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Flesh Wounds

The Culture of Cosmetic Surgery

Virginia Blum (Author)

Available worldwide
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Paperback, 366 pages
ISBN: 9780520244733
April 2005
$29.95, £22.95
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When did cosmetic surgery become a common practice, the stuff of everyday conversation? In a work that combines a provocative ethnography of plastic surgery and a penetrating analysis of beauty and feminism, Virginia L. Blum searches out the social conditions and imperatives that have made ours a culture of cosmetic surgery. From diverse viewpoints, ranging from cosmetic surgery patient to feminist cultural critic, she looks into the realities and fantasies that have made physical malleability an essential part of our modern-day identity.

For a cultural practice to develop such a tenacious grip, Blum argues, it must be fed from multiple directions: some pragmatic, including the profit motive of surgeons and the increasing need to appear young on the job; some philosophical, such as the notion that a new body is something you can buy or that appearance changes your life. Flesh Wounds is an inquiry into the ideas and practices that have forged such a culture. Tying the boom in cosmetic surgery to a culture-wide trend toward celebrity, Blum explores our growing compulsion to emulate what remain for most of us two-dimensional icons. Moving between personal experiences and observations, interviews with patients and surgeons, and readings of literature and cultural moments, her book reveals the ways in which the practice of cosmetic surgery captures the condition of identity in contemporary culture.
Acknowledgments

1. The Patient’s Body
2. Untouchable Bodies
3. The Plastic Surgeon and the Patient: A Slow Dance
4. Frankenstein Gets a Face-Lift
5. As If Beauty
6. The Monster and the Movie Star
7. Being and Having: Celebrity Culture and the Wages of Love
8. Addicted to Surgery

Notes
Works Cited
Index
Virginia L. Blum is Professor of English at the University of Kentucky. She is the author of Hide and Seek: The Child Between Psychoanalysis and Fiction (1995).
“As face lifts and tummy tucks become increasingly affordable to middle-class Americans, Blum argues, even those who have never considered the knife cannot escape cosmetic surgery’s implications and its pervasive promotion by everyone from doctors to those who play them on TV.”—Publishers Weekly
“Blum here employs a perspective that melds academic analysis with personal experience.”—Alexandra Hall Ms Magazine
“Partly a journey of self discovery--an often thoughtful one at that. It is also a shrewd analysis of the subculture of plastic surgery.”—New Republic
“Considers ways in which the practice of cosmetic surgery captures the condition of identity.”—The Bookseller
"An impressive book. An important book."—Jamie Lee Curtis

"I blame mirrors. If it weren't for them we wouldn't need plastic surgeons. In the meantime, anyone tempted to re-shape face, body and mind by means of knife should first read Blum's intelligent, persuasive and absorbing book. Both enticed and alarmed, the reader will at least know what she's doing and more importantly why. This is a book that takes you and shakes you by the throat, and leaves you the better for it."—Fay Weldon, author of The Life and Loves of a She-Devil

"An eye-opening look at the dangers, both physical and emotional, of plastic surgery and of the power of beauty in all of our lives. Blum's book is an impressive interweaving of observation, oral interviews, cultural studies, and historical sources. An absorbing read, this is a scholarly book that general readers can enjoy."—Lois Banner, author of American Beauty

"A provocative and thoroughly persuasive argument that we live in a culture of cosmetic surgery where identity is sited on the shifting surfaces of the body. Flesh Wounds brilliantly explores the link between the seductions of surgical self-fashioning and the star system, drawing on a stunning array of materials ranging from interviews with plastic surgeons, psychoanalytic theory, and the novel to the visual media of digital photography, film, and television."—Kathleen Woodward, author of Aging and Its Discontents: Freud and Other Fictions
One

The Patient's Body

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 neighbor, and my mother liked her result.

Having a parent criticize a physical feature is a complicated emotional 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 harmful 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 face that would be closer to perfect proportions? Then you would be beautiful" (78).

When my friend Leslie had her nose fixed at age seventeen, that settled it. Leslie and I never spoke about her surgery, but somehow the mothers got together and conferred. Even though I couldn't see the difference myself following Leslie's surgery, my mother was more than enthusiastic. 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 Leslie'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 tentatively 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 recalcitrant. It came out wrong. If you don't intervene on some level, you are compounding the original failure. A plastic surgeon I interviewed corrected 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 intervention 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 intervene. With surgery. It is important to remember that if you don't intervene now while there's still time, you will lose. Something. Everything. 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 objective 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 energetic in business.

The story of my household is like that of many Jewish American families whose assimilation is symbolized through physical appearance. Features, body styles—these have meaning. They tell stories all by themselves. 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 features the traces of our ethnicity. We have other aesthetically assimilating 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 selected as our distinguishing physical traits. My nose was not what my family would call "typically Jewish." It was wide. It was turned-up but "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 disappointing 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 Bradbury says of people self-conscious about their noses: "If you are concerned 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 develop a whole pattern of very anxious behavior that is intended to camouflage and conceal that part from the world" (Plastic Fantastic, "Horn of Plenty"). But, unlike the cultural fantasy of typical plastic surgery candidates, who walk around in a huddle of physical shame until one illuminating and determined moment they decide to take their bodies into their own hands and offer them up to some whiz of a plastic surgeon, I remained unselfconscious about a feature I considered perfectly acceptable. It was only after I became surgical that my features were reorganized into categories of pass and fail—a trail of sites viewed through surgical eyes. I had expected to reach my twenties with my body parts intact. This was not to be.

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 imagining what you will look like as a grown-up and picturing a surgical transformation. In contrast to the protracted process of development and aging, surgery feels like a kind of magic.

"What we do," said a surgeon, "is a very powerful magic." Most surgeons tell me about the technical aspects and the logical desire to improve your appearance along with the high satisfaction rate if the patients have reasonable expectations. This is so different from the emotional 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, everything will change."

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 defective 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," observed 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.

From the moment I entered his office, the surgeon had me. I instantly transferred my need for approval from my mother to him. This relationship forged with the plastic surgeon is a perfect example of what psychoanalysts 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 than when parents take children to the surgeon. When the parent is the one who determines the need for surgery, the surgeon inevitably becomes 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 surprised 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 accompanying 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 reality populated with bodies requiring correction.

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 insecurities 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 be beautiful. "Now," he began impressively, "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 surgery—through being the better parent, the one who would compensate for all the cruel deficiencies in the real parents. In this sense, the deficiency cured by the plastic surgeon takes place in the transference itself—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 imagine 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 secrets of faces and their potential beauty. If he tells you thus and thus will make you better looking, it is difficult to resist your conviction of his privileged knowledge. If you are the child of critical parents, you are especially at risk—both because the transference will be more entire, and because one's need is more abject. Years later, when the second surgeon operated on my nose, he casually mentioned that he was going to put a cartilage implant in my nose to offset the problem of my weak chin. For twenty-seven years, I had never once seen my chin as too small, but for several years following this off-the-cuff observation I considered a chin implant. This effect that a plastic surgeon can have on one's body image is extreme in my case, but I would argue that for everyone who undergoes plastic surgery there is a degree of dependence on the surgeon's perspective.

Not only did I confuse my own nose with the famous model's, I confused my whole face. Showing me her picture was a brilliant stroke. It created what I would call a metonymic chain of desire in which the nose became representative of the whole face—that would be mine (the ten, me as a ten) with surgery. I wanted her pre-op face as much as I wanted her post-op nose. The change he made to her nose became irrelevant in the overarching fantasy of having the face of a supermodel. Showing before and after pictures is misleading to patients, because we tend to focus on the whole image instead of the isolated alteration. Many plastic surgeons discourage showing before and after photographs, both because they stoke the expectations of prospective patients and because they violate the privacy of former patients. Each surgery is different. People have different tissues, bone structures, healing mechanisms. Avaricious surgeons out to increase their patient load will show pictures because they have such a seductive effect. In the case of the famous model, it was nearly impossible for me to separate the nose from the rest of the face that was being served up to me as a forecast of my future status as a "ten."

The originally slightly rounded tip of the model's nose was exchanged for a precision tip. There were indentations in it that I coveted because at the time they signified refinement; only subsequently did I perceive them as a grotesque imitation of the "upper-crust" nose. No nose ever came from nature with those chinks in it. With elaborate pride, he showed us a magazine article detailing the model's features, among which her nose was described as almost too chiseled, as though some surgeon had become overeager. I later learned that this model's nose job was considered a notorious disaster among plastic surgeons.

I was only eighteen, so it is no surprise that I was thoroughly taken in by this unctuous and unscrupulous man, who preyed on the insecurities of young women on the verge of college, in the throes of the all-absorbing question of how we would be received. Would we find dates? How would we rate? Ten. He promised. Like the model. Look at her. There you will be. It's so graceful, really, like a card trick.

Why did my mother take me to the plastic surgeon—especially when I didn't want plastic surgery? She wasn't atypical. Many of my friends were taken by their mothers for cosmetic surgery to their noses. Some of them said no, while others agreed. One friend describes the tactful way her parents put it. They told her that she had a large nose they would pay to have fixed—if she wanted it. But it was up to her. When your parents identify a flaw in you, your response depends on your overall relationship. Two friends say they were unequivocal about the nose job pressed upon them by mothers with whom they were in endless conflict. The "no" to the nose job was like any other "no" flung into the mother's detested face. Children more anxious to please parents will in turn be more willing to correct the perceived flaw.

Meanwhile, my mother considered it parentally irresponsible not to do what she could to make me more "marketable." These decisions are motivated by both broadly social and narrowly narcissistic impulses, which are in the end interlinked. The daughter successful in the marriage market, the ambitious son—these are familial achievements that raise parental value in their own eyes and in the eyes of the world. The failed child is a sign of parental neglect of some kind. They are clucked over by the parents' circle. Just as it may swell the mother's own self-esteem to send into the world a beautiful daughter, she will also be taken to task for her daughter's failure to thrive in the world according to socially conditioned guidelines.

For my mother, good looks meant marrying well. Marrying well, by the way, meant marrying a successful Jewish man; yet it was just these Jewish men who, supposedly, were most desirous of the too-small, imitation-WASP nose. In other words, our bodies weren't being honed and refashioned for a gentile market of prospective husbands. It was our own cultural and ethnic "brothers" for whom we were being redesigned in the conventional WASP image. It was as though circulating among us was a tacit agreement that Jewish men prefer gentile looks superimposed on originally Jewish bodies.

The Asian American community has been experiencing a similar cultural schism. Mothers take their sixteen-year-old daughters for double-lid surgery; they present it to them with love, kisses, and their blessings as a high school graduation present. Surgery on the epicanthal fold gives the effect of the Caucasian double lid so prized among the Asian community as the preeminent sign of beautiful eyes. One Asian American woman explains the system: "'Our mothers want us to be beautiful because being beautiful is one requirement for getting married. Big eyes are supposed to make you beautiful'" (Accinelli E4). Yet surgery to the eyelids of Asian daughters is intended to appeal to the aesthetic taste of young Asian men, who presumably share the very racial traits they want changed. These surgeries we perform to transform ethnically and racially different bodies into "mainstream" bodies are not in the service of thorough integration into WASP/Western culture, because the aesthetic changes are for the pleasure of our own kind. Rather, such surgeries are the badges of parental success in the "new land." A nose, a double lid—these dominant culture codes of beauty are etched into our bodies in token of our parents' simultaneous submission to the dominant culture and accomplishment within it. The entrance fee is the daughter's rehabilitated body.

Surgery

It wasn't until the morning of the surgery that the surgeon admitted he might have to break the bone after all. I hesitated. Then I murmured, "Only if you have to," as though I hadn't known from the moment he brought up the possibility that it was inevitable. The bridge would be broken. He'd known all along, and only now, as the pre-op sedatives were beginning to take effect at 6:30 in the morning—after waiting in anticipation for three months, fantasying the beautiful future of my face, after going to bed early and having no food or water in my stomach since the previous evening—only now did he divulge the whole truth about the surgery. They need to reel us in slowly.

I came in and out of consciousness during the surgery, which was performed under a local anesthetic. Not long after I awoke in my hospital bed, feeling a kind of weight and intensity in the middle of my face, I was handed a mirror. My nose was in a cast and heavily bandaged, but what struck me immediately was that the bottom of my nose was now flat where once it had been rounded. Even then, recognizing on some level that too much was missing, I was in that postsurgery haze of pure expectation—when the result could be anything. After surgery, you lie in bed waiting for your day. Instead of obscuring your face, the bandages seem more like a blank field of possibility—of the beauty promised, of the happy ending to the surgical story.

This relationship between the male surgeon and the female patient is so powerful that more than twenty years later, as an interviewer, I found that surgeons continued to have the same effect on me. Regardless of the professional career, the expertise, the presumed "grown-up" resistance to their blandishments and insinuations, no matter how big the desk between us or how sophisticated my insights—no matter how enlightened I am as to the way they harness cultural power over women's bodies in the service of their practice—these surgeons continued to be able to tell me who I am, to construct an identity for me that emerges in relation to an aesthetic standard they come to represent as the ultimate body critics (and perfecters). In their hands lies the route to the promised world of tens. Many of us can say no to the surgeon (most people never consider surgery), but it's more difficult to rise entirely above a culture where ten is something worth being.

During my interviews with plastic surgeons I found that, despite my role as interviewer, at times they assessed me as potential surgical material. Having spent a great deal of time in their offices, I am now hyperconscious of a general institutionalized distribution of power that has very little to do with the aesthetic particulars of each woman's face and body. Unless they asked, I rarely informed the surgeons that I have had surgery. For one thing, I hardly wanted them to comment on the outcome or recommend further surgery. I wanted them to interact and respond outside a surgeon-patient dynamic, which would have been all too available for them once they could position me as "patient." For the most part, the surgeons did not talk to me as though I was a prospective patient. They respected the interviewing boundary; my body remained beyond the scope of the interview—at least as a subject of discussion. Nevertheless, there were those who could not help but overstep, who seemed compelled to see me as a patient despite the institutional imperatives against doing so (the original exchange of letters, the process of signing consent forms, turning on a tape recorder). It was at these moments that I gained (harrowingly) much deeper insight into how men's and women's bodies perform in relation to preassigned roles of those who get to look, operate, impress upon, and make versus those who are looked at, assessed, receptive, and changed. It was as though the still-powerful cultural, allegorical roles of male and female bodies were ever straining against the frail reins of the professional situation. The remainder of this chapter will concentrate on just this tension between my positions as interviewer and patient and how the interview process itself made me realize how perilously close I always am to lapsing back into the patient position. The demands of my damaged and vulnerable body continue to defy the rigors of half a lifetime of cultural inquiry and feminist protest.

Damage

Viewing themselves as "healers" of cosmetic defects and emotional desperation, plastic surgeons need not interrogate their own psychological necessity for intervening in the appearance of healthy bodies. We could argue that cosmetic surgery is markedly different from the life-saving efforts of, say, the general surgeon, because in cosmetic surgery we find harm being done to a healthy body, cuts being made, blood flowing for no known medical reason. This is why plastic surgeons tend to justify their practice through the claim of psychological necessity. Psychological damage takes over for physical impairment. Healthy bodies begin to appear "diseased." In countries with national health programs, this argument is taken quite literally. In Great Britain, for example, a woman can still receive a state-funded breast augmentation if a qualified psychologist deems it necessary to her emotional well-being. The sociologist Kathy Davis documents at length the criteria established in the Netherlands (also under national health insurance) to evaluate the "necessity" for the cosmetic operation:

For example, a breast lift was indicated if the "nipples were level with the recipient's elbows." A "difference of four clothing sizes between top and bottom" was sufficient indication that a breast augmentation or liposuction was in order. A sagging abdomen which "made her look pregnant" was enough reason to perform a tummy tuck. For a face lift, the patient had "to look ten years older than his or her chronological age." (35)

While this program of government subsidized cosmetic surgeries impressively levels the playing field between those who can pay out of pocket and those who cannot, such an approach to determining a patently aesthetic "necessity" colludes with the idea that people might need to put themselves at surgical risk in order to heal their self-esteem. Plastic surgeons operate under the pretext that the damage has already been done in the form of the cosmetic defect, hence they are simply correcting a problem that originated elsewhere. They can overlook the damage inflicted by them under their supervision in their operating room. They can project onto the other, the patient, the psychological damage as well.

It is possible that plastic surgeons are acting out in a socially sanctioned way their aggression on bodies that have been shaped by forces other than their scalpel. Such "forces" are either natural (what the patients were born with) or surgical (the results of other surgeons' work) or traumatic (car accidents, etc.); whatever might be the cause of the body's appearance, it induces in the surgeon a form of rivalry. This would explain the extraordinary level of in-fighting and competition among the surgeons, which include their readiness to "correct" the mistakes of other surgeons. Indeed, open any plastic surgery journal or woman's magazine and you will find plastic surgeons bemoaning the failures of other surgeons as they extol their own corrective techniques. While it is certainly admirable that medical professionals are as attentive to psychological forms of impairment and dysfunction as they are to physiological forms, I suggest that we also consider what kind of gratification might be in it for plastic surgeons. Why might their sincere regard for patients join with and disguise this double action of damaging and repairing?

Moreover, whose aesthetic prevails? Whose body, ultimately, is it? When friends ask my advice, I tell them to go to the surgeon whose surgical results look like what you want on your own face or body. Many surgeons criticize their colleagues who reproduce a particular look on every face and body touched by their scalpel. They talk at length about tailoring the change to the individual. But then I look at their own work, and all their patients as well look like members of a not-so-extended family. There's a surgeon whose face-lifts I would recognize anywhere. His procedure is always the same: yank up that brow, stretch back those nasolabial folds, insert a silastic implant into the chin. His patients look uncannily alike in their "after" photographs, staring brightly into the camera, chins stiffly prominent, every element on their faces that could crease or fold now permanently affixed as though by a rubber band.

Pathological Concern

"Do you think you're attractive?" one surgeon asked me.

"I'm okay," I replied. Of course, this is the stock response—one always replies "okay" to such a question—or "reasonably" or something neutral. One must be prudently modest. Think of all those models and actresses who "confess" to their aching insecurities. "I've always hated my mouth," Michelle Pfeiffer admits. Are we supposed to accept at face value that she dislikes her most celebrated feature? That she really believes she looks like a duck?

At the same time one must not cross the line into flagrant self-doubt, because then you will be pathologized as "disordered" by those who specialize in body image disturbance; you will be said to suffer from a psychological affliction, body dysmorphic disorder, an extreme dissatisfaction with one's appearance, that they will promptly and efficiently try to "cure." Surgeons are trained to be wary of such individuals. But throughout the literature on body dysmorphic disorder, one is aware of an extraordinary insensitivity to the fact that some people are considered more attractive than others and that some people are considered unattractive by a significant number of people with whom they interact. How do body-image theorists reconcile their pathologization of beauty-obsessed people with their own work suggesting that the good-looking profit in all respects.

The cognitive behaviorist Katherine Phillips claims to have proved that body dysmorphic disorder (BDD) is biological in origin. Not only does she advocate treating it with a combination of antidepressants; she is also optimistic that brain scans will eventually locate the very scene of pathology. She concedes that BDD can seem related to "normal appearance concerns." But, in order to qualify as having BDD, you need to spend more than an hour a day engaged in BDD-related behaviors. Phillips considers (briefly) the cultural origins of preoccupation with appearance. She argues that while body dysmorphia may be exacerbated by excessiveness of beauty culture, it is by no means caused by it. Her proof is that if appearance-centeredness of the culture were to blame, more women would suffer than men and, in fact, it's the reverse. Yet, we could speculate that since men are not supposed to care as much about their appearance, it would only stand to reason that more men than women would be diagnosed as disordered for caring so much. "Normal" for Phillips seems to mean those of us who respond to magazine articles on "perfect thighs in this lifetime" and the possibility of going from so-so to supersexy'" (182). To respond to a cultural preoccupation with appearance is, of course, normal. But you can care too much. Then you have a disorder. Plastic surgeons follow a logic similar to that of Katherine Phillips. Normal, apparently, is to want your ethnic nose fixed.

I wound up with one of those noses surgeons display as the "before" picture for a botched surgery. My turned-up nose became Roman. It twisted to one side. It hooked. The tip was flattened out from the removal of too much cartilage. Allegra Kent describes her own disastrous result: "My new face was grotesque. It was shockingly distorted. It was not me. The doctor had done a bad job, and I recuperated slowly. My mother's obsession with externals and what could be done about them had been played out on me" (80). Both our mothers assumed that surgery was a kind of miracle, that there was no dreadful aesthetic risk involved, that these (urgent) beautification rituals inevitably made one more beautiful. Afterward, my mother and I complained, but the surgeon dismissed us as having absurd expectations. There was only so much he could do—"the bones have to go somewhere," as he put it to my mother in response to her wondering how my nose had gone from turned up to turned down. Many years later, as I was going under anesthesia for my second rhinoplastic surgery, I heard the operating surgeon say to his nurse: "Look what some joker did to this poor girl's nose." Nevertheless, the first surgeon considered his work successful—or at least he claimed as much in the face of our dissatisfaction. While I may have been condemned as a perfectionist by surgeon number one (expectations out of line with predictable outcome), surgeon number two identified me as a legitimate case for correction.

Role Reversals

"Do you think you're attractive?"

What does it mean for a plastic surgeon to turn to a woman he doesn't know (and who's not there for surgery!) and ask her if she thinks she's attractive? Does he imagine he has the right by virtue of what he does—territorial rights, to be exact, over all women's bodies? He also knows (who knows better?) that it is the essential question for women. To be attractive for women means they get what they want. But what is it that women truly want—beauty or its putative social rewards? After undergoing extensive plastic surgery to make her ugly body beautiful, Fay Weldon's protagonist Ruth in The Life and Loves of a She-Devil is still dissatisfied because she remains too tall. You must be satisfied now,' Dr. Black [one of her surgeons] was saying to this blond, simpering doll on stilts, 'if grown men are fighting over you. . . . You are beautiful, you are popular, you can go to a party and cause infinite trouble: you are the showgirl type. The balding businessman's dream'" (261). Not quite perfect enough, Ruth demands further (life-threatening) surgery. Dr. Black doesn't understand, because Ruth already has everything he imagines women could want—mainly, to be desired by most men. This, he takes for granted, is why women want to be beautiful. Certainly, Ruth wants to appeal to men (particularly her philandering ex-husband), but it is ultimately her ideal image of her body that she pursues. In other words, what women want may in the end is just beauty itself. While the number of potential partners may increase, this is perhaps not the goal but rather the proof of beauty, the approving stares and the expensive gifts and the proposals simply registered on the checklist of beauty's accomplishments. Just as the measure of a religion's truth is often made according to the numbers of its adherents, a beautiful woman achieves value through discipleship.

This is what Freud has to say on the subject of what he calls the secondary narcissism of the beautiful woman: "Strictly speaking, it is only themselves that such women love with an intensity comparable to that of the man's love for them. Nor does their need lie in the direction of loving, but of being loved. . . . Such women have the greatest fascination for men, not only for aesthetic reasons, since as a rule they are the most beautiful, but also because of a combination of psychological factors" ("On Narcissism" 89). The love object, then, is neither the partner nor the self (in any permanent sense) but instead the body and only when it's beautiful. Freud seems to have captured a cultural turning point when just being beautiful took over as the object of desire. We generally assume that women want beauty as a means to certain ends, the various benefits that become more available to beautiful women: more financially successful partners and the material pleasures they bring. But it is possible that the accomplishment of the lifestyle serves merely as an index of her value on the open market of desirability. What appear to be the cultural rewards, in other words, are just the evidence of—the thing she has, the only thing she wants—her beauty. It is not surprising that beauty has come to this pass.

In Beauty Secrets, Wendy Chapkis describes the received relationship between beauty and its benefits:

Real life and real appearance are not enough when the goal is to live in a travel poster with a beautiful person at your side and in your flesh. If only we were more stylish, if only we had more money, if only we had accomplished something more remarkable, if only we were really beautiful, then life could begin.

But as it is, we know we are too flawed to deserve it—yet. Meanwhile we wait, buying the props if we can afford them, trying to turn ourselves into closer approximations of the beautiful. We wait, aware that beautiful people are not old. (140)

What is most telling about Chapkis's wish-list is how the chain of "if onlys" culminates in beauty itself. The travel poster is the ubiquitous cultural metonymy for "the place" of success, which entails becoming beautiful in a beautiful place. When success looks like a place and place is just an appearance—the place where you are perfectly beautiful—then most of us can simply try to be "closer approximations of the beautiful," never truly "inside" the pictured paradise.

"One day," Fay Weldon writes, "we vaguely know, a knight in shining armor will gallop by, and see through to the beauty of the soul, and gather the damsel up and set a crown on her head, and she will be queen" (She-Devil 63). But in the end Weldon's She-Devil heroine, Ruth, doesn't even really want the knight—she just wants to be the queen of beauty; the knight, her ex-husband, in all his defeated confusion, merely guarantees her sovereignty. It's not that the man in the heterosexual woman's fantasy of beauty is incidental; no, he is central. He is part of the package.

What am I saying, exactly? That beauty is its own end? It seems almost too astonishing; at the same time it is such an obvious consequence of a culture that bombards women on all sides with beauty regimes, beauty solutions, beautiful images—the exigency, in other words, of beauty. It was inevitable that the thing women needed in order to be "successful" as women has ascended to the thing itself. If you tell us enough times and you show us enough appealing examples, then we will begin to believe utterly in beauty as its own reward.

As we are increasingly influenced by the ubiquity of beautiful female bodies on television, in movies, on the cover of virtually every magazine in the supermarket, it is no wonder that the identification with the image of beauty itself is so compelling. The art historian Francette Pacteau discusses the connection between men's near fetishistic representations of beautiful women and women's fascination with these images. She advances the perplexing possibility that "man-made images of female beauty are, at least in part, a product of the man's attempt to meet the desire of the woman—to accede to being her desire, by presenting her with an ideal image of herself" (190). Contrary to the commonly received notion that it is men who dictate the demand for and the terms of this female beauty, Pacteau intriguingly suggests that to some extent men are giving women what men think women want—representations of female beauty. These images serve women's demand for identification with beautiful images.

Art historian Lynda Nead emphasizes the emergence of the female nude as the favorite subject of nineteenth-century painting, which suggests not only the new centrality of the female body as the object of the gaze but also the circulation and availability of images of the female body. Thus, what I point to as the overinvestment in beauty as its own goal is the historically specific result of both identifying women with (beautiful) visual images and raising women to identify with the image of their own beauty.

"Do you think you're attractive?"

What am I supposed to do with the "think" in that sentence? What if he had asked me, "Are you attractive?" A yes or no question that people feel as though they can't answer about themselves. To ask us if we "think" we are attractive implies the power of the mind over the body. If you feel beautiful, then you are. But the plastic surgeon's very role in life is to overturn dramatically this already quite impoverished cultural fiction.

A beautiful woman in my family loves to assert that beauty doesn't make you happy—"Just look at Elizabeth Taylor," she will urge. As though Taylor's beauty interfered with her pursuit of happiness. So invested is my relative in this myth that she kept secret from me her own rhinoplastic surgery—even when I was about to have surgery myself (that first surgery). It was her cousin who accidentally spilled the beans, because he didn't know the degree to which women guard their beauty secrets. When I confronted her with her cousin's story, she conceded that, yes, she'd had a revision, but only a very little one, only a slight refinement of the tip. It is impossible ever to tap into the whole truth of these family fictions, but what I learned from her was that narcissism is shameful, and what could be more narcissistic than having cosmetic surgery?

"Do you think you're attractive?"

To be asked by a plastic surgeon whether you think you are attractive is a reversal of the real question hanging between the surgeon and the patient—Does he think you're attractive? When he asked me, "Do you think you're attractive?" what naturally sprang to mind was his opinion, not mine. Whatever I thought, he was going to tell me the truth; moreover, his question brought to light what I work hard at forgetting when I am in the company of these surgeons—the degree to which they are immediately, reflexively almost, pronouncing aesthetic judgment on me as I walk through the door. When he asked me, "Do you think you're attractive?" I felt as though I were being quizzed by a teacher who knew in advance the correct answer.

"Have you had your nose done?" he pursued.

I think back to that first surgeon pinching the tip of my nose between his thumb and forefinger. "I was checking the cartilage, in case she was Hispanic," he explained to us. "Hispanic noses don't have the right consistency for reshaping." My mother was instantly impressed with his cross-cultural expertise in the distribution and pliability of nasal cartilage. Afterward she kept referring to that moment when she had witnessed his expertise in practice, when he had pinched my nose. These surgeons trade on the cultural conviction of their ability to analyze the body's surfaces like a form of corporeal exegesis. It takes so little. A soothsayer of the body, reading my parts, my ethnicity—as though it weren't obvious. My last name is Blum. Not exactly Hispanic-sounding.

"Have you had your nose done?" He smiled. It wasn't a casual question. He may as well have been pinching my nose between his thumb and forefinger.

"Yes," I told him. He wanted to know who had (re)operated on me.
"Um, yes, I know him," he commented. He asked me to turn off the tape recorder. It was my turn to be scrutinized—as though the lamp had suddenly swung across the desk from his face to mine. He chain-smoked in my face in his small office.

My anxiety—that any moment any one of them could turn on me, tumble me off my high horse and into the muck of defective female plastic flesh—was lived out with this particular surgeon. My reaction was an extreme version of the pervasive and understood relationship between heterosexual men and women in Western culture. We are always dependent on their restraint, their charity, their ability to refrain from taking advantage of the power reposed in them. This surgeon simply acted upon the power any one of them had.

Just the same, where this power is located is not altogether clear. The power he assumed in that massive reversal was a power I attributed to him as male, as plastic surgeon, to evaluate me aesthetically. He could not have the power unless I turned it over. But I was helpless to withhold it. In other words, while his power cannot happen without my complicity, my complicity is an inevitable corollary and consequence of his cultural power. There is no choice involved in this relationship. If his effect happens only through my response, I can at the same time argue that my response wells up uncontrollably to the positional power he commands over my body. Recall that I could have turned the tables once again. I could have made his face and body an object of my gaze—I could have asked him if he had had surgery. Why didn't I ask him about his eyes, for example, because certainly they appeared operated on? But I instinctively withdrew, and it is this "instinctive" withdrawal that is ultimately structural. This institutional power is inextricably tethered to the degree to which women are the perfect subjects of and for cosmetic surgery.

I will illustrate my point through my various encounters with plastic surgeons. Early on, I was alerted to my vulnerability when a Kentucky plastic surgeon, discussing the kinds of cosmetic procedures he would and would not perform, remarked that he would do only "really bad noses," for example, "real honkers," as he put it. Then, in an offhand manner, he added: "I wouldn't do your nose, for instance." Now, I didn't take this as a compliment; rather, he was using my nose as an example of features that weren't sufficiently displeasing for him to bother reshaping them. As he emphasized, in light of his practice, which was predominantly reconstructive in contrast to cosmetic, the cosmetic procedures had to be such that he "could make a significant difference." Whether his comment was indifferent or aesthetically evaluative was irrelevant to my stunned recognition that he was looking at me in that way—that he could not help but appraise me, moreover that anyone who walked into that office was subject to his professional look. This particular circumstance applies to men and women alike. Given the surgeon's customary experience of the doctor/patient relationship taking place within his office, it was no wonder that he would see me in light of my context—that very office.

They see us all with an aesthetic gaze that is additionally a transformative gaze—what they can do for the defective face and body. Many surgeons acknowledged that often they found themselves looking at people with an eye to what aesthetic revisions they might want to make. "When I went to church more frequently," a surgeon said, "I used to while away the time looking at people and wondering what I would do if they consulted me. And that's a lot of fun." By way of showing me an example of too-heavy eyelids, one surgeon handed me a picture of his nineteen-year-old daughter. "She'll probably need something done in another ten years," he pointed out. What might this be like for the daughter of a plastic surgeon? I felt bad for her. I had noticed her photograph early on in the interview—it was a large photograph and prominently displayed. I had mistaken the gesture of the enormous photograph for a father's pride; rather, she was there as a strategy for personalizing defects. See (I could imagine him explaining genially to a patient), my own daughter suffers from this defect; in another few years, she will need the very surgery you require today. He allowed that I had eyelids. But later in the interview, as he commented on some pictures of face-lifts and noted how impossible it is to correct the nasolabial folds, he pleasantly added, "You have them already, and you're a young person."

Aesthetic Judgment

I was already wearing a mask when I entered the operating room. This was the first time I was meeting the surgeon in person, so he had no idea what I looked like. This mask covered my face from the top of my nose to my chin. Nevertheless, as he inserted a cadaver-harvested septum into the patient's nose, he asked me if I'd had my nose done—a nose he had not yet glimpsed. I was a Jewish woman raised in Southern California, writing a book on plastic surgery; I suppose it was a likely assumption. He, too, wanted to know the name of the surgeon. It was a casual question. Just as casually, after describing the transformations he was making in this woman's facial contours via the addition of a number of silastic implants, he asked me what my jawline was like, if I had a strong chin.

I was sent off to a private room to view a videotape of the surgeon describing his silastic implantation technique. He looked different to me in the tape—older, with a narrower face. Had something been done in between the filming and now? Was he surgically altered, or was I just projecting onto his face his own aesthetic fantasy? Was I seeing him as his own work-in-progress simply because I was caught inside his world at that moment—a world in which all faces are simply variations on a particular surgical theme? After surgery, he came into the room and showed me slides of his work—a series of implant miracles where flat, narrow, chinless faces suddenly bulged with the eminences of jawlines and cheekbones—tiny little features like rosebud mouths and narrow-set eyes now caught amid the mountainous terrain of their plastic bone structure. Out of the blue, he announced: "You have great eyes, full lips, good jawline and chin, a cute nose, but you need cheek implants to widen your face."

I laughed. I wasn't offended. I half expected him to say something of the kind. It was endearing in a way, thoroughly ingenuous. This is what he does—he adds bits to people's faces to make them more nearly match the current fashion in bone structure. My face is too narrow. I need cheek implants. In order to do what he does for a living, he cannot help but view the world around him as divided into those who need and those who don't need augmentation of their bone structure. It wasn't in the least aggressive. I had the feeling, in fact, that he would give me the surgery for a reduced rate, as a courtesy. He wants to make people happy.

I realized that I had to phrase my refusal cautiously—this is his life's work, after all. I told him I wasn't comfortable with the thought of foreign substances in my face. He looked bewildered, slightly wounded. "What do you mean?" "It's just me," I mumbled apologetically.

Most of his slides were impressive. I remarked on the extreme changes for the better in his patients' appearance. I hesitated, however, over one set of before and after shots. The young woman started out fine, but I didn't much care for her after photo. I was trying to figure out what had gone wrong. I wondered if perhaps she had gained weight, because her cheeks seemed too round. The surgeon interjected: "This woman has a facial shape just like yours. See the difference I made with the cheek implants." I stared. She had chipmunk cheeks. This is what he wanted for me. I explained to him that I didn't care for the changes. He was immediately uneasy. "Well, that's okay," he said. "You probably like it because it's like your own face and so that's what you're accustomed to looking at." It was unlikely, I observed, that I would use my own face as any kind of standard. "I'm confident about the work I did on her," he assured me. "It's all right that you don't like it, because I don't have any doubts about it."

Suddenly, I understood that he was anything but confident—that the point of showing me all of these slides was to win my approval. I was his perfect audience, both because I know a great deal about surgery (enough, in other words, to validate my judgment) and because I am not a surgeon myself. There is a danger in revealing one's work to another surgeon because of the element of rivalry that inevitably surges through the relationship between two "master artists," especially, perhaps, two male artists. I am a woman, and I am not a surgeon. Yet, because I have interviewed other surgeons, reviewed a great deal of the literature, in other words, momentarily borrowed their prestige, my approval goes a long way toward shoring up the surgeon's self-esteem.

As Susan Bordo puts it in "Reading the Male Body," what feminists commonly dismiss as the male objectification of women in pornography may not be desubjectifying at all. Quite the contrary, for the fantasy to thrive, the woman must be a subject who accepts the male body and its performances on any terms:

The attempt is to depict a circumscribed female subjectivity that will validate the male body and male desire in ways that "real" women do not. The category of "objectification" came naturally to feminism because of the continual cultural fetishization of women's bodies and body parts. But here it is perhaps the case that our analysis suffered from mind/body dualism. For the fact that women's bodies are fetishized does not entail that what is going on in their minds is therefore unimplicated or unimportant. Rather, an essential ingredient in porn . . . is the depiction of a subjectivity (or personality) that willingly contracts its possibilities and pleasures to one—the acceptance and gratification of the male." (276)

Bordo's analysis of a male construction of female subjectivity coincides with what I experienced at the hands of the surgeons. It is not that they are just objectifying my body (and those of their patients) as so much meat for their transformational miracles. There also needs to be an appreciative subject of the surgery who can afterward look in the mirror and recognize the surgeon's skill. While surgeons may be objectifying the body, they depend on the living subject who can evaluate outcome, insist upon a revision, go to another surgeon (where both patient and surgeon will pool their scorn for the "lesser" surgeon), then praise the "greater" surgeon to all her friends and family as a miracle worker.

The Surgical Touch

I try to walk in prepared; if they're published authors, I take out a photocopy of at least one article they have written in order to illustrate my interest in them. Since most of the surgeons I have interviewed specialize in cosmetic (rather than reconstructive) procedures, imagine what it must feel like to have a woman come in who is paying attention to them. He who spends his days nursing the narcissistic grievances of a nation of women is suddenly the object of interest. "There are a lot of women," one surgeon confides, "who have too much money and too little sense. In fact, I would say that the more they have of money, the less they have of sense." He wonders how he is supposed to render beautiful a woman of two hundred pounds—what does she want from him, after all? More than one surgeon has expressed the frustration of occupying the position of handmaid to rich, idle, overweight women who imagine that a little liposuction will restore their youthful contours. Yet why shouldn't these women be hopeful, given the proliferation of tabloid stories on miracle bodies?

So, imagine me there, sitting in the place of the patient even as I offer the services of a therapist. It's a complicated shift of the conventional daily situation obtaining in their offices. The relationship between us is so precarious, always on the verge of tipping over into the other arena, that it implies throughout the very thing it is not. I am not the patient. He is not in charge. He has something to give me that is so very different from what he gives his patient. Instead of the surgeon listening to my woes, I listen to his. To his patients he offers up (to a greater or lesser degree) the fantasy that they can become more beautiful. Some of them think they will come out looking like a favorite actress. Some of them are instructed to lie back and look in a mirror. "This is the best I can do for you," the surgeon tells them regarding the face-lift surgery. They look up into the mirror to see their skin falling back into their ears—their facial contours reemerge from the flesh that has converged in the middle of their face and sloped from the jawline.

Regarding younger face-lift interventions, a surgeon tells me, "I don't want to do a surgery that the patient won't notice. There has to be a noticeable difference in order to make it worthwhile." It's still not clear to me how this decision is reached. "You, for example," he continues. "If we were to do a face-lift on you, the result would be so minimal, you would hardly notice. Let me show you." He rises with a mirror in hand and approaches me. I have suddenly become a patient; before I even knew what was happening or could adequately prepare myself for the descent of those surgical hands, he has me. I ask him to stop as he begins to put his hands on my face. "I don't think I want to do this," a weak protest thrown up against his expeditiousness.

"Why not?" he is surprised. "Don't be silly. See here," he very gently lifts my cheeks and jawline.

"Here, look." I see myself in the mirror with my cheeks lifted—younger-looking no doubt. But the invitation to look registers as ironically hollow in the context of my feeling stripped of the ability to decide; my looking now feels as though it can only be passive and grateful. How does the woman view her future face-lift in the mirror? Consider that she is at once subject and object? I say, "It looks good." What else could I say? Worse yet, it did look better—to me, at least. I have many friends who all ardently insist that the "natural" contours of aging always look better to them than the surgical intervention. But not to me. (Indeed, certain actresses not yet "outed" for their surgeries are always claimed to be more beautiful than the surgery junkies.) What was lower was made higher. Isn't that what we're supposed to want—what we do want? What I "want" for my appearance is inscribed in the culture that shows me, everywhere I turn, what is supposed to be my ideal image—from the fifteen-year-old faces advertising makeup marketed to forty-year-olds (we're told that very young models are used because their skin tone is more regular!) to drastically underweight twenty-year-olds with enormous hardened silicone breast implants distending the fragile chest walls, puckering out from the sides of their sleeveless tops, stretching the buttons apart, like the taut skin beneath, barely able to contain the threatened excess. Far below the huge breasts linger the eighteen-inch waist, the thirty-inch hips—a comic strip heroine made flesh.

I was startled by the surgeon's hands as they swept up the contours of my cheek and jaw—ever so slightly, but permanently nonetheless: the glimpse of an imaginary future, seeing my face as though through cheesecloth draped over the camera lens, like the expanse of a morning beach flattened back into smoothness by the tide after being rumpled and pitted by visitors the day before . . . everyday we can start fresh. I glanced in the mirror tentatively, then turned away abruptly and pushed his hands from my face.

"Yes, that looks good."

"You see that?" he asked me. He glowed. "Well, then, you would be a candidate for a face-lift. If you can see it, it means you would be pleased with the result." This was the point he was trying to make to me—that the surgeon is dependent on what the patient "sees," what the patient thinks is worth the surgical price in all senses of the term. He said: "What I would do now is send you in to my nurse to discuss price and set up a date for the operation." (Like a date for the prom.) This surgeon was no monster. When he put his hands on me, he was not trying to harm me. Indeed, he was trying to illustrate for me that I would not see any difference, that I didn't have enough sag for it to be worth my while to have surgery. He was slightly surprised that I could recognize the change.

He was a nice man. He was a caring father. He talked about his daughter and her career expectations. Nevertheless, he would not have touched a male interviewer—I have no doubt about it. This does not lead me, however, to an uncomplicated revelation of the imperturbable sexism underlying all interactions between men and women in our society.

Instead, I have a heightened understanding of just how difficult it is even to evaluate let alone change a system sustained on so many different levels within the culture as well as through and within our bodies. Dismantling this system might entail a dismemberment of what we take to be the body itself. The impulse that made him rise and touch me, the retreat and submission on my own part, and then the furtive look into the mirror—even against my will, wherever that "will" might be located, which certainly wasn't in my body, not that day, not in that surgeon's office, not in relation to the mirror he held up to challenge all my superior academic distance—all of these events are part of a more wide-scale social drama of how masculinity and femininity circulate through our bodies like something that feels as basic as a life force.

Let's isolate the multiple physical and psychical events that occurred within the space of sixty seconds. We were in our places on either side of the desk, and this arrangement had a visibly disorienting effect on the surgeon (as it frequently does), because I was in the patient's chair yet the one interviewing him. You would think it would fortify the surgeon's sense of his own place, his position in the world, his doctor's position. Yet it seems to do the reverse. It is as though his position mocks him. His inability to truly occupy the place where he believes he belongs and the place he has earned through many years of medical school, through a thriving surgical practice, involves a disjunction between the arrangement of our bodies and the distribution of power, confronting him perhaps with the ultimate uncertainty of all such social spaces and the roles associated with them. Yet my aging female body beckons the roles to revert to the normative—for me to become the patient and him the doctor. There is a radical break, then, between my role as interviewing subject and my body that is a perfect object for his inspection. It is my body that obligingly (despite myself) drifts back into its familiar patient-role, where it supinely invites the surgical touch.

What is it about the relationship between the plastic surgeon and the female body that allows for such instant intimacy? Beyond the simple femaleness of my body, on what other basis did he know me? I could have been his wife, or daughter. I could have been his patient.

Lynda Nead discusses the dilemma of being simultaneously subject and object for oneself. As she puts it, "Woman [plays] out the roles of both viewed object and viewing subject, forming and judging her image against cultural ideals and exercising a fearsome self-regulation" (10). It is just this predicament of being the object of one's own remorseless gaze that acts out most transparently in the plastic surgeon's office. In a way, he feels like an extension of me—what, after all, is the difference between his hands reshaping my face in the mirror and my own doing so? Moreover, once I'm in pursuit of his skill, once I'm in the chair asking him to look at me (in the patient position), the surgery has as good as taken place. The leap from speculation to scalpel is so narrow once the surgeon considers the possibilities that hover before me like another planet drawing me into its orbit, holding out its promise of difference and specialness—a new life, a new you. In the case of the anorexic, Nead continues, "Woman acts both as judge and executioner." To execute means both "to kill" and "to make happen." So which is it? "Life Is What You Make It" is the newest advertising slogan of the American Society of Plastic Surgeons. What they don't tell you, though, is that first you need to unmake the former life.

While we all might agree that even today, despite our array of achievements, women are always being judged on our appearance, there is much less agreement when it comes to the surgical changes themselves. The otherwise seamless cultural fantasy of the "beautiful" woman is thrown into question by the enormous diversity of practiced aesthetics. Frequently, the patient and the surgeon disagree over the result. I am not talking about poor surgery here; rather, I'm talking about the confrontation of two different aesthetic paradigms, the surgeon's and the patient's, that become evident only in the aftermath of surgery. One woman complained bitterly to me about her surgeon. He wouldn't pull her face tight enough because he wanted her to look natural, while she wanted to look, as she told me, "plastic." They also disagreed on the most suitable shape for her nose. This dispute over the body (who knows best what it should look like) is a place where the apparent universality of aesthetic judgment can be undermined and revealed most clearly for the social and political act it always is.

As we can see, there is nothing inherently malevolent in the surgeon viewing the patient's body as raw material on which he can improve, because she came in looking for just this kind of judgment; moreover, she had already judged herself a fitting subject for the plastic surgeon's arts. Accustomed as they are to this particular relationship between them and the women who visit their offices, it was inevitable that I was cast as more of the same. Moreover, it doesn't really matter ultimately if it's men or women occupying the surgeon position, because it's an assumed instrumentality that acts out gendered characteristics and gendered relations but is no longer gender specific.

Having these surgeons discuss my nose reminded me that it doesn't really belong to me. There are numerous accounts of how long it takes after surgery for the patient to integrate thoroughly the changed body part into the body image. A surgeon explained the following: "A woman who has breast implants or who has her nose changed incorporates that into her body image within forty-eight hours. It's dramatic. Because I always ask them, 'Does it feel like a part of you?' and for the first couple of days, they feel like it's going to fall off, but then within forty-eight hours, or three days, it's a part of them. When you do breast reconstruction, you can't make that up. Really, if my kids were to look at the picture, the best they would say is, 'Yuck.' Yet this too gets incorporated in the body image almost instantly." On the basis of questionnaires and interviews, the researchers smugly present body integration statistics on face-lift versus nose job versus breast implant. Missing from these studies is any recognition of a culture in which women never really own any of our body parts, let alone those parts manufactured for us at the hands of the plastic surgeon. The implanted breast might feel as though it belongs to the woman but only insofar as breasts ever belong to women and are not culturally coded for visual pleasure, as a signifier of femininity. Consider as well the culturally normative "part-object" status of women's bottoms and legs.According to psychologist Joyce Nash's account, the swiftness of such bodily incorporations is vastly overrated. "Jackie reported that for nearly a year after her breast lift and augmentations she would awaken from a dream in which her breasts had shriveled up and become distorted and ugly. Following breast surgery, it is common for patients to dream that their nipples fall off or to experience their breasts as 'pasted on,' not their own, or foreign" (119). Breasts, which are an integral part of the public spectacle of femininity, are in many ways foreign to or separable from the bodies that possess them—even naturally. The experience of gaining the breasts that symbolize the to-be-looked-at-ness of femininity (as Laura Mulvey has put it) could imitate (and even exaggerate) the cultural drama taking place around "real" breasts. It's not just obvious secondary sex characteristics like breasts, however. Once you look in the mirror and think, Hmm, maybe I should have my nose done, or maybe I would look better with a chin implant, then what you possess "naturally" feels no more natural than a superadded or altered bit. Thus, it means nothing really to say that we incorporate changes almost instantaneously, when we consider that the incorporations of transitory parts are necessarily (structurally) transitory.

There is a borrowed quality to women's bodies. For the surgeons to ask me about the changes to my face (as though all of our features are potentially artificial—as though they looked at me in search of artifice) is to underscore not only that the cosmetic change is never "owned" by the cosmetic subject, but also that everything I have is only provisionally mine. For them to check my face for signs of surgery is to see my face as potentially on loan. This gaze of theirs that is registered in a particular way by my own surgically altered body at the same time sweeps the world with its inquiry: Did she do it? Or he? While this surgical gaze may be originally based on how men look at women—may, in other words, owe its cultural power to the inequality of gender roles—it is itself taking over as the predominant cultural look. The surgical gaze is shared by many people in this culture as we microscopically assess the faces and bodies of our favorite celebrities, as we dutifully peer into the mirror everyday to check our wrinkle quotient, challenged by Melanie Griffith from her surgically and digitally altered Revlon face: "Don't deny your age. Defy it." We take for granted that we can in diverse ways transform the body—either by way of exercise or makeup or hair color . . . or surgery; the body that is seen as transformable is the body at the other end of the surgical gaze. More and more it seems that what was once the relationship between the male gaze and the female body/canvas is now experienced in the relationship between technology in general and any body at all.

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