Cutie Marks Under the Knife: A Special Report
Doctor Vibrant Insignia sharpens his scalpel.
Today is operation day for twenty-nine-year-old Toola-Roola, of Ponyville. She’s here for a cutie mark replacement surgery. Her natural cutie mark—a pink-tipped paintbrush with a swirl of purple at the end—will be removed and replaced with a new cutie mark of her choice, printed on a piece of synthetic skin.
The young mare fidgets nervously in the waiting room of the clinic, perched high on the 15th floor of a Manehattan office building. The room is elaborately decorated with potted palms, a floral rug, and shiny posters.
Toola-Roola is the last of her friends to receive the surgery. Her closest friend, Coconut Cream, has already had the surgery at the same clinic.
“I’m doing this for me. I wanna look nice,” she says to me. “It’s not like I’m succumbing to peer pressure or anything. My new cutie mark’s much more refined.”
I sit next to her in the waiting room. As a journalist for The Manehattan Times, this is my first time interviewing her. “You think your natural cutie mark isn’t refined?” I ask.
Toola-Roola gazes at her flank, her head tilting from side to side. “Well, like, it’s not crude,” she says. “I mean, like, my old cutie mark’s presentable. But curls and swirls…I just don’t feel it, you know? Like, it’s not me.”
“How is it not ‘you’?”
She frowns. “Like, it’s so dated. I think the last time I saw a pattern like this was in my grandma’s needlepoint. Like, I don’t wanna walk into a room, and the first thing they see is grandma. I mean, I’m only twenty-nine.”
“What about at the very moment you got your natural cutie mark? Was it ‘you’ back then?”
“Well, I don’t know about you…”—she stares at my cutie mark of a rolled-up newspaper and a bowler hat—“…but I got my cutie mark when I was 8. Or was it 9? I’m not sure. I was really into glitter paint back then, but my mom didn’t want me to make a mess in the house. So, I remember I was sitting outside on this dirty tree stump, painting random shapes in glitter all over my brother’s physics homework. And that’s when I got…this.”
“And you’re not into glitter paint anymore?”
There’s a brief silence. She continues to stare at my natural cutie mark, this time almost with a look of contempt. “Unlike some ponies, I didn’t have my life figured out when I was 8. Or 9. Or 19. Or even now, for that matter. Even though Equestrian magic seems to think I did.
“I’ve changed. And my cutie mark didn’t change along with me.”
It started with tail extensions.
Now, more than ever, ponies are looking for new and exciting ways to change their appearances.
Once an underground procedure shunned by ponies, in just ten years cutie mark cosmetic surgery has become the latest controversial beauty trend sweeping across Equestria.
Cosmetic modification of a cutie mark is not a new concept. Ponies have covered or touched up their cutie marks with makeup for centuries, whether for disguise or beautification. However, this requires daily reapplication, since a cutie mark will magically bleed through makeup after 12 to 24 hours. With the exception of very few unicorns, there is no magical spell that can permanently change a cutie mark.
Surgically changing a cutie mark was not attempted for many years, due to the preconception that changing a pony’s cutie mark in any way would have disastrous physical and psychological consequences. “Cutting out a cutie mark with a knife” was once a common trope in Equestrian horror movies. It’s only in the last decade that surgery has been recognized as a generally safe way to alter a cutie mark.
Unlike makeup, surgical modification is permanent, requiring essentially no upkeep. And unlike magical spells or potions, ponies who have cutie mark surgery report little to no side effects. No big personality shifts, no sudden color changes, no major depressive episodes.
(The working theory among researchers is that cutie mark magic diffuses from the cutie mark into a pony’s body over the course of their life. This “core cutie mark magic” is enough to prevent any adverse side effects from occurring, even if the skin of the cutie mark is removed.)
The reasons for having cutie mark surgery vary widely. Some ponies may simply “recolorize” their cutie mark to make it stand out more, or to better match their mane. Some ponies retouch their cutie mark to make it more indicative of their natural talents. Other ponies have cutie marks with rather morbid interpretations—to avoid confusion, they modify their cutie mark’s image using a synthetic skin replacement.
Childhood friends who received linked cutie marks may wish to change them after they drift apart in their adult years. Conversely, ponies who get married may wish to get matching cutie marks as a symbol of unity.
Advocates of the procedure say it helps create a more robust society. Ponies may be more willing to try a variety of skillsets, without feeling burdened by their natural cutie mark. They also point out that there is little risk: the surgery is medically safe, requires no magic, and has a quick recovery time.
And more and more ponies are putting their cutie marks under the knife. Saddle Row in Manehattan, named for the fabulous fashion boutiques that once lined the street, is now filled with at least twenty-five independent “cutie mark clinics.”
The sudden rise of this relatively new surgery has made local authorities cautious. To date, no Equestrian city has fully legalized cutie mark surgery. Ponyville, Appaloosa, and Canterlot have outright banned the procedure. Other Equestrian cities, such as Fillydelphia and Manehattan, unofficially tolerate the cutie mark modification clinics, allowing them to operate under the euphemism of “cutie mark spa” or “cutie mark clinic.”
At Dr. Vibrant Insignia’s cutie mark clinic, each artificial cutie mark is custom designed by the patient, with the help of an in-house artist. Toola-Roola’s already designed hers in a previous appointment.
In the waiting room of the clinic, she shows me a poster-print of what her new cutie mark will look like. It’s a single orchid, white with purple venation, and a single green stem pointing downward. There’s a small hole at the top of the picture, from when she pinned it on her bedroom wall.
“It’s pretty, don’t you think?” she shoves the poster print in front of my face.
“Why did you choose an orchid?” I ask.
“Well, I like orchids. Coconut Cream and I went on a girls’ holiday at Horseolulu last winter, and like, the orchids there were just incredible. White orchids, pink orchids, yellow orchids, baby orchids. Oh yeah, there was even this shop in Waikiki that sold cyan orchids. Like, have you even heard of cyan orchids?”
“How long do you think you’ll like orchids for?”
She seems offended by my question. “Well, orchids are ‘me.’ They are. I don’t think I’d ever get sick of them. Nor do they ever go out of fashion. It’s not like glitter paint. I definitely like orchids more than I liked glitter paint.”
Due to the questionable legality of cutie mark surgery, there is no centralized database of artificial cutie marks that are currently in use. Therefore, there is a very small chance that two clinics will design and implant the same cutie mark in two unrelated ponies. Advocates of full legalization say that the creation a government-run central database will reduce the chance of accidental matching, and eliminate the possibility of cutie mark fraud.
A subset of cutie mark clinics, informally known as “celebrity tattoo shops,” sit on the lowest rung of the reputation ladder. Few stay operational for more than six months, before the owners are arrested. These shady establishments steal cutie marks from famous ponies, make very minute color changes, and sell them to common ponies as “inspired by celebrities.” These plagiarized cutie marks are bought by hardcore fans, wanting to emulate their favorite idols.
Numerous famous figures, including Countess Coloratura, Feather Bangs, and the ponies of the Council of Friendship, have sued these clinics for cutie mark fraud.
(Ponies who surgically implant the cutie mark of Her Majesty Twilight Sparkle, or of Princesses Emerita Celestia and Luna, could face up to 25 years in Tartarus for impersonation of Equestrian royalty. Nopony that we know of has dared to take this risk.)
Dr. Insignia’s clinic is not a “celebrity tattoo shop,” and never has been. Any request for a copied cutie mark without the original owner’s permission is turned down, point blank. Dr. Insignia’s clinic also provides a money back guarantee if any surgically implanted cutie mark happens to accidentally match somepony else’s.
I ask Toola-Roola if she’s worried about accidentally getting the same cutie mark as somepony else.
“Well, I don’t think I’ll get into a lawsuit. I’ve got better luck than that.” She giggles, tilting her head back, then she leans forward to check her fresh hooficure. “And I mean…so what if my cutie mark is the same as some pony living in a village 700 miles away that I’ll probably never meet?
“Actually, I’d wanna meet him. Maybe he’s cute. And it wouldn’t be awkward because somehow…we’d have a special connection. Cause we’d have the same cutie mark. And we wouldn’t have had this connection were it not for the surgery.
“I don’t think I’d even ask for my money back.”
Exact statistics on how many undergo cutie mark surgery are not known, due to the prevalence of illegal clinics. Experts estimate that last year, between 350,000 and 400,000 creatures underwent the surgery. This year, the number is projected to increase to 450,000.
This includes procedures such as cutie mark recolorization, retouching, implantation, and replacement. Price is becoming a significantly lower barrier with each passing year. At a reputable establishment like Dr. Insignia’s clinic, an artificial cutie mark replacement costs only 1000 Bits, or one week’s wage for a typical Manehattanite. A simple recoloration costs only 100 Bits, or the price of dinner for two at a five-star restaurant.
According to a survey last year by The Manehattan Times, 14% of Manehattanites said they have modified their cutie mark surgically, with recolorization being the most common procedure. Mares are more likely to have the procedure, although an increasing number of stallions are as well. In the same survey, at least 40% of stallions in Manehattan “had considered” cutie mark cosmetic surgery.
Back at the clinic, Dr. Insignia is inside the windowless operating room, preparing for his third operation of the day: Toola-Roola’s operation. He’s performed this operation for almost ten years—this will be his 800th time.
The doctor calls Toola-Roola into the operating room. His natural cutie mark—a reflex hammer and a scalpel arranged in an X shape—is covered by green surgical scrubs. “Ms. Toola-Roola? We’re ready for you. If you would step this way, please.”
She steps inside. The lighting changes from a soft yellow in the waiting room to a harsh white fluorescent. The ceiling is higher in the operating room, creating the feeling of a daylit cavern.
The doctor seats Toola-Roola on the bench and explains the operation to her, step-by-step. He speaks firmly, but with enough breathiness that it sounds soothing. He touches Toola-Roola with a hoof, trying to ease her trembling.
“I’m not sure why I’m shaking,” the mare says, turning to me. “I’ve been wanting this day for so long.”
To perform a cutie mark replacement surgery, Dr. Insignia makes a circular incision about 20cm in diameter, encircling the cutie mark region. The incision must be at least 2mm deep, reaching the dermal layer, to fully remove the pigmentation of the existing cutie mark. Then, using a knife, the skin is carefully peeled off.
In a previous appointment, a skin cell sample was taken from Toola-Roola. This was used to make a
piece of synthetic skin, on which the artificial cutie mark is printed. This synthetic skin is placed over the hole once occupied by the natural cutie mark. Small additional cuts are made so that it covers the hole exactly. Dissolving stiches are sewn in, and the wound is cleaned.
The entire operation takes less than an hour. No fasting is required. In most cases, only local anesthesia is needed. Recovery is no more than a week—this is mainly to allow time for the stitches to dissolve, which prevents the fatal embarrassment of being caught with the scars of cutie mark surgery. During that time, one should avoid sitting down or stretching the cutie mark region.
Dr. Insignia gives Toola-Roola a bag of over-the-counter antiseptic cream, in case she experiences any irritation. “Make sure to clean the incision area daily, to avoid infection. Any other questions?”
“I…I don’t think so. I can’t come up with anything right now.”
“All right then. I need to prep a few more things. You sit tight, and in the meantime if you come up with any questions just let me know, okay?”
“Okay. Thanks.”
As the doctor steps away, she starts trembling again.
In a later interview, I ask Dr. Insignia what he does with the removed cutie marks of patients. “Oh. Dispose ‘em. Most of time we just toss ‘em in the red biohazard bags. Like those over there.” He points to a roll of 100, sitting on the counter of the operating room.
After a pause, he adds, “I’m pretty sure they’re just pieces of skin. They’re not magically enchanted or anything. Haven’t seen any glowing trash bags yet.” He chuckles.
Equestria is no longer the homogeneous land of ponies that it once was. Under the rule of Her Majesty Princess Twilight, immigration into Equestria has increased by 30%. More and more dragons, kirin, changelings, and yaks are being born and raised in Equestria, having never seen or visited their homeland. The City of Manehattan recently issued revised fire codes after a young dragon whistled the Equestrian Anthem and accidentally set fire to his family’s wood-framed apartment building.
For these non-pony Equestrians, surgical cutie mark implantation offers them a chance at becoming a little closer to the place they call their “homeland.” Dr. Insignia’s clinic is one of the first to offer cutie marks in a variety of skins, including reptilian skins for dragons and kirin, and even exoskeletion plates for changelings.
I got the chance to talk with one of Dr. Insignia’s first non-pony patients: Gabby, a griffon who’s lived in Equestria for almost 20 years, and who received her cutie mark implant four months ago.
I meet her for afternoon tea at her house, located just outside of Ponyville.
Gabby has a bubbly personality, very atypical of griffons. Her cheerful giggling echoes in the room. “Any griffon, changeling, yak, hippogriff, dragon, or whatever who’s lived in Equestria for a long time and says they’ve never wished they had a cutie mark—they’re lying, I assure you.”
She tells me that she’s wanted a cutie mark as soon as she first heard of its existence. As a teenager, she even went to the Cutie Mark Crusaders personally, asking them for one. They could not deliver.
“They felt bad for me, so they gave me this hunk of wood with the image of a cutie mark painted on it.” She giggles again. “At least I like to think they felt bad for me.”
She burnt the wooden “cutie mark” in the fireplace a long time ago.
With a single talon, she pulls apart the sheer curtain in her living room window, looking out onto a grassy open meadow. “I think somehow I was meant to be a pony. I get along with ponies so much better than I do with my own kind. Not like I feel like I was born in the wrong body or anything, but…” she trails off.
It suddenly goes quiet.
Her apartment is cluttered with Equestrian memorabilia: shiny, laminated posters from the Running of the Leaves, the start of cider season, and Equestria Fashion Week. The only mirror in the room is cracked, heavily scratched, and frosted over.
“I lied,” she mumbles after a long, dead silence.
She looks out the window again. “This would be a nice day in Griffinstone, you know. The clouds and the fog, that’s considered normal over there.” She hasn’t turned on any lights in the room.
With written permission from the Cutie Mark Crusaders, Gabby received her matching cutie mark implanted onto her flank. It is in the same style as the three original CMCs, except with a trophy over the middle stripe.
She leans forward in her chair to show it to me, and her mood seems to improve almost instantly. “It suits me, doesn’t it? You should’ve heard what Scootaloo said about it—the three of them actually came up here to throw a cuteceanera for me, you know? Well, a cuteceanera slash bar trot. Heh! I think it was just an excuse for them to not have to teach their classes at the School of Friendship. Applebloom may or may not have threw up into a creek at 3am…” she laughs for a solid ten seconds.
I watch as she leans back in her chair and pops a few oat-raisin bites in her mouth. “You want some? I just made a fresh batch today. I’ve been working on the recipe for years now, and I think I’ve finally got it. The two ponies next door, Holiday and Lofty, they say I make ‘em just as good as Sugarcube Corner.”
She giggles. “It almost makes me feel like a pony.”
Back at the clinic, Toola-Roola sits on the bench and sips some warm water. Her trembling has eased significantly. I still have a few minutes to chat with her before Dr. Insignia starts the operation.
“Coco told me she didn’t feel anything weird after she got her surgery,” Toola-Roola says to me, regarding her friend Coconut Cream. “I mean, well, you hear weird stories in the papers, so, erm, at first I was kinda worried about doing it. But, well, Coco says it’s totally fine, and, well, she changed her cutie mark from a pie to a palm tree—which is a pretty big change, if you ask me…isn’t that right, right?”
I only manage to say, “I suppose.”
She gulps the last bit of water, crumples the paper cup, and tosses it towards the trash can, missing it by two meters.
She continues to ramble. “And, and Coco was still the same pony after the surgery. At least to me, and, well I’ve known her for over 20 years, you know. Like, she still made our spa appointment eight days after her surgery. She still complained about the boring décor in the massage room, like she always does. And she still got mad at me for not hoarding free samples at the spa shop. I already told her, it’s not right.”
There is an awkward pause. Toola-Roola has a strangely dejected look on her face.
“Are you worried that you might have side effects from the surgery?” I ask.
She gets herself another half-cup of warm water, gargling it to soothe her throat. “Well, like, I don’t know the exact statistics. Doctor Insignia told me during one of our appointments. I think it was 0.1%. Or was it 0.2%? I don’t know. Somehow numbers don’t really get to me. My friend had the surgery and, well, she’s fine. And that’s what matters to me. If 300,000 ponies were fine, but my friend said she was not, I wouldn’t do it. But my friend is fine, so that point is totally moot…”
—her tone suddenly shifts—
“…orchids are ‘me,’ right? They’re me, right? I mean how could they not be!? Orchids have to be me. They are ‘me.’ Orchids are ‘me,’ right!?”
She crumples up the plastic cup in her hoof again. She looks up at me. There’s a look of panic on her sweat-coated face.
“Orchids are ‘me’, right!?”
I don’t know how to respond.
Numerous academic studies agree that cutie mark replacement surgery has few to no short-term side effects for ponies or non-pony creatures.
As mentioned before, a widely accepted theory is that is that cutie mark magic diffuses from the cutie mark into a pony’s body over the course of their life. Therefore, even when the cutie mark is removed surgically, the diffused “core cutie mark magic” is still retained deep in the pony’s muscle fibers. This “core cutie mark magic” is enough to prevent any adverse side effects from occurring.
An eight year long study by the Canterlot School of Medicine found no significant side effects of cutie mark cosmetic surgery for any creature. Less than 0.1% of patients report temporary mood swings for about a month after the surgery—the researchers believe this to be psychologically induced, due to fear and anxiety from the surgery.
On the flipside, the Canterlot study also notes positive effects. Patients who receive cutie mark surgery report feeling greater self-esteem (77% of patients), less anxiety (55%), and more confidence in social interactions (62%).
“I have ponies come back and tell me how they’ve finally gotten the courage to try a new career, hippogriffs who feel more confident interacting with their pony peers, or dragons that’ve become closer to their adopted parents,” Dr. Insignia tells me in a later interview. “It’s stories like that that get me up in the morning.”
Over the past ten years, Dr. Insignia has built himself a reputation as one of the most trusted cutie mark surgeons in Equestria. Starting out as an eye surgeon in Manehattan, he was first inspired to perform cutie mark surgery fifteen years ago, after his young daughter received a similar cutie mark to her abusive, alcoholic mother.
“She was nothing like her mother. She was the sweetest, kindest little filly you’d ever meet,” the doctor tells me. “But she had that reminder of her past, right there on her flank. Even after the divorce and the restraining order, the mark was still there. She never could get over that. I just wished I could’ve changed things before it was too late.” He wipes his tears and takes a few deep breaths.
Dr. Insignia’s daughter committed suicide at the age of 16.
Admittedly, even the most forward-thinking Equestrians feel uneasy about fully legalizing cutie mark cosmetic surgery. A recent poll showed 52% of Manehattanites are either “against” or “strongly against” widespread legalization of cutie mark surgery. This is compared to 75% of Canterlotians, and 84% of Ponyvillians.
One of the most outspoken critics of cutie mark surgery is Starlight Glimmer, the principal of the School of Friendship in Ponyville. Her influence in the town is part of the reason why the surgery is outright banned there.
Seven months ago, at a school assembly attended by students and members of the public, Starlight Glimmer delivered an impassioned speech warning of the potential dangers of cutie mark surgery.
“I, of all ponies, know the pain that results from changing one’s natural cutie mark. When I first discovered the spell to change cutie marks, I didn’t know the harm it could cause. I was young and naïve. I thought I could create some good if ponies could be freed from their cutie mark. I created an entire village, based on this false ideal. That’s how I learned the truth. The hard way.
“At first, after I changed their cutie marks, things were fine. After a month, after a year, two years, even five years. But then, slowly…I watched my villagers begin to lose themselves. Every passing year, it was like air escaping from a pinhole in a balloon. I watched mothers abandon their foals in the cold. Couples wouldn’t touch each other. I watched a pony smile and eat a whole plate of buns while the pony next to her starved to death. Their souls…had just crumbled away.
“This…surgery hasn’t even been around for ten years. Maybe everypony’s fine for now, but they won’t be in the long term. They’ll lose themselves, just like I saw in my former village.”
By this point, she had burst into tears. “I don’t blame you all for not knowing this. I did not know either. Like it or not, ponies were meant to live with their naturally bestowed cutie marks. They always have. And I will do everything in my power to make sure our society remembers this.”
Experts in cutie mark magic have denounced the claims in Starlight Glimmer’s speech. Most scholars agree that using magic to change a cutie mark, as Starlight did, is fundamentally different than simply removing the skin with a knife, as is done in cutie mark cosmetic surgery. Therefore, their long-term effects cannot be compared.
Dr. Insignia admits that nocreature can truly predict the long-term effects of cutie mark cosmetic surgery. “Medicine can always surprise you, in my three decades of experience. And I think Starlight Glimmer genuinely believes this surgery is medically unsafe for ponies.”
However, he joins the experts in disagreeing with Starlight’s claims. “She said that she used to enslave ponies by changing their cutie marks against their will. And that makes changing cutie marks bad?” He scoffs. “It’s the ‘against their will’ part that makes it bad.”
“How so?” I ask.
“Well, it’s like sex, really. Normally, sex is a great thing. When you wanna do it, and you’re doing it with someone you love, it brings you joy and happiness. But when it’s done against your will, it brings you pain and trauma. But that doesn’t mean we should just all stop having sex.”
Right or not, Starlight Glimmer’s controversial speech has done its damage. The School of Friendship, once lauded as one the finest learning institutions in Equestria, is now mired in scandal. Classes are regularly interrupted by angry picketers who breach the barricades. School administrators are in court for lawsuits more often than they are on campus. One of these lawsuits accuses Starlight Glimmer of refusing admission to ponies and other creatures who had cutie mark surgery, or whose parents had cutie mark surgery.
The controversy came to a head last month when The Ponyville Journal released a shocking exposé of the School of Friendship’s finances, revealing that the school had received 5,000,000 Bits of funding last year from several radical Equestrian fundamentalist organizations. Of this, 2,000,000 Bits came from The United Equestrian Front, a hate group founded by Chancellor Neighsay, the disgraced former head of the EEA. The United Equestrian Front has been linked to at least 50 violent hate crimes against non-ponies, in Manehattan alone.
(Cutie mark implantation by non-ponies has led Equestrian fundamentalists to oppose all forms of cutie mark cosmetic surgery as “unnatural” and “undermining the sacred culture and traditions of the superior pony race.”)
Ever since the exposé was published, parents of the School of Friendship student body (who is 62% non-pony) have been pressuring Starlight Glimmer to resign. Some parents have traveled from their homelands just to picket outside the school gates. Enrollment among pony and non-pony students have sharply decreased in the past semester.
Her Majesty Princess Twilight, the founder of the School of Friendship, is no longer affiliated with the School since her ascension to the throne. Although she declined our request for an interview, she issued the following written statement regarding the scandal:
“A cutie mark is a powerful symbol of pony culture that unites the three tribes of earth pony, pegasus, and unicorn. But it is just that—a symbol. True friendship, which We have advocated for since Our coronation, transcends all physical symbols, enchanted amulets, or magical markings—namely, cutie marks. Whether one chooses to retain their natural cutie mark, modify their existing cutie mark, or even remove it entirely…there will always be room for the magic of friendship.
“We have had the privilege of knowing Starlight Glimmer for many years, and have gotten to know all facets of her complex personality. Based on our assessment, We are confident that Starlight will make a decision that will be for the greater benefit of the School of Friendship, Equestria, and our allies.”
Our sources suggest that Her Majesty may be estranged from her former pupil.
Back at the clinic, the surgical lights have been turned on. Toola-Roola is lying belly down on the medical bench, ready for the operation. I observe discreetly through a thin plexiglass window.
Toola-Roola closes her eyes. Whether she’s savoring one last moment of her old cutie mark, or eagerly anticipating her new one, I’m not sure.
There’s some clattering of instruments. The doctor puts up a transparent plastic slide of a white orchid with purple venation. He turns around, the fabric of his coat rustling.
Then all is quiet.
Toola-Roola turns and looks at me through the plexiglass window. She can’t see me very well because of the reflection. But she gives me that same look of panic—the same look of fevered panic that she had when she asked me,
Orchids are “me,” right!?
I still don’t know how to respond.
The doctor draws a circle around both cutie marks with a marker. He swabs some local anesthesia on the flank. He readies his scalpel.
“Ready?” he asks.
The patient nods, and the doctor pushes the scalpel in.
Author's Note
I hope you enjoyed reading this. I have tried my best to make this AU as convincing and immersive as possible. Let me know what you think. If you see any typos please PM me.
