Botox business is booming

Boobs, botox and a booming business

A young woman’s smile, flawless skin, delicate nose with perhaps a trace of worry in her eyes, pictured under the words: “When will your man start seeing a younger woman?”

The advert, recently thrust through the letterboxes of householders in north London, contains a cunning piece of marketing speak – does it seem almost inevitable that your man will start “seeing” a younger woman? Why not become that younger woman, it urges. The advert is for botox injections.

The Highbury-based clinic’s flyer is one of a steady stream of adverts for what are termed non-surgical cosmetic treatments that breach the Advertising Standards Authority’s guidelines. The clinic’s botox treatments are classed as Prescription-Only Medicine by the Medicines and Healthcare products Regulatory Agency, for which direct advertising to customers is banned altogether.

Olivia Campbell from ASA said: “Although we don’t get lots and lots of these, they do pop up on a steady basis. Mostly they are by small firms who either don’t know the code or deliberately flout it.”

She said the restriction on advertising also covers other licensed medicinal treatments such as Viagra, for which the firm AMI recently fell foul for placing prominent billboard adverts for “longer lasting sex” across London.

Adverts for surgical procedures such as breast resizing or facelifts have also come under fire. In September, adverts showing a picture of an unhappy, flat-chested woman alongside a second picture of her with a wide grin and substantial breasts, and another unnaturally shaped woman alongside the line “Gorgeous breasts just got easy with cosmetic surgery” were pulled by the ASA.

The British Association of Aesthetic Plastic Surgeons, BAAPS, warned against “anatomically impossible breasts” and the suggestion of “lunchtime facelifts” or “easy” surgery.

“Surgery is a serious undertaking which requires realistic expectations,” it said, recommending that adverts should only include real life cases, not professional models, enhanced or otherwise.

It also criticised clinics that offer discounts for clients that signed up for surgery quickly and those that downplayed potential problems, encouraging people not to think about the consequences.

The use of cosmetic surgery and non-surgical treatments has rocketed over the last five years, propelled by a combination of falling prices, easy credit and celebrity endorsements, such as Kylie’s use of botox. The industry, which topped £1billion last year in Britain, carried out 230,000 treatments like botox or collagen injections in 2005, doubling to 472,000 in 2006. Surgical operations have tripled from 10,700 in 2003 to 34,100 last year, according to a survey of BAAPS members.

A growing number of men are also having treatments, from reshaping the nose or chin, to brow lifts, wrinkle reductions or liposuction.

The industry has benefitted from a virtuous circle of media coverage and increasingly overt advertising. Advertisements in Britain have risen from 132 in 2003 to 417 in 2007. The industry has moved from something deemed unpleasant, somewhat reprehensible and rarely admitted, to something commonplace. A Liverpool radio show even offered a free breast enhancement awarded by public vote to the contestant with the best reason for wanting a “new pair of funbags.”

American psychotherapist and author Catherine Baker-Pitts said advances in technology and an image-obsessed, visual culture were to blame.

She said: “The advertising market sells cosmetic treatment as empowerment and appeals to women’s desires to take control of their bodies. The irony of course being that surgery involves risk and complications, and while under anaesthesia there is a total loss of control.”

Even non-surgical treatments presented as ‘botox parties’ are presented as something for a fun, champagne-quaffing, feel-good, girl-bonding exercise, rather than injecting a poison, Botulinium, into the skin.

Celebrity culture and fantasies of perfection, as seen by television programmes like The Swan, I Want a Famous Face, Plastic Surgery Live and many others have all “normalised” the idea of reshaping the body as deemed necessary.

“The paradox is that women seek cosmetic surgery but aim to emerge looking ‘natural.’ Clinics emphasis the work involved in maintaining an acceptable female image, yet this work is meant to be invisible,” Baker-Pitts added.

The need to reappraise and if necessary alter the body is also driven by billboard, newspaper and magazine images that are increasingly unreal. Cover shoots are no longer model+photographer but the complex result of teams of stylists and experts, lighting and digital manipulation that enhance the model’s image beyond what is naturally possible.

On one estimate, we see between 2,000 and 5,000 images a week that have been digitally manipulated or ‘Photoshopped.’ While incidents such as Kate Winslet’s complaint about being slimmed for the cover of GQ magazine make occasional headlines, it is utterly routine – the March 2008 edition of Vogue contained 107 adverts and 36 fashion pictures including the cover that had been digitally altered. One highly sought-after re-toucher, Pascal Dangin, said: “It is known that everybody does it, but they protest. The people who complain about retouching are the first to say, ‘Get this thing off my arm.’”

Baker-Pitts said: “Even when consumers know that retouching happens, these images seep into our unconscious lives. Just as someone might binge eat or start planning their next diet in response to emotional distress, now people are turning to a cosmetic makeover, a sizeable distraction, to avoid uncomfortable feelings.”

A recent press release from Transform, one the UK’s largest cosmetic surgery clinics, trumpeted: “How to avoid redundancy during the credit crunch – get a boob job!” claiming that “while millions are struggling to buy food, pay for fuel and cloth themselves, boob jobs are playing a bigger part in our society.”

For as long as companies are able to exploit women’s insecurities or subconscious desires – and for as long as women allow them to – that is likely to be the case.


[This article originally appeared in The Big Issue, April 2009]


Early Intervention

Illustration: Holly Wells -

The Laming report into child protection published last week revealed that the most vulnerable children at risk are still not adequately protected. The report blamed the slow pace of reform, bureaucratic and legal complexities, and the immense pressure on social workers that leads to a high turnover of staff and 3,000 unfilled positions.

The fact is that with time and budgets constantly squeezed, local authorities can only ever care for a fraction of those thought to be at risk. Of 11million children in England in 2008, social services directly intervene in the lives of around 125,000. A further 200,000 children live in households where there is a known risk, and 235,000 are children in need of local authority support – but their circumstances never quite cross the threshold of “significant harm” to warrant action.

Over the last few decades, a picture has emerged of millions of parents whose chaotic lives – often drink or drug addicted, or with severe mental health problems – inflict physical and emotional abuse on their children. Growing up with fear and uncertainty around them from a young age, these youngsters all too often become the abusers and neglecters of the next generation.

Between 1971 and 1991, single parent families rose from four per cent, or 2.1million, to six per cent, or 6million, according to the Office of National Statistics’ Social Trends report. By 2007 it was 12 per cent, almost 7million.

There were 8,700 permanent and 363,450 temporary exclusions from state schools in 2007. Some 4.4 per cent of pupils are regarded as “persistent absentees”, typically missing 20 per cent or more of their school days. The rate of absence among the poorest families with children eligible for free school meals was almost triple that of the rest of the school population.

Hardships at home lead to emotional difficulties which flare up at school leading to exclusion. Leaving school with few – if any – qualifications restricts opportunities to find gainful employment and can lead to unemployment, homelessness, and crime.

It is perhaps no surprise then to find that youngsters in the criminal justice system are more than 80 per cent likely to have suffered family breakdown, neglect or abuse, and this is reflected in the adult prison population. A Social Exclusion Unit survey of the prison population in 2002 found nearly a third had been in local authority care, a third of women and almost half of men had been excluded from school, more than half of men and nearly three quarters of women had no qualifications. Almost three quarters had two or more mental health problems, and a fifth “severe” problems. A third of women in custody had suffered childhood sexual abuse.

All the while reoffending rates remain higher than ever – three quarters of young men convicted in 2004 reoffended within two years, at an annual cost to the country of £11 billion.

Efforts to reach those whose lives seem to rebound between care, crime and custody, are increasingly treating the matter as an issue of public health, not justice and retribution. But though the statistics and the science support this view, public policy has been slow to follow suit or to dedicate meaningful sums to tackling the problem.

For example, the government’s much vaunted investment in early years care has seen investment of £250million nationwide, while its plan to build a series of Titan super-prisons holding 2,000 offenders each is projected to cost £2.7billion.

Social organisations, charities and government are all searching for novel ways to interrupt this vicious circle.

Illustration: Holly Wells -
Illustration: Holly Wells -

A pilot scheme launched in Nottingham last year early shows the government has picked up on the ideas of ‘early intervention.’

The aim, the council said, is “to break intergenerational underachievement and deprivation” by finding those children and families at risk and getting to them quickly, on the understanding that healthcare, crime and justice costs in the future will far outweigh the cost of social care now.

The scheme in Nottingham, where 38,000 children live in families on benefits or very low incomes, includes efforts to tackle drug and alcohol use by children and their parents, the families of adult offenders, teenage pregnancies, help for young mums and single mums, homelessness and a mentoring project.

The scheme focuses on little victories that make a difference, as well as large ones. For example, the city has experienced a 15 per cent drop in persistent school absences. Dana Knight, 11, was bullied and increasingly refused to go to school. She had found it hard to fit in after moving from primary school – a common problem –and suffered low self-confidence. Elaine’s older brother also missed school, often associated with younger siblings following the same route, prompting support workers involvement.

Her mum Elaine said: “Dana was missing one or two days a week. It got to the stage where she just would not go in. She would say she had a tummyache or headaches but I noticed it was often on certain days.”

Among other things, the scheme gives financial aid to help families solve problems, even simple things such as paying for a bus pass for mum Elaine so she could take Dana to school in the morning.

Dana said: “I would feel sad on Sundays and start shouting at my mum but my mum takes me to school now.” And she has high hopes for the future. “I want to be a vet,” she said.

In the nine schools in which the scheme is being trialled, absence is down 14 per cent.

Graham Allen, Labour MP for Nottingham North, said: “To fix an intergenerational problem, policies need to be in place for a whole generation.”

With a change of governments, he said, must come an understanding that early intervention is no “costly bureaucratic dream”, but “a proven, positive plan that will save us money, and crucially transform the life prospects of our most vulnerable citizens.”

That Allen has co-authored reports with Iain Duncan Smith MP, chairman of the Centre for Social Justice thinktank at the heart of the Conservatives’ recent approach to social policy, shows that perhaps that broad political base is building.

Kids Company based in south London has for 13 years opened its doors to children who come for help, without the need for referral by a social worker. Almost by word of mouth alone, the charity has expanded its outreach into 33 schools, with more than 200 staff and 11,000 children and teenagers on the books.

The charity’s purpose is to be the family these children have lacked, offer the love, attention and feeling of safety that has often been absent from their lives. Mentors are assigned to each child, working as parent, friend, and teacher.

Director Camila Batmanghelidjhs’ ideas, built up over a 20-year career in social work and psychology, are supported by a substantial body of scientific evidence that demonstrates how childhood trauma affects the developing brain.

“Social and emotional deprivation is creating a new kind of brain,” she said. “The element linking all these childrens’ lives is the absence of a functioning parental figure. If you don’t have a parent there is no food in the house, no one washes your clothes or organises socialising for you, you don’t get taken to the GP, the dentist or the optician. You live in chaos.”

Kids Company’s neuroscientist, Max Benjamin, explained their current advertising campaign comparing brain scans from traumatised and unaffected children.

“Adults have the tools to cope with stress, our brains are able to regulate our response to stressful situations. But for children whose brains are still developing, childhood trauma disrupts those mechanisms,” he said.

“Faced with violence or fear, a child’s stress response becomes hyperactivated – their flight or fight response becomes automatic because the child’s brain is changing to help it survive in a hostile environment. It doesn’t switch off. This leads to behavioural problems, emotional problems and extremely aggressive behaviour.”

The ‘flight or fight’ response floods the brain with hormones like adrenaline and cortisol, but if this is sustained – such as in cases of severe, long-term abuse – parts of the brain that deal with memory, learning and emotional response become damaged or fail to develop properly.

Childhood trauma literally changes the wiring of the brain, increasing the chances of learning difficulties, educational failure and subsequent social exclusion.

“It has far-reaching implications for social care, and in terms of crime and justice, instead of locking them up and giving them Asbos, children with a history of trauma need rehabilitation and removing from the cycle of violence,” Benjamin added. “Reoffending is sky high. Punitive interventions just don’t work.”

The damage, however, though especially devastating before the ages of five or six, is reparable though it takes time.

Batmanghelidjh warned: “It’s not an argument for absolving kids from responsibility, but equipping them to take responsibility with techniques to balance their emotions.”

Their techniques appear to work: a University of London evaluation in 2007 showed that of those Kids Company helped, 89 per cent were helped to move away from crime, 81 per cent went into education or training, 79 per cent reported better emotional wellbeing, and 69 per cent better relations with their families. The charity is credited as the source of the Conservative’s recent “hug a hoody” approach to social justice.

For some boarding school is synonymous with privilege, rather than social need. But a project matching children struggling at home or school with boarding schools shows that some of the most needy can benefit from the schools’ rarefied environment.

While councils have long been able to fund assisted boarding places for children it was largely used as an alternative to care. However, the government’s Boarding Pathfinder scheme begun in 2006 introduced 18 local authorities and 80 schools to the idea that boarding school could benefit a far wider range of youngsters in difficult but less dire circumstances.

The scheme’s evaluation in January found children at boarding schools can benefit from “a strong ethos of personal and social development and access to many extra-curricular activities, as well as opportunities for educational success.”

But progress has been slow, with only 17 of the 76 children identified as potentially suitable for the scheme being placed at boarding school, and just 11 still at their schools after a year.

Many children considered were ruled out because they were not seen as capable of coping away from home, or boarding didn’t appeal to the child or family, or because their needs were seen as too high – suggesting the scheme is likely to exclude the children most in need.

One schoolgirl, Zoe, was 14 when she began at boarding school a year ago and is now taking her GCSEs. Her mother, Sarah, said: “She was a complete pain in the neck, smoking, drinking, arguing. One evening she punched me when she wouldn’t get off the computer. I was at the end of my tether.”

Through their local authority, Zoe was offered a place at a small boarding school in Norfolk.

“I think the main thing for Zoe is not having to switch between school and home, she couldn’t cope with the transition from one to the other,” Sarah added. Now she has to get along with everyone because she can’t just run away and not come in the following day.”

The school allows no mobile phones and little television. “It’s back to basics, it forces them to communicate with one another,” Sarah said. “She’s gone back to being a schoolgirl from being a rebel.”

Zoe, who has been granted funding to do her A-levels at a different boarding school, said she felt a different person.

“I realised I was out of control but couldn’t stop myself,” she said. “I’ve changed so much, I feel more sane, happier, more like a normal kid rather than a wannabe rockstar.

“It’s a much smaller school and they can lay down the law because they know who’s done what. I’d hate to think what would have happened to me – probably scraped a couple of GCSEs and be struggling to get a job. Now I want to go to university and study journalism.”

Paul Spencer-Ellis, headteacher at the Royal Alexandra and Albert School in Reigate, Surrey, is already familiar with Pathfinder’s aims. “Well, we’ve been doing it since 1760,” he said.

The school is one of a handful of state boarding schools, originally an orphanage, that has taken charity or local authority-funded pupils for more than 250 years.

He said: “It’s a very good idea. Other school heads can see it makes sense. At its simplest, we ensure the children get up, eat breakfast, get to school, eat lunch, have some activity in the afternoon, do their homework and are put to bed. Ask the head of a comprehensive if this will help his problems, he’ll say: of course. We are being the parents, giving them structures and boundaries.”

For the eight years he has been headteacher, funded pupils have been among the top achievers.

“When children are going off the rails it will help,” he said. “They have to want to do it, you can’t impose this on them. But they realise that education is their way out, and grasp the opportunity with both hands.”


[This article originally appeared in The Big Issue, April 2009]