‘Skin Them Like in a Computer Game’: In 2024, Is Plastic Surgery OK?

It will make me feel better, in the same ephemeral way I feel better when I dye my hair, when I wear a great outfit, when I have a fresh set of nails or when I buy a new pair of shoes. It will make me feel better in that same fleeting, vapid, gluttonous way – the queasy feeling of consumption because you can, the sparkling feeling of updating your avatar skin. 

Body modification as a form of self-expression is not new. But in a cosmetic doctor’s world, the human body is a wad of clay, born to be sculpted. Has the potential to adjust, tweak or reduce our features with the slice of a knife or the prick of a needle broken something deep at the core of our human experience? Has it all gone too far?

Cosmetic doctors are not asking this question.

When I asked Dr Naomi McCullum, a Sydney-based injectables doctor, whether there were any procedures she frequently wished were possible, her answer, in all its point-blank macabre, assured me such:

“I wish I could make eyes further apart, I wish I could make eyes more projected. I wish I could make hair thicker or remove or shrink skin without a scar. I wish patients had the option to assign themselves whatever skin tone they desired. I could go on and on,” she said. 

“I wish human anatomy was different, I want blood vessels in a different place so that some of my favourite filler procedures would have a lower risk. Honestly, I wish we had total control over our real-life avatars – our superficial appearance – and could skin them like in a computer game.”

Skin them like in a computer game. It's where we are likely headed. Many of these “fixes” will become possible in our lifetimes.

For now, we can experience them through face filters on TikTok and Instagram. A slight smoothing of the skin, bigger lips, smaller nose, sharper cheekbones – we can come face to face with our potential higher selves, and then we can present them to the online world.

Cosmetic surgery has come a long way in the past two decades – in terms of safety, advancements in procedures, the tastes of the consumer, and the success of the service in burrowing into the mainstream.

In 2023, we watched Kardashian butts deflate, the mass disappearance of celebrity buccal fat and the proliferation of lips flipped up to the point where drinking can only be achieved through a straw. In the ocean of body modification, you don’t even speculate about a celebrity’s surgery any more. It’s just a given that they’ve done something. Everyone has. So if there is an endpoint, where is it?

For Doctor Steven Liew, a specialist plastic surgeon who founded the Shape Clinic in Sydney’s Darlinghurst in 2005, the ultimate goal is eternal youth. 

“Nowadays, with a lot of technology and understanding, we can slow down and improve the age-related changes to the face. We can also improve muscle tone, as well as maintain the fat. One thing we can't do is to stop or slow down body ageing,” he told VICE.

“I think the future's bright and I'm sure at some stage we will find some sort of injectable that will slow it down. And once we do that, once we achieve that… It's the Holy Grail.”

Plastic surgeons naturally have a proclivity for biblical references; they are playing God. But the metaphor rings true because, under Western Capitalism, we are all afraid of expiring. Instead of dismantling the system that discards us once we are deemed useless for generating profit, those who can afford it simply get some filler and pretend it isn’t happening.

Dr McCullum was specialising in psychiatry in her 20s before she switched to a career in cosmetics. 

“When I look at people, I think I subconsciously register a list of ‘flaws’ from most relevant to least relevant. It's hard to explain.”

“Botox arrived in Australia and of course I went and had a treatment, and at that first cosmetic appointment I was like, ‘yes!’ and saw my whole future immediately.”

“I also see people's ‘future faces’, like how they will be in 10-20 years. However, I don't have judgement relating to beauty, it is just angles and proportions that I'm observing, so it feels more like doing maths in a way.”

Facial reconstructive surgery is on the other end of the spectrum, where Dr Liew began his career. But he believes it isn’t dissimilar from elective, cosmetic reconstructions. 

“Most great plastic surgeons worldwide who perform cosmetic surgery have come from a background of plastic reconstructive surgery because they are both interlinked… Without that artistic acumen that you've learned from scratch, you will never be able to create or perform great cosmetic surgery.

“Imagine having to reconstruct a nose,” he said, “when the entire nose has been removed because of cancer, or has been destroyed from trauma. Imagine having to reconstruct the entire face that has been burned, where all you can see is everything's completely charred and scarred up. Imagine having to reconstruct breasts that have been completely removed after breast cancer, where all you have is a flat surface.”

If God created us in his image, cosmetic doctors continue the work by putting us back together. 

“There is no doubt that facial reconstructive surgery is a pure art form,” Dr Liew said. 

Before choosing a medical career, Dr Liew wanted to work in fashion, but his conservative background pushed him to pursue “a proper job”. He said he found creative expression within cosmetic surgery.

“Everything that we do as a plastic surgeon is visible, unlike other forms of surgery – abdominal surgeon, chest surgeon, heart surgeon, a neurosurgeon – everything's internal, whereas as a plastic surgeon, everything that we do is open to criticism and display.”

“Everything we do has to meet the main objective that everyone will notice, but no one will know.”

But Dr McCullum said students training to be cosmetic surgeons aren’t taught how to design a face. 

“The artform aspect is a huge missing link in our field and it shows,” she said.

So is the comparison between art and injectables that much of a stretch? Or are injectables just another form of technology?

Dr McCullum said she was driven by seeing patients “optimise their function in their lives”. 

“The juice for me is seeing patients optimise their function in their lives because we have transformed their appearance. They show up to the world differently: happier, at peace, more motivated and ready to just achieve their goals. How incredible to be a catalyst for that.” 

If I wasn’t getting filler, I’d still be spending money every month on lip liners and glosses. Women should be free to do whatever they choose with their bodies – even, unfortunately, when that involves moulding themselves to fit a beauty standard that is undeniably prescribed by the patriarchy and its systems. It’s shallow, but it's also expression.

It’s creation. I’m creating the reality I want for myself – I think.

I’m tweaking my algorithm to optimise myself better for the world.

“I love this quote,” said Dr McCullum, “‘There is no perfect beauty that hath not strangeness in the proportion’.” 

“And this is something I respond to when looking at people. It's like there is an algorithm for beauty, but in this algorithm there are also wildcards, rulebreakers and surprises.”

“Rulebreakers and surprises” aside, the beauty algorithm just so happens to be favoured by the algorithms that guide our consumption. We are all being sucked into one big averageness feed, whether we consent to it or not. Choice is just an illusion.

Arielle Richards is the multimedia reporter at VICE Australia, follow her on Instagram and Twitter.