January 27, 2021

You’re Not a Vanity Purchase: Dr. James Marotta

Plastic surgery gets a bad rap in America. But did you know it’s celebrated in many different parts of the world? That humans have been performing acts of cosmetic enhancement since the beginning of recorded time? In his new book, You’re Not a Vanity Purchase, Dr. James Marotta offers a deep dive into history, sociology, and psychology to show why plastic surgery is a form of empowerment, not pride.

The drive to look good is about far more than vanity, it’s about being psychologically healthy, fulfilled, and confident. As you’ll hear in today’s episode, Dr. James has repeatedly heard patients express shame and guilt about wanting to change their appearance.

They second guess themselves and worry about coming off as superficial, they’re afraid of being judged by friends and family, but Dr. James is here to say that you should not have to feel bad about wanting to look good. Enjoy.

Miles Rote: Hey everyone, my name is Miles Rote and I’m excited to be here today with Dr. James Marotta, author of You’re Not a Vanity Purchase: Why You Shouldn’t Feel Bad about Looking Good. Dr. James, I’m excited you’re here. Welcome to The Author Hour Podcast.

Dr. James Marotta: I’m excited to be here with you, Miles, thank you for having me.

Miles Rote: Yeah, this is such an interesting topic and I’m excited to dive in. But before we do, tell us a little bit about your background and what inspired you to write this book?

Dr. James Marotta: I’m a facial plastic surgeon. I’ve been in private practice for 15 years and what inspired me to write the book was really my interactions with so many patients over the years.

In particular, a few patients stuck out in my mind that inspired me to write it. People dealing with the fallout sometimes from their loved ones, from their family, from their friends–people would always plant a seed of doubt. If somebody came in and wanted to have a procedure done or was interested in changing their appearance, it would always be, “My friends think I’m crazy,” or “My daughter has told me she’d disown me if I had a facelift.” Always some kind of negativity around it.

Then, the patients who are coming in to see me, they firsthand had the experience, they had the consult, they had the information, they saw the before and after pictures, they saw that really, it’s not so scary. In the end, outcomes are overwhelmingly fabulous, and people get what they want when they come out and they don’t have to worry about becoming a different person or altered or changed.

There’s nothing freakish or macabre about plastic surgery, despite the general feeling out there. At least, from my experience and even just kind of the elevator chat, when I run into somebody and they ask me, “What do you do?” When I tell them, invariably, somebody will bring up something negative right after they had an initial kind of introduction.

“Did you see X, Y, and Z celebrity’s face, she looks strange or she looks altered.” It’s always something like that. Partly, the book was to dive into trying to help my patients navigate these kinds of issues because they really seem a little distressed over their decisions.

There was a very lovely, old, elderly patient who said to me, “You know, I’m in my 80s, my husband passed away, I have no one who is looking at me, but I care. I don’t know doc, am I vain, am I crazy? What’s wrong with me, why do I care so much?” Those words stuck in my head and I said to myself, “Why would somebody in their 80s be here, what is it about appearance that drives people to do these procedures well into their 80s with little prospect of romantic love?”

There’s got to be something more, there’s got to be a deeper biological, neurologic drive that makes people so concerned about the way they’re presenting themselves to the world, and I just needed to dive into that a little bit more and find out, not only from my patients, but for myself, what those motivations were.

Miles Rote: Let me back up a little bit. I’m one of those people that I don’t know much about plastic surgery and I do, I guess, take on that kind of negative connotation when I hear it.

Because, as you mentioned, that’s kind of the pervasive sentiment of the American culture. I do want to talk about that, and I do want to talk about how in other countries, that’s not really the case. But before we do, the story that you were telling with this woman and her desire to feel good, it’s not even necessarily just through plastic surgery, right?

Because we always are looking for ways to feel good, we’re getting haircuts and brushing our hair and putting makeup on and taking vitamins and going to tanning salons. How different really is plastic surgery from what we do in our everyday lives?

Dr. James Marotta: That’s one of the points I make in the book is that we do quite a bit of grooming to present ourselves to the world because we know how we present ourselves not only affects how others feel about us but how we feel about ourselves.

Just as we wouldn’t walk around with hair that’s unkempt and let our beards grow down to our knees or there are some who women wouldn’t dare be seen without makeup on. When you have a facial flaw or something that really bugs you, some people can’t get past that.

The difference is, surgery is a little bit more intense than going to get a haircut, but in some respects, it’s no different.

Miles Rote: Right, let’s set the table here and define plastic surgery because despite what people may believe, it really has nothing to do with the material plastic at all.

Dr. James Marotta: Absolutely, yeah. Plastic comes from the word “Plastikos” in Greek that means, to mold or change. That’s really, I think, more of the kind of the PR problems that plastic surgery has because you think about plastic, fake, phony–I think that’s kind of rubbed off and gives the profession a negative connotation just by virtue of the name.

I don’t think most people would really understand that and they might think it’s really more dealing with making people into a mold or a plastic mold or something like that, right?

A Negative Stigma

Miles Rote: Right. Yeah, it definitely carries that negative connotation. Why do you think it is that here in America, there is that negative stigma when it comes to plastic surgery wherein other cultures, it’s actually celebrated?

Dr. James Marotta: Some may say, it’s a stretch, but what I go into in the book is that really our roots in America are based on early Christian values and puritanical morays. The quaker influence was great and we learned to basically hate the body.

You may guess, in America, we’re a lot more prudish when it comes to things, even things regarding sex. Topless beaches are a common thing in Europe, they’re a lot freer with their–not in a perverted sense but they’re a lot more free or open with their bodies than we are here.

Whereas we’re somehow stilted or reserved when it comes to matters of the physical presence and I think it has to do with those roots. Beyond that, most of the time, as we talked about a little bit, is that plastic surgery, when it is portrayed in this country is portrayed in a negative light, you know?

That funny movie with Adam Sandler where he’s the plastic surgeon and he administers Botox to a patient, I forgot the comedian’s name, the female comedian but one of her eyebrows is like up at the mid-forehead and the other eyebrows is down by her feet, and it’s just hysterically funny. But you know, in a way, that’s people’s general opinion of what plastic surgery does to you.

The reality is that 99% of people seeking these procedures and having them done are everyday normal people and the results are just undetectable, natural, and something you wouldn’t necessarily even pick out of a room.

Miles Rote: Yeah, that was something that I really took from your book–realizing that number and how most of them are completely undetectable. Whereas, as you mentioned, what we typically see in the media are those very rare situations where something goes very wrong, and then it’s just everywhere in the news.

It reminded me the same way that we hear about plane crashes where it’s so rare but of course, it’s just ingrained in our brains and it’s all over the media when it does happen. Do you think that’s a big part of it is the media’s portrayal of it in America?

Dr. James Marotta: Our brains are geared to pay attention to those things that inspire fear. The amygdala is the fear center of the brain and it’s the very reason why newscasts will focus on basically the negative happenings because they grab our attention.

Just like a train wreck or car wreck that we can’t help but stare at, the plastic surgery nightmares are the train wrecks or car wrecks of the medical world. That’s why a show like Botched becomes so popular because people just can’t stop watching that kind of stuff–but is it the reality?

I think people do have a good point. Sometimes they’ll say, “Well, look at the celebrities who have had plastic surgery.” Well, if you realize, most of the people you’re talking about who you might feel had bad plastic surgery–like Kenny Rogers for example, like Mickey Rourke, like Donatella Versace. A lot of that work was done in the infancy of plastic surgery. In the 70s and 80s where techniques were evolving and they’re certainly not what we have today.

Look at the more modern-day celebrities, look at some women who are clearly well into their fifth, sixth decade and look absolutely stunning. That doesn’t happen by accident. They certainly had some work done but it was good work, so it’s not as apparent.

Miles Rote: Yeah, there’s definitely a connection between looking good and feeling good, and this is something you talk a lot about through your book. That’s part of that impetus I’m sure that we have to put on a good suit, brush our hair, and put makeup on. It helps us feel better.

Tell us a little bit about that as far as what you’ve seen in patients, when people are looking better and how it actually makes them feel better?

Dr. James Marotta: I have a vivid memory of this younger guy I did, he’s probably about 18 years old and he had a rhinoplasty done. Beforehand, he was kind of this mousy guy, really didn’t have any confidence, he would barely make eye contact when he came into the office.

After he had surgery done, he said “Doc, my whole life changed.” He says, “I have a girlfriend now, my outlook on life is completely 180, I feel more confident, I feel like I can talk.” I mean, just beaming from ear to ear. That’s just one of the thousands of patients that I’ve seen over the years, that have that same story about how their physical flaws kind of held them back.

They couldn’t get past it. Once that was gone, it was literally a weight off their shoulders. They felt so much better about life and that physical transformation led to a mental and spiritual transformation for many people.

The Attractiveness Advantage

Miles Rote: Yeah, and in addition to the mental and spiritual transformation, there actually is a difference as you point out in your book even how you’re treated in the world and there is a term called the attractiveness advantage. Tell us what that means and how that affects people?

Dr. James Marotta: Well, the attractive advantage is a pervasive situation in life. People get promoted to jobs at higher rates because of their height. For example, people who are above the average male height and in the six-foot range earn something like two to three percent more income annually than other people or get promoted to CEO positions or elected presidents more often.

People who are deemed, younger and more attractive in the workplace get promoted at higher rates, and certainly, ageism plays a part in the workplace and holding people back. The attractive advantages are essentially the more attractive you are, the higher advantage, the greater advantages you have in life. That is really hard data that translates to money, in terms of success.

To make yourself as attractive as you possibly can be is not just vanity all the time. It’s also part of leading a healthy, successful life and optimizing your earning potential, optimizing your potential success not only with the workplace but socially, with a mate. It’s the reason that we pass on biologically our genes by seeking people who we are attracted to and that’s nature’s way of having us read somebody else’s DNA by analyzing and looking at the extent to which we’re attracted to them physically, emotionally, and socially.

When you have a physical flaw, if you look rundown or tired or you just don’t look as good as you possibly can, social interactions are not as full because those negative visual cues have a feedback loop. They give people who are interacting with you a sense that, “Hey, this person might not be as vital as I am, so maybe I should not listen to them.”

Then you internalize that because you might not be getting the reception you want from other people, and there’s kind of a negative feedback loop in your life when you have some of those issues going on.

Miles Rote: Your perception of self could be extremely skewed because you may think that they don’t like you when really subconsciously, it’s the cues that they’re receiving that influences them in ways they don’t even necessarily understand but it may have nothing to do with them as a person.

As humans, when we’re looking at other people, we get biofeedback from them. How long has plastic surgery in some form been utilized by humans? Is this a newer thing or has this been going on for a long time?

Dr. James Marotta: Well, it’s been going on for millennia. Some of the earlier descriptions you can find are from India, and from Egypt. The first rhinoplasty surgery was in Germany hundreds of years ago. So, it’s as old as time that people have been doing procedures to look better. Some of the historical references in the book–in ancient Egypt, adoring yourself with makeup and how you appeared was so important.

It was actually considered a holy act, so a lot of times, buried in their tombs were beauty products to help them look better in the afterlife.

It has been around as long as time and from a biological perspective, it is ingrained in our brains. We are visual human beings, we can’t help but subconsciously analyze. Our brains do it automatically in essentially a blink.

When we meet somebody new, there is all kinds of data going into our brains about physical characteristics that we interpret almost automatically and subconsciously. So, ignoring that part of human interaction and saying, “You know what? I don’t care what I look like,” is ignoring human evolution and human communication.

There are lots of times where we’ll have a patient comes in and she–say it’s an older female–she’s got really deep forehead furrows and creases between the brow or could be a male with a very heavy brow and the brow is kind of drawing down and inward. You look at the person and before they even speak, you think, “Wow, they’re a mean person.” You’re almost afraid to talk to them and then when they open their mouths, they’re the sweetest kindest person you could possibly meet.

That is just one example of how sometimes the visual cues are not correct. Everybody would say that about them who laid eyes on that person, and that’s what the patients come in complaining about saying, “Geez, everybody is telling me I look angry but I’m not angry. I’m very happy.” Or, “Everybody is telling me I look tired or I look rundown but I feel great,” and they have big fat bags under their eyes. The interpretation of that visual information is happening whether you like it or not.


Miles Rote: Right, that’s probably where that old adage, don’t judge a book by its cover, comes from is because we do judge books by their cover and the same thing with our faces, just naturally it happens without us even consciously processing it. Let’s talk a little bit about aging, some argue that we should just let nature have its way and we should look older and plastic surgery would be considered unnatural.

But you make a great point in your book and say, you know cancer is a natural process, and we don’t think twice when we intervene with that. Tell us your perspective on aging and plastic surgery?

Dr. James Marotta: I don’t think there’s anything wrong. If you’re happy with aging, and the aging process, and you’re happy with the way you look, then obviously, let that play out and don’t do anything. I’m not here to coax, cajole, promote, or intervene in any way, shape, or form.

But if the aging process is something that you are not happy about or you are picking up on these situations where the aging process is affecting your life, certainly there are clearly things you can do to intervene in that natural process to reverse, stall, and basically defy it. Because there’s no reason not to do it.

The aging process is the physiologic degradation of our cells on a microscopic and macroscopic level. The cells themselves are becoming more senescent, more old. They are dividing over and over again, and the DNA in them is becoming old and damaged. Our cells don’t produce as much healthy material as we age and the cells themselves degrade.

So, you can basically intervene in that process by encouraging good cell turnover. For example, one of the aging processes is a loss of facial volume, bony volume, muscular volume, and fatty volume.

You can replenish those things using plastic surgery interventions, which are strangely natural. For example, one of the things that I do a lot of in facial rejuvenation surgery is fat transfer. Fat has a very high percentage of stem cells and as we age, the number of stem cells that we have declines in our tissues, and with fat transfer, I basically am harvesting a person’s own fat, putting the fat back into the facial fat pads where they used to have more fat.

It’s the same exact substance and on top of that, adding a higher concentration of their own stem cells to reverse some of the aging changes in the face.

Miles Rote: Wow.

Dr. James Marotta: You don’t get more natural than that. So, a lot of procedures in plastic surgery–even facelifts can be extremely natural. Basically, we’ll reposition the fat pads and the muscle tissue into those areas where they used to be. Gravity is essentially taking hold or retightening those structures and then the natural healing process is basically what holds it in place. You know, as strange as people might think it is, plastic surgery is actually quite natural.

Miles Rote: Wow, okay. I am learning a lot here. This is great Dr. James. Okay, so let’s say someone is considering plastic surgery and they’ve had their doubts because they’ve maybe had that those feelings of guilt or shame if they went through it but let’s say maybe after this conversation, they’re thinking about it more and more and they want to do some research and they want to find the right one. Do you have any tips or advice on folks looking for the right plastic surgeon?

Dr. James Marotta: Yes, I go into great detail in the book with a guide to what kind of steps you should take. And what you really should avoid. Essentially, you want a well-trained specialist who does the kind of procedure that you’re interested in all the time. Just as you wouldn’t want somebody who’s going to build your house be the first house that they built. You want to make sure that that individual has done–if you’re looking for a facelift, plenty of facelifts.

Some surgeons might do one or two facelifts a year and I’ll do two a day. So, you have to make sure that the surgeon that you are looking at is a specialist in that procedure. I’m a facial plastic surgeon, so I don’t do any tummy tucks or breast, if you want somebody who does a lot of those things.

Number one, they have to do a lot of those procedures and have a lot of before and after pictures to show you in that particular procedure. They should be board-certified in their specialty. There’s a course at the specialties that do the majority of cosmetic surgery in the country and generally, the training and background and the scientific knowledge is better in those course specialties. You should look for someone who is board-certified in that area. Do your homework.

Obviously, you want to look at the online reputation. Online reputation is these days very important. They should have lots of good reviews. Of course, they are going to have a couple of bad ones for sure, but they should have a lot. The good should outweigh the bad in terms of how they treat patients and the outcomes. You should look at their before and after pictures when you go to their office and analyze them. I go into a lot more detail in the book on that stuff.

Miles Rote: If you could recommend just one or two things that you want readers to take away from your book, what might they be?

Dr. James Marotta: I really think it is just the essential theme in the book that it is not about vanity. Looking your best and feeling your best is so much more about making the best of your life, and you shouldn’t have remorse or guilt or fear when it comes to approaching your plastic surgical procedure. The book will help guide you through the process of overcoming that.

You know, if you’re running into a situation where other people are laying that on you, maybe give them a copy of the book too and have them read it. I think it will hopefully help some people to start on their journey if they are interested in doing that.

Miles Rote: James, this has been such a pleasure. I’m so excited for people to check the book out. Everyone, the book is called, You’re Not a Vanity Purchase: Why You Shouldn’t Feel Bad about Looking Good, and you can find it on Amazon. Besides checking out the book, where can people find you?

Dr. James Marotta: They could also find us on our website at www.marottamd.com.

Miles Rote: Dr. James, thank you so much and for shining light on this subject.

Dr. James Marotta: Miles, thank you so much. It’s been a real pleasure.