The body is not a toy. Interview with Dr Cédric A. George.

In the past, we used to look in the mirror, today we have video conferencing in the home office. You look at yourself from below, see a double chin, the sagging skin around your eyes. Plastic surgeons call this "zoom dysmorphia", referring to the negative self-image that people can develop when they spend hours looking at themselves through the camera of their laptop or mobile phone.

Couldn't an injection help people to tolerate their own image better? the demand for cosmetic surgery is increasing rapidly. According to figures from the International Society for Aesthetic Plastic Surgery, more than 33 million procedures were carried out worldwide in 2022. That is 40 per cent more than in 2018.

There are no such statistics for Switzerland, but Cédric George says things are moving in a similar direction. George is a plastic surgeon and the doctor in charge at the Pyramide am See clinic in Zurich. He founded the private clinic in 1993, and today the Centre for Plastic Surgery performs 1,000 to 1,500 aesthetic procedures there every year.

Mr George, you are a plastic surgeon. Aren't you the kind of doctor who injects lips, sucks out fat and enlarges breasts? Does your profession have a bad reputation?

The problem starts with the term cosmetic surgeon; it's not a protected title, any doctor can call themselves that. So it says nothing about your qualifications. I am a trained plastic surgeon who also performs cosmetic surgery.

So the sector lacks respectability?

There are colleagues who think they are gods and can recreate people. Sometimes you see figures walking around and I say: Not like that! The problem is the injection-moulded faces, where no surgery has been carried out, only sagging skin has been filled in. These people look like balloons. And this creates a false image of our industry, which actually works on a stable and serious basis.

Can you paint a more accurate picture?

I try to fill the profession with meaning. As a plastic and aesthetic surgeon, for example, I do a lot of tumour surgery. I remove the cancer from the breast and then have to make sure that it is restored. Plastic surgery comes from traumatology; during the First World War, many soldiers suffered severe mine injuries to their faces. At that time, doctors learnt how to repair these people. This gave rise to aesthetic surgery. It is defined by the fact that there is no compelling medical reason for an operation. It is elective surgery. Let's focus on cosmetic surgery. From a global perspective, it is a billion-dollar industry. The demand for certain procedures such as a tummy tuck is growing at double-digit rates.

What has happened?

People see what's being done on Tiktok and Instagram and they want it. At the same time, there is now a provider on almost every corner. General practitioners, dermatologists, gynaecologists, they can all offer aesthetic procedures and some of them use very aggressive marketing.

Supply or demand, which came first?

The basic human need to be beautiful is ancient. Diane de Poitiers, the maîtresse of King Henry II of France, swallowed gold back in the 16th century because she believed it would stop the ageing process. Fortunately, today we have better options to fulfil these wishes, which have always existed.

What is most in demand at your clinic?

There are weeks when I only tighten tummies and weeks when I mainly reduce the size of breasts. There is no bestseller. Of course, I'm getting older and my clients are getting older, so the demand for facelifts is increasing.

How much does a facelift cost?

There is a lot going on under this heading. There are doctors who cut open the ears, pull the skin back and stitch it up again. However, a real facelift involves the whole face plus neck. Such an operation takes three to four hours and costs around 25,000 francs. With eyes we would be at 30,000 francs.

How do you come up with such a price?

I have to look at the operation: How much work is involved? How much safety do I build in? If you want to do it right, the biggest cost items are the infrastructure and the staff. Let's stay with the facelift: here, for example, the chef must also be informed about the operation so that he prepares a meal that the patient doesn't have to chew. Compared to other countries, Switzerland has a high density of doctors offering aesthetic procedures.

Is competition a problem?

There is healthy, normal competition, which is important in a free market, thanks to it you stay fit. And then there is the competition that is destroying the market: self-proclaimed specialists with very good marketing. There are clinics that offer their patients a bulk discount on Botox injections if they bring someone with them. There's one in Lucerne with a campaign called Busenfreundin: bring two people and you'll get a discount on a breast augmentation.

What do you say to that?

Motivating people with money is stupid. There are colleagues who work with banks. The customer comes to the practice, signs a form from this institution and then receives the money for the operation.
Completely wrong.

Is there quality control for aesthetic procedures?

No, there isn't. You can only constantly monitor who has how many satisfied customers. And then there are the Google reviews, which aren't that bad. They create transparency.

Anyone who types your name into Google will find a single rating: 5 stars. The Centre for Plastic Surgery has no reviews.

At least we don't feed Google with false reviews, because that also exists.

In the financial world, a lot is currently centred around cryptocurrencies, while everyone in the tech industry is talking about artificial intelligence. What are the biggest innovations in your field?

That would probably be tissue engineering. We can now grow artificial tissue from stem cells. A 3D printer will one day mould certain implants from this - using the patient's own cells! Sounds futuristic, but it is feasible. We will move away from artificial materials more and more in the future.

There have been a lot of reports recently about the new Ozempic and Wegovy weight loss injections. Some doctors are praising the injections as a miracle cure. What do you think?

I'm sceptical about that. We still know too little about any long-term side effects.

Do your patients ask about the injections?

That does happen. Then I always say: You'd better buy yourself a cross-trainer and go hitchhiking for 45 minutes every day. Don't eat spaghetti for dinner and you'll lose weight. I'll put both my surgeon's hands in the fire for that!
in the fire!

You refer to your patients as your customers. Who are the people who keep your business going?

All over the place, there really is everything. There is a difference in gender when it comes to aesthetic procedures: 80 per cent are women, 20 per cent are men. The demand for cosmetic surgery is also increasing among younger people. Young people are coming to us less, we are too reserved for that. But take a look around Zurich and see how many young people have injected lips, piercings and tattoos. These are all aesthetic procedures where a needle goes into the skin. This trend worries me. The body is not necessarily a toy.

But you could be happy: what you describe are your customers of tomorrow.

As a doctor, I don't treat fashion trends. A medical service must not be used exclusively for self-optimisation, there has to be a certain amount of suffering. Pricked ears are a good example: they are not a deformity per se, and yet we all find it normal when we fold a boy's ears back.

You once said: "Not everything that is desirable is feasible, and not everything that is feasible is sensible." When do you say no to a potential deal?

When the risks are greater than the probability of achieving the desired result. Sometimes people come to me and want me to lift the tip of their nose by three millimetres. Three millimetres, that's microscopic! Then I always say that we are doctors and not sculptors. It may be that the wound healing process changes the shape of the nose and it is still not three millimetres higher afterwards.

We keep reading about the shortage of skilled labour in the healthcare sector. Do you feel it?

Definitely. It starts in administration, medical practice assistants and medical secretaries are in short supply. It's also very difficult in nursing.

What are you doing about it?

Fighting, searching, optimising working conditions. But it's not easy. The subsidised hospitals offer higher salaries and more holidays, and we keep losing employees to them. We can't keep up because we have to earn every franc we spend.

What is the situation with doctors?

It is no longer so easy to find well-trained young doctors who have a certain attitude to their work. Look, if you're a doctor, you can't finish work at 5 pm. A surgeon has to be there for his patients, this principle comes first. In the nineties, I had a mobile phone C, a phone that was as big and as heavy as a suitcase. And I always had it with me. Always. So my patients could reach me. Today they have my mobile phone number.

What does that have to do with young doctors?

Young people want a work-life balance, a nine-hour day and then a weekend off. When I was a senior doctor at the university hospital, there was a weekend shift that lasted from Friday evening to Monday morning. And the regular shift started on Monday morning, even though I might not have slept properly for two or three nights. That was normal back then. Today, only a few young doctors still have this feu sacré.

Interview with Janique Weder, NZZ