The Many Faces Of Cosmetic Surgery
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Cosmetic Surgery: What’s The Truth?
In Tuesday’s newsletter, we asked you your opinion on elective cosmetic surgeries, and got the above-depicted, below-described, set of responses:
- About 48% said “Everyone should be able to get what they want, assuming informed consent”
- About 28% said “It can ease discomfort to bring features more in line with normalcy”
- 15% said “They should be available in the case of extreme disfigurement only”
- 10% said “No elective cosmetic surgery should ever be performed; needless danger”
Well, there was a clear gradient of responses there! Not so polarizing as we might have expected, but still enough dissent for discussion
So what does the science say?
The risks of cosmetic surgery outweigh the benefits: True or False?
False, subjectively (but this is important).
You may be wondering: how is science subjective?
And the answer is: the science is not subjective, but people’s cost:worth calculations are. What’s worth it to one person absolutely may not be worth it to another. Which means: for those for whom it wouldn’t be worth it, they are usually the people who will not choose the elective surgery.
Let’s look at some numbers (specifically, regret rates for various surgeries, elective/cosmetic or otherwise):
- Regret rate for elective cosmetic surgery in general: 20%
- Regret rate for knee replacement (i.e., not cosmetic): 17.1%
- Regret rate for hip replacement (i.e., not cosmetic): 4.8%
- Regret rate for gender-affirming surgeries (for transgender patients): 1%
So we can see, elective surgeries have an 80–99% satisfaction rate, depending on what they are. In comparison, the two joint replacements we mentioned have a 82.9–95.2% satisfaction rate. Not too dissimilar, taken in aggregate!
In other words: if a person has studied the risks and benefits of a surgery and decides to go ahead, they’re probably going to be happy with the results, and for them, the benefits will have outweighed the risks.
Sources for the above numbers, by the way:
- What is the regret rate for plastic surgery?
- Decision regret after primary hip and knee replacement surgery
- A systematic review of patient regret after surgery—a common phenomenon in many specialties but rare within gender-affirmation surgery
But it’s just a vanity; therapy is what’s needed instead: True or False?
False, generally. True, sometimes. Whatever the reasons for why someone feels the way they do about their appearance—whether their face got burned in a fire or they just have triple-J cups that they’d like reduced, it’s generally something they’ve already done a lot of thinking about. Nevertheless, it does also sometimes happen that it’s a case of someone hoping it’ll be the magical solution, when in reality something else is also needed.
How to know the difference? One factor is whether the surgery is “type change” or “restorative”, and both have their pros and cons.
- In “type change” (e.g. rhinoplasty), more psychological adjustment is needed, but when it’s all over, the person has a new nose and, statistically speaking, is usually happy with it.
- In “restorative” (e.g. facelift), less psychological adjustment is needed (as it’s just a return to a previous state), so a person will usually be happy quickly, but ultimately it is merely “kicking the can down the road” if the underlying problem is “fear of aging”, for example. In such a case, likely talking therapy would be beneficial—whether in place of, or alongside, cosmetic surgery.
Here’s an interesting paper on that; the sample sizes are small, but the discussion about the ideas at hand is a worthwhile read:
Does cosmetic surgery improve psychosocial wellbeing?
Some people will never be happy no matter how many surgeries they get: True or False?
True! We’re going to refer to the above paper again for this one. In particular, here’s what it said about one group for whom surgeries will not usually be helpful:
❝There is a particular subgroup of people who appear to respond poorly to cosmetic procedures. These are people with the psychiatric disorder known as “body dysmorphic disorder” (BDD). BDD is characterised by a preoccupation with an objectively absent or minimal deformity that causes clinically significant distress or impairment in social, occupational, or other areas of functioning.
For several reasons, it is important to recognise BDD in cosmetic surgery settings:
Firstly, it appears that cosmetic procedures are rarely beneficial for these people. Most patients with BDD who have had a cosmetic procedure report that it was unsatisfactory and did not diminish concerns about their appearance.
Secondly, BDD is a treatable disorder. Serotonin-reuptake inhibitors and cognitive behaviour therapy have been shown to be effective in about two-thirds of patients with BDD❞
~ Dr. David Castle et al. (lightly edited for brevity)
Which is a big difference compared to, for example, someone having triple-J breasts that need reducing, or the wrong genitals for their gender, or a face whose features are distinct outliers.
Whether that’s a reason people with BDD shouldn’t be able to get it is an ethical question rather than a scientific one, so we’ll not try to address that with science.
After all, many people (in general) will try to fix their woes with a haircut, a tattoo, or even a new sportscar, and those might sometimes be bad decisions, but they are still the person’s decision to make.
And even so, there can be protectionist laws/regulations that may provide a speed-bump, for example:
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Holy Basil: What Does (And Doesn’t) It Do?
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First, a quick clarification:
- Ocimum sanctum is the botanical name given to what in English we call holy basil, and is what we will be discussing today. It’s also called “tulsi“, so if you see that name around, it is the same plant.
- Ocimum basilicum is the botanical name given to culinary basil, the kind you will find in your local supermarket. This one looks similar, but it has a different taste (culinary basil is sweeter) and a different phytochemical profile, and is certainly not the same plant.
We have touched on holy basil before, in our article:
Herbs For Evidence-Based Health & Healing
…where we listed that it helps boost immunity, per:
It’s popularly also consumed in the hopes of getting many other benefits, including:
- Calming effects on the mood (anti-stress)
- Accelerated wound-healing
- Anticancer activity
So, does it actually do those things?
Against stress
We literally couldn’t find anything. It’s often listed as being adaptogenic (reduces stress) in the preamble part of a given paper’s abstract, but we could find no study in any reputable journal that actually tested its effects against stress, and any citations for the claim just link to other papers that also include it in the preamble—and while “no original research” is a fine policy for, say, Wikipedia, it’s not a great policy when it comes to actual research science.
So… It might! There’s also no research (that we could find) showing that it doesn’t work. But one cannot claim something works on the basis of “we haven’t proved it doesn’t”.
For wound healing
Possibly! We found one (1) paper with a small (n=29) sample, and the results were promising, but that sample size of 29 was divided between three groups: a placebo control, holy basil, and another herb (which latter worked less well). So the resultant groups were tiny, arguably to the point of statistical insignificance. However, taking the study at face value and ignoring the small sample size, the results were very promising, as the holy basil group enjoyed a recovery in 4 weeks, rather than the 5 weeks recovery time of the control group:
Herbal remedies for mandibular fracture healing
An extra limitation that’s worth noting, though, is that healing bone is not necessarily the same as healing other injuries in all ways, so the same results might not be replicated in, say, organ or tissue injuries.
Against cancer
This time, there’s lots of evidence! Its mechanism of action appears to be severalfold:
- Anti-inflammatory
- Antioxidant
- Antitumor
- Chemopreventive
Because of the abundance of evidence (including specifically against skin cancer, lung cancer, breast cancer, and more), we could list studies all day here, but instead we’ll just link this one really good research review that has a handy navigation menu on the right, where you can see how it works in each of the stated ways.
Here’s the paper:
An Update on the Therapeutic Anticancer Potential of Ocimum sanctum L.: “Elixir of Life”
Want to try some?
We don’t sell it, but here for your convenience is an example product on Amazon 😎
Enjoy!
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Having dense breasts is linked to cancer. But advice about breast density can depend on where you live
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Having dense breasts is a clear risk factor for breast cancer. It can also make cancers hard to spot on mammograms.
Yet you might not be aware you have dense breasts, even after mammographic screening.
In Australia, advice for women with dense breasts and their health-care professionals can be inconsistent and confusing.
This is because there’s not currently consensus on whether women who have dense breasts, but no symptoms, benefit from further imaging such as ultrasounds. Concerns include potential cost of these tests and the risk they can produce false positives.
Gorodenkoff/Shutterstock What is breast density?
Breasts are made up of fatty tissue and fibroglandular tissue (including glands that make milk, held together by fibrous tissue).
On a mammogram – an x-ray of the breast – fibroglandular tissue appears white and fatty tissue appears dark. The white areas are referred to as breast density.
Fibroglandular tissue shows up white on a mammogram. Nata Sokhrannova/Shutterstock A higher proportion of fibroglandular tissue means your breasts are dense.
There are four categories to classify breast density:
- A: almost entirely fatty
- B: scattered areas of fibroglandular density
- C: heterogeneously or consistently dense
- D: extremely dense.
Breast density is very common. Around 40% of women aged 40–74 are estimated to have “dense breasts”, meaning they fall in category C or D.
What’s the link to cancer?
Breast density is associated with the risk of breast cancer in two ways.
First, breast density usually decreases with age. But if a woman has high breast density for her age, it increases her likelihood of breast cancer.
One study looked at the risk of breast cancer over the age of 50. It found there was a 6.2% risk for the one-third of women with the lowest density. For the 5% with the highest density, the risk was 14.7%.
Second, breast density “masks” cancers if they develop. Both cancers and breast density appear white on a mammogram, making cancers very hard to see.
Breast cancer screening saves lives through early detection and improved treatment options. But we don’t yet know if telling women about their breast density leads to earlier cancer detection, or lives saved.
In Australia, screening mammography is free for all women* aged 40 and older. This is run through BreastScreen Australia, a joint national, state and territory initiative. Those aged 50-74 are invited to have a mammogram, but it’s available for free without a referral from age 40.
However, the messages Australian women currently receive about breast density – and whether it’s recorded – depends on where they live.
What does the advice say?
In 2023, the Royal Australian and New Zealand College of Radiologists updated its position statement to recommend breast density is recorded during screening and diagnostic tests in Australia and New Zealand.
Meanwhile BreastScreen Australia says it “should not routinely record breast density or provide supplemental testing for women with dense breasts”. However this position statement is from 2020 and is currently under review.
Some state and territory BreastScreen programs, including in Western Australia, South Australia and soon Victoria, notify women if they have dense breasts. Victoria is currently at an early stage of its roll-out.
While the messaging regarding breast density differs by state, none currently recommend further imaging for women with dense breasts without speaking to a doctor about individual risk.
What are the issues?
Providing recommendations for women with dense breasts is difficult.
The European Society of Breast Imaging recommends women with extremely dense breasts aged 50–70 receive an MRI every two to four years, in addition to screening mammography. This is based on a large randomised controlled trial from the Netherlands.
But the Royal Australian and New Zealand College of Radiologists describes this recommendation as “aspirational”, acknowledging cost, staffing and accessibility as challenges.
That is, it is not feasible to provide a supplemental MRI for everyone in the screening population in category D with extremely dense breasts (around 10%).
Further, there is no consensus on appropriate screening recommendations for women in the category C (heterogeneous density).
We need a national approach to breast density reporting in Australia and to do better at identifying who is most likely to benefit from further testing.
BreastScreen Australia is currently undergoing a review of its policy and funding.
One of its goals is to enable a nationally consistent approach to breast screening practices. Hopefully breast density reporting, including funding to support national implementation, will be a priority.
*This includes those recorded female at birth and who are gender diverse.
Jennifer Stone, Principal Research Fellow, School of Population and Global Health, The University of Western Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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A Guide to the Good Life – by Dr. William Irvine
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“Living well” is a surprisingly underrated part of wellness. We spend much of our lives in turmoil. Some of us, windswept and battered by the storms of life; others, up in quietly crumbling towers, seemingly “great” but definitely not feeling it. Diet and exercise etc will only get us so far. What else, then, can we do?
For Dr. Irvine, the key lies in two main things:
- Deciding how we intend to live our life (and doing so)
- Remaining tranquil in the face of external stressors
In Japanese terms, these things can be seen in ikigai and zen, respectively. This book puts them in Western terms, specifically, that of Stoic philosophy. But the goals and methods are very similar.
Far from being an abstract tome of wishy-washy philosophy, this book offers down-to-earth practical exercises and easily applicable advice. There was even an exercise that was new to this reviewer who has been reading such things for decades.
The writing style is also, true to Stoic principles, unpretentious and simple. This is an easy book to read, while being nonethless very engaging from start to finish—and thereafter!
Bottom line: so far as we know, we only get one shot at life, so we might as well make it a good one. Applying the ideas found in this book can help any reader to live better, and take more joy in it along the way.
Click here to check out a Guide to the Good Life, and live your best!
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Knee Pain Going Down Stairs? Probably Reversible (Here’s How)
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It’s probably not arthritis. Even if you have arthritis, then if you’re getting pain going downstairs and not up, then it’s probably actually this:
Getting eccentric
Why downstairs hurts but upstairs does not: walking downstairs loads your quadriceps eccentrically—your muscles are lengthening under load—which is harder to control than the concentric work used going upstairs, and weakness here commonly shows up as pain at the front of your knee.
The reason that this is so common is because daily life mostly trains concentric muscle action, and with more sitting and less movement over time, overall quadriceps strength—especially eccentric control—declines.
Fun fact: one head of your quadriceps crosses your hip, so prolonged sitting can make it tight and less effective, often causing stiffness or ache in the front of your hip, and reducing your ability to control your knee when stepping down.
This means that if your hip muscles are not working well, your knee may drift inward when you step down—called a valgus force—which increases stress on your kneecap, and causes that familiar pain at the front of your knee.
How to test it: when walking downstairs, hold a handrail and watch whether your knee collapses inwards as you load it.
How to fix it: you can restore proper hip movement with mobility work and strengthening your hip abductors—the muscles on the side of your hip—to keep your knee aligned and reduce patellar compression (see the “learn more” below for more details on an excellent exercise for that, that doesn’t even require any equipment, nor getting on the floor).
For more on all of this meanwhile, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like:
The Only Exercise You Need To Strengthen Every Hip Muscle (Ages 50+)
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The Exercise That Protects Older Adults From Cancer
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The relationship between exercise and cancer has sometimes been laden with confusion, and in particular, it was long popularly believed that exercise accelerates cancer once it occurs, but now it seems that’s not the case.
You might have read about that, and specifically about how a research team (Dr. Alice Avancini et al.) analysed data from 22 randomized controlled trials (total n=968 participants) that investigated the effects of exercise on various pro-inflammatory biomarkers (mostly interleukin variants, but also c-reactive proteins) that are known to increase breast cancer reoccurrence risk.
What they found was:
❝Exercise induced small to large significant reductions in IL-6 (SMD = -0.85; 95% CI = -1.68 to -0.02; p = .05) and TNF-α (SMD = -0.40; 95% CI = -0.81 to 0.01; p = .05) and a trend for a decrease in CRP.
When stratifying by exercise mode, trends toward reduction in IL-6 and TNF-α were observed for combined exercise, whilst changes were not generally affected by exercise program duration❞
The “combined exercise” mentioned?
Aerobic exercise and resistance training.
This is important, because as regular 10almonds readers may remember…
What Your Metabolism Says About How Aggressive Cancer Is Likely To Be For You ← this makes a huge difference to survival chances
So, this study’s findings are very consistent with that, because:
- Aerobic training increases cardiovascular fitness, improving metabolism
- Resistance training increases muscle mass, improving metabolism*
*because muscle “costs” calories to maintain, prompting an increase in metabolism, whereas fat prompts our metabolism to slow, to conserve energy to face the obvious food shortage that must be coming
See also: Stop Cancer 20 Years Ago
Exercise & aging muscle
Yes, we said “older adults” specifically in the title, and now we’re getting to that part!
Most recently, another team of scientists (Dr. Jun Nishiyama et al.) that healthy skeletal* muscle acts as an anti-tumor organ, releasing tiny particles called extracellular vesicles (EVs) that help suppress the development of tumors.
*This means the muscles that move your skeleton, as opposed to different kinds of muscle such as, for example, the smooth muscle that operates the peristaltic motion of your intestines, or that forms the main part of the walls of your uterus (if you have one), or that wiggle your ears, and so forth.
As muscles age and lose mass (per sarcopenia), they produce fewer of these vesicles. The vesicles that are released also contain lower levels of a molecule (known as miR-7a-5p to its friends) that normally helps restrain tumor growth. As a result, aging muscle can lose a lot of its natural cancer-fighting ability.
The good news is that exercise appears to reverse part of this process. The researchers found that physical activity reactivates a biological pathway involved in EV production, restoring the release of protective signals from muscle.
In other words: exercise more (be it with aerobic activity or resistance training, though ideally both), and greatly reduce your risk of cancer.
You can find this paper in full, here: Sarcopenia promotes tumorigenesis by disrupting NOTCH-SDC2-regulated biogenesis of muscle-derived extracellular vesicles
Want to learn more?
You might like this excellent book we reviewed:
Moving Through Cancer – by Dr. Kathryn Schmitz
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‘Sometimes you need to eat an entire cucumber’: nutrition experts on the viral TikTok trend
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“Sometimes you need to eat an entire cucumber.”
So begins a series of viral videos by TikTok “cucumber guy” Logan Moffitt, who has raked in millions of views for his cucumber salad videos. He’s also inspired thousands of copycat videos showcasing cucumbers as a hero ingredient in salads and other dishes.
This trend has reportedly caused a surge in cucumber demand, leading to cucumbers being sold out in several stores in Australia and internationally.
But what’s actually happening in your body when you eat an entire cucumber? Let’s review the science of cucumbers.
@logansfewd via Instagram Cucumbers 101
Cucumbers (Cucumis sativus) are technically fruit that belong to the gourd family Cucurbitaceae. This family includes pumpkins, melons and zucchinis.
Cucumbers originated from India over 3,000 years ago. They grow on vining plants and are typically harvested while still firm and unripe.
Cucumbers are mostly water (96%), which is why Logan Moffitt has been described as the most hydrated person on the internet.
Based on our calculations using the Australian Nutrient Reference Values, if you “ate an entire cucumber” (300g), you would consume:
- about 11% of your daily carbohydrate needs (an important energy source)
- about 5% of your daily fibre needs (fibre aids in digestion and gut health)
- more than 50% of your daily vitamin K needs (important for bone health and blood clotting)
- about 10% of your daily vitamin C needs (important for immune health, skin health and wound healing)
- about 10% of your daily potassium needs (potassium regulates blood pressure and helps with muscle function).
Unsurprisingly, there are no modern scientific studies that have specifically examined the health impacts of consuming an entire cucumber daily.
However, cucumbers also contain cucurbitacins (especially in the skin) which researchers think may help with inflammation and could be a potential anti-cancer agent.
More broadly, people have used cucumbers to:
- help in digestion and weight loss
- support heart health
- reduce pain from sunburn and swelling on the skin.
Can cucumbers help with hydration?
Given they’re about 96% water, cucumbers could meaningfully increase daily fluid intake when eaten in moderate amounts.
For example, an entire cucumber (about 300g) would contribute roughly 288 millilitres of water, which is just over one cup. We need plenty of water each day, so this additional intake could be helpful for some people.
Their high water content, combined with essential electrolytes like potassium, makes them a refreshing snack, especially in hot weather or after exercise.
While cucumbers can contribute to daily hydration, they shouldn’t replace drinking water. Adding cucumbers to meals or snacks could be a tasty way to stay hydrated, but you still need to drink water.
Can someone eat too many cucumbers?
Cucumbers can be a great addition to a healthy diet. Yet, relying on them too heavily might have unexpected downsides.
Cucumbers are generally easy to digest and low in fermentable carbohydrates (FODMAPs), which means they are unlikely to cause bloating for most people in moderate amounts.
However, when eaten in large amounts, some people may experience digestive discomfort, especially if they’re sensitive to fibre or have a history of irritable bowel issues.
Being low in carbohydrates, fats and protein, cucumbers are unsuitable as a primary food source. In other words, you can’t just live on cucumbers. They don’t provide the essential nutrients needed for energy, muscle maintenance and overall health.
If someone were to primarily eat cucumbers over an extended period, they could be at risk of undernutrition. https://www.youtube.com/embed/ZmXMLh006yU?wmode=transparent&start=0
What about adding MSG ‘(obviously)’?
Many of the cucumber-based dishes on TikTok also include ingredients such as garlic, soy sauce, fish sauce, sesame oil and sugar – all well known to home cooks who like to boost flavour in their own dishes.
Moffitt is also fond of saying “MSG, obviously”, when listing his favourite cucumber salad ingredients.
MSG is monosodium glutamate, also known as food additive 621, an umami substance added to enhance the flavour of many Asian dishes.
Despite past scare campaigns about MSG, it is safe and authorised for consumption in Australia and other countries.
Typically, MSG is consumed at about 0.5g per serving, but some people report sensitivities at higher doses, such as over 3g.
It’s also worth noting that many foods – including tomatoes, mushrooms, and parmesan cheese – naturally contain glutamate, the main component of MSG.
So, should I eat an entire cucumber?
Well, like any food, moderation and variety are key.
Cucumbers are a refreshing and hydrating addition to a balanced diet, and work best nutritionally when paired with ingredients from other food groups.
For example, to create a balanced meal, try combining cucumbers with protein-rich foods like tuna, chicken, eggs, or marinated tofu, along with whole grains such as wholemeal bread, pasta, or rice. This combination will help you to consume essential nutrients for sustained energy and overall health.
And if you are looking for tailored dietary advice or a tailored meal plan, it’s always best to speak with an accredited practising dietitian.
Lauren Ball, Professor of Community Health and Wellbeing, The University of Queensland and Pui Ting Wong (Pearl), PhD Candidate, Culinary Education and Adolescents’ Wellbeing, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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