Paris thin to the Kardashian butt, it’s boom time for cosmetic ‘cowboys’

When a young woman consulted plastic surgeon Dr Dan Kennedy some years back he witnessed a potentially ugly side effect on self-esteem that a brush with parts of Australia’s booming cosmetic surgery industry can have.

Asked by her what she needed to do to improve her appearance, Kennedy examined her and concluded: nothing. “I thought she was completely fine,” he says, adding: “She was very relieved.”

Reality TV star Kim Kardashian, pictured with then husband Kanye West, is considered one inspiration for many women seeking cosmetic surgeries in Australia.Credit: AP

So relieved, in fact, that she confessed she was an undercover journalist working on a first-person story to explore cosmetic surgery options.

The woman told him she had been concerned by what two cosmetic surgeons – medical practitioners who offer operations but lack the 10-12 years’ specialist surgery training – had told her: that she needed larger breasts, liposuction and a nose job.

“She felt they’d say ‘you’re fine, don’t do anything’ and was quite taken aback to be told she needed breast implants, liposuction off her thighs and ‘you need your nose fixed’,” says Dr Kennedy, president of the Australasian Society of Plastic Surgeons.

“She was really surprised about how she felt about it. She said she came away a bit damaged.”

For years, he says, specialist plastic surgeons have been trying to get the message across that cosmetic operators who lack registration with the Royal Australian College of Surgeons should not be selling procedures to clients - more than 90 per cent of whom are women - under the guise of “surgeon”.

“We’ve been trying to put it out there that you need to be trained as a surgeon to operate as a surgeon. Our concerns have not been adequately heard, nor enforced,” he says.

The spotlight has again fallen on the cosmetic surgery industry this week after the Herald, The Age and ABC’s Four Corners uncovered allegations of troubling practices across Dr Daniel Lanzer’s network of clinics, including serious hygiene and safety breaches, and multiple examples of botched procedures that have left patients in extreme pain and requiring further medical treatment.

Meanwhile demand for cosmetic procedures boomed during the pandemic - when people could recover at home - with an increase of 50 per cent in face lifts, breast enhancements and other treatments. And Australian women are among the world’s biggest cosmetic surgery spenders.

Influencer culture has helped normalise operations that were once considered a “big deal” and too expensive. Clinics are now on TikTok and Instagram (some offering bargain prices) and global stars such as Bella Hadid, Emily Ratajowski, and Kendall Jenner are setting a heavily desired beauty aesthetic.

Tummy tucks, breast augmentation, eye, brow and face lifts or multi-surgery “mummy makeovers” – and, more recently, bum-boosters and “designer vaginas” – are promoted as proudly aspirational.

Since Instagram and its popular filter FaceTune began allowing us to curate our faces, “having work” to emulate these improvements in real life has become unremarkable.

Model Bella Hadid is said to be one of the global inspirations for those seeking cosmetic procedures to achieve the current Instagram ideal.

So much so that the “cosmetic cowboy” revelations about Dr Lanzer’s cosmetic surgery chains may have come as a shock to would-be clients lured by glowing social reviews and the promise of long payment plans and “quick” recoveries.

Safety breaches shown on Four Corners were described as “the tip of the iceberg” by Clinical Professor of Surgery at the University of Melbourne, Mark Ashton.

As former patients speak of trauma from botched procedures, and revelations of doctored reviews emerge, clinical psychologists such as Dr Gemma Sharp are examining the factors driving Australian women into the arms of a sector whose regulation was last week described by former ACCC chair, Allan Fels, as “freewheeling”.

Paris Hilton’s “all over skinny” look was aspirational in the early 2000s before a curvier silhouette became more fashionable, says Dr Gemma Sharp.Credit: Arthur Mola

The rise of a uniform face and body ideal, currently embodied by Kim Kardashian, and of the coveted look dubbed “Instagram Face” – defined by the site Pedestrian TV as “why all professionally hot people look the same” – seemingly has much to do with it.

Paris Hilton made “all over skinny” hot in the early 2000s, says clinical psychologist and body image researcher Dr Sharp, but thanks to exponential social media growth, the influence of the Kardashian silhouette is now pervasive.

And where traditional influences such as magazines, TV, movies and music videos were “quite passive”, social media apps allow people “to be interactive about their own appearance, which is a big driver [of rise in cosmetic surgery]“.

“The biggest increase has been in non-invasive injectables and Botox, but we’re seeing an increase in invasive procedures like liposuction, breast augmentation and now the Brazilian butt lift is the latest trend,” says Dr Sharp, head of the Body Image Research Group at the Monash Alfred Psychiatry Research Centre.

The latter involves “harvesting” fat from one part of the body and injecting it into the buttocks to make them bigger, higher and rounder.

It is popular despite the price ranging from $6000 to $12,000 in Sydney, and $9000 to $12,500 in Melbourne with one clinic offering bottoms titled “Sports Illustrated”, “Beyonce” or “Kim Kardashian”. The Brazilian butt lift is considered the most deadly of aesthetic procedures. It has a reported death rate overseas of about one in 3000 due to fat embolisms that block arteries.

One Sydney cosmetic surgery clinic offers a ‘Beyonce’ butt lift.Credit: Invision

The mainstreaming of pornography and sexting has also prompted a big rise in demand for cosmetic surgery on women’s genitals, known as labiaplasty, to “tidy up” the area and create “one, smooth curve with no protruding external genital tissue visible ... like Barbie”, says Dr Sharp, who is also a researcher into the influences on women’s decisions around labiaplasty.

You wouldn’t have a gastroenterologist posting on TikTok. It’s very specific to this profession.

Dr Gemma Sharp, of the Monash Alfred Psychiatry Research Centre

Heavy marketing of cosmetic surgery to young people has been a contentious issue for a long time.

“You don’t see this as much with other medical professionals - you wouldn’t see a gastroenterologist posting videos on TikTok. It’s very specific to this profession, ” Dr Sharp says.

“The vast majority hold their profession to a high standard and want to do good for patients, but they saw the traditional website was not going to get you anywhere with young people, you need to be on the same platforms they are,” she says.

Dr Gemma Sharp with her childhood Barbie - she holds one of the dolls up in lectures to illustrate what is being pushed as the “ideal” appearance of female genitalia - “one smooth curve”.Credit: Ben Searcy

As a result, “there is more body dysmorphia (a mental health disorder in which people focus obsessively on perceived defects) than we’ve ever seen. More people are dissatisfied with their own bodies,” she says.

Psychologist Sarah McMahon, a director of the specialist mental health group Body Matters Australasia, says technology that presents the idea “we can look how we like”, coupled with the normalisation and accessibility of cosmetic surgery - “it’s marketed ... as a refresh” - and the bombardment of homogenised imagery, is prompting more women to consider cosmetic surgery.

Changing our appearance “is something we think we can easily do now”, she says. “Because of the use of filters people think they have a certain image to maintain and uphold. We hear stories about people becoming more and more obsessive and dedicated to using these,” says McMahon.

“It’s a motivator for people wanting to (take steps) to look more like this idealised version of themselves that they’re publicly displaying,” she says.

Even people you may assume keep a critical eye on the difference between projection and reality can fall victim to obsessing with their “faults”: “The pressure to conform is astronomical,” says McMahon.

Many clients simplify the idea of “surgery that is permanent and potentially dangerous”, and have a skewed perception of the risks and complications.

Though many say they want cosmetic surgery just to please themselves, which is a valid choice, “even things like recovery from surgery and the reality of what it’s going to look like for them is minimised and the benefits are amplified”.

Professor Jayashri Kulkarni, head of psychiatry at Monash University medical school, believes some women are being taken advantage of by some cosmetic surgery providers. She describes the popularity of labiaplasty among very young women as “terrifying”.

“Younger women are much more into genital cosmetic surgery. They go out and get all sorts of things done without knowing, of course, you can cut nerve endings,” she says.

“Many women walking around with fashionable vulvas ... have actually lost sexual feeling - and this is a rapidly rising sector of surgery. It’s frightening when you look at the numbers of young women going to get labiaplasty, you think, ‘What happened to feminism?’”

There is also “a massive acceleration” among middle-aged women opting for cosmetic surgery as they feel the need to compete in an ageist society. “There is seen to be a certain look on social media influencing older generations too, an unrealistic representation of the female form,” Kulkarni says.

Donna Patterson has spent 21 years living with the mental and physical scars of a breast reduction operation conducted in a Melbourne cosmetic surgery clinic.Credit: Aaron Smith/ABC

Specialist Dan Kennedy says surgeons would continue to lobby for more transparency in the cosmetic surgery industry, specifically around qualifications of doctors.

“If you go to a knee surgeon, you have every expectation they have an orthopedic fellowship, they’re not a GP practising knee surgery. However it’s become accepted you might go along (to a cosmetic surgery) and somebody with general medical certification might do your face lift, liposuction or genital surgery,” he says.

“It is remarkably common to hear, (patients coming for corrective procedures say) ‘but he was a surgeon, he was a plastic surgeon’,” he says.

“I hear that again and again. Typically, it’s in circumstances where people say, ‘If I’d known (the professional was not a registered surgeon) I would never have gone to them’.”

Safety checklist

• Avoid being operated on by a fly-in-fly out surgeon.
• There should be at least two consultations before surgery, a thorough discussion will rule out external pressures or other issues that may need to be addressed.
• The offer of free consultations is a red flag.
• Professional plastic surgeons are members of the Royal Australasian College of Surgeons.
• There should be no pressure to have any procedure, “they should be listening to your concerns and pointing out alternatives, including the alternative of doing nothing, which is often not well discussed in some commercial practices”.
• Beware of the offer of big discounts if you sign up on the spot: “That’s not ethical or reasonable. It could be an inflated price not a meaningful discount and what’s their motivation for you to ‘sign up today’?

• From Dr Dan Kennedy of the ASPS