Addicted to Beauty

Beauty ideals have survived the millennias of years. We still find the sculpture of the Egyptian queen Nefertiti attractive today and the Greco-Roman statues still exude plenty of eroticism in modern times, or, for example, the painting “Maja desnuda” created by Goya in 1795 still has a sensual effect today. There is probably a genetic basis for what we classify as “beautiful”. However, we also know that standards of attractiveness are created by socioculturally established “ideals” [1]. Humanity has always been concerned with the subject of beauty, which is impressively represented by traditional art and literature [2]: In ancient Egypt, beauty was associated with divinity, which was also reflected in ancient art [3]. Archaeological evidence of cosmetics was discovered in the tombs of the ancient Egyptian pharaohs, and beauty was glorified beyond death: sophisticated embalming techniques were used to ensure that the deceased looked good in the afterlife [3]. In ancient Greece, beauty also embodied the divine, the best example of this is Aphrodite.

Sociocultural influences have shaped what has ultimately been established as “attractive” [1]. In this context, there are certainly different norms and ideals of beauty in different cultures. It is certainly strange that in countries with a surplus of food there is an ideal of slimness, while in countries where there is starvation, full-bodied citizens are considered desirable [4,5]. In many traditional societies, obesity is considered a sign of wealth and health, for example among the semi-nomadic Moors in the Sahara, who have cultivated a female ideal of extreme obesity for centuries [6]. In modern societies in Europe, Asia and North America, however, a very slim body type is considered attractive, as is portrayed in most media [7], although advertising has recently discovered that slightly fuller people are also a target group for advertising. Since preferences for “beauty” definitely influence the choice of partner, it has also developed through sexual selection [8], and good-looking people are known to have advantages in this respect. The fact that studies have found a cross-cultural consensus on the perceived attractiveness of faces supports this selection theory. Certain preferences are therefore part of our biological rather than our cultural heritage [4,9]. One indication of this are beauty characteristics such as facial symmetry or feminine female features in female faces and masculine features in male faces, which will be discussed in more detail below [10,11].

The role of the media

The increasing popularity of social media plays a crucial role in the development of an addiction to beauty. Media not only creates pressure to conform to a desired appearance, but also provides an additional and increasingly relevant platform for bullying when societal beauty ideals are not achieved. For example, 30.7% of male and 36.3% of female adolescents between the ages of 12 and 17 report having been bullied in the past [12]. The possibility of bullying and the proclamation of beauty ideals through the Internet have thus taken on new dimensions, which have found expression in so-called “body shaming” [13]: Body shaming involves unsolicited, usually negative comments about a target’s body. Body shaming can range from well-intentioned advice to truly malicious insults and mostly takes place via social media. Overall, body shaming represents a form of social aggression that has negative effects on the individual [14]. According to another online survey, 94% of female and 64% of male adolescents said they had been victims of body shaming online [15].

In order to conform to beauty ideals, the images are edited accordingly before they are published online. In this context, the terms “digitalized dysmorphia” and “Snapchat dysmorphia” have been developed, since the face can be optimized instantly by using special mobile phone programs such as Snapchat, Instagram, etc. [16]. These programs can create, for example, smooth skin, a small snub nose, large eyes, long eyelashes and full lips in no time at all while taking a “selfie”, i.e., a photo of yourself (Figure 1).

Figure 1:Left is the original real photo, right is editing with the smartphone app PhotoDirector.

In addition, programs such as Photoshop or Photo Director can be used to adjust both the face and the body to the ideal of beauty before it is published on social media [16]. The incongruity between the optimized online appearance and the real appearance naturally creates dissatisfaction and is associated with the development of anxiety disorders, body dysmorphic disorders and problems with behavior and emotion regulation [16-18]. The divergence between the ideal of beauty propagated by the media and the actual appearance is not a new phenomenon. Before social media became so influential, advertising and television constantly propagated new beauty norms that had a negative impact on body satisfaction [19,20]. There is a strong connection between the frequency of social media use and the development of body dysmorphic disorder [21]. Body dysmorphic disorder refers to a disorder of the perception of one’s own body. It describes a subjectively perceived ugliness that is not perceptible to others but causes a great deal of suffering [22]. The development of “Snapchat dysmorphia” has sparked a debate about the de novo emergence of body dysmorphia [18]. The suffering of not drinking alcohol in our society is relatively low, although people often look at you strangely if you don’t drink anything at all. In contrast, the suffering of not looking good in a country of beauty can be considerable, especially among young people.

Addictions

When you think of the topic of “addiction”, most people initially think of drug or alcohol addiction, but there are many more forms, such as gambling, shopping, bulimia, internet, collecting, or sex addiction. Basically, people can become addicted to anything that causes the reward system in the brain to release happiness neurotransmitters. It is therefore not surprising that there is also an addiction to beauty. In 2023, Germans spent around 28.4 billion euros on alcoholic beverages [23], while the beauty sector in Germany recorded sales of around 7.4 billion euros [24]. This area is growing steadily, which can be attributed to increasing social pressure. It is striking that around 86% of people who undergo cosmetic surgery are women, which indicates a clear gender difference. With alcohol addiction, the opposite is true, with statistically there being around 2.5 men for every woman addicted.

How many people do you think lie on the operating table under the scalpel every year to look more beautiful? According to the International Society for Plastic Surgery, there are almost 500,000 in Germany alone, with the top treatments being anti-wrinkle injections, breast enlargement with implants or breast lifts for sagging breasts, liposuction and tummy tucks.

Examples

The story of a 28-year-old travel agent on Instagram highlights the risks that can come with an addiction to beauty. What started as a nose job led to a series of other cosmetic surgeries: breast augmentation, upper eyelid surgery, liposuction on the legs, lip injections, and regular hyaluronic acid and Botox treatments. Eventually, she realized that she had become addicted to cosmetic procedures, which prompted her to actively work to overcome this addiction and break the vicious cycle of constant physical changes. This type of addiction is not uncommon in an age where social media and the emphasis on external beauty can put a lot of pressure on individuals. The travel agent’s story is representative of many who have to conform to beauty standards in their private lives (e.g., singles) as well as in their professional lives, and shows the psychological consequences of such an obsession. Another wellknown case study of a person who became addicted to cosmetic surgery is the story of Cindy Jackson. Cindy holds the record for most cosmetic surgeries and has had numerous procedures since the 1980s, including facelifts, rhinoplasties, liposuction, breast augmentation and many other cosmetic procedures. Her story has been documented in countless media outlets and also studied to understand why people can go to such lengths, as most of these procedures are painful. Cindy Jackson herself has explained in interviews that she originally began her surgeries to improve her self-perception, but over time these procedures became a regular part of her life. She stresses that her “transformation” did not begin from an initial addiction, but she now recognizes the risks and the type of psychological dependency that can accompany constant cosmetic surgery.

Extreme examples of a downright addiction include the Spanish Duchess of Alba, who had so many cosmetic surgeries that she ended up looking more like a human cat, or Jocelyn Wildenstein, who reportedly spent over 4 million euros on cosmetic procedures. Angelika Vollrath, the German Living Barbie, has had her lips operated on seven times and today admits that, despite a multitude of aesthetic procedures, she is very afraid of getting older.

What is beauty?

“Beauty is in the eye of the beholder” is a popular saying; this is basically true. It is surprisingly difficult to define beauty objectively, because not only the aesthetics of the object itself, but also the effect on the other person is crucial. The assessment of the beauty of another person takes place in an astonishingly short period of time; apparently just 13 milliseconds are enough for our brain to decide whether they are “pretty or ugly”. It has also been proven that attractive people unconsciously receive a more positive assessment in the first 3 to 5 seconds after meeting them. The beauty of the face is the strongest predictor of perceived overall attractiveness [25].

When it comes to the question of which face is judged to be more or less beautiful, we return to ancient Greece, where symmetry was defined as one of the most important indicators. The different parts of a face should be in a certain ratio, the golden ratio, to each other so that maximum beauty could be achieved. According to the theory of proportions, for example, the width of the face should be two thirds of its length and the distance between the eyes should be exactly the width of the eye, which in turn is identical to the width of the nose. Symmetry probably serves as an indirect indicator of fitness, indicating good genes for the development of healthy offspring [26]. As already mentioned at the beginning, from an evolutionary biological point of view, an asymmetrical face is probably not considered as attractive, as it can reflect genetic damage. This also includes skin blemishes. An absolutely clear face without pimples promises physical health and reproductive ability. Evenly applied make-up creates exactly this impression [27].

However, recent research refutes this symmetry hypothesis at least in part. Super symmetrical faces, which are generated by mirroring one half of the face, are not particularly attractive, sometimes even perceived as frightening, strange or even mask-like (Figure 2). According to the broken symmetry hypothesis, a slight asymmetry is perceived as more attractive; typical examples are asymmetrical hairstyles or the beauty spots that were glued on in the 17^th century [28].

Figure 2:Left: a right-symmetrical face, middle: the real original face and right: the reflection of the left side of the face.

Figure 3:Over-optimization of the childlike parts of a face, such as in Japanese manga characters. This makes women appear more childlike and feminine, but men do not appear more masculine.

A second theory states that we consider faces to be attractive when they are closest to the average. This may sound boring, but it makes sense from an evolutionary biology perspective. Using morphing techniques, such an average face can be calculated. According to studies by Langlois and Roggman, attractiveness is highest when the proportions are close to the mathematical average of the basic population. Accordingly, an attractive face only represents the arithmetic mean of the population [29]. However, it would probably be really boring if we simply found mediocrity beautiful. The attractiveness of the average face can at least be increased: a significant improvement is achieved in women’s faces, for example, by having a smaller nose, larger eyes and a smaller chin than average. Basically, this corresponds to the child schema postulated by the behavioral biologist Konrad Lorenz, according to which typical childlike characteristics elicit positive reactions in the observer, such as the protective instinct. As a result, men also attribute childlike characteristics to an adult woman who fulfills these criteria of a child schema, e.g., youthfulness, untouchability, health, innocence and also trustworthiness. However, fulfilling the child schema alone is not enough to make a woman sexually attractive, i.e., the corresponding secondary sexual characteristics of the maturing woman must be added. Only the right interaction with characteristics of sexual maturity then increases attractiveness [30]. However, it must be pointed out that not every (potential) partner necessarily desires a child schema woman; there is certainly a market for resolute and dominant women who go through life assertively and self-confidently (Figure 3).

Beauty research has long focused on women. But what makes a man attractive? The more childlike attributes a male face has, the less attractive it is perceived by women. Here, features such as a large chin, high cheekbones, deep eyebrows, narrow eyes and lips, and strong beard growth are in the foreground. However, these attributes only correspond to the theory of sexual dimorphism. According to this, women’s faces are considered particularly attractive if they look typically feminine. Conversely, male faces are considered particularly attractive if they have masculine features [31,32]. In recent decades, there has been diversity, particularly in the Western world, in which gender differences are increasingly being leveled out. Ultimately, men and women should be completely equal and we should pay attention primarily to a person’s character, which, however, requires an elaborate image of the other person and therefore takes up more energy and time than subconscious processes, which represent the first path of assessment.

However, another factor in the assessment of beauty has remained, and this is the affective state. A positive expression, especially a smile, naturally always increases the attractiveness of a face [33] (Figure 4).

Figure 4:Optimization of the typically masculine physique of men.

A beautiful face alone is usually not enough in the assessment. The body shape is also subject to beauty standards in our society. Reference values here are the body mass index (BMI), and for women also the waist-to-hip ratio (WHR), which now reflects the ratio of hips to waist. Being overweight is often associated with a negative assessment (at least in the western world). The waistto- chest ratio (WCR), i.e., the ratio of chest width to waist, also plays a role in the attractiveness assessment of female bodies. In men, broad shoulders, long legs and strong muscles are primarily attractive. These proportions are also probably millions of years old; they promise that the man is a good hunter and can feed his family with protein-rich food and protect them [34,35].

The addiction to be beautiful has advantages

“Beauty is the best letter of recommendation,” said the Greek philosopher Aristotle almost 2,000 years ago. Pretty women in particular receive more positive attention. Today, many studies show that being perceived as beautiful can be extremely advantageous. Aside from better chances of choosing a partner, beauty is associated with a higher socioeconomic status and popularity, and attractive people are also considered to be more intelligent [4,5].

In various scientific studies, good-looking people have been attributed more desirable personality traits, such as being intelligent, kind, active, successful, sensitive, open-minded, curious, humorous, lustful and flexible. Characteristics such as sociability and assertiveness are also more likely to be associated with pretty people. Apparently, a narrow face, medium mouth and eye size, close-fitting ears, a high forehead, a narrow nose, a thin-lipped mouth or wearing glasses are signs of high intelligence. On the other hand, a round or long face, a low forehead, large or pinched eyes, a bulging upper lip, a dull look, protruding ears and a general asymmetry within the face are considered indicators of slightly lower intelligence. This effect is more pronounced in men than in women. However, Zebrowitz and colleagues showed in 2002 that there is actually no significant connection between the physical beauty of an adult and their actual IQ; it is an error in assessment. On the other hand, scientific studies have shown that attractive people earn more than less aesthetically looking people. Especially in job interviews, the stereotype of a connection between a person’s beauty and the attribution of positive character traits seems to be a defining factor. The misbehavior of an aesthetic person is even played down by the social environment or attributed to external conditions. Attractive people are less likely to be charged or receive a lighter sentence in court than less aesthetically looking people. Physically attractive people are attributed to greater social competence than less attractive people. A scientific study showed that people with well-pronounced cheekbones are more likely to be classified as socially competent, a medium-length chin yielded the highest scores in terms of social skills, and people with a receding chin were classified as having a weak character. However, there are gender-specific differences. Women with well-pronounced cheekbones are seen as particularly socially competent, while men with medium-pronounced cheekbones are desirable. In the spirit of emancipation, a certain trend reversal can also be seen in this area. Nowadays, women are increasingly attributed more characteristics that were previously seen as purely masculine.

Would you rather be an alcoholic or a beauty addicted?

The neurological correlates of the addiction to beauty and attractiveness are deeply rooted in the mechanisms of the brain’s reward system. When we look at a beautiful face, the nucleus accumbens in particular is activated. This neural network is a central area of the reward system that is responsible, among other things, for the release of dopamine, a neurotransmitter that plays a key role in motivation. The release of dopamine conveys a feeling of satisfaction and pleasure, which could explain why people repeatedly seek out the sight of beautiful faces and even consider surgical interventions to be perceived as more attractive themselves [36]. In addition to the nucleus accumbens, the orbitofrontal cortex (OFC) plays an essential role in the assessment of attractiveness. Studies using functional magnetic resonance imaging (fMRI) have shown that the OFC is more activated when people see beautiful faces. This activation correlates with the subjective assessment of attractiveness, meaning that the OFC not only detects beauty but also evaluates it [37].

Another important system involved in the perception of beauty is the brain’s opioid system. Research has shown that blocking opioid receptors, such as with the drug naltrexone, can lead to faces being rated as less attractive. This suggests that the opioid system plays a crucial role in enhancing the perception of attractiveness and may contribute to the development of addiction to cosmetic surgery or other aesthetic procedures [36,37].

Such findings show that the fascination with and pursuit of beauty are deeply rooted in the neurological processes that are also involved in other forms of addiction. The activation of these brain areas and systems makes it clear that attractiveness is not just a superficial matter but has profound psychological and neurological implications. Ultimately, a person can also become addicted to a woman’s beauty; one of several foundations for the development of love and long-term commitment. Alcohol addiction involves similar neurological mechanisms as beauty addiction, particularly with regard to the role of the reward system. Alcohol activates the mesolimbic dopamine system, which includes the nucleus accumbens. Consuming alcohol releases dopamine, leading to a feeling of pleasure and reward. This process increases the desire for further consumption, as the brain learns to associate the consumption of alcohol with positive feelings [38]. In addition, the opioid system is activated, which also plays an important role in reward processing. Alcohol is known to promote the release of endorphins, the body’s own opiates. These endorphins bind to the opioid receptors in the brain and produce pleasant sensations that stimulate the reward system. This dual activation - of dopamine and endorphins – increases the addictive potential of alcohol, as together they produce a strong feeling of reward and well-being that drives the desire for further consumption [39]. The orbitofrontal cortex also plays a crucial role in decision-making and reward evaluation. Chronic alcohol abuse can impair the OFC, causing sufferers to have difficulty evaluating the long-term consequences of their behavior. Instead, they become increasingly focused on the immediate reward that comes from consuming alcohol. This alteration in the function of the OFC contributes significantly to the maintenance of addiction, as the brain’s reward system becomes dysfunctional and the ability to exercise self-control and assess long-term risks is impaired [40].

In summary, alcohol dependence is characterized by excessive activation of the reward system and altered function of the orbitofrontal cortex. These changes in the brain contribute to sufferers continuing to consume alcohol despite negative consequences, explaining the strong and difficult-to-overcome nature of ad diction.

As with any addiction, it is difficult to identify on an individual basis when the line has been crossed into pathology. According to ICD-10, there are clearly defined diagnostic criteria that make it possible to identify an addiction:
A. strong desire and/or compulsion to consume the addictive substance.
B. reduced ability to control the start, amount and/or end of consumption.
C. physical withdrawal symptoms.
D. development of tolerance (loss of effectiveness) or increase in dosage.
E. increased time required to obtain the substance or to recover from the consequences of consumption, combined with the neglect of other interests.
F. continued consumption despite subsequent damage.

Even if the addiction to beauty has not been recorded in the diagnostic criteria of the ICD-10, transitions into pathological addictive behavior can hardly be denied. Where should the line be drawn between dyeing your hair, using anti-wrinkle cream on the one hand and liposuction on the stomach, breast implants or a face lift on the other? All forms of beauty treatment have the potential to become an addiction. According to Leipzig psychologist Ada Borkenhagen, this is especially true when they are met with low self-esteem, regardless of real attractiveness. One sign of this is when someone has more and more areas of the face or body treated and the intervals between treatments become shorter and shorter. As soon as one flaw has been corrected, those affected find further weaknesses in their appearance.

Substance addictions such as alcohol or drug addiction have serious and often destructive effects on the lives of those affected. They can lead to physical deterioration, social isolation, financial problems and an increased risk of various diseases. These addictions attack life piece by piece, impair health and often lead to premature death. The addiction to beauty, especially when it manifests itself in excessive use of cosmetic surgery, also carries risks. While an attractive appearance per se can indeed have social benefitssuch as better job opportunities, positive social interactions, and increased self-esteem-there is a danger that the pursuit of beauty goes too far. Many procedures can lead to physical complications and unnatural results. Underlying psychological disorders, such as body dysmorphic disorder, should be taken into account here, in which those affected remain dissatisfied with their appearance despite the procedures and subjectively discover more and more flaws in themselves.

“Her supple and long body was expressive. You felt that even if you covered her face, you could guess her thoughts and that she smiled with her legs as she spoke with her torso. Only those women who have not gone through the long winters of the North have this grace and this freedom. Her hair was dark chestnut, but from a distance it shone almost black, lying on her neck in the shape of a thick shell. Her cheeks, whose outlines were of extraordinary sweetness, seemed to be dusted with every delicate flower that lies like a mist on the skin of Creole women. The thin border of her eyelids was naturally deep dark.” Piere Louys describes the development of an addiction to a woman’s beauty very understandably in the book “The Devil is a Woman”. In the end he gives her everything and she gives him nothing - except the sight of her beauty.

The Data Governance Regulation, approved in 2022 and entering into force on 24 September 2023, aims to ensure a robust legal framework for data sharing and governance in the European Union. It establishes the conditions for the creation of data intermediation platforms, which facilitate access to public and private data, while ensuring privacy protection and compliance with the General Data Protection Regulation. Its implementation aims not only to improve the use of data for innovation purposes, but also to reduce the legal and operational barriers that hinder the circulation of data in the European internal market [33].

The desire to be beautiful is so widespread today that it seems as normal as a glass of wine in the evening for most people. It is smart to spread your addictions across many small areas, a bit of everything, so that the urge is not so noticeable. Perhaps the aphorism of Heinrich Martin (1818-1872) also warns us here: “Anyone who places too much value on external beauty shows that he lacks beauty of the soul.”

As with any addiction, you have to be careful not to overdo it. In an age in which you can modify your body to look the way you want it to through cosmetic surgery or, for example, permanent body decoration such as tattoos, there is always a danger of overdoing it. The human thinking machine between the ears works in the sense of operant conditioning in such a way that you absolutely want to repeat something pleasant that you have experienced. If you have had a nose that is too big surgically corrected and now feel more attractive, this leaves a positive neural trace in the brain. The next time you are frustrated, your mind will fall back on wanting to experience something beautiful again and then remember the positive feelings after the nose job. “Nip it in the bud” is an aphorism, you should always try to find an exit from the highway of addiction early on.

It should be noted here that the addiction to beauty is often closely associated with low self-confidence. As already shown, there is a complex relationship between social media use, body image and self-perception. Studies indicate that constant confrontation with idealized beauty standards on platforms such as Instagram can lead to dissatisfaction with one’s own body, especially among young women [41]. A dangerous trend is already emerging here, as the age for cosmetic surgery is steadily decreasing. The relationship between beauty addiction and a lack of self-confidence is particularly evident when people compare themselves too often with idealized images of beauty and develop feelings of inadequacy. Research has shown that self-objectification – the evaluation of one’s own worth based on one’s external appearance - can be reinforced by social comparisons triggered by such images [42]. In extreme cases, this can lead to an over-reliance on cosmetic procedures to meet these unrealistic standards. Studies also highlight how such behaviors can undermine self-confidence as the pursuit of “perfection” becomes unattainable and insatiable [43], simply because of the inevitable process of aging. While some people seek validation from their environment through an “optimized” appearance, this very search can paradoxically lower self-confidence as the discrepancy between real and idealized beauty becomes ever greater. This can potentially lead to addictive behavior around beauty alterations and fragile self-esteem [44].

Plastic surgeon Rolf Bartsch said in an Internet interview: “If you want to be beautiful, charisma and inner satisfaction are the most important keys. Aesthetic medicine can only provide support.” These words should be taken into consideration before going to the surgeon; people who have found their inner balance always radiate beauty.

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