An aspect of health-care reform that has not been much discussed is cosmetic surgery.

At a time when President Obama and other political figures are urging reform that will help more people, especially the poor, get basic medical care, one aspect of health care seems to be a booming business.

And, it seems, many people have no trouble spending large sums of money on what could be considered — and often is — vanity.

In 2008, in the United States alone, over 10 million surgical and non-surgical cosmetic procedures were performed at a cost of $11.8 billion.

Cosmetic surgery is not just for the rich and famous.

And although the number of operations fell slightly that year because of the recession, the demand for cosmetic surgery has been generally increasing for the past 60 years. Since 1997, the number of men and women undergoing cosmetic procedures in the U.S. has grown by a staggering 457%.

According to the American Society for Aesthetic Plastic Surgery, the most requested surgery in 2008 was breast enlargement followed by liposuction, cosmetic eyelid surgery, rhinoplasty (nose reshaping) and tummy tucks (removal of excess fat and skin).

But is any of this moral? Although the Catechism of the Catholic Church doesn’t address the phenomenon directly, it says the Church “rejects a neo-pagan notion that tends to promote the cult of the body, to sacrifice everything for its sake, to idolize physical perfection and success at sports” (No. 2289).

Yet the Church generally looks favorably on plastic surgery and has never condemned it in itself, according to Father Pablo Requena, professor of moral theology at the Pontifical University of the Holy Cross in Rome. The morality of such treatment, he said, depends on each case.

He referred to what appears to be the only formal and lengthy papal statement on the subject, given by Pope Pius XII to Italian cosmetic surgeons just days before he died in 1958. Pius struck a largely positive note and stressed that the morality of cosmetic surgery “depends on the specific circumstances of each case” but that “many faces of God’s children, whom misfortune has refused them the gift to reflect their beauty, regain their lost smile by your science and your art!”

Pope John Paul II, when addressing Italian dental and maxillofacial surgeons (who operate on the neck, face and jaws) in 1989, stressed that the “indissoluble unity of the person means that what is defective or deficient in the body also has serious indirect impact on the human psyche.” He told the doctors that their work is “a true art,” that it is “a very noble mission” and “a service to the harmonic composition and good functioning of various parts of the body.”

“I would say that in principle the Catholic Church has a positive view of cosmetic surgery if its aim is to improve the beauty of people because beauty is a good,” explained Father Requena. “It is clear that many exaggerate ‘care of the body,’ even letting it become the cult of the body. That is not compatible with the anthropology of the Church because they see the bodily earthly life as the definitive one. This is not the case. In Christianity, the body is good, and to take care of the body is an obligation.”

‘Tricked by Fashion’

Pius XII did warn in his speech of the “unlawfulness” of cosmetic surgery undertaken for “mere vanity, caprice or fashion” or in order to increase a person’s “strength of seduction and so more easily induce others to sin,” or to “cause injury to regular functions of physical organs.” But he stressed the importance of right intentions, of which he said there were many, and argued for “rational and proportionate” reasons for such “extraordinary means.”

Dr. Vito Del Deo, a practicing Catholic and an Italian-American cosmetic surgeon working at the clinic of San Michele near Naples, said it bothers him that some patients will come to him solely because they are “tricked” by fashion and worldly values. He therefore questions their motives before proceeding with an operation, leading some to change their mind about surgery.

“Unfortunately, I have to play around those world rules and standards, making this person feel accepted and more confident,” he said, adding that the impetus can come not from the patient as such, but the misleading images of beauty and perfection that surround us.

But Del Deo added that even if they choose to go ahead chiefly because of the “lie” of advertising, he saw his work in some way fulfilling a Christian purpose. “I am responding to a lie, but I am not fulfilling that lie,” he maintained. “I am fulfilling that person’s desire who, at that moment, is looking for freedom from that lie, the source of that anxiety and discomfort.”

He also stressed that these “chains” enslaving the patient are not broken down by him but by Christ, and that he is merely acting as God’s instrument in the process. That conviction, he said, gives him solace and peace.

The San Michele clinic is run by Dr. Crescenzo Barletta, a devout Catholic who said he regularly receives divine inspirations in his work, as did his father who founded the clinic. Barletta said money is certainly not his first priority when running the clinic. “My desire is the first consequence of the surgery, to see something made right that was part of God’s plan,” he said.

His comments echoed those of Pius XII: “The success of an operation that restores decorum to a young face is in itself enough to pay the surgeon for their effort,” said the late Pope. “It is also appropriate to stir admiration for the art that he has so wonderfully achieved.”

But the variety of treatments and motives of a patient mean that clear moral guidance on plastic surgery remains vague. “I think a space exists which prevents us from making a strong statement about the morality in these cases,” said Father Requena. “Maybe if asked, I would advise in many cases not to do it, but I’m not sure that I can say it is a sin. It would be better to put it in another perspective: How should a Christian, who wants to live his faith seriously, act?”

Said Father Requena: “There are many acts that are not sinful and at the same time are not the best choice to carry out.”

Edward Pentin writes from Rome.