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in category Fiqh (Jurisprudence)

Is plastic surgery permitted in Islam?

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Islamic researcher, graduated from Al-Azhar University, Islamic Studies in English.
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In a Nutshell
In principle, changing one's appearance created by Allah, by doing plastic surgery etc., is prohibited. However, it becomes permissible if this surgery aims at eliminating either physical or psychological harms by concealing congenital defects or ones that occur later in life.
Introduction

Plastic surgery is a surgical specialty involving the restoration, reconstruction, or alteration of the human body. It can be divided into two categories. The first is reconstructive surgery which includes craniofacial surgery, hand surgery, microsurgery, and the treatment of burns. The other is cosmetic or aesthetic surgery. While reconstructive surgery aims to reconstruct a part of the body or improve its functioning, cosmetic surgery aims at improving the appearance of it. (Royal College of Surgeons, "What is Cosmetic Surgery")

Assumption

In shari'ah, the general rule (asl) regarding changing one's original creation (e.g. changing facial features, making tattoo, etc.) is that of prohibition (haram).

Evidences

Allah narrates the challenge of the Shaytaan of deceiving people to change their creation:  

وَلَأُضِلَّنَّهُمْ وَلَأُمَنِّيَنَّهُمْ وَلَآمُرَنَّهُمْ فَلَيُبَتِّكُنَّ آذَانَ الْأَنْعَامِ وَلَآمُرَنَّهُمْ فَلَيُغَيِّرُنَّ خَلْقَ اللَّهِ ۚ وَمَن يَتَّخِذِ الشَّيْطَانَ وَلِيًّا مِّن دُونِ اللَّهِ فَقَدْ خَسِرَ خُسْرَانًا مُّبِينًا- النساء 119

I will certainly mislead them and delude them with empty hopes. Also, I will order them and they will slit the ears of cattle1 and alter Allah's creation. And whoever takes Satan as a guardian instead of Allah has certainly suffered a tremendous loss. (Qut'an 4: 119)
The Prophet (saw) also condemned this notion aiming to change their creation:

عَنْ عَلْقَمَةَ، قَالَ لَعَنَ عَبْدُ اللَّهِ الْوَاشِمَاتِ، وَالْمُتَنَمِّصَاتِ، وَالْمُتَفَلِّجَاتِ لِلْحُسْنِ، الْمُغَيِّرَاتِ خَلْقَ اللَّهِ‏.‏ فَقَالَتْ أُمُّ يَعْقُوبَ مَا هَذَا قَالَ عَبْدُ اللَّهِ وَمَا لِيَ لاَ أَلْعَنُ مَنْ لَعَنَ رَسُولُ اللَّهِ، وَفِي كِتَابِ اللَّهِ - البخاري 77/154 

Alqama (ra) narrated: Abdullah cursed those women who practised tattooing and those who removed hair from their faces and those who created spaces between their teeth artificially to look beautiful, such ladies as changed what Allah has created. Um Ya'qub said, "What is that?" Abdullah said, "Why should I not curse those who were cursed by Allah's Messenger (saw) and are referred to in Allah's Book?" (Bukhari 77:154)
عنِ ابْنِ عَبَّاسٍ، قَالَ لُعِنَتِ الْوَاصِلَةُ وَالْمُسْتَوْصِلَةُ وَالنَّامِصَةُ وَالْمُتَنَمِّصَةُ وَالْوَاشِمَةُ وَالْمُسْتَوْشِمَةُ مِنْ غَيْرِ دَاءٍ‏  – أبو داود 35/12

Ibn Abbas (ra) narrated:

The woman who supplies fake hair and the one who asks for it, the woman who pulls out hair for other people and the woman who depilates herself, the woman who tattoos and the one who has it done when there is no disease to justify it have been cursed. (Abu Dawud 35:12)

The Review of the Scholarly Views

In his commentary on the above-mentioned verse, ibn Kathir noted:

قَالَ اِبْن الْحَسَن الْبَصْرِيّ يَعْنِي بِذَلِكَ الْوَشْم وَفِي صَحِيح مُسْلِم النَّهْي عَنْ الْوَشْم فِي الْوَجْه وَفِي لَفْظ : لَعَنَ اللَّه مَنْ فَعَلَ ذَلِكَ وَفِي الصَّحِيح عَنْ اِبْن مَسْعُود أَنَّهُ قَالَ : لَعَنَ اللَّه الْوَاشِمَات وَالْمُسْتَوْشِمَات وَالنَّامِصَات وَالْمُتَنَمِّصَات وَالْمُتَفَلِّجَات لِلْحُسْنِ الْمُغَيِّرَات خَلْق اللَّه عَزَّ وَجَلَّ ثُمَّ قَالَ : أَلَا أَلْعَن مَنْ لَعَنَ رَسُول اللَّه صَلَّى اللَّه عَلَيْهِ وَسَلَّمَ - ابن كثير، تفسير القرآن العظيم 1/367

It means tattooing, according to Al-Hasan al-Basri. In his Sahih, Muslim recorded the prohibition of tattooing the face, which in one of its wordings states: "May Allah curse whoever does this." It is also recorded in the Sahih that Ibn Mas'ud said, "May Allah curse those who have tattoos and those who do it, who pluck their (facial) hairs and the one who does it for them, and those who make spaces between their teeth for the purpose of beauty, changing what Allah has created." (Ibn Kathir, Tafsir al-Qur'an al-Azim, vol. 1, 367)
In the two hadiths mentioned above, the Prophet (saw) cursed the ladies who changed their natural appearance created by Allah. Scholars, however, said that this prohibition is related to the one seeking beautification. But if one suffers from a disease or a defect, it is permissible to do such changes.

قال الشوكاني: قوله : "من غير داء" ظاهره أن التحريم المذكور إنما هو فيما إذا كان لقصد التحسين لا لداء وعلة ، فإنه ليس بمحرم  - الشوكاني، نيل الأوطار 6/229

Al Shawkani mentioned that the Prophets' (saw) saying "من غير داء – when there is no disease" refers that the stated rule of prohibition is related to the one seeking beautification, not which that done due to a disease or a defect. Hence, the latter is not prohibited. (Al Shawkani, Nayl al-Awtar, vol. 6, p. 229)
Also, it is reported:

عَنْ عَبْدِ الرَّحْمَنِ بْنِ طَرَفَةَ، أَنَّ جَدَّهُ، عَرْفَجَةَ بْنَ أَسْعَدَ قُطِعَ أَنْفُهُ يَوْمَ الْكُلاَبِ فَاتَّخَذَ أَنْفًا مِنْ وَرِقٍ فَأَنْتَنَ عَلَيْهِ فَأَمَرَهُ النَّبِيُّ صلى الله عليه وسلم فَاتَّخَذَ أَنْفًا مِنْ ذَهَبٍ ‏-  أبو داود 36/16، والنسائي 48/122

Abdur Rahman ibn Tarafah said that his grandfather Arfajah ibn As'ad who had his nose cut off at the battle of al-Kilab got a silver nose, but it developed a stench, so the Prophet (saw) ordered him to get a gold nose. (Abu Dawud 36:19; Nasa'i 48:122)
But scholars said that only the necessary and needed interventions are permitted. 

Cases when Plastic Surgery is Permissible

Whilst the general rule is the prohibition, there are a number of case where such surgeries would be permitted, such constructive and cosmetic surgeries that aim at eliminating either physical or psychological harms which affects the stability of life in general and of marital life in particular, by concealing congenital defects or ones that occur later in life. (Dar al Iftaa al Misriyyah, fatwa No. 4215)

In 2007, the International Islamic Fiqh Academy (IIFA) (al-Majmaʿal-Fiqh al-Islāmiy al-Duwaliy) issued a report about plastic surgery, in its resolution No. (173), following a discussion amongst its member. The report stated that:

لَا يُجَوِّز إِجْرَاءُ جِرَاحَةِ التَّجْمِيلِ التَّحْسِينِيَّةَ الَّتِي لَا تَدْخُلُ فِي الْعِلاَجِ الطِّبِّيِّ وَيُقَصَدُ مِنْهَا تَغْيِيرُ خِلْقَةِ الْإِنْسانِ السَّوِيَّةِ تَبَعًا لِلْهَوَى وَالرَّغْبََاتِ بِالتَّقْليدِ للآخرين مِثْلُ عَمَلِيََّاتِ تَغْيِيرِ شَكْلِ الْوَجْهِ لِلظُّهورِ بِمَظْهَرِ مُعَيَّنٍ أَوْ بِقَصْدِ التَّدْلِيسِ وَتَضْلِيلِ الْعَدَالَةِ وَتَغْيِيرِ شَكْلِ الْأَنْفِ وَتَكْبيرِ أَوْ تَصْغِيرِ الشِّفَاهِ وَتَغْيِيرُ شَكْلِ الْعَيْنَيْنِ وَتَكْبيرُ الْوَجْنََاتِ.

It is not permissible to make cosmetic plastic surgeries without a medical necessity performed to change the nature created by Allah only to satisfy one's desire and whims and to imitate others such as the surgeries performed to change the facial features to appear in a certain way, or to reshape the nose, or to decrease the size of lips, or to change the eyes' shape, or to increase cheek fat etc.
The International Islamic Fiqh Academy also explained, in the same report, the necessary cases where making such plastic surgeries are permissible:

  1. Reshaping the normal structures of the body.
  2. Reactivating the original function of the body' organ.
  3. Correcting birth defects like having cleft lip, deviated nose, birthmark, polydactyly (having an extra finger or toe), hyperdontia (having an extra teeth), syndactyly (two or more digits are fused together) when it causes physical or psychological harms.
  4. Concealing the defects resulting from burns, accidents, diseases and the like. For example, dermatoplasty, reshape woman's breast after total or simple mastectomy, when the breast size causes a disease and hair transplant especially for women who suffer from hair loss.
  5. Eliminating one's hideousness causing him physical and psychological distress.
Conclusion

In principle, altering one's appearance created by Allah, by doing plastic surgery etc., is prohibited. However, it becomes permissible if this surgery aims at eliminating either physical or psychological harms by concealing congenital defects or ones that occur later in life.

References

International Islamic Fiqh Academy (IIFA), resolution No. 173
Dar al Iftaa al Misriyyah, fatwa No. 4215
Ibn Kathir, Tafsir al-Qur'an al-Azim

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