For many South Africans, adjusting one's physical features has become as easy as getting a spa treatment. Is this progress? Or the symptom of a culture of senseless narcissism? Shanthini Naidoo investigates Ever looked in the mirror and frowned at that wobbly bit just under your chin?Firstly, don't frown; it's bad for your forehead.Secondly, ask yourself whether this imperfection (according to current ideals) is an inseparable part of your physical identity, or an unwelcome and easily removable blob of surplus matter?Your answer may depend on your self-esteem. But contemporary culture urges the latter response. And in an increasingly narcissistic society, more and more South African women (and men) with money to spare are choosing to adjust their faces - using a wave of new methods that are subtler and less risky than the surgeon's scalpel.story_article_left1That flabby bit, bluntly called a fat pad, is apparently so distressing to some that removing it has become a common cosmedic (non-surgical, medically administered cosmetic) procedure. It can cost around R40 000 to lose."It makes a big difference to someone who is bothered by it every morning," says aesthetician Dr Anushka Reddy. "The procedure involves injecting a lipolytic or fat-dissolving agent and fillers to firm up the jowls. It will tighten up the area with a few treatments."She demonstrated on a patient, an attractive 40-something lady whose fat pad I had not noticed.After a dose of local anaesthetic, about 30 long needles were inserted into the offending area, where a man might grow a beard (great way to cover up a fat pad, a beard).Some of the needles contain threads, the latest technology in cosmedics. These are sugar proteins that act as a sort of scaffolding for the skin.It looked painless, bled slightly and pinched only where the anaesthetic had worn off. Slight swelling is a side-effect and the results would show in a few weeks.The patient said if it firmed up the underside of her chin, she would look and feel slimmer and more youthful.full_story_image_hleft1Reddy, president of the South African Association of Cosmetic Doctors, says small tweaks via cosmedics are already mainstream. So much so that millions of men and women all over the world consider them part of their regular beauty routine.Her own office is a hybrid of a surgery and a spa - there is a consulting table in white leather, a silky pink cushion with diamanté trim, a pebble feature and a wheely surgical tray where the vials and needles go."It is a splurge, on a natural look, without going under the knife. We live in such a competitive society that looking youthful is almost as important as power dressing for the corporate world. People want to look good for as long as they can," Reddy says."We see men, women, of all races and people in their 20s onwards. Good genes don't mean you don't need something done - but the need arises later on for some of us."With darker skins, we see pigmentation and there are these lines around the mouth, rivulets that give the appearance of unhappiness. Who wants to look unhappy? We can get rid of them with fillers," Reddy says.sub_head_start The new wave of cosmedics sub_head_endCosmetics, globally speaking, is a R1.2-trillion business. The money that goes into researching anti-ageing could rival that which is spent on medical science - and in fact there is a crossover.story_article_right2There has been massive investment in the development of active ingredients in anti-ageing creams, seemingly alive with microscopic wrinkle fighters. Some cost R10 000 a bottle. This industry and the common, false advertising that goes with it, such as suggesting a cream can restructure one's DNA, are vigorously challenged by regulatory authorities.The new wave of cosmedics is led by the use of injectables, also known as mesotherapy - the injection of plant extracts, vitamins or chemical compounds.If you have a bothersome fat pad, bat wings, flabby jowls or sad lines, there are several options.Micro-needling involves piercing tiny holes in the face to bruise it and encourage cell growth. Vampire facials deploy your own blood plasma, injected into the skin to plump it up.Not forgetting chemical peels. Radio frequency therapy. Light therapy and galvanic current therapy. Scalp micro-pigmentation to hide baldness.Some of the treatments are stranger than fiction: there are face masks made using placenta, bee venom, 24-carat gold, sperm and urine.sub_head_start The risks sub_head_endIf a cosmedic treatment is done well, an observer might not detect any signs of it. But on close inspection, most people can tell if someone they know has been fiddling with their face.One somatologist (or health and beauty therapist) commented: "You only have to visit Hyde Park mall to see the bad effect of all this technology. Elderly ladies in high heels with fake boobs and too-plump lips, shiny foreheads from all the Botox. Why do we put up with this? We are starting to look ridiculous, like gargoyles."mini_story_image_vleft2Reddy says the gargoylism problem arises because the industry is not regulated. "The problem with this selfie generation and collective narcissism is that everyone wants to do it and try it. Cosmedica has become the Wild West of medicine. Unqualified people are doing it and overdoing it, getting it wrong. The effects are so obvious," she says.Of course, the experts do not want their clients to look like they had a run-in with a wall at the age of 35. It is bad for business.Says a thirty-something skeptic: "I have a most beautiful friend who started with Botox and fillers just because it is the norm in our circle. She looks so smooth and shiny - waxy, almost. I struggle to recognise her sometimes. It makes me want to keep my frown lines, thanks."Bunny lines appear on the nose (wrinkles near the bridge) when a person smiles because the rest of the face is frozen by Botox, which paralyses the muscles.A waxy appearance. "Blow job" lips that can't curl into a smile. Fillers that make a person look like she is eating ping-pong balls. All side-effects of botched or clumsy procedures.Apart from the aesthetic blunders, the risks include permanent paralysis of muscles and in the worst cases, blindness. Incorrectly applied fillers that clog the wrong duct can be fatal. Reddy says blunders are common in countries where these procedures are done cheaply, and in cultures where they are part of everyday beauty regimens.Addiction to face-altering is also not uncommon. Extreme addictions to plastic surgery are well documented, such as the cases of men who aspire to be Human Ken Dolls. One of them, Justin Jedlica, underwent more than 100 surgeries to resemble the plastic figurine.mini_story_image_vright3Johannesburg clinical psychologist Jana Morgan says body dysmorphic disorder might be the reason some people make constant adjustments to their faces and bodies. The psychiatric disorder occurs when people mistakenly believe they have abnormal features and, often, want them "corrected"."A person with a 'normal' nose believes it is enormous and it needs surgery for fixing. Often times, the dysmorphic area is then shifted to another body part, because procedures to fix 'problematic areas' do not address the underlying emotional and psychological issue," she says.An unwillingness to age and aspiring to unnatural versions of oneself are subtler, and not so much mental disorders as cultural mind-sets. Alterations and adjustments have become the norm - hair extensions, artificial nails, constant makeup and extreme body-sculpting through exercise - and injectables are becoming part of this "new normal"."Simple societal pressure is a more well-known area of concern, and an explanation as to why people try and change their faces and bodies to look a certain way. Suddenly 'normal' means looking like a supermodel, not like an ordinary, good enough person," says Morgan.sub_head_start Can cosmedics boost your confidence? sub_head_endRetired nurse Maria Khumalo (not her real name), wants to get rid of her "sad lines" in time for her 70th birthday party. She read about fillers in a magazine her niece buys. Khumalo has spent about R6 000 on her first round of treatment."I just wanted to look good, for my old self. I am happy with it. It is expensive, but what can you do?"I've seen some ladies my age on TV and they look so smart, for example Winnie Mandela, look how beautiful she is. She is older than me. We have to take care of ourselves. I haven't told anyone - it is my secret. If people ask, I just leave them and say, thanks. I am going to surprise everyone at my party."If we are so concerned about how we look, why pretend we don't care about beautification?Helene Bramwell, a Johannesburg cosmetologist who started in the beauty industry 45 years ago, has seen its evolution from the days when acne treatment involved a hot towel over a bowl of steaming water laced with herbs."It is a whole new trend now, but it is the same underlying reason. During the war they sold more lipstick than ever. Why? It makes a person feel better."A man or woman must wake up pleased with how they look. It sets the tone for the day. The older generation has to be out there in the world, we are just not retiring at 55 any more. If you have a flaccid neck and need to lift it at a surgeon, by all means do it. It's like getting a hem in your skirt. Just don't over-hem above the knee if you are of a certain age," she says.Reddy speaks about Hollywood actress Renée Zellweger's recent transformation. "She had some work done, obviously, and it hadn't settled in. Which is why she looked taut, swollen. Done properly, she would look great."Here is the thing: Zellweger is 45, says she is healthy "for the first time in her life" and the photos with which the tabloids compared her current face were taken 12 years ago.Is society asking us not to age, or to treat ageing as if it were a disease?full_story_image_hleft4"Scientifically speaking, these treatments cannot make you feel beautiful. But maintaining youth seems to be part of the platinum lifestyle. Is it wrong?" Reddy asks. "Women in their 50s want that fab factor, they know they can look amazing. Celebrity culture tells them that."It starts off in the head - how we feel about ourselves. That is why the world over, more plastic surgeons are doing less-invasive procedures and there is a huge jump in non-surgical treatment. It is a safe, non-permanent fix," she said.story_article_right3Jana Morgan, a clinical psychologist, says cosmetic, cosmedic or surgical changes to the face and body could work both ways on the psyche."If a person has confidence, esteem or inferiority issues, adjustments won't make a difference. If you do not improve the psychological issue, the changing of your exterior self won't fix emotional problems. But if getting rid of a few wrinkles makes you feel more confident, that is a positive psychological effect and then adjustments are a great idea."Bramwell says guilt still surrounds self-preservation . "That is the one thing that I think is part and parcel of the beauty industry. We want it but we won't admit it. Why not? We won't lie that we have cut our hair."Besides, she says, it is mentally therapeutic. "One hour in professional hands has a very positive effect on the psyche. It is the best mercy in the world. Cancer patients in the ICU feel like a new pin after having a facial. This business that 'I'm too old to look good' is absolute nonsense."Reddy says: "There is this worry that 'I'm being vain'. But it is the more educated and informed women and men who know how to look out for themselves. Sales executives, corporate older men who want to compete with the younger guys at the boardroom table."There is a stigma about vanity, nobody wants to admit to committing this 'sinful act' to improve themselves. Women hide it from their husbands - they have secret Botox stashes. Part of it is that they want others to think that they look this good naturally."At face value, it seems middle-class society is heading towards a uniform representation and preservation of beauty. Fixated on youth and unwilling to embrace the process of ageing, we forget that laugh lines and greying hair are naturally beautiful, too.Follow the author of this story; Shanthini Naidoo on Twitter @ShantzN..