Westerfeld has suggested that Uglies, and other dystopian teen novels like it, are part of an understandable response to the increased surveillance and nonsensical rules teens today are subject to, both at school and at home. In interviews and essays, Westerfeld has also taken issue with the increasing interest in policing teens’ whereabouts and behavior, specifically as parents’ ability (or potential ability) to track teens through their phones, cars, and even dental implants have made headlines.
In the 10 years prior to Uglies’ publication, cosmetic procedures on patients younger than 18 increased dramatically, from around 14,000 procedures in 1996 to 333,000 procedures in 2005. Today, medical associations differentiate between plastic surgery (which is reconstructive and corrects impairments like cleft palates or traumatic injuries) and cosmetic surgery (which is elective and includes procedures like breast augmentation, facelifts, and liposuction) it’s cosmetic surgery that Westerfeld takes issue with in Uglies. Though people have been repairing bodies for millennia, elective surgery wasn’t much of a possibility until the mid to late 19th century, thanks to the development of anesthesia and antibiotics.
The earliest mention of what would be considered plastic surgery today appears in the Edwin Smith Papyrus, a medical text dating to between 30 B.C. The Uglies series was inspired by the increasing availability of plastic surgery (especially for young people), as well as the increase in surveillance that Westerfeld sees young people experiencing.
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