Breast Augmentation, Liposuction, and...Cauliflower Ears?1. Objectives
After completing this module, you should be able to simply yet effectively
1.) Teach the basic anatomical layers of the human body
2.) Identify some of the enormous capabilities of cosmetic surgery today
3.) Lead a discussion on enhancement - what it is, why it is difficult to define, and why it is an important area of study
4.) Present the ethical questions raised by using cosmetic surgery for cauliflower ear syndrome
Curriculum Integration Ideas
This brief may be used in life science classes during units for topics including:
1.) Human anatomy
2.) Public policy discussions on medical regulation and physician practices
2. Anatomical Layers
The human body is comprised of millions of individual cells of various kinds - nerve cells, muscle cells, blood cells, etc. Cells of the same kind group together to form tissues and all different types of tissues form together to make an organ. Some of these organs are located right where you can see them, such as the skin, while others, such as the heart, are protected under many layers of your body. Starting from the surface, the first layer you see is skin. The skin is actually comprised of three individual layers - epidermis, dermis, and subcutaneous. The epidermis is the layer you see and has pigment cells that are responsible for the color of your skin. The second layer, the dermis, has the hair cells, sweat glands, and elastic fibers so that your skin can stretch. Finally, the subcutaneous layer contains blood vessels and nerves and also helps regulate your body temperature.
Beneath the skin, there is a layer of a thick, fibrous material called fascia. Fascia covers your body from head-to-toe under your skin and helps to keep what's inside, in. Fascia also helps to protect your body from infections and gives you shape. Underneath the fascia, there is muscle and bone. These are the muscles and bones that help you move and make you look the way you do. Finally, underneath all these layers, there are many organs such as your heart, lungs, and stomach. These organs are protected by your bones and muscles and carry on the many processes needed to sustain life.
3. Cosmetic Surgery
Cosmetic surgeons are special types of surgeons that are trained in a wide variety of surgical techniques and procedures. Some of these are very popular such as nose jobs (rhinoplasty), breast augmentation, tummy tucks (abdominoplasty), face lifts (rhytidectomy), and botox to minimize wrinkles. Others, are just as important but are not as well publicized and include dermabrasion to improve skin texture, blepharoplasty or eyelid surgery, and body contouring after major weight loss.
Another procedure is performed on earlobes and can be used to treat cauliflower ear. Cauliflower ear is also called hematoma auris or perichondrial hematoma which mean blood under the ear. This is because the condition is most common in wrestlers, boxers, and martial artists that get bruises after receiving a blow to the ear. If the blow is bad enough, the blood clot will separate the cartilage in the ear below it and the fibrous ear tissue above it, the perichondrium. This starves the perichondrium since it is unable to get its nutrients through the blood clot. The outer skin around this part of the perichondrium then becomes swollen and deformed. Cosmetic surgery can be used to restore the ear to its normal appearance.
4. What Are Some Of The Ethical Issues Raised?
There is a wide variety of ethical issues that have been raised by cosmetic surgery in general and the treatment of cauliflower ear in particular. Some of these are -
Physical Enhancement
Enhancement was defined by the President's Council on Bioethics as the "use of biotechnical power to alter, by direct intervention, not disease processes but the ‘normal' workings of the human body and psyche, to augment or improve their native capacities and performances." So if medicine is used to treat disease, it is therapy; if not, it is enhancement. So is cosmetic surgery enhancement? Patients certainly do not need a tummy tuck or breast augmentation to cure a disease, but it does make them feel better about themselves. Also, cauliflower ear can be treated by simply draining the blood clot and the cosmetic surgery is simply done to restore the normal appearance. Are these procedures enhancement? Or do they count as medical therapy because they make people feel good about themselves?
Distributive Justice
A "big picture" question that is raised is that of distributive justice. Distributive justice deals with how society allocates its scarce resources among its members. Cosmetic surgery is rarely covered by insurance since it is elective, or something that a patient chooses to do that is not necessary to sustain life. This means that it is more likely that the rich will be able to afford the thousands of dollars it costs to undergo cosmetic surgery. Is this fair? If cosmetic surgery truly does make people feel better about themselves, should everyone be allowed to have it? Or should society spend its money on medical technologies that are life-saving such as organ transplantation, heart attacks, and burn victims?
Risks and Benefits
Bioethicists often measure things using risks and benefits. That is, do the potential benefits outweigh the potential risks? For example, if you had to wade into a shallow pool to rescue a drowning infant, the risk of getting your clothes wet is outweighed by the benefit of saving a life. Cosmetic surgery is not without its risks. Just like any surgery, the risks include reactions to the anesthesia used including abnormal heart rhythms, airway obstruction, heart attacks, and death. The surgery itself also has risks including causing blood clots, blood loss, infection, and skin death. Do the benefits of cosmetic surgery outweigh its risks?
5. Review Questions
1. Explain the layers and functions of human skin
2. Discuss how the layers of the human body function together as a whole
3. Identify three ethical issues raised by treating cauliflower ear through cosmetic surgery and discuss your stance on each of these issues
4. What is enhancement? Is enhancement always bad? Discuss other technologies that could be considered enhancements.
5. Can you identify other areas in your life where the risks may outweigh the benefits?
References
1. Gray's Anatomy of the Human Body
2. American Academy of Cosmetic Surgery
3. American Society of Plastic Surgeons, Cosmetic Surgery Procedures At-A-Glance
5. President's Council on Bioethics, Beyond Therapy: Bioetechnology and the Pursuit of Happiness