The Culture of Cosmetic Surgery - part 1 pps

THE BEGINNING My first nose job was performed by an otolaryngologist otherwise known as an ear, nose, and throat doctor who, in concert with my mother, encouraged me to have surgery.. He

The Culture of Cosmetic Surgery

Virginia L Blum

UNIVERSITY OF CALIFORNIA PRESS

Berkeley Los Angeles London

Berkeley and Los Angeles, California

University of California Press, Ltd

London, England

© 2003 by the Regents of the University of California

Library of Congress Cataloging-in-Publication Data

(Permanence of Paper)

CONTENTS

Acknowledgments

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Notes

Works Cited Index

ACKNOWLEDGMENTS

Many people have contributed to this project, from reading chapters to helping me think through a range of ideas and possibilities, from pro-viding close editorial scrutiny to sharing enlightening telephone con-versations For their encouragement, good humor, and editorial advice

I would like to express my gratitude to my writing group, Susan Bordo, Dana Nelson, Suzanne Pucci, Sue Roberts, and Ellen Rosenman They were my first guides on this project, and their criticisms, both compas-sionate and critical, were indispensable I thank Claire Kahane for an early and crucial response to the project as well as Steve Pile and Dan Smith, who both raised important questions To Jim Kincaid, who read the whole manuscript in less than two weeks, complete with abundant notes and encouragement, I cannot thank you enough for what I can only describe as heroic feats of friendship

Thanks to those people who sent me materials and made dations along the way: Mardel Blum, Sandy Blum, Bonnie Burman, Janet Eldred, Susan Kessler, Heidi Nast, and Michael Uebel

recommen-Thanks to my two brilliant workaholic graduate students who sisted me with the research, Ann Beebe and Ann Ciasullo Thanks also

as-to Meredith Jones for her painstaking transcriptions

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I thank the Institutional Review Board of the University of Kentucky for advising me through this project and finding ways of accommodat-ing someone with so little experience in the realm of human subject re-search I especially thank Graham Rowles for his time and effort in teaching me how to conduct interviews

Thanks also to the University of Kentucky for generously supporting this project with a research grant and research assistant stipends

I want also to offer particular thanks to the numerous surgeons and cosmetic-surgery patients who contributed so generously to this project While their names remain anonymous for the reader, I am deeply grate-ful for their sincere commitment to expanding the range of commentary

on this complicated cultural phenomenon Special thanks go to those surgeons who allowed me to observe their surgeries I thank as well their staffs who gave me so much information about the nature of the proce-dures, not to mention good-naturedly tolerating my intrusion into their work space I thank the patients for their willingness to speak with me

so openly

Thanks go to my project editor, Cindy Fulton, for all of her efforts toward making this a better book Without the expertise of my copy-editor, Robin Whitaker, this book would be considerably less readable,

so I cannot thank her enough And thanks so much to Sierra Filucci, assistant to the editor, for all her time, attention, and concern Finally,

I thank Naomi Schneider, my wonderful editor at the University of California Press, for her extraordinary patience in seeing this project through

THE BEGINNING

My first nose job was performed by an otolaryngologist (otherwise known as an ear, nose, and throat doctor) who, in concert with my mother, encouraged me to have surgery Without consulting me, my mother made an appointment and then convinced me to go with her — just to see what he had to say He had operated on the nose of a neigh-bor, and my mother liked her result

Having a parent criticize a physical feature is a complicated tional experience that induces both anger and guilt You feel as though you have let the parent down Why didn’t you come out right? At the same time, the pervasive mythology of parent-child relations tells you that parents think their children are perfect, no matter what From my mother’s perspective, however, criticism of my nose didn’t seem harm-ful because it wasn’t permanent Such problems could be resolved — fixed Ballerina Allegra Kent writes about the nose job similarly imposed upon her by a mother invested in “conventional beauty” (79) “Allegra [said her mother], if you had a little more chin and a little less nose, you would be so much prettier” (78) And then: “Aren’t you interested in a

I suppose her postsurgical nose was slightly smaller In those days, the only kinds of noses that made me think of surgery were very large noses Slightly large (like my friend’s) or wide noses (like mine) or noses with bumps all seemed fine to my adolescent perception of faces

Young children and adolescents receive their body images wholly from the outside The adolescent girl, especially, enters the world ten-tatively and waits for it to say yes or no to her face and body Now that

my face had emerged from its childish amorphousness, it was finished enough to predict its disadvantages Negotiating adolescence can feel like traveling in a herd of sorts, always under fire or under threat of some dangerous predator; you hope that you will escape notice Then one day you are singled out — shot down in the field —just when you imagined yourself safely swallowed in anonymity

My experience of learning there was something wrong with my nose

is inscribed in my mind (and on my body) as a story of imperfection that

“required” correction The story goes this way: Your body is trant It came out wrong If you don’t intervene on some level, you are compounding the original failure A plastic surgeon I interviewed cor-rected my terminology: “It’s not an intervention I hate that word Let’s call it what it is It’s surgery.” But psychically, it feels like an in-tervention in the body’s wayward path This holds true for both image-changing surgeries like rhinoplasty and rejuvenation surgeries like a face-lift Your body is heading in a certain direction that threatens to make “you” worthless unless you rise up in resistance —unless you in-tervene With surgery It is important to remember that if you don’t intervene now while there’s still time, you will lose Something Every-

recalci-thing Love Money Achievement This is what we learn even from the

body-image scholars who write about how much easier it is to thrive in the world if one is good-looking I worry about these supposedly objec-tive studies, because I think they have the unfortunate effect of making

us all more anxious than we already are You! Yes, you there, because you

are plain, you will be sentenced to ten years in prison instead of three And you— don’t even think about applying for that job until you have

those jowls and double chin sucked smooth We require streamlined faces to match our precision office spaces Body-image studies become yet more fodder for plastic surgeons, who explain to me that men “need”

to have their eyelids tucked in order to be considered young and getic in business

ener-The story of my household is like that of many Jewish American ilies whose assimilation is symbolized through physical appearance Fea-tures, body styles — these have meaning They tell stories all by them-selves Certain kinds of noses speak Jewishness I have heard too many people say that he or she “looks” Jewish on the basis of the size of a nose Jews assimilating into a largely gentile culture thus strip from our fea-tures the traces of our ethnicity We have other aesthetically assimilat-ing rituals We straighten curly hair, dye dark hair light We get very thin to disguise what we often imagine are Jewish-coded thighs and hips What we choose to treat are precisely the features that are culturally se-lected as our distinguishing physical traits My nose was not what my family would call “typically Jewish.” It was wide It was turned-up but

fam-“too wide,” as my mother declared Every picture of me would become

an aesthetic catechism “Do you know why this is a flattering picture? It’s taken from the side so your nose looks good.” There was that picture

of me from my tenth-grade play I was looking up at another actor, pointing my perfect gentile profile at them, concealing the disappoint-ing full-face version That picture became a kind of emblem —how good-looking I could be if only I held myself in profile Dr Eileen Brad-bury says of people self-conscious about their noses: “If you are con-cerned about your nose from the side view, then you will do everything you can to prevent other people from seeing it from the side You de-

When surgery enters your experience, the mirror becomes a kind of blueprint on which you project and plan the future of your body This happened with my nose At first, I looked at my nose and it looked fine

I couldn’t really see the problem my mother had identified It looked like

“me.” There is a difference between looking in the mirror and ing what you will look like as a grown-up and picturing a surgical trans-formation In contrast to the protracted process of development and ag-ing, surgery feels like a kind of magic

imagin-“What we do,” said a surgeon, “is a very powerful magic.” Most surgeons tell me about the technical aspects and the logical desire to im-prove your appearance along with the high satisfaction rate if the pa-tients have reasonable expectations This is so different from the emo-tional reality of a practice that feels, as this one surgeon admitted, magical You go to sleep one way and wake up another It is the stuff of fairy tales How different, ultimately, is cosmetic surgery from the story

of, say, Sleeping Beauty, who goes to sleep a young, isolated maiden and wakes up to love and perfect happiness forever after? This is what you want at the end of the surgeon’s wand They will never admit as much to

me — that it’s what we all want None of us is rational when it comes to surgery, no matter what we say to them, no matter what rational claims surgeons assert It won’t change your life, most of them tell me But of course it will, one way or another And indeed, at the same time as the

surgeons offer me their professional “truth,” in confidence they claim,

Oh yes, this will change people’s lives “Once they look better, thing will change.”

every-One young woman who had her nose fixed describes it thus: “I always looked in the mirror and thought, I want that bump out I’ve thought,

Oh, I feel hideously ugly But I’ve always thought, it’s like you have a car that has a dent in it — if you got it fixed it would be quite a nice car So

I thought, apply the same thing to your face” (Plastic Fantastic, “Horn of

Plenty”) Notice how her nose is both her and not-her, something that makes her feel “hideously ugly” at the same time that it’s as materially distinct as a car This is what happens to your body when you start changing it surgically The “you” who feels ugly is linked to the defec-tive piece but is also imaginatively separable Partly, this double effect of your body that is both “you” and replaceable feels like a split right down the center of your identity I am my body and yet I own my body

THE SURGEON

“A bad outcome of a rhinoplasty can be devastating for a young girl,” served the surgeon I was interviewing “It can ruin her appearance.” We echoed each other’s moans over the plethora of otolaryngologists barging into a field best left to board-certified plastic surgeons I confessed that I was one of those teen-aged victims of an inept ENT He paused, then responded cautiously, cordially: “Your nose isn’t so bad.” I wanted him to protest with surprise, “But your nose looks great,” even though I know it is merely a rescued nose—a good enough nose reconfigured into reasonable shape after the original, botched job

ob-From the moment I entered his office, the surgeon had me I instantly transferred my need for approval from my mother to him This relation-ship forged with the plastic surgeon is a perfect example of what psy-choanalysts mean by the process of transference, whereby unconscious attachments to early figures are transferred onto contemporary people

in one’s life The parentified plastic surgeon is nowhere more apparent

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than when parents take children to the surgeon When the parent is the one who determines the need for surgery, the surgeon inevitably be-comes a parent surrogate This role is freighted with responsibility In part, what I wanted from this surgeon was for him to become the good parent who would tell the bad parent she was wrong, her daughter was beautiful Go home Let her get on with her life

He looked at me and smiled ingratiatingly He was an ugly man with

a large sagging face; his eyes seemed almost attached above an enormous nose Thatches of gray and dark hair erupted unevenly from his head This is how I remember him at least I remember him as a monster, as the slayer of my nose, the creator of a surgical subject

I’ve asked surgeons what they do about the mother problem — the mother who drags a demurring daughter into the surgeon’s office “I talk

to the daughter alone,” one surgeon replied “I ask the mother to leave

us alone until I’ve had a chance to talk to the daughter about what she

wants.” Some surgeons go on to say they won’t operate if the daughter says she doesn’t want the surgery But, in general, the surgeons have sur-prised me They’ve said the daughter wants the surgery, that’s why she’s there Even though her mother made the appointment, told her to get ready for the appointment, drove her to the appointment, and explained

at length to the surgeon what she wanted for her daughter’s nose while the daughter sat in an abstracted silence as if not there or as if just ac-companying her body part, her infamous nose They’ve told me that you need to get her alone so she tells you what she wants for her own nose

They don’t consider that she might want nothing Better still, what if the surgeon were to say, Your nose is really fine; it suits your face None of the surgeons told me this story I was hoping for just one But this isn’t what surgeons do They see the defect from the other side of the room The defect (or deformity, as they term it) hails them, flags them down, implores their assistance They see, in other words, the need for surgery They don’t recognize the daughter’s need to be sent home, surgery-free

In part, this has to do with their construction of a particular kind of ality populated with bodies requiring correction

re-A surgeon tells me: “When I walk into a room, anywhere, I can’t help

thinking about what I could do to make improvements in the faces around me.” I shudder as he looks me over and smiles coolly

Certainly, a surgeon who preyed on maternal fantasies and the curities of young girls wasn’t about to let me go, not once he had me in his orbit I made it clear how little I wanted this surgery He said that he would never operate against my wishes, but I should be aware that this rhinoplasty would make me beautiful “Now,” he began impressively,

inse-“you are better looking than eight out of ten girls.” He hesitated slightly before elaborating more profoundly: “With this surgery, you will be

a ten.” My mother almost exploded with vicarious narcissism Never mind that she knew as well as I that I had plenty of other flaws in my face; did doctors lie? The doctor must see beauty in her daughter that had eluded her own eyes This was exactly how he seduced me into sur-gery — through being the better parent, the one who would compensate for all the cruel deficiencies in the real parents In this sense, the defi-ciency cured by the plastic surgeon takes place in the transference it-self — the implicit promise he makes to be the parent who will call you beautiful The surgical transformation is only a literalization, then, of what happens psychically in the moment when he makes, or you imag-ine he makes, this promise

He showed us a picture of his most famous patient, an early 1970s model “She came in with the same problem,” he explained “Her tip was bulbous.” He showed us a picture of the pre-op woman, whose nasal tip was wide, although not as wide as mine, nor was the bridge as wide He was telling me I had the same nose, and I found myself seeing her nose

as though it were like mine, even though at another level I recognized the enormous difference between them

This moment when your perspective intersects with or is overtaken

by the surgeon’s is crucial to the process of transformation itself He functions as the aesthetic expert, the one who plumbs the deepest se-crets of faces and their potential beauty If he tells you thus and thus will