Second Opinion: A brief history of vanity

Dr. April Sanders takes a look at the earliest days of beauty treatments, many of them dangerous, to today's obsession with youth

The history of vanity is as old as time, and for thousands of years cosmetics have been a big part of the vanity toolbox.

Cosmetics provide a plethora of social signals designed to enhance beauty, indicate status and advertise sexuality. For centuries, they were the palate of the privileged class (and the oldest profession). For example, Cleopatra’s day would have begun with slaves applying emollients composed of beeswax, olive oil, castor oil and fragrance to soften her skin. Kohl, a mixture of lead, copper, ash and burnt almonds, was applied to encircle her eyes to give the cat-like look so coveted in her time.

Flash forward to the 1600s when the pale face symbolized ultimate beauty. The highest class of European women responded by sun avoidance and to best their competitors, many resorted to bloodletting. The voluntary loss of a pint or two would achieve the desired pallor. The pale face became even paler in the 1700s when ceruse, a white paint composed of lead and arsenic, became available at a time when smallpox scars were ubiquitous; the plaster- like substance could fill the depressed areas and hide imperfections. The downside to ceruse, however, was deadly. Lead and arsenic caused eye swelling, rashes, tooth loss and even death. The quest for beauty accelerated in the 1800s with the increased accessibility to the mirror and the invention of the photograph. To present a beautiful complexion for the camera, 17th century women ingested Fowler’s solution, a dilute concoction composed of arsenic, to improve the skin.

The driving force behind the cosmetic boom of the 20th century was the movie industry. Cosmetic enhancement became mainstream and entrepreneurs like Max Factor, Elizabeth Arden, Helena Rubenstein and many more delivered what women of ancient times dreamed of, a whole constellation of products guaranteed to enhance the female face and body at an affordable price. Coco Chanel, for better or worse, convinced the modern woman that a tan was the new fashion accessory. At the start of the 20th century the average life expectancy of a woman was only 42 years. As advances were made in public health and medicine, people lived longer and the demand for cosmetic product to fight the visible signs of the aging process became big business.

Cosmetics, however, could only enhance one’s features or hide imperfections. Aging women needed more. The movie industry and its aging leading ladies led the charge towards antiaging surgery, and the niche of the cosmetic surgeon was born. The arms race towards youth and away from old age escalated with the proliferation of plastic surgery procedures. Now a tighter face, flatter stomach, larger breasts, slimmer limbs and designer vaginas were only a nip and tuck away.

For those unwilling to go under the knife, Botox and tissue fillers opened up a new world of possibilities. Now for a price, anyone can have a wrinkle-free face, plumper lips and look years younger.

Some may ask, when does the madness end?  My answer is that it doesn’t. As long as men and women are still breathing there is a desire to be relevant in a culture that values beauty, status and sexual attractiveness.  Some may be shocked by the voluntary exsanguination by women in the 15th century to achieve pale skin, but today’s woman is willing to do far more.

Botox, or botulinum toxin, was first used for strabismus (cross-eyes or lazy eyes) and blepharospasm (eyelid spasm or twitching disorders). When it was noted that these patients had a dramatic improvement in wrinkles, Botox was licensed for cosmetic use as well. Injection of cosmetic Botox is commonly restricted to the muscles of negative self-expression. The result is smoother skin and a relaxed look. In Canada, Botox is a scheduled drug and only available to doctors. Physicians (and dentists) and RNs under the supervision of doctors are the only health care professionals who are licensed to inject Botox. If an esthetician injects Botox, it has probably been acquired online, and should be considered suspect.

Botox is an excellent product for the upper face, but the aging process in the lower face requires other interventions. As the face ages, there is a loss of subcutaneous fat that alters facial shape. The older face is characterized by flattening of the apple of the cheek, deepening of the nasolabial folds, formation of marionette lines  and laxity of the jaw line. To reverse these changes, the most popular products today are hyaluronic acid (HA) fillers. HA is a naturally occurring substance in the body and is not recognized as a foreign substance by the immune system. Injections of HA can re establish volume loss secondary to the aging process.

And so the history of vanity continues. Instead of olive oil, beeswax and kohl, we have Botox, fillers  and so much more. We are not so different from our predecessors. The good news today is that we have better and safer tools to achieve these objectives. What will the future hold? I predict an effective treatment for hair loss is just around the corner.

Dr. April Sanders is a physician in Vernon, B.C., with Sanders Medical Inc. Vein and Laser.