Cosmetic procedures are broadly about the quest for beauty, whereas reconstructive ones restore functions lost or impaired. The two may share history, expertise and technology, but when it comes to our attitudes toward going under the knife, the dichotomy matters.
Netflix’s new reality show “Skin Decision: Before and After” demonstrates, however, the distinction between what is considered cosmetic and reconstructive isn’t always so clear.
Across the first season’s eight episodes, Dr. Sheila Nazarian and nurse Jamie Sherrill consult patients carrying the scars, irregularities and deformities of personal trauma. Some have suffered violent attacks or road accidents; others bear painful reminders of lifelong acne or the physical damage of alcoholism.
Dr. Sheila Nazarian and nurse Jamie Sherrill. Credit: Netflix
But it could be argued that all of the participants stand to gain psychologically from undergoing some form of surgical or non-surgical cosmetic procedure, even if it isn’t strictly necessary. Using their field’s latest technologies, Nazarian and Sherrill eliminate scar tissue, smooth damaged skin and restore patients’ smiles (quite literally in the case of one man, whose facial injuries caused pain every time he smiled).
They use tucks, fillers and lasers — treatments that are, on paper, cosmetic rather than reconstructive. Yet, their patients aren’t searching for perfection.
Unlike other plastic surgery reality shows, which routinely document wealthy participants’ efforts to remove wrinkles, enlarge breasts or lift buttocks, those appearing on “Skin Decision” often just want to return to their former selves. As a patient with large amounts excess skin, following a dramatic weight loss, explains in one episode: “I don’t have to look like Barbie. I just want to look normal.”
“It’s an emotional change, it’s a therapeutic thing we do rather than just vanity and a spectacle.”
Dr. Sheila Nazarian, “Skin Decision”
Before and after shots show Katrina Goodwin’s transformation following a horrific attack. Credit: Netflix
“Every time I took a shower I was reminded (of the tragedy),” she told CNN over the phone from Washington, D.C. “Now, when I take a shower I’m reminded … that this is phase two. This is my new beginning.
“Before appearing on the show, I didn’t realize how defeated I was — defeated in my whole body language,” she added. “Now friends and family say, ‘You walk taller, you walk prouder, you seem happier.’ So it was a transformation, and a way for me to reclaim myself and feel complete, like a normal woman.”
When it comes to plastic surgery, the idea of normality is a subjective one, according to professor of clinical psychology and psychotherapy at Germany’s Ruhr-University Bochum, Jürgen Margraf, who has studied the mental impact of undergoing cosmetic procedures.
“There’s nothing to argue against getting rid of a scar — why should you walk around with a scar?” he said in a phone interview. “But then you can extend this argument. Let’s say you’re born with a crooked nose. Why should you live with that and try to make the most of it?”
Nazarian pictured in surgery during an episode of “Skin Decision.” Credit: Netflix
“Skin Decision” surgeon Dr. Nazarian, who carries out a broad range of procedures at her Beverly Hills clinic, also appears more concerned with how realistic patients’ expectations are — and how likely they are to be pleased with the results.
“The question I’m constantly asking myself is, ‘Is this person capable of happiness?'” she said in a phone interview. “If I think someone is perseverating over something imperceptible, I’ll tell them, ‘I don’t think I can make you happy.’
“I think (‘Skin Decision’) is the first time that plastic surgery has been shown for what it is,” she added. “It’s an emotional change, it’s a therapeutic thing we do rather than just vanity and a spectacle.”
Patients in need
Today, a variety of cosmetic procedures are being used to treat patients in unexpected ways, according to Dr. Linda Lee, an assistant professor of otolaryngology at Massachusetts Eye and Ear’s Facial Nerve Center, part of Harvard Medical School.
“When the muscle is wasted, there’s no surgery that’s going to make that better. But two syringes of cheek filler make an amazing difference in five minutes,” Lee said in a phone interview, saying that the injections have given her patients’ faces a more balanced appearance.
“It’s a different skill (as a doctor) — I’m not trying to make you look younger, I’m trying to make you look symmetrical.”
Research by Massachusetts Eye and Ear’s Facial Nerve Center, part of Harvard Medical School, used facial filler injections to help patients with Bell’s palsy. Credit: Massachusetts Eye and Ear Facial Nerve Center
But as far as insurers — or, in countries with public healthcare systems, state hospitals — are concerned, work like this exists in a “gray area” between cosmetic and reconstructive surgery, Lee said. Healthcare policies traditionally only pay out for procedures that are shown to restore function or the ability to carry out everyday tasks. (Nazarian said she would not expect the procedures carried out in “Skin Decision” to be covered by insurance companies in the US).
As such, participants in the Harvard Medical School study had to pay out of pocket for the injections, though they were offered at cost price (around $350 to $400 each). Lee hopes that her research can help encourage insurers to cover the treatment, which is far less invasive than alternatives like facial reanimation surgery — even though “people think of fillers as for aging and wrinkles.”
As one of the study’s patients, Suzanne Nevins, attests, this “cosmetic” procedure can help restore function too. Having suffered paralysis on the right side of her face, the 67-year-old postnatal nurse said that her speech and ability to eat foods like soup had been impaired by the condition.
“I could cry, because I could not believe how much getting that lower lip firmer helped,” she said in a phone interview. “I ate better, I spoke better and I was much more comfortable. It’s physical health, but it’s also mental.”
Related video: How red lipstick became a symbol of strength
As our understanding of mental wellbeing becomes more nuanced and holistic, so too may our definition of “functionality.” It more often relates to the physical, but what if a body issue affects a patient’s ability to function socially, professionally or interpersonally?
“There’s a continuum, from having social anxiety to being severely impaired (by it),” said Margraf. “At one end of the continuum, social anxiety has an illness-like quality that impairs your quality of life more than being a terminal cancer patient.”
“Skin Decision” uses a variety of surgical and non-surgical cosmetic procedures. Credit: Netflix
For patients in “Skin Decision” and Harvard’s Bell’s palsy study alike, the potential psychological gains of cosmetic work are self-evident. Yet, there is evidence that patients’ ability to benefit from aesthetic procedures depends on their mental well-being going into them.
“If you’re not ready, if you’re not strong enough and if you haven’t gotten the right help mentally before doing this, you may be doing it for the wrong reasons.”
Katrina Goodwin, patient on “Skin Decision”
“Past behavior is a good predator of future behavior,” Margraf said. “So, if you’re depressed before the procedure, you’ll come out more depressed, in comparison to others, in the future.”
Nazarian and Sherrill in a promotional still from Netflix’s “Skin Decision.” Credit: Netflix
Goodwin, who completed filming for the show two-and-a-half years after surviving the tragic murder-suicide, said that having cosmetic surgery “opened my own mental prison.” But the 39-year-old also pointed to the dangers of treating it as a psychological cure-all.
“Your heart and mind have to be emotionally ready… If you’re not ready, if you’re not strong enough and if you haven’t gotten the right help mentally before doing this, you may be doing it for the wrong reasons.”
Top image: Nicholas Bravo, a participant in “Skin Decision,” after receiving treatment for facial scarring following a road accident.
An earlier version of this story did not include Linda Lee’s title. She is Dr. Linda Lee.
All the products we found to be the best during our testing this year
Throughout the year, CNN Underscored is constantly testing products — be it coffee makers or headphones — to find the absolute best in each respective category.
Our testing process is rigorous, consisting of hours of research (consulting experts, reading editorial reviews and perusing user ratings) to find the top products in each category. Once we settle on a testing pool, we spend weeks — if not months — testing and retesting each product multiple times in real-world settings. All this in an effort to settle on the absolute best products.
So, as we enter peak gifting season, if you’re on the hunt for the perfect gift, we know you’ll find something on this list that they (or you!) will absolutely love.
Beginner baristas and coffee connoisseurs alike will be pleased with the Baratza Virtuoso+, a conical burr grinder with 40 settings for grind size, from super fine (espresso) to super coarse (French press). The best coffee grinder we tested, this sleek look and simple, intuitive controls, including a digital timer, allow for a consistent grind every time — as well as optimal convenience.
Best drip coffee maker: Braun KF6050WH BrewSense Drip Coffee Maker ($79.95; amazon.com)
During our testing of drip coffee makers, we found the Braun KF6050WH BrewSense Drip Coffee Maker made a consistently delicious, hot cup of coffee, brewed efficiently and cleanly, from sleek, relatively compact hardware that is turnkey to operate, and all for a reasonable price.
Best single-serve coffee maker: Breville-Nespresso VertuoPlus ($165; originally $179.95; amazon.com)
Among all single-serve coffee makers we tested, the Breville-Nespresso VertuoPlus, which uses pods that deliver both espresso and “regular” coffee, could simply not be beat for its convenience. Intuitive and a snap to use right out of the box, it looks sleek on the counter, contains a detached 60-ounce water reservoir so you don’t have to refill it with each use and delivers perfectly hot, delicious coffee with a simple tap of a lever and press of a button.
Best coffee subscription: Blue Bottle (starting at $11 per shipment; bluebottlecoffee.com)
Blue Bottle’s coffee subscription won us over with its balance of variety, customizability and, most importantly, taste. We sampled both the single-origin and blend assortments and loved the flavor of nearly every single cup we made. The flavors are complex and bold but unmistakably delicious. Beyond its coffee, Blue Bottle’s subscription is simple and easy to use, with tons of options to tailor to your caffeine needs.
Best cold brewer coffee maker: Hario Mizudashi Cold Brew Coffeepot ($25; amazon.com)
This sleek, sophisticated and streamlined carafe produces 1 liter (about 4 1/4 cups) of rich, robust brew in just eight hours. It was among the simplest to assemble, it executed an exemplary brew in about the shortest time span, and it looked snazzy doing it. Plus, it rang up as the second-most affordable of our inventory.
Best nonstick pan: T-fal E76597 Ultimate Hard Anodized Nonstick Fry Pan With Lid ($39.97; amazon.com)
If you’re a minimalist and prefer to have just a single pan in your kitchen, you’d be set with the T-fal E76597. This pan’s depth gives it multipurpose functionality: It cooks standard frying-pan foods like eggs and meats, and its 2 1/2-inch sides are tall enough to prepare recipes you’d usually reserve for pots, like rices and stews. It’s a high-quality and affordable pan that outperformed some of the more expensive ones in our testing field.
Best blender: Breville Super Q ($499.95; breville.com)
With 1,800 watts of motor power, the Breville Super Q features a slew of preset buttons, comes in multiple colors, includes key accessories and is touted for being quieter than other models. At $500, it does carry a steep price tag, but for those who can’t imagine a smoothie-less morning, what breaks down to about $1.30 a day over a year seems like a bargain.
Best knife set: Chicago Cutlery Fusion 17-Piece Knife Block Set ($119.74; amazon.com)
The Chicago Cutlery Fusion 17-Piece Knife Block Set sets you up to easily take on almost any cutting job and is a heck of a steal at just $119.97. Not only did the core knives included (chef’s, paring, utility and serrated) perform admirably, but the set included a bevy of extras, including a full set of steak knives. We were blown away by their solid construction and reliable execution for such an incredible value. The knives stayed sharp through our multitude of tests, and we were big fans of the cushion-grip handles that kept them from slipping, as well as the classic look of the chestnut-stained wood block. If you’re looking for a complete knife set you’ll be proud of at a price that won’t put a dent in your savings account, this is the clear winner.
Best true wireless earbuds: AirPods Pro ($199, originally $249; amazon.com)
Apple’s AirPods Pro hit all the marks. They deliver a wide soundstage, thanks to on-the-fly equalizing tech that produces playback that seemingly brings you inside the studio with the artist. They have the best noise-canceling ability of all the earbuds we tested, which, aside from stiff-arming distractions, creates a truly immersive experience. To sum it up, you’re getting a comfortable design, a wide soundstage, easy connectivity and long battery life.
Best noise-canceling headphones: Sony WH-1000XM4 ($278, originally $349.99; amazon.com)
Not only do the WH-1000XM4s boast class-leading sound, but phenomenal noise-canceling ability. So much so that they ousted our former top overall pick, the Beats Solo Pros, in terms of ANC quality, as the over-ear XM4s better seal the ear from outside noise. Whether it was a noise from a dryer, loud neighbors down the hall or high-pitched sirens, the XM4s proved impenetrable. This is a feat that other headphones, notably the Solo Pros, could not compete with — which is to be expected considering their $348 price tag.
Best on-ear headphones: Beats Solo 3 ($119.95, originally $199.95; amazon.com)
The Beats Solo 3s are a phenomenal pair of on-ear headphones. Their sound quality was among the top of those we tested, pumping out particularly clear vocals and instrumentals alike. We enjoyed the control scheme too, taking the form of buttons in a circular configuration that blend seamlessly into the left ear cup design. They are also light, comfortable and are no slouch in the looks department — more than you’d expect given their reasonable $199.95 price tag.
The Stila Stay All Day Liquid Lipstick has thousands of 5-star ratings across the internet, and it’s easy to see why. True to its name, this product clings to your lips for hours upon hours, burritos and messy breakfast sandwiches be damned. It’s also surprisingly moisturizing for such a superior stay-put formula, a combo that’s rare to come by.
The Stila Stay All Day Waterproof Liquid Eyeliner is a longtime customer favorite — hence its nearly 7,500 5-star reviews on Sephora — and for good reason. We found it requires little to no effort to create a precise wing, the liner has superior staying power and it didn’t irritate those of us with sensitive skin after full days of wear. As an added bonus, it’s available in a whopping 12 shades.
The Steelcase Series 1 scored among the highest overall, standing out as one of the most customizable, high-quality, comfortable office chairs on the market. At $415, the Steelcase Series 1 beat out most of its pricier competitors across testing categories, scoring less than a single point lower than our highest-rated chair, the $1,036 Steelcase Leap, easily making it the best bang for the buck and a clear winner for our best office chair overall.
Best ergonomic keyboard: Logitech Ergo K860 ($129.99; logitech.com)
We found the Logitech Ergo K860 to be a phenomenally comfortable keyboard. Its build, featuring a split keyboard (meaning there’s a triangular gap down the middle) coupled with a wave-like curvature across the body, allows both your shoulders and hands to rest in a more natural position that eases the tension that can often accompany hours spent in front of a regular keyboard. Add the cozy palm rest along the bottom edge and you’ll find yourself sitting pretty comfortably.
Best ergonomic mouse: Logitech MX Master 3 ($99.99; logitech.com)
The Logitech MX Master 3 is an unequivocally comfortable mouse. It’s shaped to perfection, with special attention to the fingers that do the clicking. Using it felt like our fingers were lounging — with a sculpted ergonomic groove for nearly every finger.
Best ring light: Emart 10-Inch Selfie Ring Light ($25.99; amazon.com)
The Emart 10-Inch Standing Ring Light comes with a tripod that’s fully adjustable — from 19 inches to 50 inches — making it a great option whether you’re setting it atop your desk for video calls or need some overhead lighting so no weird shadows creep into your photos. Its three light modes (warm, cool and a nice mix of the two), along with 11 brightness levels (among the most settings on any of the lights we tested), ensure you’re always framed in the right light. And at a relatively cheap $35.40, this light combines usability and affordability better than any of the other options we tested.
Best linen sheets: Parachute Linen Sheet Set (starting at $149; parachute.com)
Well made, luxurious to the touch and with the most versatile shopping options (six sizes, nine colors and the ability to order individual sheets), the linen sheets from Parachute were, by a narrow margin, our favorite set. From the satisfying unboxing to a sumptuous sleep, with a la carte availability, Parachute set the gold standard in linen luxury.
Best shower head: Kohler Forte Shower Head (starting at $74.44; amazon.com)
Hands down, the Kohler Forte Shower Head provides the best overall shower experience, offering three distinct settings. Backstory: Lots of shower heads out there feature myriad “settings” that, when tested, are pretty much indecipherable. The Forte’s three sprays, however, are each incredibly different and equally successful. There’s the drenching, full-coverage rain shower, the pulsating massage and the “silk spray” setting that is basically a super-dense mist. The Forte manages to achieve all of this while using only 1.75 gallons per minute (GPM), making it a great option for those looking to conserve water.
Best humidifier: TaoTronics Cool Mist Humidifier (starting at $49.99; amazon.com)
The TaoTronics Cool Mist Humidifier ramped up the humidity in a room in about an hour, which was quicker than most of the options we tested. More importantly, though, it sustained those humidity levels over the longest period of time — 24 hours, to be exact. The levels were easy to check with the built-in reader (and we cross-checked that reading with an external reader to confirm accuracy). We also loved how easy this humidifier was to clean, and the nighttime mode for the LED reader eliminated any bright lights in the bedroom.
Best TV: TCL 6-Series (starting at $579.99; bestbuy.com)
With models starting at $599.99 for a 55-inch, the TCL 6-Series might give you reverse sticker shock considering everything you get for that relatively small price tag. But can a 4K smart TV with so many specification standards really deliver a good picture for $500? The short answer: a resounding yes. The TCL 6-Series produces a vibrant picture with flexible customization options and handles both HDR and Dolby Vision, optimization standards that improve the content you’re watching by adding depth to details and expanding the color spectrum.
Best streaming device: Roku Ultra ($99.99; amazon.com)
Roku recently updated its Ultra streaming box and the 2020 version is faster, thanks to a new quad-core processor. The newest Ultra retains all of the features we loved and enjoyed about the 2019 model, like almost zero lag time between waking it up and streaming content, leading to a hiccup-free streaming experience. On top of that, the Roku Ultra can upscale content to deliver the best picture possible on your TV — even on older-model TVs that don’t offer the latest and greatest picture quality — and supports everything from HD to 4K.
Best carry-on luggage: Away Carry-On ($225; away.com)
The Away Carry-On scored high marks across all our tests and has the best combination of features for the average traveler. Compared with higher-end brands like Rimowa, which retail for hundreds more, you’re getting the same durable materials, an excellent internal compression system and eye-catching style. Add in smart charging capabilities and a lifetime warranty, and this was the bag to beat.
Best portable charger: Anker PowerCore 13000 (starting at $31.99; amazon.com)
The Anker PowerCore 13000 shone most was in terms of charging capacity. It boasts 13,000 mAh (maH is a measure of how much power a device puts out over time), which is enough to fully charge an iPhone 11 two and a half times. Plus, it has two fast-charging USB Type-A ports so you can juice a pair of devices simultaneously. While not at the peak in terms of charging capacity, at just $31.99, it’s a serious bargain for so many mAhs.
Trump’s misleading tweet about changing your vote, briefly explained
Searches for changing one’s vote did not trend following the recent presidential debate, and just a few states appear to have processes for changing an early vote. But that didn’t stop President Trump from wrongly saying otherwise on Tuesday.
In early morning posts, the president falsely claimed on Twitter and Facebook that many people had Googled “Can I change my vote?” after the second presidential debate and said those searching wanted to change their vote over to him. Trump also wrongly claimed that most states have a mechanism for changing one’s vote. Actually, just a few states appear to have the ability, and it’s rarely used.
Trump’s claim about what was trending on Google after the debate doesn’t hold up. Searches for changing one’s vote were not among Google’s top trending searches for the day of the debate (October 22) or the day after. Searches for “Can I change my vote?” did increase slightly around the time of the debate, but there is no way to know whether the bump was related to the debate or whether the people searching were doing so in support of Trump.
It was only after Trump’s posts that searches about changing your vote spiked significantly. It’s worth noting that people were also searching for “Can I change my vote?” during a similar period before the 2016 presidential election.
Google declined to comment on the accuracy of Trump’s post.
Trump also claimed that these results indicate that most of the people who were searching for how to change their vote support him. But the Google Trends tool for the searches he mentioned does not provide that specific information.
Perhaps the most egregiously false claim in Trump’s recent posts is about “most states” having processes for changing your early vote. In fact, only a few states have such processes, and they can come with certain conditions. For instance, in Michigan, voters who vote absentee can ask for a new ballot by mail or in person until the day before the election.
The Center for Election Innovation’s David Becker told the Associated Press that changing one’s vote is “extremely rare.” Becker explained, “It’s hard enough to get people to vote once — it’s highly unlikely anybody will go through this process twice.”
At the time of publication, Trump’s false claims had drawn about 84,000 and 187,000 “Likes” on Twitter and Facebook, respectively. Trump’s posts accelerated searches about changing your vote in places like the swing state of Florida, where changing one’s vote after casting it is not possible. Those numbers are a reminder of the president’s capacity to spread misinformation quickly.
On Facebook, the president’s post came with a label directing people to Facebook’s Voting Information Center, but no fact-checking label. Twitter had no annotation on the president’s post. Neither company responded to a request for comment.
That Trump is willing to spread misinformation to benefit himself and his campaign isn’t a surprise. He does that a lot. Still, just days before a presidential election in which millions have already voted, this latest episode demonstrates that the president has no qualms about using false claims about voting to cause confusion and sow doubt in the electoral process.
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Nearly 6,000 civilian casualties in Afghanistan so far this year
From January to September, 5,939 civilians – 2,117 people killed and 3,822 wounded – were casualties of the fighting, the UN says.
Nearly 6,000 Afghan civilians were killed or wounded in the first nine months of the year as heavy fighting between government forces and Taliban fighters rages on despite efforts to find peace, the United Nations has said.
From January to September, there were 5,939 civilian casualties in the fighting – 2,117 people killed and 3,822 wounded, the UN Assistance Mission in Afghanistan (UNAMA) said in a quarterly report on Tuesday.
“High levels of violence continue with a devastating impact on civilians, with Afghanistan remaining among the deadliest places in the world to be a civilian,” the report said.
Civilian casualties were 30 percent lower than in the same period last year but UNAMA said violence has failed to slow since the beginning of talks between government negotiators and the Taliban that began in Qatar’s capital, Doha, last month.
The Taliban was responsible for 45 percent of civilian casualties while government troops caused 23 percent, it said. United States-led international forces were responsible for two percent.
Most of the remainder occurred in crossfire, or were caused by ISIL (ISIS) or “undetermined” anti-government or pro-government elements, according to the report.
Ground fighting caused the most casualties followed by suicide and roadside bomb attacks, targeted killings by the Taliban and air raids by Afghan troops, the UN mission said.
Fighting has sharply increased in several parts of the country in recent weeks as government negotiators and the Taliban have failed to make progress in the peace talks.
The Taliban has been fighting the Afghan government since it was toppled from power in a US-led invasion in 2001.
Washington blamed the then-Taliban rulers for harbouring al-Qaeda leaders, including Osama bin Laden. Al-Qaeda was accused of plotting the 9/11 attacks.
Calls for urgent reduction of violence
Meanwhile, the US envoy for Afghanistan, Zalmay Khalilzad, said on Tuesday that the level of violence in the country was still too high and the Kabul government and Taliban fighters must work harder towards forging a ceasefire at the Doha talks.
Khalilzad made the comments before heading to the Qatari capital to hold meetings with the two sides.
“I return to the region disappointed that despite commitments to lower violence, it has not happened. The window to achieve a political settlement will not stay open forever,” he said in a tweet.
There needs to be “an agreement on a reduction of violence leading to a permanent and comprehensive ceasefire”, added Khalilzad.
1/4 I return to the region disappointed that despite commitments to lower violence, it has not happened. The window to achieve a political settlement will not stay open forever. https://t.co/hVl4b032W6
— U.S. Special Representative Zalmay Khalilzad (@US4AfghanPeace) October 27, 2020
A deal in February between the US and the Taliban paved the way for foreign forces to leave Afghanistan by May 2021 in exchange for counterterrorism guarantees from the Taliban, which agreed to sit with the Afghan government to negotiate a permanent ceasefire and a power-sharing formula.
But progress at the intra-Afghan talks has been slow since their start in mid-September and diplomats and officials have warned that rising violence back home is sapping trust.
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