” are now so normalised, that women are left feeling like freaks if they don’t get on the train. And if this all began decades ago, it’s been wildly accelerated by the digital transformation — for with this has come the power to sculpt our own ideal “selves”.

Last week, for example, the internet was full of videos of women crying because they turned on a TikTok filter that did, in essence, what Deets was doing to her own images with the Coconutkitty persona: turned their faces back to a “teenage” version. This gap between customisable virtual selves and unfiltered “IRL” existence is now a well-documented source of distress for many — especially young women.

More from this author

How robots make us human

By Mary Harrington

One poll reported that 71% of respondents would never post a photo without editing it. Others show a straight line between editing your virtual self, and longing to do the same thing to your flesh. Some plastic surgeons report “they now regularly have patients come in with photos of themselves that have been so heavily Facetuned they would be anatomically impossible to replicate”. In other words, the seeming ability to dissolve and re-make our appearance, online, is normalising a belief that we can do so in the real world as well.

Twentieth-century cultural theorists saw this coming a long way off — or, perhaps, encouraged it. In an influential 1949 paper on the “mirror stage”, the psychoanalyst and cultural critic Jaques Lacan argued that we arrive at adult selfhood by coming to recognise idealised “mirrored” versions of ourselves, whether literally reflected in a mirror or as “reflected” in another’s gaze.

“Humankind cannot bear very much reality” wrote TS Eliot in 1935 — words echoed in Lacan’s 1949 paper, where the real, material world was described as only ever indirectly accessible. Encountering the Real was, Lacan thought, always traumatic: a perspective that makes sense, perhaps, in the light of the brutal realities Europe had only recently endured. And while Lacan’s theories don’t feature heavily in modern psychotherapeutic practice, the psychological flight he theorised away from reality into mirrors, language and identification has been wildly influential, via someone even less willing than he to bear very much reality: the queer theorist Judith Butler.

Suggested reading

Is it racist to like big butts?

By Kat Rosenfield

Judith Butler argued that there’s never a point when we can encounter material reality save through language and ideal — and that language and ideal also shape material reality. And this has implications even in the supposedly “natural” and irreducible domain of sex: something that, Butler argued, isn’t “natural” at all but as it were performed into existence.

A much-reduced pop-Butlerism has long since percolated from the academy into popular culture — not least because our increasingly digital-first social lives make it seem plausible. Online, everything really is so disembodied you can feel as though it might be possible to “LARP” anything into existence in the real world; and pretty much everyone younger than me has been socialising partly (or in some cases almost exclusively) in virtual spaces, some since childhood. Online, we all live in Judith Butler’s world: a space where “performance” and reality are, effectively, the same thing.

Increasingly, wave after wave of young people reaches adulthood armed with pop-Butlerism via university and Tumblr alike. No wonder growing numbers long to edit their meat avatars as they might their online ones, and that this isn’t confined to young girls pursuing unattainable beauty ideals. Reddit hosts anecdotal reports from individuals who decided to transition after using the digital funhouse mirror to feminised themselves, and deciding they liked that look better.

Suggested reading

Demisexuals are scared of sex

By Kat Rosenfield

But the trouble is that this is only true until you log off. The digital age holds out a promise of total emancipation from material reality — one that, in politics, is now driving an increasingly bitter divide between those who can sustain this illusion and those still forced to deal with the real world. And, implicitly, we’re told we can apply this digital Prometheanism to our bodies, too. But it doesn’t work: the gap between protean sex-swap fantasy and sutured, bleeding, often complication-filled reality can be the stuff of nightmares — one that’s now prompting a surge of lawsuits. All that happens is that we open up a new, futile (but still highly profitable) war of attrition against our own nature.

The multimillionaire transhumanist and trans activist Martine Rothblatt may claim that the results of sex change surgery are “so persuasive that rarely can a “new man” or “new woman” be distinguished from a biological original”. But even if this were true (and it generally isn’t), no amount of Woman of the Year awards will change the fact that the individual formerly known as Bruce Jenner remains male down to the cellular level.

Today, Big Tech billionaires are throwing vast sums into the war on death — while the middle classes, and women in particular, find ourselves pressured to submit to expensive procedures aimed at approximating our flesh to the digitally-tweaked ideal in our pocket funhouse mirror. But no amount of “you go, girl” celebration of Madonna’s increasingly bizarre look alters the fact that it’s no more possible to halt the passage of time than it is to change sex.

Suggested reading

The tragedy of becoming a woman

By Sarah Ditum

Lacan envisaged a world where our reflections structure our worlds, and reality is at best a shadowy intermittent interruption. But he never imagined a situation in which we don’t just receive the reflections that shape our self-images, but claim the power to control them. In this world, the magic mirror offers unreal ideal selves to order: the “me” we would like to be, whether thinner, prettier or the opposite sex. And the upshot is that humankind can bear ever less reality — even as we throw ever more of our resources at paying to defy it. Now, with young people reaching adulthood having never known an age before the editable online mirror, we shouldn’t be surprised that so many believe the only compassionate response to an unwanted reality is to dissolve it — digitally, or medically, or both.

But it’s a scam. In practice, “liberating” ourselves from the reality of our bodies amounts, without fail, to increasing our dependence on for-profit services. As 51-year-old fashion director Anna Murphy points out, in explaining why she’s rejected “tweakments” route, it’s a “one-way street”. One procedure leads to the next, and eventually “your face becomes a jigsaw puzzle that doesn’t quite fit together any more — unless you pay someone else to do it for you”.

And for those who can’t quite afford the payments, there’s always the digital-only filter option. But this comes at a terrible cost. For as the gulf between mirror and matter widens, many find the gaze of the other reflects a reality they’d rather not bear.

Mary Harrington’s Feminism Against Progress (Swift) is out now!

I have a skincare regime, because who doesn’t? Very simple: just wash, serum, sunscreen in the morning; cream cleanser, gel cleanser, retinol treatment and face oil at night. But I don’t wear makeup every day: just a light layer, three or four times a week, which takes about five minutes. (A full face takes 20 minutes, but I’ll only bother with that once a week.)

Leg and underarm shaving is optional — hey, I’m a feminist! Once or twice a week. It’s just nice not to be hairy if I’m going to the gym, which I do three times a week for about an hour a time, but that’s about fitness as much as appearance. It’s not like I’m having fillers or Botox or plastic surgery. I love myself the way I am. I just spend hundreds of hours and thousands of pounds every year to achieve it.

Listing everything I do for beauty makes me sound, I know, unserious. If you’re a man, you may feel incredulous at this litany of vanity. Possibly you’re wondering how I have the time or the money for these commitments. If you’re a woman, though — even if you’re a woman who has opted out of all this stuff — then you will recognise the pressure to go along with it.

Nora Ephron called it “maintenance”, in a 2005 essay: “Maintenance is what you have to do just so you can walk out the door.” More recently, the philosopher Clare Chambers has coined a new word for the daily effort we expend on our bodies. In her new book Intact: A Defence of the Unmodified Body, she calls it “shametenance”.

But what’s so shameful about the unmaintained face? Many men insist that they prefer the “natural look” in women; then again, far fewer men demonstrate a preference for women with grey hair, wrinkles and hairy armpits. When a female celebrity gets papped without makeup, it’s a conspicuous enough event to make the Mail’s sidebar of shame. A bare female face is an invitation to ask: can she get away with it?

More from this author

Porn will destroy you

By Sarah Ditum

This, though, is a time of exceptional frankness about the work of femininity. Maintenance is no longer cloistered in dressing rooms, but out there in Instagram stories and TikTok tutorials. Actresses no longer pretend their extended youthfulness comes only from nothing but sleep and hydration; instead, they try to sell us things.

Being obviously beautiful can now be a full-time job. Very few influencers bother with the tedious fiction that their desirable “skinny-thicc” figures (narrow waist, full hips, big tits and behind) are the lucky outcome of good genes and exercise. Instead, they put up sponsored posts about the surgeon who did their Brazilian butt lift (BBL).

And so, if honesty about beauty can eliminate some feelings of inadequacy, it only replaces them with a shopping list for becoming adequate. If the idea of the “natural look” has been debunked, it’s only allowed the most extreme and graphic plastic surgery to be normalised. Meanwhile, the “shametenance” list grows ever longer. These days you can get fillers at your family dentist.

And the more routine these interventions seem, the more people want them, even at considerable risk. If you can’t afford Botox from a medical professional in a clinic, an unqualified practitioner working in their living room can inject an unlicensed alternative into you instead. Victims of this black market suffer infections, sores and permanent scarring. For every 6,000 women who have a BBL, one or two will die as a result. It’s still the fastest-growing cosmetic surgery in the world.

Suggested reading

Why women are faking it

By Zoe Strimpel

Maybe there’s an argument that the BBL is at least a rejection of the “waif” beauty standard formed in the Nineties and Noughties. In Sexual Revolution, Laurie Penny writes: “Today, the ideal woman takes up as little space as possible. She is fragile, breakable, thin and hungry-looking.” But that is not what the “ideal woman” looks like in 2022. If it were, women would not be spending thousands of pounds for a big bum and a non-zero chance of an embolism.

If the thinness of the waif was the point, then the skinny-thicc look ought to be liberatory: it’s all about having an ass that takes up as much space as possible. But the difference in the ultimate appearance of these ideals is irrelevant. What matters is that both advertise, through their exaggerated aesthetic, the effort that went into them: a waif is waifish because she scrupulously manages her food intake, a skinny-thicc is skinny-thicc because she’s put in the hours on the operating table.

In 2004, the sex advice columnist Dan Savage was asked about another fashion in female body shape: why weren’t women in porn getting enormous, “bigger-than-your-head” breast implants anymore? And this is what he replied:

“The sudden appearance of women with ridiculously huge boob implants was arousing in part because of its shock value. There was the shock of women with such exaggerated racks, of course, but there was also the more important and, sadly, the infinitely more arousing shock of women finding a novel new way to imperil their health in order to attract the attention of men.”

The point of all these extremes is their demonstration of commitment to being beautiful — to fulfilling the assumption, as Chambers describes it, that “to be a woman is to be sexually attractive, or at least to be sexually available, or at least open to judgement for being or not being sexually attractive and available”. It’s not that these physiques are universally desired by men at the times they become popular. It’s that they become the accepted symbol of a woman’s willingness to reshape her body in order to be pleasing.

Suggested reading

My body will never be erased

By Rosie Kay

Trends are cyclical: an aesthetic gains ascendency, spreads to ubiquity, is pushed to absurdity in the competition for attention, and then collapses under the physical limitations of the body to be replaced by the next standard. When the thing after skinny-thicc begins to emerge, it might feel like an escape, but it won’t be. It will go through the same process, have the same distribution of winners and losers, exhaust itself the same way.

Women’s bodies, in other words, will always be a problem to solve. They will never be acceptable. That’s what makes Chambers’s position in Intact so appealingly radical: she argues that bodies do not need to be modified. Your body is valuable just as it is, because it is you. And I agree — while being enormously grateful that Chambers leaves enough flexibility in her thesis for me to agree without having to change any of the habits I’m attached to.

Intact is not absolutist. Sometimes, writes Chambers, modification is justified — for reasons of health or happiness. So it’s okay to spend £150 getting my hair done, because it’s a pleasure. (I’m a primate: it’s nice to be groomed. The sociological term for this is “the beauty touch”, says Chambers.) It’s okay for me to lift weights in the gym; so long as steroids aren’t involved: “bodybuilding can be good for both body and soul.” My tattoos are perhaps a more challenging case, but they too are defensible for Chambers as acts of “self-expression”.

In fact, any kind of body modification turns out to be acceptable in the end, because “the principle of the unmodified body asserts a premise, not a goal”. This saves her from doing anything as gauche as telling other people what to do with their bodies, but it does set her argument a little adrift: her book is part passionate defence of physical integrity, part “you do you” shrug.

Suggested reading

How feminism ate itself

By Kat Rosenfield

Chambers is also careful to make a fine distinction between “unmodified” and “natural”, pointing out that the latter is an unhelpful concept because “if being natural means being without human interference, then no human and no body can ever be natural”. Everything you consume, every movement you make, can alter the appearance of your body. How can a woman decide what to do with her body when every possible choice is loaded with value?

I’m not as scared of being censorious as Chambers is. As far as I’m concerned, wanting to change your appearance is part of being human, and one of the ways we signal status and group loyalty. But not all modifications are equal, and the ones we should be wary of are, first, the ones that infringe on the body’s ability to be a body: that destroy its capacity for function or pleasure (labiaplasty), that attack its self-reliance by turning it into a permanent patient (fillers that must be endlessly refilled so the stretched-out cavity won’t sag).

We should also be suspicious of modifications that distort our idea of the average. If you want Botox and can afford the good stuff, I do chafe at the idea of banning it. However, and as Chambers argues, we should not pretend the ethics here end with individual choice: if you eliminate your fine lines, you will change how others feel about theirs. When you’ve seen enough strangely ageless faces, your own normal creases begin to feel like deformities.

And finally, we should query modifications that are displays of pure female submission — by which I mean the extreme and dangerous forms of plastic surgery, but which arguably includes a great many of the less intrusive things I do. Chambers describes makeup as the ultimate in self-objectification, because when we wear it, “we see ourselves as others see us, and treat their perspective as the one that counts”.

I baulk at this — my face is a means of communication, and makeup is a fun way to play with the vocabulary of expression — but I should, at least, accept the possibility that I might be wrong. Beauty may be laborious. But declining to do beauty is its own kind of hard. In a society that judges women in particular so harshly on the way they look, it’s an announcement of non-compliance, and it’s often met with hostility.

The point is, even when a woman decides she will not make a statement with her body, she is making a statement. The point is, this is exhausting. The point is, it’s supposed to be: even on the days I’m not spending hours in a salon or carefully painting wings along my lash line, I’m still distractedly thinking about how I look at least some of the time. And if I stopped thinking about it? Someone else would still be thinking about it for me, judging me. The point is, there is no way out. We’re damned if we care, and damned if we don’t.

“Many this year want a pout like Sharon,” says Hoo, meaning Sharon Gaffka, the former beauty queen turned Department for Transport administrator who — despite having prominent work done to lips, face and breasts — failed to form a romantic connection with any of the men and was booted out of the villa last week.

Her failure to attract represents a painful Love Island irony: the correlation between surgery and attractiveness to men — and especially the ability to generate strong feelings — is weak. The less obviously enhanced women, from surfer-girl Lucie Donlan to winner Amber Rose in winter 2019, to Millie and Lucinda in this season, more often stoke an unambiguous, instant lust (they’re “fire”), while the women with more exaggerated features often struggle. Season Five’s Anna Vikali’s £100,000 of plastic surgery didn’t stop her from being summarily dumped when a better option came in, while Shaugna Phillips’ (Season Six) boldly artificial-looking mouth, eyes and nose did not keep Callum Jones from trading her in for a thinner, younger blonde at Casa Amor.

So why do women bother getting work done? Partly, of course, because it’s a fashion, disseminated at warp speed since the arrival of Instagram through the lucrative, Kardashian-inspired world of ultra-filtered influencers. That fashion has capitalised on a uniquely contemporary mixture of deep insecurity, and the politicisation of that insecurity: a defiant pride in “doing what makes you happy” and therefore doing what it takes to “pass, to survive and to thrive” — even if that means capitulating to one of patriarchy’s most devious regimes.

More from this author

Why young men love Milfs

By Zoe Strimpel

The confused but angry politics of the new beauty burst to the surface in the first gripping set-piece of the current season of Love Island. The islanders were playing a game in which each person had to guess something about the person they were paired up with, to show how well they’d got to know them. The women’s cosmetic procedures were included in the game, with a frankness never seen before in the programme’s six-year history: one of the questions the men had to answer was what “work” their women had had done.

I’d have found such a question excruciatingly embarrassing, but then I belong to an outdated era in which one’s beauty is meant to look effortless — a fairly burdensome requirement in itself. By contrast, these women wrote with jolly loudness on their little blackboards what they’d all had done: all bar one (Kaz) had had something; a significant number had had Botox, filler and breast surgery. All of them were under the age of 27, and none of them seemed remotely coy about it.

A number of questions involved each party stating what they liked, or didn’t like, in a partner. Fan favourite Hugo, a 24-year old PE teacher with a club foot who has frequently been passed over for being “too nice”, used the word “fake” three times. He declared a strong dislike for “fakeness” or “anything fake” in women — personality and looks. It sounded like a fairly general word for a barrage of bad things in a society obsessed with authenticity, and no worse than what the other men claimed to revile, including women with visible arm hair. But after Hugo’s second invocation of “fake”, the heavily enhanced Faye growled: “that word keeps getting thrown around, doesn’t it?”

On the third time, Sharon and Faye exploded, calling Hugo “ignorant” and demanding he “get fucking educated” about why “girls get work done”. Hugo, oblivious, then burst into tears at the extreme consequences of his word choice, to which Faye responded, “I don’t give a fuck if he’s upset, he can fuck off”.

Suggested article

Do men love bitches?

By Louise Perry

It was clear now that “fake” had been taken as a slur word on a par with open racism — a comparison later made by a furious, filler-lipped Sharon, to the consternation of fans. Twitter duly exploded with “fake gate”, with former islanders — women who’d had work done — weighing in. Amber Rose agreed that the word had seemed pointed, while Laura Anderson, of Series Four, claimed that the women had “gone too far” in their reaction.

Faye explained her strong retort in telling terms:

“For me the word fake doesn’t go well. My mum and dad watched me cry every day from the age of 13 to 18 because I was underdeveloped, then they bought me a boob job for my 18^th birthday because I was having such a tough time.”

Getting work done was a reaction to body insecurity — a helpless, only-human female response to patriarchy. Sharon had also taken offence because “fake” insulted women who were driven to do it: “you don’t know the reasons why we’ve had stuff done and I think that’s really unfair”.  That she — that all the women on Love Island — had embraced and then benefitted hugely from the system she’s criticising was not acknowledged.

Fake-gate highlighted a new kind of feminist, then: a woman who sees her obsession with her own looks as both something justifiable and a sign of patriarchy-created vulnerability. This type of feminism has crystallised since social media allowed people, especially women, to get rich and famous from home-made self-portraits and videos — the more suggestive and exaggerated the better. The “fake” look condemned by Hugo is more likely to be seen on working-class women (the Love Island fan base is not generally middle class), but influencers’ use of some form of sexiness crosses class. This sexualised route to stardom doesn’t feel particularly feminist to someone schooled in, say, Women’s Liberation — but then, it can certainly be lucrative.

Suggested article

Sex positivity can't last

By KATHERINE DEE

And she may even recognise, like the women of Love Island, that she’s playing a game with rules set by patriarchy. Sissy Sheridan, a teen TikTok star with 5.3m followers — whose videos mainly show her pouting and lip-syncing in bikinis — believes her medium “is the most misogynistic platform ever,” replete with “slut-shaming and cyberbullying” of female stars. She condemns these slut-shamers as “haters,” proclaims to be a “feminist,” and continues to dance near-naked for her fans and rack up followers: one more example of how blurred the lines between feminism and sexualised self-selling have become.

Love Island’s fake-gate is another example, of course. But the row caught fire because the manipulation of our bodies has never been as explosive a political issue as in this era of trans rights and body positivity. In some circles, “natural” — one of the buzzwords of the body positivity movement — has become as political as “fake”. Right-on beauty observers like Sesali Bowen see the celebration of the “natural” as a judgement of those who manipulate their bodies because they are “marginalised”: trans people getting surgery to suit their true gender identities, say, or those hoping to escape pressures intensified by racism, ableism and lookism. Bowen also argues that plastic surgery is a democratising force that wrests “pretty privilege” from the hands of the few.

Perhaps she’s right. But the downsides of excessive bodily manipulation are painfully obvious. As well as signalling a moveable feast of insecurity and the tyranny of constant self-monitoring, fake-gate has highlighted how easily women can plunge from the envied and powerful into the pitied and reviled. This is part of a long-term female conundrum: how do we change our bodies enough to be beautiful but not too much to cloud our sexual allure? As Ben Jonson put it in a 1609 song, “Still to be neat, still to be dressed”, women should aim for a look of “sweet neglect”, which required being “powdered, still perfumed” — but subtly. Women who use too many additives are suspected of falseness (fakeness’s ancestor) and trickery. Robert Herrick, the 17^th century poet, railed at those who were: “False in legs, and false in thighs; / False in breast, teeth, hair and eyes”.

The potential for pitiable grotesquerie has always been waiting in the wings for women grasping too hungrily at perfect figures, faces and eternal youth. Today, we are inundated with stories of plastic surgery gone wrong; of monstrous transformations in which the attempt at beauty radically backfires. Testimonies by remorseful surgery addicts make eye-watering reading. Heidi Montag, an American reality star, has admitted to procedures all itemised in print: mini brow lift, forehead botox, nose job “revision”, fat injections in her cheeks, chin reduction, neck liposuction, pinned back ears, second breast job, liposuction on hips, waist and inner thighs, and buttock augmentation. “People have fewer scars from car accidents than I have on my body,” she observed.

More from this author

The hateful heart of Love Island

By Zoe Strimpel

Like Montag, the women of Love Island — and their millions of fans and followers — are caught up in a stressful, physically damaging game in which the potential payoff of fame is pitted against the brutal facts of time, human flesh, and fashion. And what are they playing for? The islanders throw everything into their appearance but seem flummoxed about how to actually talk to each other. In the end, the contestants find, no amount of paid-for, hard-won bodily perfection can fill the gap left by really “getting to know” someone — and liking them. When everyone has bodies on the tight spectrum of contemporary perfection, the ability to attract comes down to other things — in Love Island parlance, having “a bit about” you.

And the fashion may soon be turning sharply against enhancements — or “tweakments,” as they’ve called them this season. Ex-contestant Anna Vikali has just announced she is reversing her £100,000 of work, starting with a breast reduction, and Molly Mae Teague, runner up of winter 2019, has turned anti-“tweakment” after failing to recognise her own reflection in the mirror.

Still, the demand for surgical enhancement is continuing to rise, and the danger is that fakeness — understood in the surgical sense — becomes more seamlessly integrated into standard aesthetics, perhaps even morphing into the “natural”. After all, tweakments are now presented by their “feminist” purchasers as an only natural response to marginality, suffering and patriarchy. Like Faye and Sharon, they’ve cracked under the pressure to look a certain way, and surgery was their answer.

But forcing this unfortunate chain of events into a vocabulary of politicised victimhood conceals the seriousness of the motive, which is an obsessive focus on the body as the font of all worth. Recognising this helps us to see Botox, fillers, butt-lifts and boob jobs for what they really are — extreme, often counterproductive measures to fight time and nature — rather than acts of female bravura. They are short-term solutions, not only for individual women, but for women generally — who’d be much better off if the whole sexist system were dismantled, rather than propped up “fake” feminism.