Poor Philippa of Hainaut! After 12 children, the 14th century queen of England developed what may have been dropsy and congestive heart failure, which caused massive swelling and bloating.
Her husband Edward III was not exactly Mr. Understanding. Theirs was a noble political marriage of respect. But Edward was a womanizer. He had already caused a scandal by raping the Countess of Salisbury and now he had a young mistress -- Alice Perrers -- who was said to use black magic to restore his potency. The legend goes -- probably apocryphal but it's a good story -- that as Philippa lay dying, her bloated body covered by specially woven tapestries to hide her sprawling flesh, Edward shuffled up to her deathbed, reached for her swollen hands and began pulling the rings off her fat fingers to give to his lithesome mistress.
If Philippa lived today, doctors could diagnose her congestive heart failure and prescribe digitalis and diuretics to reduce swelling. In short, there is a medical fix for women like Philippa. The treatment would not only address her physical problem but also in the current medical lingo enhance her quality of life.
It is this latter role of life enhancement that has pushed the medical profession beyond the treatment of disease to the forefront of the youth and beauty business. No longer is the search for the fountain of youth the preoccupation of poets and latter-day Ponce de Leons. Appearing to be all that you can be has become a legitimate medical specialty made up of a burgeoning pool of beauty docs who are drawn from the ranks of dermatology, endocrinology and plastic and reconstructive surgery.
In the annals of looking-good therapy, the development of Retin-A wrinkle-blocking cream is the cosmetic equivalent of the discovery of penicillin. Finally physicians have something in their black bag that is noninvasive and relatively harmless to treat one of the most common signs of aging -- fine wrinkles caused by exposure to sunlight. The anti-aging product was introduced with all the medical fanfare usually reserved for a new AIDS drug or heart transplant technique: A scientific paper in the respected Journal of the American Medical Association. An elaborate press conference. And front-page headlines the next day.
Which is why the Retin-A boom is in full swing. Pharmacies can't stock enough of the miracle potion. All it takes is a physician's prescription to purchase what is seen by many men and women as a one-way ticket to permanent youth. With Retin-A, the beauty business becomes thoroughly medicalized. In fact, its discoverer has founded a Center for Human Appearance at the University of Pennsylvania.
But not everyone approves of this new line of work for doctors. To many health experts, there is a danger for doctors when the line gets blurred between treating disease and making people look better. "It undermines the professionalism of physicians," said Dr. Sharon Romm, assistant professor of plastic and reconstructive surgery at Georgetown University Medical Center and chief of plastic surgery at the Veterans Administration Hospital. "The physician becomes like a cosmetic vendor, wearing a white smock behind a counter instead of a white coat in the office."
No one would dispute that it is the proper role of physicians to improve the appearance and thereby enhance the quality of life for people who suffer a major illness or traumatic accident: The badly scarred burn victim who receives skin grafts, for example, or the cancer patient whose breast is recontoured after surgery.
What's more, advances in plastic surgery over the past decade have helped many people with significant deformities. These same techniques have also improved the appearance of those who just wanted to change the shape of a nose or chin or lift up some sagging jowl.
In the process, however, society may be raising unrealistic expectations for 99 percent of the population.
"The emphasis on staying young pushes one to ignore reality," said Dr. Alan Levenson, chief of the department of psychiatry at the Arizona Health Sciences Center in Tucson. "We build into the culture a self-fulfilling prophecy of failure. With that there is a sense of loss of self-worth, a loss of self-esteem."
Cosmetic surgeons are well aware that a number of people who want to change their appearance have a hidden agenda. These patients think that once they have different-sized breasts or a reshaped nose, their problems in life will disappear. Their marriage will suddenly be happy, their career will take off, their popularity will soar. But beauty is, well, only skin deep.
"Yes, people look better, but they are still the same person inside," said Levenson. "It doesn't necessarily change how people will react to them."
Most candidates for major cosmetic surgery undergo a psychological assessment to make sure they don't have unrealistic expectations of what the operation can do. Patients with hidden agendas are not suitable candidates for cosmetic surgery.
Now Retin-A offers a medical fix for millions seeking to change their appearance. Unlike those getting a face lift or a tummy tuck, Retin-A addicts are unlikely to get psychological counseling for any hidden agendas they may have. This in turn sets the stage for disappointment en masse.
Cosmetic companies have long exploited people's wrinkle angst, from Tuscany mud baths to Elizabeth Arden's Visible Difference. In advertising products, the beauty industry has always promoted appearance as the ticket to happiness. As one cold-cream ad pounded into the American female psyche more than 30 years ago: Lure a man. Sure, you can. The most fabulous thing happens to a girl who tries Ponds . . .
Consumers expect that kind of hype -- and hope for happiness -- from the cosmetic industry. The goal, after all, is to sell beauty salves. But Retin-A, as a prescription drug, has not only the medical seal of approval but the involvement of physicians. That means instead of seeking the new and improved you in a beauty salon, people can now look to their physician as the grand wizard of happiness.
Cosmetic changes have limits. And so does medicine. Remember Philippa of Hainaut. Today's doctors could clear up her swelling and even prescribe a little Retin-A to smooth her face. But her problem was not just medical -- or even cosmetic.
Philippa's main problem was that she was married to a jerk.