Plastic surgery is concerned with the correction or restoration of form and function. There are two types of plastic surgery, cosmetic or aesthetic and reconstructive. The purpose of “reconstructive” plastic surgery is to correct physical features, which are grossly deformed or abnormal by accepted standards, either as a result of a birth defect, illness, or trauma. Reconstructive surgery aims to reconstruct a part of the body or improve its functioning, while cosmetic surgery aims at improving its appearance. Islam welcomes plastic surgery, if performed for the patient’s benefit. Islam prohibits the cosmetic surgery that has the intention of changing the creation of God.
Key words: Plastic surgery, Aesthetic surgery, Cosmetic surgery, Islam, medical ethics
The word “plastic” in plastic surgery, is a Greek word meaning “to form”. Plastic surgery involves the restoration, reconstruction, or alteration of the human body. Plastic surgery is divided into two sections, cosmetic surgery and reconstructive surgery. The former seeks to improve the patient’s features on a purely aesthetic level, where there is no deformity or trauma. The goal of reconstructive surgery, on the other hand, is restoring functional disorders resulting from trauma, accidents, diseases and congenital defects.1
In cosmetic surgery, an often-overlooked aspect of a patient’s cultural is his and her religious beliefs. There is a paucity of resources for cosmetic surgeons to enable them to properly service their religious patients. Specific patient concerns should be addressed with the patient’s own religious advisor.2 Based on Islamic Law, Muslim Jurists have categorized plastic surgery into two types: a) Plastic surgery that is permissible. b) Plastic surgery that is not permissible.
Islamic law (Shari’ah) is based on 2 foundations: The Qur’an (the holy book of all Muslims) and the Sunna (the aspects of Islamic law based on the Prophet Muhammad’s words or acts). The development of Shari’ah in the Sunni branch of Islam over the ages has also required “Ijmaa” (consensus of all competent jurists after the death of the Prophet) and “Qiyas” (analogy) using the human reason when no clear rule is found in the Quran or Sunna, resulting in 4 major Sunni schools of jurisprudence. Where appropriate, consideration is also given to “Maslaha” (public interest) and “Urf” (local customary precedent).3, 4
Objectives of Islamic Law (Maqasid al-Shariah)
The objectives of Islamic law could be divided into three parts: (1) Necessities (daruriyat): These include preservation of faith, life, mind, progeny, and property. They are essential for life, religion, and community. (2) Needed Things (hajiyat): these are needed for the community, or for persons. They can live without procuring them, but they are recognized needs for the welfare of society and individuals. (3) Recommended (tahsiniyat): They are also needed by the society or individuals to make life more comfortable and, more beautiful, and try to reach the level of satisfaction and happiness for both the individual and society.5, 6 The objectives of Islamic law were discussed fully by Muslim scholars over 1,000 years ago. Knowledge of these objectives is an important prerequisite in the formulation of any fatwa (decree) through the process of (ijtihad) which is a self-exertion by a scholar to deduce fatwa (decree) on any issue that does not have direct guidance in the primary sources of the Quran and the Prophetic traditions.7 These objectives can be viewed as a useful tool in Islamic law to discuss issues pertaining to bioethics. It is an approach originally brought forth by Imam al-Shafii, the founder of the Shafii School. Al-Juwayni (d 478 H/1085 CE) was the first to classify the objectives of Islamic law (Maqasid al-Shariah) into three categories, beginning with dharuriyyat (essentials), hajiyyat (necessities), and tahsiniyyat (desirables). Of these, the most critical is “essentials” (dharuriyyat) where “five” matters are given prominence for protection and preservation, namely the protection and preservation of faith, life, intellect, progeny, and property. These five aspects are collectively known as (the five essentials), and are important in protecting and preserving the dignity of mankind.5, 8
Al Izz ibn Abdul Salam, a renowned Islamic jurist (d 660H/1243 CE) in his book “Qawa’id al Ahkam (Basics of Rulings) said: “The aim of medicine, like the aim of Shari’ah (Islamic law), is to procure the “maslaha” (utility or benefit) of human beings, bringing safety and health to them and warding off the harm of injuries and ailments, as much as possible.” He also said: “The aim of medicine is to preserve health; restore it when it is lost; remove ailment or reduce its effects. To reach that goal it may be essential to accept the lesser harm, in order to ward off a greater one; or lose a certain benefit to procure a greater one.”. This is a very pragmatic attitude, which is widely accepted in Islamic jurisprudence, and it is frequently applied in daily practice in all fields including medicine.9, 10 It is important to emphasize that intention (niyya) is very important in any deed in Islam. The Prophet said: “Deeds are judged by intention.”11 An action though may be good apparently, but done with bad intention will be judged by God on the Day of Judgement, and will be punished. On the contrary, if someone intends to do a good deed, but when performing it, he unintentionally produced some harm, then he will be pardoned. The prayer in the Qur’an touches upon this theme: “Our Lord do not impose blame upon us if we have forgotten or erred” (Quran, 2: 286).
The Principle of intention comprises several subprinciples. The sub principle “each action is judged by the intention behind it” calls upon the physician to consult his inner conscience and make sure that his actions, seen or not seen, are based on good intentions.12
Islamic view of Plastic surgery
Contemporary Muslim scholars seem to be in agreement that a plastic surgery is allowed when there is a real necessity or need, such as removing congenital defects (for example, removing an extra digit), or to treat defects caused by sickness, traffic accidents, burns, etc.13 This view applies to the reconstructive plastic surgery. This ruling is deduced from the incident where the Prophet (Peace be upon Him) (PBUH) allowed a companion called Arfajah ibn Saad, whose nose was cut in a battle, to wear a nose made of gold.14 Besides, conducting such surgeries is not intended to what is termed as “taghyir khalq Allah” (changing God’s creation), which is the essential factor why many scholars forbid many types of modern plastic surgeries. In reality, the main reason for allowing such surgeries is to remove harm, and relieve the person concerned from physical and psychological suffering.15
Medical intervention is justified on the basic principle is that injury, if it occurs, should be relieved. An injury should not be relieved by a medical procedure that leads to an injury of the same magnitude as a side effect and this will be decided by trustworthy specialist. This issue comes under the ruling which says: (an injury should not be removed by another injury).15, 16
The desire to undertake plastic surgery arises out of dissatisfaction with defects and the associated embarrassing appearance. Thus technology to remove or correct defects is not opposing or changing God’s creation.
The purpose of surgery on congenital malformations is restoration of the normal appearance, to relieve psychological pressure or embarrassment, and restore function. These purposes do not involve change of “fitra” (primordial human nature) but restoration to its state before the injury. A surgical operation to reveal the true gender of an apparent hermaphrodite is not change of human nature, but an attempt to restore the altered structure by hormonal or chromosomal damage, to its normal shape and function. Such operations have another objective of trying to preserve or restore the reproductive function.12
Similarly, scars left by skin diseases, or caused by accidents and burns can induce physical and psychological pain and harm. Islam allows people afflicted with such deformities to rectify them by surgical means.17
Several biomaterials, either alone or in combination with cultured cellular products, have been introduced to compensate for the scarcity of autologous donor tissue or to improve healing in a variety of surgical specialties such as abdominal and plastic surgery. Many of these biomaterials are of porcine origin. It is well known that Islam has prohibited the use of porcine or any of its products. In life-threatening conditions as well as severe diseases, the use of porcine-derived products is permissible if similar non-porcine-derived materials are not available. In this case, the use of porcine-derived products represents a necessity and is allowed.18
Cosmetic (Aesthetic) surgery
Seeking beautification is encouraged by Islam in the first place. The Prophetic hadith says: “God is beautiful and He likes beauty”.19 Therefore, intending more beautification is generally lawful. In addition, seeking beautification in one’s body, according to many traditional jurists, can also be a way to remove psychological harm and stress. Removal of harm, be it material or psychological, is intended by Islam, as the universal rule indicates “Harm should be removed”.15
Beautification used to reshape a significantly deformed part of the body is generally permitted in Islam, as long as it is used for a valid reason. Some scholars, on the other hand, report that surgeries for beautification are the result of the materialistic design followed by Western civilization, primarily focusing on the body and its desires. Standards set by Hollywood or sport stars, and the media are the main reason behind their increasing popularity. People preoccupied with the body than with soul, indulge in excessive beautification and reshaping of their bodies, unnecessarily changing what God has created and subjecting themselves to pain, torture and waste of money. Mutilation of the body is clearly prohibited in Islam. Cosmetic surgery may be considered as deliberate self-mutilation, which is indeed what happens when some cosmetic surgeries fail.20
Cosmetic surgery is not permissible when the purpose of this procedure is to take a normal body structure and improve it to make it look better and improve the person’s self-esteem or appear more attractive; for example, breast augmentation, tummy tucks (abdominoplasty), face lifts, etc.13, 17 This kind of surgery has been condemned in the Qur’an and Hadith as it entails interfering with the natural way God has created a person without a valid reason. The intention behind these types of surgeries is just seeking beautification, which does not stand alone as a suitable reason for permitting them. Rather, intending mere beautification was the reason for the cursing by the Prophet (PBUH) of those women, who pluck their eyebrows and file their teeth for the purpose of beautification and change the creation of God”.21 Therefore, it is unlawful for a Muslim surgeon to carry out surgery in order to merely make someone look better or to improve their appearance.15
Carrying out a cosmetic operation for ill-intentions is totally prohibited. For example, the surgeries carried out to deceive other people (such as a woman or a man doing face lifts to look younger with an intention to deceive a marriage candidate), or the surgeries meant to disguise criminals to avoid detection. Sex reassignment surgery (Sex change) is definitely prohibited. However, operations to decide the sex in cases of pseudo hermaphroditism are permitted.15, 17
Some scholars state that every type of cosmetic surgery should be examined individually, since each has its own features and motivations, which should be the base for extracting the proper legal ruling. The motivation for many modern plastic surgeries is not always just seeking mere beautification. Rather, they can be for other reasons, which can place them under the category of hajiyyat (necessities), or even under the category of dharuriyyat (essentials), both of which can render what is unlawful lawful. For examples, breast augmentation is prohibited when the breasts are in the normal size and carrying on a cosmetic surgery on them has no real demand; but it can be permissible in some circumstances where the breasts are extremely flabby, in a sense they cause the person concerned great psychological and physical suffering. Likewise, tummy tucks are permissible when they are intended, for example, for medical treatment to protect from serious diseases, or to restore a woman’s significantly enlarged abdomen to its natural shape after multiple pregnancies and childbirth.15, 22
Legal liability in cosmetic surgery is distinctly different from general principles of professionalism, because the objectives in cosmetic surgery are different from common therapeutic targets. The cosmetic surgeon may not encounter a “patient”, but may face a “healthy person” who is seeking beauty. The results of surgery are not always in accordance with the patients’ expectations, so surgeons should make the patient fully aware of the risks and complications, both expected and potential, of the operation. 1, 23
Islamic Fiqh Academy Resolution on Plastic Surgery
One of the most influential bodies of Islamic ethico-legal deliberation is the Organization of Islamic Conferences’ Islamic Fiqh Academy (OIC-IFA) which brings together scholars of Islam and medicine for Islamic ethico-legal deliberation around bioethical challenges faced in the Muslim and non-Muslim world. The International Islamic Fiqh Academy discussed the issue of plastic surgery in 2007 and issued the following resolution:
- It is permissible to perform the necessary plastic surgery, which is intended to:
(A) Restore the shape of the body organs to the situation in which man was created according to God saying: (We have certainly created man in the best of stature) [Quran: 95:4].
(B) Restoring the normal function of the body,
(C) To repair congenital defects such as: cleft lip, severe nose deformities, nevus, excess fingers and teeth and finger adhesion, if their presence causes physical or moral harm.
(D) Repair of acquired defects caused by burns, accidents, diseases, etc., such as: skin grafting, full reconstitution of the breast if removed, or in part if it is large or small, causing a medical problem.
(E) Removal of “ugliness” causing a person psychological or organ damage.
2. It is not permissible to perform cosmetic plastic surgery which is not considered a medical treatment and is intended to change the creation of the normal person, according to his/her desires, and desires of the tradition of others, such as changing the face shape to appear with a certain appearance, or with the intention of deceiving and misleading justice, or change the shape of the nose or eyes, or enlarge or reduce lips, or cheeks.
3. The body weight may be reduced by the approved scientific means, including surgery (Liposuction), if the obesity poses a medical problem, and there was no way other than surgery, provided there is no damage.
4. It is not permissible to remove wrinkles by surgery or injection, unless it is a medical Problem, provided there is no damage” 24.
Islam permits plastic surgery for the purpose of treating the disease and to save or preserve the function of the body organs. It is not permissible to undergo cosmetic surgery when the purpose is merely to beautify oneself or improve one’s appearance as it entails altering the creation of God without a valid reason. It will only be permissible to undergo cosmetic surgery when it is needed due to a health issue or some type of deformity on the body.
Conflict of interest: The authors declare that they have no conflict of interest.
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