Text Laura Pitcher

Even with consent, there’s a grey area for specific procedures that ultimately do harm to the body – especially when mental health is taken into account

For Steve Haworth, body modification artist and the inventor of subdermal and transdermal implants, having access to body modification is as important to personal choice as having the freedom to style your own hair. Yet, modifications such as sensory magnet implants, ear pointing, shaped punches, and extreme plastic surgeries such as having ribs removed, all have varying degrees of mental and physical health risks that the patient is willingly undertaking. Earlier this year, Brendan McCarthy, a tattooist known as Dr Evil, was sentenced to 40 months in jail for performing consensual body modifications, including ear removal, nipple removal, and the splitting of a tongue. Then there’s Robert Smith, a former surgeon who performed voluntary amputations on patients that were later found to be suffering from a body dysmorphic disorder (BDD), a mental illness involving an obsessive focus on a perceived flaw in appearance, known as apotemnophilia. With the legal punishment of surgeons and body modifiers performing consensual procedures, the question becomes who really can be held accountable for a person’s desire for modification, even at the risk of bodily harm? While many view body modification as a tool for self-expression, psychological disorders such as body dysmorphic disorder bring into question the issues with consent when coming from someone with a mental illness.

While body modification artists such as Steve Haworth actively advocate for the right to self-expression through modification and perform ‘extreme’ procedures, the moral line for modifiers and surgeons varies from person to person. Dr Barry Eppley, a cosmetic and reconstructive surgeon in Indiana, told The Cut earlier this year that if his practice had a slogan, it would be “We don’t care why you want it.” Haworth, on the other hand, takes requests on a case-by-case basis and does deny asks through his professional ‘black line’. This, he says, is usually when someone who has no visible tattoos or piercings and is asking for something like horn implants or when it’s a request to make the body appear more ‘normal’. “I have been asked to effectively perform nose jobs or tummy tucks, I have been asked to take a stretched lobe and close it back to normal. All of these things modify the person to what society considers normal,” he explains. “I will modify a stretched earlobe to a smaller size but I will not close it down completely. My art form is all about modifying the individual away from what society considers normal or pleasing. It always has been and it always will be.” Dr Ira D. Papel, a professor in the division of facial plastic and reconstructive surgery at Johns Hopkins University and the medical director at the Aesthetic Center at Woodholme, navigates whether or not to perform a surgery using the opposite mentality. “To make someone happy about a fad, which will come and go with a permanent procedure and which there really is no going back to ’normal’, that's not a good thing,” he says. “We should be advising patients not to do that kind of thing.” Through first-hand experience of performing on patients that he was unaware were untreated for BDD and through his research into the connection between plastic surgery and BDD, Dr Papel says he is currently saying no to ‘extreme’ requests every week. “Increasingly, people come in with strange ideas, like wanting their eyebrows raised so high that they're in the middle of their forehead or a rhinoplasty done to make their nose so small that it would not only look funny but hard to breathe as well.” While he doesn’t think this should be imposed by national standards or regulations, he believes each surgeon should navigate every patient’s request with a variety of physical and psychiatric indicators in mind.