Abstract
The readings in Cosmetic Surgery: A Feminist Primer suggest that feminists have contributed little to expand our understanding of this practice since Susan Bordo and Kathryn Pauly Morgan’s insightful cultural analyses in the 1990s. Excerpts from their publications are included with new commentary. Kathy Davis revisits her debate with Bordo over whether cosmetic surgery is an act of self empowerment or disempowerment. Recognizing that women, like men, have agency is not incompatible with recognizing that cultural context shapes the outcome of that agency. Continuing this sterile debate does not advance our understanding of this socially constructed epidemic. In 2009, women chose to have 89% of the 1.47 million cosmetic surgical procedures performed in the United States and 91% of the 8.5 million nonsurgical procedures (American Society of Aesthetic Plastic Surgery, 2011). The gendered nature of cosmetic medicine begs for feminists willing to excavate the contexts that encourage women to medicalize their appearances.
Unfortunately, few chapters dig below the surface. Three describe cosmetic surgery discourse. Suzanne Fraser contrasts her previous finding that women’s magazines present cosmetic surgery as a middle-class career strategy with reports by others that makeover television presents cosmetic surgery as a working-class reward for past suffering and means for personal growth. Dennis Weiss and Rebecca Kukla lament that Extreme Makeover “offers transformations that are extreme in size, but conservative in kind” (p. 128) and mirror the conventional standard of attractiveness that pervades television. Virginia Braun reminds us that medicalization of appearance is ongoing. She reports that websites offering vaginal surgery pathologize anatomy that falls short of the Playboy ideal. While vaginal surgery may be relatively new, the use of media to “educate” women about their deficiencies is not.
Co-editor Cressida Heyes analyzes the literature on ethnic cosmetic surgery and concludes that all cosmetic surgery reflects internalized racism. She claims that concerns about Asian eyelid surgery reflect a “double standard” (p. 192) that ignores surgeries aimed at making white people whiter, such as the reconstruction of Mediterranean noses. How designer vaginas, abdominoplasty, and many other cosmetic procedures fit in her racialized model of cosmetic surgery is unclear. While I agree with co-editor Meredith Jones that “there is much to be gained from looking closely at cosmetic surgeons” (p. 187), this chapter is, however, full of literary references and short of actual research findings.
Alexander Edmonds points to the importance of Brazil’s structural and cultural context for creating one of the highest rates of cosmetic surgery in the world. Despite high levels of poverty, its public health system provides free or discounted cosmetic surgery. Edmonds traces this policy to the emerging service economy, rapid decline in fertility and traditional patriarchal family structure, and corresponding increase in divorce and later life dating. He argues that these changes support an “eroticized” cultural context that views women’s sexual attractiveness as an essential part of their health and value. He also suggests that the right to cosmetic surgery compensates for rights to basic municipal services that remain elusive for poor Brazilians.
The last section presents “ambivalent voices” (p. 207). Cindy Patton and John Liesch discuss the varied responses of ten aging, HIV-positive, gay men to severe facial wasting. Although a few view their facial atrophy as a “badge of honor” or tribal marker, most are concerned with negotiating physical disability and social stigma. Six of the seven who had filling procedures viewed their choice as reconstructive rather than cosmetic. Diane Naugler addresses the sometimes blurred line between cosmetic and reconstructive surgery in her chapter on breast reduction. She argues that the distinction supports “the entrenchment of normative notions of femininity . . . [and] . . . society’s unwillingness to accept scarred and/or differently proportioned female bodies” (p. 235), but seems to misunderstand the mission of reconstructive surgery when she asks, “if breast reduction surgery can address physical pain as well as produce normative aesthetic results, is it still reconstructive surgery?” (p. 230). Would she want a surgeon to achieve anything less than normative aesthetic results when reconstructing a cleft lip or fractured face? In the last chapter Diana Sweeney, a professional model, shares her experience with cosmetic surgery. The humorous tone of her cautionary tale downplays the risks involved, which are not addressed elsewhere in the anthology. Her experience shows that patients do not always get the results they seek, most outcomes are temporary, and physical complications are common. What isn’t mentioned is that a small portion of patients are left with chronic health problems or die from complications. We lack data to measure these risks because this commercial sector of medicine is only minimally regulated.
Feminist scholarship on cosmetic surgery continues to consist mostly of personal reflections, discourse analyses, and interviews with a few former patients. Respect for women’s agency has led many to ignore structural factors. The chapter on Brazil illustrates their importance. None of the chapters address the economics or ethics of cosmetic surgery. At a time when 50.7 million Americans lack insurance to cover necessary health care, Americans (mostly women) spent $10.5 billion on cosmetic procedures (American Society of Aesthetic Plastic Surgery, 2011). What are we sacrificing to change our appearance and can the cost be justified?