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The days of the freak show may officially be over but the human fascination with physical appearance is stronger than ever. According to the American Society for Aesthetic Plastic Surgery, nearly 8.5 million people in America had some form of cosmetic surgery during 2001. That's a whopping 48% more than the previous year, despite a national recession.

Yet having more techniques to control our appearance doesn't lead to greater individual freedom. Instead, it makes us feel as though we have to do everything possible to conform to the accepted ideal. And our sense of failure is doubled if, after all that, we still don't look 'perfect'. But while some people embark on a ruthless regime of self-control in this quest for 'perfection', others rebel against the pressure to conform by dramatically changing their appearance.

People with disabilities, who have some clear physical difference from this ideal, come under even more pressure to conform. Cosmetic surgery, for example, can be used to alter the distinctive facial features of people with Down's syndrome. Prosthetic limbs look so much like the real thing that only those in the know can tell the difference. But this assumes that people with disabilities are dissatisfied with how they look and that other people won't accept them unless they imitate some notion of 'normality'.

The surgeon's scalpel has become a double-edged sword, but who determines our templates for beauty? And how attractive are they?

Voyeur of discovery

There was a voyeuristic element involved in the allure of the freak show. Today we are more likely to associate that with pornography and the sex industry – but it is driven by the same desire to view that which is shocking and usually hidden. In Amsterdam, Soho and Pat Pong, the peep show has replaced the freak show, but many of the 'exhibits' are just as physically astonishing as their Victorian counterparts. Would a slender woman balancing glasses of wine on 55FF breasts have been an object of sexual desire 100 years ago in the way she is today, or touted by some hyperbolic talker outside a freak show?

Cutting edge chic

Thanks to film, TV and magazine exposure, the surgically modified female figure with disproportionately large breasts has become a familiar fashion of our time. This sought-after image combines the full-figured, 18th century, Rubenesque ideal that signified affluence, and the 21st century waif that indicates youth and heroin chic. Is this the best of both worlds or an unnatural physical image that panders to fantasy?

It barely matters. A once shocking image has now been assimilated into popular culture and emulated. The tubby, ruddy-faced old man that symbolised jollity has been replaced by the belief that youth and beauty are the key to happiness and fulfilment. Husbands buy wives a new pair of boobs for Christmas or pop down the supermarket to take 10 years off their own appearance with a bottle of hair dye (slipped inconspicuously under the tomatoes). Whilst they only accounted for 12% of overall figures in the US last year, men in the 35-50 age bracket were the fastest growing consumer group investing in cosmetic surgery. Most were having their beer bellies liposuctioned away. Still, many speak of surgery becoming addictive. There's always something else to be nipped or tucked, and the satisfaction it brings can be short-lived.

Breaking the mould

	Bride of Wildenstein PA Photos

Conversely, there are those who choose surgery as a means to express their individuality and set themselves apart from the Stepford beauties. Orlan, a French performance artist, goes through regular plastic surgery as a comment on the various beauty ideals and historical models of female perfection. Broadcasting films of her operations, she provides commentary under local anaesthetic and describes her work as 'a stand against the standards of beauty, against the dictates of a dominant ideology that impresses itself more and more on feminine ... flesh'.

Surgery isn't the only means by which people enhance or alter their appearance. Once frowned upon, piercings, tattoos and brandings are all means of experimenting with the body – the one thing that is truly our own. 'Lizard Man' Eric Sprague and 'Leopard Man' Tom Leppard have both endured hundreds of hours of tattooing to take on the appearance of animals. Eric describes his transformation, which also included surgically forking his tongue, as an act of 'self-fulfilment and satisfaction'. Tom wanted to be the 'biggest of something' and achieved it through tattoo.

Those with disabilities, though, do not often have the same choice or freedom to alter their appearance. Whereas some non-disabled people choose a freakish image, others, born with striking physical differences from the assumed ideal have no choice but to learn to live with their appearance. More importantly, everyone else needs to learn to live with those differences, too.

Control freaks

Previous generations may have wished they could have such control over their appearance but in reality it diminishes our ability to live with what we've got and fuels our pursuit of what we're not. Even though we pay lip service to valuing diversity, it seems that most of us can still only accept human differences if we've chosen them ourselves.

And whilst surgery has given us choices, perhaps we don't always make the best ones. The famous 'Bride of Wildenstein', a wealthy society woman who repulsed people with her surgically enhanced, cat-like appearance several years ago, became an alarming symbol of how distorted our perceptions of beauty can be. People are finding it harder to accept their differences from the ideal, when those differences are just what make us individuals.

As some people go to enormous lengths to achieve perfection, others use the same tools to stand out in a sea of uniformity. So are these different worlds, or just opposite ends of the same spectrum?

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