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The democratization of beauty

The Democratization of Beauty
Mention plastic surgery and the more judgmental among us immediately rat-tle off a list of traits its devotees probably share: vanity, frivolousness, narcissism,low self-esteem. We imagine shallow socialites or vain movie stars desperatelytrying to forestall the ravages of time. But in fact, cosmetic surgery is not anindustry built on vanity alone, but also on two much more powerful emotions:denial and envy. Cosmetic surgery thrives on our collective denial of aging andon our refusal to accept physiological limits. It feeds our envy of those whoembody nature’s most powerful but fleeting charms—youth, strength, beauty,and fertility. Its supporters praise its ability to change lives and its criticsdenounce it as the expression of our society’s worst impulses. It is a useful fath-ometer for assessing the state of our democracy and a Rorschach test for people’sviews about much broader social currents: the glorification of youth, the tenor ofpopular culture, the peculiar but strenuous American anxiety about identity. It isalso a wildly successful industry—one based on ingenuity and an array of con-stantly evolving techniques and products, overseen by an army of trained profes-sionals eager to protect and enhance their market prestige.
In recent years, a peculiar species of thought has emerged—call it Vanitus Democratus —that doesn’t merely tolerate, but embraces cosmetic surgery as evi-dence of our country’s commitment to equality, prosperity, and individual auton-omy. “Envy is the basis of democracy,” as Bertrand Russell observed, but sincebeauty is a valuable commodity that is unfairly distributed (what political theo-rists call “the injustice of the given”) it can prompt extremes of envy about itsundemocratic effects. Americans loathe such unfairness, but ours is not a societythat would tolerate—à la “Harrison Bergeron”—a beauty handicapper whowould force-feed the svelte and inflict male pattern baldness on those with thicktresses. Our solution is to democratize beauty, to make it something that, fueledby envy and with enough money and effort, anyone can attain. This blunts itsforce as an instrument of inequality.
We have succeeded in crafting a narrative of cosmetic surgery as a modern democratic solution (in that it endorses the free market, personal fulfillment, andindividual autonomy) to a most undemocratic problem. As cultural historianSander Gilman has noted, “In a world in which we are judged by how we appear,the belief that we can change our appearance is liberating. We are what we seem Christine Rosen is a senior editor of The New Atlantis and resident fellow at the Ethics and
Public Policy Center. Her book
Preaching Eugenics: Religious Leaders and the American
Eugenics Movement was just published by Oxford University Press.
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to be and we seem to be what we are!” This narrative also feeds into the long-standing American belief in individual transformation and the reinvention ofself: unmoored from the traditional hierarchies, we are free to pursue our bliss.
And pursue it we do. Cosmetic surgery is becoming increasingly popular and increasingly democratic. Today it is not only the haut monde getting nipped andtucked, but also the average American. Ten years ago, if you shouted “nasolabialfolds” at a crowd of middle-class, middle-aged women, they’d return baffledglances. Today they would nod knowingly, instantly begin trading tips on Botoxinjections and facelifts, and offer their informed reviews of the latest plastic sur-gery reality television show. People who used to cower in Greta Garbo-likeseclusion until their stitches healed now proudly display their post-operativescars at dinner parties. Shame over such surgeries has given way to celebration.
Television personality Greta Van Susteren was hailed as a pathbreaker for speak-ing openly about her facelift, which gave her a tighter, slightly Martian appear-ance for her new role as a permanent Fox News pundette. Last fall, as the NewYork Times reported, a cosmetic surgeon rented a Long Island banquet hall toshowcase his handiwork: “With music throbbing and her proud family lookingon, Amanda Draizin, 16, strutted down a runway, wearing a little black dress andher brand new nose,” the story noted. Other participants flaunted new breastsand tightened eyelids, while the good doctor basked in the exuberant praise ofhis invited guests.
In a mere decade (between 1982 and 1992), according to the American Academy of Cosmetic Surgery, the number of people surveyed who said theyapproved of cosmetic surgery increased by 50 percent, and the number who dis-approved declined by 66 percent. Consumer demand for surgery has skyrocket-ed alongside this evaporation of disapproval. As Alex Kuczynski wrote recentlyin the New York Times, “The American Society of Aesthetic Plastic Surgeryreports that the overall number of cosmetic procedures has increased 228 per-cent since 1997. The numbers are likely to rise as the population ages, pricesdrop, younger patients seek out surgery, technology and genetic engineeringgenerate new techniques, and more doctors from various fields offer cosmeticsurgical procedures.” At the very moment in history when we are living longerand healthier lives than any society before us, we want to stop aging. We wantto live longer, but only if we can remain frozen in appearance as a rather distin-guished but active 35 years for men or a still youthful and vivacious 25 forwomen.
But cosmetic surgery is not without potential harms—both to individuals and to society as a whole. Since cosmetic surgery is, as historians David andSheila Rothman have noted, “enhancement at its most pure,” it is a troubling casestudy of how American culture grapples with techniques designed for therapythat can be used to fulfill our personal desires. Buried in the logic of cosmetic sur- Copyright 2004. All rights reservedfor more information.
gery are some disturbing truths about what our culture believes: that it is accept-able to be satisfied by the external markers of success; that the pursuit of suchmarkers is, in and of itself, a useful and psychologically healthy goal for people;that what used to be encouraged—a lifelong process of moral education—is lessuseful, in the long term, than the appearance of success, health, and beauty; andthat if we can overcome the limits nature places on our physical bodies, we should.
“One way to deny our dependence on nature,” Christopher Lasch wrote manyyears ago in The Culture of Narcissism, “is to invent technologies designed to makeourselves masters of nature.” This is what cosmetic surgery promises to do.
The New Consumer of Beauty
There is a deeply human intuition about beauty—perhaps, as evolutionary psy-chologists suggest, because it used to delineate the healthy from the diseased andthus offered signposts to choosing the most appropriate and most fertile sexualpartner. Culture has also long linked physical appearance to moral worth.
Children’s stories are filled with characters—beautiful princesses and uglywitches—whose outward appearance speaks to their inner goodness or wicked-ness. Other classic tales endorse the notion of physical transformation as theroute to happiness—the Ugly Duckling, Pygmalion, and Cinderella. And thepower of beauty has long been recognized, in figures such as Helen of Troy andDante’s Beatrice, if not always universally admired. In the nineteenth century,phrenologists, early criminologists, and, later, eugenicists all accepted the notionthat outward physical appearance marked internal worth, and they used partic-ular aesthetic standards (such as the slope of the nose and the size and shape ofthe head) as justification for ranking people of different ethnic and racial groups.
The plasticity of the body is also hardly a modern discovery, as such tradi- tional (and multicultural) practices as foot binding, corseting, the use of arsenicpowders to whiten skin, and plates placed in the lips to extend them can attest.
In Europe in the sixteenth century, physicians began making early, surgicalattempts to alter physical appearance, largely to mask evidence of syphilis, whichwas spreading rapidly throughout the continent at the time and which producedmarked disfigurements in its victims, particularly to their noses. It was not untilWorld War I, however, that reconstructive surgery became a permanent part ofmedical practice. Trench warfare maimed a generation of young men, and earlyreconstructive surgeons devised techniques for patching them back together.
After the war, reconstructive surgery gained a permanent, if initially small,perch in surgical medicine.
What began as an effort to mask genuine disfigurement eventually became a way to conceal more modern woes, such as aging; a “medical response to themedical emergency of modern warfare,” as one historian described it, became amedical response to modern notions of beauty and perfectibility. Sifting through Copyright 2004. All rights reservedor more information.
stories from these early days of cosmetic surgery is like entering the sawdust-choked confines of a sideshow tent—new horrors behind every curtain! Here youwill find quack physicians injecting paraffin wax (sometimes spiked withVaseline) into women’s lips, cheeks, and breasts; men and women enduringbotched nose jobs and crude fat removal procedures; and terrifying characterssuch as the notorious “beauty doctor” Gertrude Steele, who, as historianElizabeth Haiken noted, was forced to flee the United States in 1925 “after autop-sies on two of the patients whose faces she had peeled revealed traces of phenolpoisoning in the brain.” This is not what the average American consumer saw, ofcourse. They saw glamour. In the 1920s, advertisements for beauty products andcosmetic procedures often featured images of elegant women staring rapturous-ly into the mirror with captions such as, “Your masterpiece—Yourself !” As decades passed, techniques improved, and patients began demanding more control over the kind of cosmetic procedures they were purchasing. As his-torians David and Sheila Rothman note, surgical work in the 1960s was often sohomogeneous that “when a slide of a sixty-year-old woman who had her nosereshaped appears [at medical conferences] plastic surgeons will jocularly callout ‘Long Island 1965’ or ‘the Joseph Nose.’” But that would change asAmericans took the final steps on their journey to becoming consumers of cos-metic surgery, not traditional patients.
The Kindest Cut
Cosmetic surgery is one of the only surgical procedures that eagerly embracesthe practice of self-diagnosis. Patients are not physically sick, nor do they sufferfrom a diagnosable disease, nevertheless they come to a surgeon with theiretiologies clearly worked out: one person feels her nose is misshapen, anotherthinks her thighs are too large, still another is unhappy with the bags under hiseyes. It is difficult to imagine traditional physicians taking seriously a personwho walks into their office, states with absolute certainty a complete diagnosis,and demands a specific cure. What explains cosmetic surgery’s unusual relianceon this practice? The greatest boon to modern cosmetic surgery was not the development of any particular technique or the creation of a miracle product. It was an importfrom psychology: the inferiority complex. Popularized by Viennese psychologistAlfred Adler in the early twentieth century, it reached an eager audience in theUnited States. The inferiority complex provided a crucial link: it joined individ-ual mental health with physical appearance and thus psychologized cosmetic sur-gery. People suffering from an inferiority complex because their breasts weresmall or their chins droopy were ill; they required medical intervention to alle-viate their psychological suffering. As Haiken notes, by the 1920s and 1930s,Americans had made this link between physical appearance and mental health Copyright 2004. All rights reservedor more information.
permanent; as a result “their demands for surgical attention became more insis-tent at the same time as the new language of psychology made these demandsmore persuasive.” By 1940, Good Housekeeping magazine was asking, “whyshould anyone suffer under the handicap of a conspicuously ugly feature? Whynot let modern science give him a normal face and an equal chance with otherpeople?” The practice continues today. If you accept the World Health Organization’s current definition of health—“a state of complete physical, mental, and socialwell-being”—then cosmetic surgery is an encouraging health trend. The psy-chologizing of cosmetic surgery has allowed cosmetic surgeons to feel certainthat they are treating their patients’ deepest concerns; it releases them from thedifficult responsibility of determining whether someone really should be havingsurgery or not. Since the experience of living with one’s given physical traits isentirely relative, and the standards for assessing the impact of an ugly nose or achubby thigh on any one individual are virtually nonexistent, surgeons needonly affirm their patients’ concerns and fix them.
“We have embraced plastic surgery as a legitimate way to relieve people’s suffering regarding their appearance,” says Dr. George Weston, a plastic sur-geon with a reassuring, southern-inflected voice and eighteen years experienceat the Austin-Weston Center for Cosmetic Surgery in Reston, Virginia.
“Cosmetic surgery is designed to get your attention off of your appearance,” hesays. “It sounds odd to put so much attention on your appearance to get it off ofit, but the real secret of cosmetic surgery is what happens inside: a newcontentment. We have to transcend our appearance at some point,” he said.
“Cosmetic surgery helps with that.” Dr. Weston told me that he has operated ona number of psychiatrists; he asked one of them why she was getting surgeryinstead of therapy. The response? “Why spend years talking to a therapist aboutmy self-esteem when I can spend two hours on your operating table and elimi-nate the issue altogether?” Dr. Weston chuckled, “It’s psychiatry with a ten-centknife blade!” The desire for cosmetic surgery is not fueled only by irrational fears and low self-esteem, however. There are apparently real economic harms and benefitstied to personal appearance. A 1993 study conducted by economists DanielHamermesh and Jeff Biddle and published by the National Bureau of EconomicResearch found that “holding constant demographic and labor-market character-istics, plain people earn less than people of average looks, who earn less than thegood-looking. The penalty for plainness is 5 to 10 percent, slightly larger thanthe premium for beauty. The effects are slightly larger for men than women; butunattractive women are less likely than others to participate in the labor forceand are more likely to be married to men with unexpectedly low human capital.”One of the earliest students of this economic lesson was well-known stage Copyright 2004. All rights reservedfor more information.
actress Fanny Brice, who in 1923 submitted to a nose job—and an onslaught ofpublicity—in the hope that she would no longer be typecast in “ethnic” (read:Jewish) roles. Her adventures in rhinoplasty prompted Dorothy Parker’s wither-ing assessment that Brice had “cut off her nose to spite her race.” Nancy Etcoff, in her book Survival of the Prettiest, has noted other examples of the unjust benefits that accrue to beauty: One psychological study askedcollege-age men, if given a choice between an attractive and an unattractivewoman, for whom would they do the following: “help move furniture, loanmoney, donate blood, donate a kidney, swim one mile to rescue her, save her froma burning building, and even jump on a terrorist hand grenade.” With the excep-tion of loaning money, the men were more likely to do all of these for the moreattractive woman. Other studies, involving leaving a dime in a phone booth andstranding two women next to a broken-down car by the side of the road, yield-ed similar results: “87 percent of people return the dime to the good-lookingwoman, but only 64 percent return the dime to the ugly woman.” And the beau-tiful woman is, of course, offered roadside assistance first.
Youthfulness is a similarly desirable commodity, as Americans in the corpo- rate world are learning. A February 2004 report in the Wall Street Journaldescribed a recent survey by ExecuNet that asked senior-level corporate execu-tives about attitudes toward aging. The result found that “82 percent considerage bias a ‘serious problem,’ up from 78 percent three years ago. And 94 percentof these respondents, who were mostly in their 40s and 50s, said they thoughtage had cost them a shot at a particular job.” Many of these executives—maleand female—are turning to cosmetic surgery to help them stay competitive.
“Youth in this country gets the rewards,” Dr. Weston told me matter-of-factly. “Isee older people competing with younger people out there, and what happens, aswe get older, is that we no longer look as sharp and effective. Men get loosenecks, their faces look like they are not as sharp and competent.” As a result, hesays, “Your face can send a false message.” Cosmetic surgery helps “eliminatethat misrepresentation.” Critics of cosmetic surgery argue that it is not your face that betrays you, but society’s unrealistic expectations. Many of these critics are avowedly feminist intheir outlook, and decry the “beauty myth” that targets women in particular withits pernicious message that your value is tied to your youth and sexual attrac-tiveness. But this insight no longer has any practical resonance, if it ever did.
Thoroughly routing the idea of a woman-only “beauty myth” is the very real factthat men are a rapidly growing consumer niche in cosmetic surgery. They aregetting procedures such as Botox and chemical peels, although they are not yetas willing to admit their cosmetic habits as women. One New York plastic sur-geon told the Wall Street Journal that “17 percent of his patients undergoing eye-lid surgery and about 11 percent choosing facelifts are male, double the percent- Copyright 2004. All rights reservedfor more information.
age of ten years ago.” According to the American Academy of Cosmetic Surgery,the most popular procedures for men are Botox injections, hair transplantation,chemical peels, microdermabrasion, and liposuction. But more than ten thousandmen have also had cosmetic surgery to lengthen or widen their penises, as wellas calf and pectoral implants to upsize their musculature.
But for now, women are still the major consumers of cosmetic procedures.
And it is one of the great ironies of contemporary feminism that the rhetoricabout control over one’s body (“my body, my choice”) became a rallying cry forwomen’s “right” to reshape their noses, breasts, and thighs through cosmeticsurgery. Part of what was supposedly useful and liberating about the feministmessage was its insistence that women’s value was not linked inextricably toappearance or reproductive powers. But eventually, most women make the fertil-ity link themselves (how else would we have a sense of something like a biolog-ical clock?). And eventually, all women must face the realities of aging.
Even former feminist stalwarts implicitly recognize this fact. Perusing a list- ing of upcoming lectures at the 92nd Street Y in Manhattan, I stumbled acrossan announcement for a panel discussion featuring Letty Cottin Pogrebin, one ofthe original founders of Ms. magazine. The topic: “Juicy Living After 50!”—including tips on maintaining your sexual allure during your “crone years.” Thisis the same avid denial of aging that fuels the cosmetic surgery industry. By thetime we reach middle age, women—and increasingly, men—must confront oursuccesses and failures in arenas where we might not feel we exercise as muchcontrol as we once did—careers, relationships, perhaps even in our family lives.
Cosmetic surgery offers us control over one thing: our physical appearance. Thefew avowedly feminist supporters of plastic surgery endorse this insight. KathyDavis, who teaches in the Netherlands, has argued for the merits of plastic sur-gery in the feminist journal Hypatia, noting that, for many women, deciding tohave cosmetic surgery is “about taking one’s life into one’s own hands.” Feminist critics are correct that the demand for cosmetic surgery is closely linked to a society’s cultural norms regarding aging, especially for women. Plasticsurgery is less popular in France, where a cultural appreciation of a “femme d’uncertain age”—an older woman who looks her age, but whom the process of grow-ing older has marked with wisdom and (daresay!) a certain kind of sexual allure—exists. American culture yields little on this score: when older women who looktheir age are paired with younger men, they are often depicted as harridans orvoracious man-eaters—such as Mrs. Robinson in the 1967 film, The Graduate(though it is worth noting that when the movie was made, Dustin Hoffman, whoplayed the young, puzzled, and sexually awkward Benjamin Braddock, was thir-ty-one years old; his erstwhile seductress, Anne Bancroft, was thirty-six). In ouryouth-oriented, image-driven democratic culture, visible signs of aging, particu-larly for women, will soon be markers of declining status.
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Welcome to Your Facelift
The contemporary cosmetic surgery industry is a lavish smorgasbord ofoptions for the American consumer. A partial list of the procedures availableinclude: Cheek implants, mentoplasty (chin augmentation), collagen and fatinjections, otoplasty (pinning back the ears), blepharoplasty (eyelid tightening),rhytidectomy (facelift), forehead lifts, hair transplantation (using scalp reduction,strip grafts, and plugs), rhinoplasty (nose job), brachioplasty (arm lift), breastaugmentation, mastopexy (breast tightening), breast reduction, buttock lift,thigh lift, calf implants, pectoral implants, abdominoplasty (tummy tuck), penileenlargements and implants, and the ever-popular Botox (where diluted doses ofthe botulinum toxin are injected into wrinkles) and liposuction (the removal ofdeposits of fat using a suction cannula).
According to the American Academy of Cosmetic Surgery, approximately 860,000 cosmetic surgery procedures were performed in 2002, mostly onwomen, although men accounted for 150,000 procedures. One-third of cosmeticsurgery patients are between the ages of 35 and 50; another 22 percent arebetween the ages of 26 and 34. And 18 percent of people getting cosmetic sur-gery are under the age of 25. Instead of the smoke and mirrors of the old freakshow, we now have, online, hundreds of “before and after” pictures of cosmeticsurgery patients—all of them encouraging a belief in the surgeon’s power oftotal transformation.
Aging is not the only problem cosmetic surgery seeks to solve—it also offers a solution to the American obsession with our waistlines. In his bookBattleground of Desire: The Struggle for Self-Control in Modern America, PeterStearns notes how, as early as 1916, popular magazines were equating control ofone’s weight with the health of one’s character. The first diet cookbook, pub-lished in 1900, stated matter-of-factly in its preface, “An excess of flesh is lookedupon as one of the most objectionable forms of disease.” Liposuction, a techniquefor removing deposits of fat using a tool called a suction cannula, was developedby French surgeon Yves-Gerard Illouz in the 1970s, and it is the most popularinvasive cosmetic surgery procedure: 74,000 people had liposuction in 2002alone.
The language of artistic achievement suffuses the industry: surgeons describe their work as “body sculpting” or “body contouring,” and liposuction is known as“blind subcutaneous sculpturing.” But the anodyne terms mask physically brutalprocedures. The trauma of this kind of surgery can be considerable. As RyanMurphy, the creator of the FX network’s plastic surgery drama Nip/Tuck told theNew York Times jocularly, “one plastic surgeon told me that getting your face doneis basically the equivalent of going through a car window at 70 miles an hour andsurviving.” His show is one that revels in gory details. “I think the public thinks Copyright 2004. All rights reservedor more information.
that this is delicate surgery, and these surgeons treat the face as if it were porce-lain,” he said. “And in fact they treat it like it was sirloin.” The faces and bodies of many celebrities testify to the unhealthy lure of excessive physical transformation: Michael Jackson’s many surgeries have lefthim nearly unrecognizable, and Jocelyn Wildenstein, a terrifying spectacle of asocialite, has had multiple surgeries, including an enormous chin implant, lipimplants, facelifts, and eyelifts so that her face would have the features of a largecat. Respectable surgeons do try to vet candidates for surgery to avoid encour-aging the activities of these “scalpel slaves.” “I wish we had a questionnaire thatcould warn us,” Dr. Weston said. “We sit down with patients in consultation, butwe’re both interviewing each other.” Weston concedes that if he refuses to oper-ate on someone who is obviously mentally unstable or who has unreasonableexpectations for surgery, “they’ll eventually find someone else to operate onthem.” More mundane dangers exist for people who undergo cosmetic surgery. One study, conducted by a plastic surgeon in 2000 and described by David and SheilaRothman, found that “the rounded mortality rate for liposuction surgery in thelate 1990s hovers near 20 per 100,000.” Compare that to the 3 per 100,000 ratefor hernia operations. In the space of only a few months this year, several wide-ly publicized cosmetic surgery deaths—notably that of 54-year-old novelistOlivia Goldsmith, who had checked into an Upper East Side hospital for a chintuck—have prompted halfhearted handwringing in the media, but no discernibleslackening of interest among consumers. “We educate our patients about therisks,” says Dr. Weston, “and you’re safer in my operating room than you aredriving on the Capitol Beltway.” But it is still surgery. Complications can arisefrom inappropriate use of anesthesia, heart attacks, and post-surgical blood clots.
As with any lucrative enterprise, cosmetic surgery also has its share of fringe practitioners—men and women who lack board certification (or, in some cases,even medical training) who advertise their services, often targeting lower-income groups with lower prices than legitimate surgeons. Earlier this spring,Dean Faiello, who in 2002 had pled guilty to practicing medicine without alicense, was arrested in Costa Rica and charged with murder after the body ofinvestment banker Maria Cruz was found, encased in concrete, at Faiello’s for-mer Newark, New Jersey home. Ms. Cruz had gone to Faiello’s makeshift clinicin Manhattan for a cosmetic laser procedure to remove a growth from hertongue and died, likely as a result of the anesthesia Faiello administered.
Despite the risks, demand grows—and continues to trickle down the social scale. Cosmetic surgery, once the province of celebrities, has in the last severaldecades begun to appeal to other public figures, including politicians. FormerSenate Majority Leader Bob Dole’s post-retirement facelift led to lucrativeadvertising work for Pepsi and Viagra, and his new, tensile look is not the only Copyright 2004. All rights reservedor more information.
one inside the Beltway. House Minority Leader Nancy Pelosi’s official websiteunwittingly features two images that represent commendable examples ofhuman achievement in architecture: the Golden Gate Bridge in her home state ofCalifornia, and Ms. Pelosi’s own stretched, lifted, and resculpted visage. Beltwayobservers have also remarked on Senator Joseph Biden’s flourishing hairplugs.
Commenting on the American scene recently, a reporter for an Australian news-paper noted, “It’s hardly surprising that while Bill Clinton’s presidential cam-paign of the 1990s was haunted by whispers of infidelity, the first rumor to dogthe campaign of … Senator John Kerry was that he had had Botox injections inhis patrician forehead.” Today, after setting aside his plough, Cincinnatus wouldhave to get a quick mini-lift and chemical peel before returning to rule Rome.
Our vices are also reflected in new cosmetic treatments. Surgery to cure bunions and other foot ailments is increasing, and women are even having theirtoes shortened (at a cost of $2,500 per toe) and feet injected with collagen so thatthey can wear the high-heeled, pointy-toed shoes now in fashion—despite thereal risks such surgeries carry, including permanent nerve damage.
Youth for the Masses
The latest trend is “Age Dropping,” with increasingly younger men and womenits target market. Like the fable of the grasshopper and the ant, women in par-ticular are being warned that, like the industrious ant, they should shore up theirsupply of youth and beauty by having an increasing number of carefully calibrat-ed nips, tucks, and peels performed in their thirties so that they don’t end up, likethe hapless grasshopper, without an adequate supply in their winter years.
Writing recently in the New York Times Magazine, beauty editor Mary Tannenconfessed to pangs of doubt about her own decision to resist plastic surgery.
“Perhaps I am deluded in thinking that my jowls are an advertisement forcourage, proclaiming that I’m not afraid of growing old,” she writes. “Maybethey are shrieking that I am a clueless loser who doesn’t have the wherewithalto have my chin taken care of.” In certain social milieus such as hers, she notes,“the lifted face has started to seem normal, leaving the unlifted one looking, well,strange.” When I asked Dr. Weston what he would recommend as a preventative, “age- dropping” measure for a thirty-year-old female of average height and weight(which I happen to be), he hesitated, noting, “everybody’s face is different,” butquickly told me not to smoke and to stay out of the sun. He added that there werea lot of procedures that could be performed in one’s thirties to forestall the worsteffects of aging. Another surgeon, Dr. Gerald Imber, is more forthright in hissupport of preventive measures—so much so that he wrote an entire book, TheYouth Corridor, outlining the best methods of age dropping. “My philosophy,”Imber writes in the introduction, “advocates preventing wrinkles, rather than Copyright 2004. All rights reservedor more information.
curing them, and smaller procedures and earlier surgery for generally youngerpatients, in order to maintain one’s appearance throughout the adult years inwhat I call the Youth Corridor.” The book includes dramatic pencil sketches of awoman’s face becoming progressively more haggard, like Dorian Gray’s portrait,because she failed to follow Dr. Imber’s multi-point strategy for wrinkle-freegolden years.
What “age dropping” and other trends suggest is a diminishing tolerance for imperfection and aging. Writing in The New Yorker in 2001, Malcolm Gladwellnoted that “we have come to prefer a world where the distractible take Ritalin,the depressed take Prozac, and the unattractive get cosmetic surgery to a worldruled, arbitrarily, by those fortunate few who were born focused, happy, andbeautiful. Cosmetic surgery is not ‘earned’ beauty, but then natural beauty isn’tearned, either. One of the principal contributions of the late twentieth centurywas the moral deregulation of social competition—the insistence that advan-tages derived from artificial and extraordinary intervention are no less legiti-mate than the advantages of nature.” The inevitable result is a sense that, in cer-tain settings such as the corporate boardroom or Capitol Hill, cosmetic surgeryis beginning to be considered a career necessity.
Meanwhile, democratization sends this message ever further down the income scale. The average cosmetic surgery patient is not rich. As historianHaiken notes, “only 23 percent of patients come from families earning more than$50,000 per year. Families with incomes under $25,000 account for 30 percent ofpatients, while those earning between $25,000 and $50,000 account for another35 percent.” “The worst perception of cosmetic surgery is that it’s for the rich,vain, and foolish,” Dr. Weston told me. “The reality is that most people are mid-dle class and most people save their money for it. You can have almost anythingdone for the price of a used car. It’s considered a tremendous value.” The future of cosmetic surgery is a story of continual expansion and increased consumer demand. In the years to come, “there will be more cosmeticsurgery done than all surgical procedures combined,” predicts Dr. Weston.
Techniques are improving, and the surgeon’s work is becoming more difficult tospot. “If cosmetic surgery looks like cosmetic surgery, it’s not good cosmetic sur-gery,” he says. “You don’t want someone to say ‘nice facelift.’ … You want to hear,‘Gosh, you look good, did you lose weight?’ or ideally, ‘My God, are you in love?’Then you know it’s really good cosmetic surgery.” Non-surgical treatments are expected to continue to increase in popularity as well. New injectable gel-like substances with names such as CosmoDerm,Hylaform, and Juvederm are hitting the market as wrinkle fillers. The New YorkTimes reported last year that “it’s not unusual for women in New York to spend$2,000 every few months on fillers, which run about $500 a treatment and lastaround six months.” New treatments for hair loss are also coming down the cos- Copyright 2004. All rights reservedor more information.
metic pipeline, such as “follicular unit transplantation,” a procedure that pur-ports to be a vast improvement over the crop-rotation-like aesthetic of first-generation hair plugs. Overall, industry projections are rosy: as Medical Devices& Surgical Technology Week recently reported, “demand for materials and equip-ment used in cosmetic surgery procedures will advance over 11 percent annual-ly to $1.8 billion in 2007.” Cosmetic surgery is even going global. The Washington Post recently report- ed on the increasing acceptance of such practices in China, particularly a proce-dure to create creases in women’s eyelids to give the eyes a rounder, moreWesternized look. Breast implants are also popular, “a status symbol, an indica-tion of an ability to afford the accouterments of a wealthy life.” Hardly the greatleap forward Chairman Mao had in mind, but further evidence of the cross-cultural lure of physical perfection.
The democratizing trend in cosmetic surgery is nowhere more evident than with liposuction and breast implants, which speak to two American obsessions:weight and sex. Liposuction is the most popular invasive cosmetic procedure, butit is not a permanent weight-loss solution. People who regain weight after lipo-suction look as if they never had the procedure to begin with; indeed, somepatients report looking worse, because the new fat deposits itself in strangelymisshapen ways on their previously vacuumed hips and thighs. Still, websiteslike liposite.com offer galleries of anonymous before and after liposuction pic-tures, and it is not unusual to find images of 19-year-old women who are by nomeans overweight but seem intent on resculpting their bodies to suit the reign-ing slim-hipped, thin-thighed ideal.
With breast implants, the democratic message has flowed down to meet a demand that originally traveled from the bottom of the respectable social scaleup: once the province of strippers and porn actresses, breast implants eventual-ly became popular among Hollywood celebrities. Today, it is middle classAmerican women who scrimp and save to achieve the figures they’ve alwayswanted. According to a recent industry newsletter, “breast implants are the mostsignificant single product type in the cosmetic-surgery market, alone accountingfor 20 percent of demand, and will continue to be among the highest profileproducts.” In 2002 alone, nearly 34,000 women had breast implants. Althoughliposuction is the most popular invasive cosmetic procedure, accounting for 74percent of all such procedures performed in 2003, the demand for breast aug-mentation has increased at a faster pace. It is also the procedure (after rhinoplas-ty and otoplasty) with the youngest average age for patients—33 years old.
Breast implants are a good example of some of the ironies of our pragmatic, democratic approach to cosmetic surgery. Women who get them to feel moresexually attractive are making a strange bargain. In the process of looking moresexually appealing, they rob themselves of several uniquely female experiences.
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Women with breast implants frequently report a loss of sensation in theirbreasts, eliminating a site of natural sexual pleasure. They cannot breastfeedtheir children, eliminating both the bonding and health benefits of this practice.
They must, on average, have their implants replaced or adjusted every ten years,and rippling, hardening, and significant movement of the implant and surround-ing tissue are common. And popular culture, always a fickle beast, suggests thata quiet backlash against implants is building, with purveyors of pornographyincreasingly touting their “all natural” performers.
Modern Burlesque
It is not clear if this shift from artificial to natural (like the trend in popular “nat-ural foods” sales) will make a permanent mark. Beauty standards change as oftenas the seasons. But lately, popular culture has offered more insight into our col-lective embrace of cosmetic surgery. Alongside our paeans to the transformativepower of plastic surgery rests a fascinated disgust with its extremes. There is alurid subculture devoted to documenting the cosmetic surgery of celebrities, forexample, who often deny having altered their appearance. Websites such aswww.awfulplasticsurgery.com adopt a “gotcha!” tone and feature galleries of pic-tures documenting starlets’ shrinking noses and ballooning bustlines—a concoursd’elegance of the human body.
Televised burlesques satisfy a similar impulse, one not far removed from the freak shows of carnivals past. Programs such as Extreme Makeover, whichdeploys radical plastic surgery to transform unattractive women into glamoroussirens, and Nip/Tuck, a plastic surgery drama told through the somewhat jaun-diced eyes of two Miami plastic surgeons, have proven wildly popular. The lat-est show in the plastic surgery oeuvre is Fox’s The Swan, which “takes womendescribed as ugly ducklings and puts them under the cosmetic surgery knife,fixes their teeth, lets them see a shrink, makes them work out, styles their hair,does their makeup” and turns them into “swans,” according to the San FranciscoChronicle. There is a twist, of course. The women are not allowed to look in amirror for three months, after which time they see themselves briefly beforebeing shuttled off to a beauty contest where they face savage competition fromother former ducklings. The show so pushes the limits of taste that it drove thecheeky but reliable television critic for Salon.com nearly apoplectic: “The Swan isbad for you. It’s bad for me,” she wrote, after watching the premier episode.
“Openly reject those who discuss this show. Go ahead. Ostracize them. Limittheir freedom of speech. Let the FCC roll its cannons onto this battlefield.” Employing a more documentary style, MTV’s I Want a Famous Face tracks men and women (and even a pre-op transsexual) who are so enamored of mod-ern celebrities that they endure major plastic surgery to look more like them. Arecent episode chronicled the misadventures of Sha, a 19-year-old woman from Copyright 2004. All rights reservedor more information.
Texas whose ambition in life is to become a Playboy centerfold. To further heraim, she receives enormous breast implants, lip implants, and chin liposuction inan effort to ape the appearance of former Playmate Pamela Anderson. The showshows only brief snippets of the actual surgery—zooming in on Sha’s anes-thetized face as her surgeon crams the huge lip implants into place with a large,metal, chopstick-like tool. As he sews up her newly enhanced chest, the surgeonquips, “This ought to satisfy Playboy !” The camera then lingers over Sha one daylater, mummified in bandages and weeping in agony.
Unlike Extreme Makeover, MTV gives a nod to surgeries gone bad; they interview another former aspiring Playmate who endured a similarly challeng-ing transformation, but who, several years later and with enormous breastimplants beginning to ripple and relocate on her chest, has had little luck find-ing work. This cautionary tale fails to dissuade Sha; even the recommendation ofa Playboy scout, who gently tells her that the magazine is opting for a more “nat-ural” look these days, fails to prompt second thoughts. By the end of that week’sepisode, Sha, recovered from surgery, is proudly posing for a special issue ofPlayboy called “Voluptuous Vixens” and is by her own account very happy withher surgery. “I want to be somebody,” she says, tossing a marabou boa over hershoulder as she preens for the camera. “I want to be famous.” It is not difficult toimagine, a few decades hence, a “where are they now?” show that tracks downthese carved up exhibitionists to see how they are holding up.
All of these shows are far more extreme expressions of older cultural tropes.
In 1924, the New York Daily Mirror sponsored a “Homely Girl contest,” with anadvertisement that read: “Who is the homeliest girl in New York? Daily Mirrorwants to find her—for a great opportunity awaits her.” The paper promised thewinner the full surgical services of Dr. W. A. Pratt and an opera audition; thewinner was a sweatshop worker named Rosa Travers, according to historianHaiken. Less than twenty years later, Good Housekeeping featured the fairy-taletransformation of a “dowdy” and “rather untidy” girl with a big nose who, thanksto “a brief five days in the hospital” and the “skilled surgical hands” of anunnamed doctor, now had a nose of “pleasant proportions” which she acces-sorized with “a brand-new pompadour” and “a touching new-born vanity.” Popular culture has produced a few critiques of plastic surgery, too. The Twilight Zone tackled the topic on a few episodes in the 1960s, and in 1996, JohnCarpenter produced a critically panned movie called Escape from L.A., whichtouched on the West Coast’s obsessive commitment to appearance and cosmeticsurgery. In this futuristic action flick, the city of Los Angeles has become adepraved penal colony, with Beverly Hills a neighborhood inhabited bypolysurgical addicts who capture newcomers and harvest their body parts, allunder the watchful rule of the Surgeon General of Beverly Hills, whose hands aremade of scalpels. The social message of the film is somewhat undermined by inad- Copyright 2004. All rights reservedfor more information.
vertent moments of high camp, such as a scene where a doctor, examining thebreasts of a recently-captured woman, exclaims in horror, “My God, they’re real!” Popular culture currently rewards (with fifteen minutes of fame and free sur- geries) a clatch of Americans who are clearly eager to have their worth judgedby the fickle democratic masses. The viewing audience might observe this circusfrom an ironic distance, but it is clear that the impulse to measure success by out-ward appearance has more adherents than merely the contestants on reality tel-evision shows. Cosmetic surgery—better, cheaper, more widespread—encour-ages this kind of measurement. What it doesn’t offer is a solution to an intransi-gent fact: no matter how much surgery a person has, there will always be some-one younger, more naturally beautiful and outwardly appealing. And democraticculture, which tends to cater to the well-being of the body more than the well-being of the soul, will continue to seek out and reward those younger, morebeautiful people. The ultimate futility of cosmetic surgery is perhaps the leastremarked upon of its features.
You—Only Better
In the end, cosmetic surgery is in some sense self-defeating, since it cannot per-manently stop the process of aging. And yet, many of us know formerlydewlapped matrons and love-handled forty-something rogues who are objective-ly much happier after their surgeries; indeed, some people experience more sat-isfaction from a “marriage abdominoplasty” (combination lipo and tummy tuck)than they do in their own marriages. In a free society, why should anyone standin the way of another person’s transformation from tatterdemalion to goddess?Isn’t this simply the laudable and democratic pursuit of happiness? If opponents of cosmetic surgery are too quick to dismiss those who claim great psychological benefits, boosters are far too willing to dismiss those whoraise concerns. Cosmetic surgery might make individual people happier, but inthe aggregate it makes life worse for everyone. By defining beauty up—fifty isliterally the new forty if a critical mass of people are getting face-lifted andBotoxed—the pressure to conform to these elevated standards increases. So, too,does the amount of time and money we spend on what is ultimately a futile goal:cheating time. Even for men and women who have objectively achieved suc-cess—the award-winning novelist, the highflying CEO—the refusal to meetthese beauty standards will brand you as uncompetitive, evidence to the contrarynotwithstanding.
The risk is not a society of beautiful but homogeneous mannequins. “Most of my patients want to look more like themselves than they’ve looked in a longtime,” Dr. Weston told me. “They don’t want to look like someone else.” The dan-ger is a growing intolerance for what we would naturally look like without con-stant nipping, tucking, peeling, and liposuctioning. In the process, it contributes Copyright 2004. All rights reservedor more information.
to that “philosophy of fatigue” and “disappointment with achievements” that PaulNystrom, an early and astute critic of modern marketing techniques, argued ledto society’s embrace of “more superficial things in which fashion reigns.” In part, the discomfort some people have with cosmetic surgery is a discom- fort about the particular form of denial it represents: a denial of bodily limits. Thelanguage of cosmetic surgery does everything to obscure this. Something “cos-metic” is not supposed to be a permanent alteration, as plastic surgery is. Andhumans are not “plastic,” but beings embodied in tissue, flesh, and bone that will,at a certain point, resist our efforts to remold it. But the freedom to do what wewill with ourselves, which is the model for cosmetic surgery, presents a real chal-lenge when we start thinking about permanent alterations to the human body. Asa case study for how we might act in the genetic future, cosmetic surgery—whichis individualistic, consumer-oriented, largely unregulated, and invokes the thera-peutic language so popular today—is hardly a reassuring model.
In the 1990s, a French performance artist named Orlan embarked on a multi-stage cosmetic surgery art installment that involved having surgery per-formed that would give her the chin of the Venus de Milo, Mona Lisa’s forehead,and Psyche’s nose, among other things. Pictures of one of her “performances”show a partially anesthetized Orlan reclining on an operating room table, drapedin a surreal, mirrored gown and speaking into a cordless microphone. Buzzingabout are surgeons and nurses decked out in scrubs designed by Issey Miyakeand Paco Rabanne. But Orlan has other enthusiasms. As the New York Timesnoted, she “grandly proclaims her work to be ‘a fight against nature and the ideaof God’ and also a way to prepare the world for widespread genetic engineering.”Orlan offers us a disturbing peek into our future.
In the end, the questions raised by cosmetic surgery pose a special challenge for conservatives. Conservatives advocate free markets and individual autonomy(albeit linked to personal responsibility), but profess horror at the logical excess-es of this view. We cringe when commercial culture throws up a Michael Jacksonor an Extreme Makeover, but on what grounds do we argue for their end? Likeour new reproductive technologies, cosmetic surgery collides with intimate, per-sonal choices about the kind of lives we want to lead. And it becomes difficult toargue against the exercise of choice either legally or politically.
Perhaps this is the point at which culture becomes more important than pol- icy, and the direct engagement with our cultural extremes a way of helping usfind a more rational center. In the end, democratic culture seeks authenticity, butit doesn’t always find it in the old forms where conservatives tend to feel morecomfortable. And so we need to ask less threatening but no less fundamentalquestions—questions about the excesses of individualism and the extremes ofdemocracy, questions about what are and what are not genuine social goods, andquestions about how we measure success and failure.
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We are not yet a nation of Narcissi, content to stare happily into the pool, our surgically enhanced self-esteem intact but our character irrevocably compro-mised. But we would do well to be more engaged in the culture that is encour-aging us to move in that direction. “There are no grades of vanity, there are onlygrades of ability in concealing it,” Mark Twain purportedly wrote. Concealingour desire for physical perfection behind a mask of democratic or therapeuticrhetoric will ultimately do us no good. We should, instead, bring cosmetic sur-gery out into the open, not merely to please our taste for voyeurism, but tounderstand how we might handle new and increasingly sophisticated techniquesfor empowering our vanity—techniques which stand to make that vanity muchharder to conceal and to control.
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Source: http://www.onaantrekkelijk.be/achtergronden/thedemocratisationofbeauty.pdf

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