Between Thoughts -Intellectual Musings

BBLs, Nose Jobs, Skin Bleaching, and What We Are Actually Trying to Fix

Part II of the Fakes We Buy Series.

I ran into an old acquaintance recently. Maybe five years since I last saw her. Last time she was a Nubian,  cocoa butter queen,  melanin rich, full and unashamed. And then jiki, she called my name across the room and I turned around to find someone who looked vaguely familiar but also… gecko-adjacent. Snow White adjacent. I did what all socially trained primates do in moments of total cognitive collapse. I smiled. I said ‘You look amazing’,  three times. I lied. And then I went home and sat with that lie for a long time, because lying is not the interesting part of that story. The interesting part is this: what happened between five years ago and today, and what does it mean?

This is Part II of the Fakes We Buy series.

If Part I was about the fake narrative,  the personal brand performance, the LinkedIn highlight reel, the curated self, then Part II is about the fake body. The purchased body. The surgically corrected, chemically bleached, fat-transferred, cartilage-reshaped, height-augmented, abdominal-etched body that is becoming, in the circles I move in, almost unremarkable.

Before I continue: this is not a judgment piece. You have an absolute, sovereign right to cut, shape, bleach, inflate, deflate, and reconstruct your body in any way you choose. You do not need my blessing. You do not need a public referendum. What you owe me and what I owe you, is cognitive empathy and  honest intellectual engagement with what all of this means. Not what it means about you, individually. What it means about us, collectively.

The body has always been a political document. In South Africa, it was never just yours.

I. The Catalogue: What People Are Buying
Let us be precise about what we are discussing. The menu has expanded dramatically.

Brazilian Butt Lifts (BBLs),  fat harvested from the abdomen, flanks, or thighs and injected into the gluteal region to achieve a specific volume and projection,  carry the highest mortality rate of any elective cosmetic procedure globally. The risk from fat embolism reaching the lungs sits between 1 in 3,000 and 1 in 2,000, depending on the study and the surgeon’s technique. Dr. Frank Graewe, a Stellenbosch-based plastic surgeon and former APRASSA (Association of Plastic, Reconstructive and Aesthetic Surgeons of Southern Africa) committee member, has noted publicly that the South African BBL complication landscape is severely under-documented because a significant proportion of procedures happen outside regulated operating theatres.

Rhinoplasty, nose reshaping, is one of the oldest procedures in the catalogue. In a South African context, the specific direction of the reshaping is worth noting. The research is uncomfortable. Multiple studies from the University of the Witwatersrand confirm what any honest person who works in aesthetics will tell you privately: a disproportionate number of Black and Coloured South Africans seeking rhinoplasty are specifically requesting narrower nasal bridges and reduced tip projection. The Eurocentric direction of the modification is statistically measurable. It is not random.

Skin lightening, now often called ‘brightening’ or “perfect colour complex”  or ‘evening’ in its marketable, socially acceptable form, occupies a peculiar space in the conversation because it exists along a spectrum from the cosmetically mild (Vitamin C serums) to the medically dangerous (illicit mercury-based creams still widely circulated in South African township pharmacies and certain hair salons). The Medicines Control Council (now SAHPRA) has flagged this repeatedly. The enforcement is inconsistent.

High-definition abdominal etching. Height-increasing leg procedures. Lip fillers that migrate. Jawline contouring with filler that erases one’s genetic facial architecture. This is the full catalogue. And it is expanding.

We are not talking about vanity. We are talking about a species responding to a radically new environment.

II. The Psychology: What You Are Actually Buying
Let us be honest about what cosmetic surgery is, psychologically, most of the time. It is a physical answer to an internal question. The question varies. Sometimes it is: ‘Am I enough?’ Sometimes it is: ‘Will they take me seriously now?’ Sometimes it is: ‘Can I outrun the woman my mother was?’ Sometimes it is: ‘Does this face belong to me or to the father who never came back?’

Dr. Colleen Adnams, a South African psychiatrist who has written on body image and aesthetic psychiatry, and her colleagues at UCT’s Department of Psychiatry have noted that Body Dysmorphic Disorder (BDD), a clinical condition characterised by obsessive preoccupation with perceived physical flaws that are minor or nonexistent, is significantly underdiagnosed in cosmetic surgery populations in South Africa. International studies suggest BDD prevalence among cosmetic surgery seekers is between 7% and 15%. Most of these individuals leave consultations with a surgery date, not a referral letter.

The dopamine mechanism is worth understanding. Social media platforms do not merely show us other people’s bodies. They are engineered, this is the correct word, engineered,  to trigger reward responses. A post-surgery reveal receives ten times the engagement of a normal selfie. The algorithm rewards transformation. It rewards before-and-after. It rewards the drama of becoming. This is not accidental. Meta and TikTok have internal research confirming body image deterioration in adolescent female users specifically, research they chose not to publish until litigation forced it into the open.

‘Snapchat Dysmorphia‘ is the term coined in 2018 by Dr. Tijion Esho,  a British-Nigerian aesthetic physician,  to describe the growing phenomenon of patients presenting to surgeons not with a photo of a celebrity or public figure as a reference point, but with a filtered photo of themselves. The request has shifted from ‘I want to look like her’ to ‘I want to look like my filtered self.’ This is clinically significant. You are no longer comparing yourself to an external ideal. You are failing to match your own digitally falsified reflection.

The surgery, in most of these cases, does not resolve the internal question. The Johannesburg-based psychologist and academic Dr. Sumaya Laher, who has researched identity and body image in South African clinical populations, would recognise this pattern immediately: the relief is temporary. The question resurfaces. And then the catalogue reopens.

The surgery is not the problem. The unanswered question is the problem. The surgery is just the most expensive wrong answer.

III. The South African Layer: Post-Apartheid Body Politics
There is something specific happening in South Africa that does not fully show up in the American literature or the Brazilian literature or the Korean literature on cosmetic surgery. Something that requires a different lens.

Apartheid was, among its many crimes, a systematic assault on the Black body. It criminalised certain bodies. It devalued certain skin tones. It built entire legal architectures,  the pencil test, the population register, the Group Areas Act, around the physical measurement and classification of human beings. The message, delivered across decades, was specific: some bodies are worth more than others, and yours is not one of them.

Post-apartheid did not erase that message. It complicated it. Liberation brought political dignity but did not automatically install psychological dignity. Wits researcher Dr. Kopano Ratele, whose work on Black masculinity and body politics in South Africa is essential reading, has argued that the post-apartheid generation is navigating a profound contradiction: formal equality in a social environment still structured by Eurocentric aesthetic hierarchies. The lightening creams and the narrowed noses and the skin bleaching are not random. They are legible. They are responses to a specific, historically inscribed wound.

At the same time and this is where the analysis has to resist the comfort of a single narrative there is a parallel movement. The BBL is not a Eurocentric aesthetic. Wide hips, full gluteal projection, and a dramatically contoured waist are not the beauty standards of Copenhagen or Portland. They are, in modified and surgically exaggerated form, aesthetics with deep roots in African and Afro-Caribbean cultural preference. The BBL boom in South Africa is partly an exaggerated expression of an indigenous beauty ideal, not an escape from one.

These two movements,  the Eurocentric thinning and lightening trajectory and the hyper-Africanist contouring trajectory,  co-exist. Sometimes in the same body. Sometimes in the same clinic, on the same day. This is the specific complexity of the South African cosmetic surgery moment that imported frameworks cannot fully explain.

Ubuntu says: I am because we are. But what happens when ‘we’ has been taught to be ashamed of what ‘I’ looks like?

IV. Michael Jackson, My Kids, and the Memory of Melanin
My children do not believe me when I tell them that Michael Jackson was Black. Not politely Black. Deeply, fully, unambiguously Black. A Black boy from Gary, Indiana who sang like God and danced like something God had not yet invented. They know only the later Michael J, the translucent, narrow-nosed, surgically reconstructed Michael. The after.

His father called him ‘big nose.’ That detail, from the Leaving Neverland era and confirmed in multiple biographies, sits in my chest. Because it is not just about Michael Jackson. It is about what happens when the people who are supposed to mirror your worth back to you, mirror shame instead. The father’s voice becomes the internal voice. The internal voice becomes the surgeon’s brief.

This is the behavioural science of intergenerational shame. It is transmitted. It does not require explicit instruction. A mother who bleaches her skin teaches her daughter something about which skin is acceptable. A father who calls his son’s nose ‘big’ is not commenting on cartilage. He is placing a value judgment that the son will carry for decades. Dr. Pumla Gobodo-Madikizela, the clinical psychologist whose work on trauma, memory, and South African identity is internationally recognised, would frame this as unprocessed historical wound expressed through the body.

The body remembers what the mind has been told to forget.

Skin bleaching is not a beauty preference. It is a confession about what colonialism taught us to hate.

V. The Class Dimension: The Walking Receipt
Let us not be naive about the economics. In a country with South Africa’s Gini coefficient,  one of the highest in the world,  the body has become an extraordinarily legible class document. A flat, surgically etched abdomen. Unblemished, lightened skin. A surgically refined nose. Full, filler-augmented lips. Perfectly projected, BBL-assisted curves. This is not merely beauty. This is wealth display. This is what Dr. Thorstein Veblen, writing in 1899 about conspicuous consumption, could not have imagined: the body as the luxury good.

Turkey for the BBL. Switzerland for the skin treatments. South Korea for the jawline and the eye work. Brazil for the body contouring. The passport of the surgically optimised South African professional is a geographical record of disposable income. Flying to Istanbul for a nose job is expensive. Knowing which clinic in Istanbul is expensive. Recovering from the procedure without having to return to work in two weeks is expensive. The entire enterprise signals class membership.

The dangerous consequence of this is what happens at the bottom of the market. When the aspiration is democratised but the access is not, the demand does not disappear,  it migrates to backroom clinics, unqualified practitioners marketing themselves on Instagram, illegal fillers, non-medical grade injectables administered in hair salons in Soweto and KwaMashu. APRASSA issues warnings. SAHPRA issues warnings. The Health Professions Council of South Africa issues warnings. The demand continues. Because you cannot tell people that a certain body is the social currency and then expect them to simply opt out because the safe version is unaffordable.

You cannot make the body the ticket and then police who can afford the ticket.

VI. What the Research Actually Says About Outcomes
Here is the inconvenient empirical truth, drawn from peer-reviewed literature:

Short-term satisfaction is measurable and real. Studies published in the Journal of Aesthetic Plastic Surgery consistently show post-operative improvements in self-reported body image scores, confidence, and social ease ,  particularly for procedures addressing features the individual has experienced shame around since childhood.
The improvements plateau and often do not transfer. The psychological relief is procedurally specific. It does not generalise. The woman who fixes her nose remains anxious about her stomach. The man who etches his abdomen becomes preoccupied with his hairline. The catalogue reopens.

For BDD patients, surgery actively worsens outcomes. Dr. Katharine Phillips, whose research on Body Dysmorphic Disorder at Brown University is the global standard, found that approximately 97% of BDD patients who undergo cosmetic surgery report no improvement in BDD symptoms. Many report worsening. The surgical outcome is irrelevant to the psychological distress.

Mortality and morbidity data for unregulated procedures in South Africa is structurally underreported. What we know from emergency room data at Chris Hani Baragwanath, Charlotte Maxeke, and Groote Schuur hospitals represents a fraction of the actual complication burden, because many patients seek treatment from the same unqualified practitioners who caused the damage.

This is what the data says. It does not say ‘don’t do it.’ It says: understand what you are doing and why, and be honest about whether the surgery is aimed at your body or at something deeper that the body cannot reach.

The scalpel is not a therapist. It is an extraordinarily precise and expensive tool that has no access to the rooms where the real problem lives.

VII. The Honest, Uncomfortable Conclusion
Here is what I actually think, as honestly as I can put it, without the diplomatic packaging:

Most people who are making these modifications are doing something deeply human. They are trying to feel at home in the world. They are trying to reduce the friction between the self they carry internally and the body that gets evaluated every time they walk into a room. That impulse is not vanity. It is not stupidity. It is a rational response to a world that has made physical appearance into social currency, and then handed out the starting amounts unequally.

But I also think we need to be honest that a significant portion of what is driving this is not personal preference,  it is internalised hierarchy. The specific direction of so many modifications in the Black South African context is not random. The lightening. The narrowing. The European-adjacent reshaping. These are not coincidences. They are the aesthetic expression of a self-concept that was shaped, at least partially, by systems designed to make Black people feel insufficient.

I think the most important question is not ‘should I do this?’ It is ‘do I know why I want this?’ And beyond that: ‘have I sat with that why long enough to know whether a surgeon or a therapist is the more honest answer?’

The acquaintance I passed in the street,  the one whose name I remembered only when she called mine,  is not a cautionary tale. She is a person who made a series of choices about her body in a world that pressures people to make exactly those choices. What I felt in that moment of non-recognition was not disgust or moral superiority. It was grief. Grief for the original. Grief for the Nubian queen who, somewhere along the way, was made to feel that she was not enough.

That grief is the correct emotional response. Not judgment. Not a lecture. Grief. Because something was lost that did not need to be.

The most radical thing a Black South African can do is decide that their original body was not a mistake to be corrected.

A Note on the Awkward Moments
Before I close: we need new social vocabulary. We genuinely do. When someone you know has changed radically,  through surgery, bleaching, or both,  the current lexicon fails. ‘You look amazing’ is a lie. ‘I barely recognised you’ is the truth but lands like an accusation. ‘What happened to you?’ is worse.

I am working on this. My current working phrase is: ‘It’s genuinely good to see you.’ It is true. It deflects. It does not perform enthusiasm about the modification. It does not shame. It redirects to the relationship rather than the body. Imperfect. But more honest than ‘amazing’ times three.

And on the genetic anxiety,  the question I genuinely sit with as a biologist manqué,  what happens when the surgically modified mother or father has children? The baby arrives carrying the original genome. The original nose. The original skin tone. The original body. And someone has to look that child in the eye and tell them they are not a problem to be fixed. That task, I would argue, is harder if the parent has spent the last decade implicitly communicating the opposite through their own choices. This is not a reason not to do surgery. It is a reason to do the psychological work alongside it.


Sources & Scholarly Grounding
– APRASSA (Association of Plastic, Reconstructive and Aesthetic Surgeons of Southern Africa),  regulatory frameworks and BBL mortality data, aprassa.co.za
– Phillips, K.A. (2005). The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder. Oxford University Press.
– Ratele, K. (2016). Liberating Masculinities. HSRC Press, Cape Town.
– Gobodo-Madikizela, P. (2003). A Human Being Died That Night. Houghton Mifflin.

– Laher, S. & Cockroft, K. (Eds.) (2014). Psychology in South Africa. Oxford University Press Southern Africa.
– Wits Wiredspace Research — Cosmetic surgery demand and CPI elasticity in Gauteng: wiredspace.wits.ac.za
– ISAPS Global Survey 2023 — South African data via aestheticappointment.co.za
– IOL/Saturday Star (April 2026) — ‘The Truth Behind the Effortless Beauty Trend’: iol.co.za
– Esho, T. (2018). ‘Snapchat Dysmorphia’ — British Journal of Plastic Surgery correspondence.
– SAHPRA — warnings on illicit skin-lightening products containing mercury and hydroquinone: sahpra.org.za

=====================
© Dr. Mzamo Masito

Between Thoughts — Intellectual Musings 

Where the uncomfortable questions get a seat at the table.