Skin Deep? or Merely Shallow?

Recently I had the opportunity to watch “Skin Deep,” a program that was aired on the Discovery Channel in 1999. The show was about Michael Morris, a three year old boy with Down syndrome. Michael’s parents decided to have him undergo facial reconstruction in order to “normalize” the appearance of his face. The program captured the family before, during, and after the surgery.

Before the surgery, the family was very anxious. They looked at computer images of how Michael’s face could look after the procedure. His father commented on how he could look like a young Kevin Costner. It became obvious to me that the parents were ready to put their child through this surgery out of vain. They were very proud of their son, but it seemed as though they were ashamed of his facial appearance. When the parents saw Michael for the first time after his surgery his face was completely covered with bandages, many of them bloody. The father appeared to be in shock. I understand that they were trying to make their son’s life easier so that he wasn’t stigmatized in school, but going as far as to put their child through a gruesome surgery just doesn’t seem like the solution. Just about everyone gets ridiculed at some point in their lives. Why couldn’t the family have invested time and energy into something more productive (and less invasive!), like educating the public about Down syndrome to reduce the stigma? Personally, I think the child looked better before he had his surgery.

I found an interesting article that emphasizes how major plastic surgery on the faces of children with Down syndrome is extremely unnecessary. This article by Jones (1) a shockingly compares the surgery to female circumcision. I feel that the author went a little overboard with this comparison, but he makes a good point. The author also compares the importance of the surgery to the correction of cleft lips and palates (1). Jones explains that the surgery on the cleft palate has major social advantages because of the functional and cosmetic improvements while the surgery on the faces of the children with Down’s syndrome does not (1).

Overall, I oppose the reconstruction of the faces of children with Down syndrome when it is merely for aesthetic purposes. I support those procedures that are essential for improvement in function, such as tongue reduction to improve speech. I do understand that the cosmetic surgery is a personal decision, but I believe that parents should include their children in the decision making process even if that does require waiting a few years.

Reference

1. Jones RB (2000). Parental consent to cosmetic facial surgery in Down's syndrome. J Med Ethics 26:101-102.