Intended for healthcare professionals


The best version of you—says who?

BMJ 2024; 384 doi: (Published 30 January 2024) Cite this as: BMJ 2024;384:q218
  1. Margaret McCartney, GP
  1. Glasgow

“The best version of you”; “The confidence you deserve”; “Age refined”; “Fight the signs of ageing”—I challenge you to go on social media or open a glossy magazine and avoid similar exhortations, which are usually selling something.

This isn’t about clothes, haircuts, or nail varnish but about cosmetic medicine. It used to be a medical fringe activity, the stuff of rent-by-the-hour clinics in Harley Street. Now these messages are mainstream, coming from GPs and dentists who do some NHS clinics mixed with some private aesthetics. The result is numerous private clinics, operated by healthcare professionals. The outcome: wouldn’t a bit of filler, botox, or non-surgical enhancement, with some pseudoscientific mumbo-jumbo-ology, suit nicely?

I despair for the generation to whom this is presented as normal. To whom a standard visit to the hairdresser includes the offer of something injectable. To whom a dental visit isn’t just about tooth decay and function but about “natural rejuvenation and a more attractive facial appearance.”

I’m not talking about restorative treatment for people with damaged teeth—cosmetic dentistry may be a route to feeling back to themselves. The interventions dentists can do to restore methadone damaged dentition, for example, are remarkable. But I feel sorry for the younger customers who are targeted. For this is something different: the feeling that it’s ordinary, expected, or even essential to seek “tweakments,” that your face can always be improved, that the ageing process is something to disguise, trick, and disavow—and that it’s an equally valid use of highly trained professionals’ time to do this rather than provide the care they were primarily trained for.

Buying into the delusion

This is a race to the bottom. We talk about our horror of young children becoming aware of societal preferences for beauty. But if older adults in the room agree that there’s nothing wrong with a little prescribed fix here and there, we’re buying into the same delusion: that we must all be someone else’s version of perfect.

Occasionally, young women attend my GP clinic and ask me to recommend them a surgeon, as their boyfriends say that their thighs are too fat, their stomachs are too wobbly, or their arms aren’t well toned. No way. There’s certainly bodyweight to be shed in that relationship, but it’s never hers. Doctors should be speaking up against this, not buying into it. If we do buy in, it’s a betrayal of all the people with bodily insecurities who have decided to pay no attention to societal beauty standards and to prioritise what really should matter in life. (None of this means that I don’t care about the way I look—I very much like clothes, handbags, and hairdressing, but none have to be prescribed by a medical professional.)

Yet clinicians who deal in cosmetic medicine will say that they have happy customers, behave ethically, and enjoy using their skills in a less pressurised environment. Yes, freedom of choice is important. But what it means is that fewer professionals are available for patients with healthcare needs. The workload stacks up for those left in the NHS, making it an even less sustainable place to work.

As the pressure to attain a particular appearance affects ever more people, a standard of beauty is developing that’s unattainable without “getting something done.” When we tell our children that “you’re perfect just the way you are,” do we believe that? And do we believe it enough to demonstrate that we, too, will avoid the knife and the needle?