Addicted to Surgery / 285 ible protests against the aging process seem all the more painful as they flail against the invincibility of young beauty. Who else but actresses so aptly represent the struggle between wax- ing and waning beauty? The bodies of actresses are affixed with other- wise more inarticulable and diffuse cultural experiences and representa- tions of femininity. This is why what happens to their bodies (literally, as in surgery) can have such profound effects on the culture. It is because we have projected onto them a certain representational status of the female body— of how we are supposed to look at her, feel about her, contain her, experience her, what angles we are allowed to see, and what angles are interdicted by the camera—by the actress herself. 4 PROMISES, PROMISES: THE NEW WORLD OF CONSUMER CHOICE In the July 2000 issue of Vogue, you will find one of this magazine’s many predictably high-culture accounts of our fascination with cosmetic sur- gery. In contrast to something like, say, Marie Claire’s middle-class menu of new and fabulous options for the masses, Vogue’s articles tend to sus- tain the upscale associations of the process—Park Avenue surgeons, Soho dermatologists, Aspen socialites, and so on, alongside coy and ironic critique. The author of this piece, Elizabeth Hayt, poses such so- cially rigorous questions as “So has fake become the new standard?” (200). It’s important for the self-reflexive aspects of the upscale articles to offset their true purpose—the menu, the possibilities, the excitement of it all. Here’s how you can tell. When you finish this kind of article you have a mild sensation of intellectual fulfillment (after all, this is supposed to be an intelligent overview of a cultural trend) wedded to a surge of desire (only, of course, if you are already predisposed) for at least one among the many new procedures described. Whether we like it or not, the reader is carried along on the wave of paranoia, competition, and consumer enthusiasm. On the surface, such articles make it sound 286 / Addicted to Surgery like so much fun. The writer and her interview subjects are both prac- tical, indolently tongue-in-cheek (“‘Artificial beauty? Is there any other kind?’”) and armed with the most up-to-the-minute information on preserving their bodies intact forever. Even the addictive components are presented as amusingly commonplace. Indeed, such articles can par- ticipate in addiction, yoking as they do our narcissistic vulnerability to the rigors of vigilant consumer practice. Almost veiled, but not quite, by the trendiness of Hayt’s presentation, are the feelings of destitution and loss and panic underlying even the most well-heeled encounters of the jet set with their Beverly Hills or Park Avenue surgeons: “Another of Hidalgo’s patients, a former model . . . an avid skier who lives in Col- orado and has a body to rival Gisele Bündchen’s—is used to the reac- tions of disbelief when she confesses her age, 47. Twelve years ago, after her (beastly) former husband told her he never dated women over 35, she decided to stop the clock” (200). Since this time, she’s had several pro- cedures, and she reports, “‘I look to my plastic surgeon to guide me. He is my VIP, as are my dentist and my trainer’” (201). Why might women be turning over their bodies to a maintenance crew? We might dismiss this example because, after all, she’s a model, whose self-esteem for most of her life has been located in what can only be a transient beauty. How can we recognize an addict when we see one? Talk to people about their surgeries, and you soon find out that they typically compare their own “minimal” interventions with either “serious” plastic surgery or “someone who’s addicted.” A woman who has had her breasts aug- mented, her nose fixed, and her eyelids trimmed and is now contem- plating a full face-lift considers herself entirely in the “normal range” of body maintenance in contrast with people who “overdo” it. Another woman who had a nose job as a teenager and lower eyelid surgery at forty compares herself with people who are “real surgery junkies.” Ac- tresses who confess to surgery often say something like, “Well, I’ve only had my jawline tucked, not a whole face-lift.” The jawline “tuck” is a face-lift, in case you’re wondering. Even patients suffering from the Addicted to Surgery / 287 effects of silicone breast implants engage in acrimonious comparison. Those whose implants are postmastectomy criticize those whose sur- geries were for pure vanity, as though that group deserved their com- plications. 5 Why do we need to cast other people as “worse,” more “ad- dicted,” the true victims of surgery fever? It’s never us—we’re prudent, careful, reasonable. THE PERVERSE CYCLE OF ADDICTION They are called delicate self-cutters, most often adolescent females who cut their skin in moments of intolerable anxiety. They make shallow rifts across the surface of their skin. “The cuts are carefully wrought, some- times simple parallel lines but also intricate patterns; rectangles, circles, initials, even flowerlike shapes” (Kaplan 373). These cuts can be a work of art, elevating the body from what is felt to be its abject changes ( men- struation, for example) and longings; they can reassert the distinction between the inside and the outside. At the same time, the cuts can func- tion as counterphobic responses to a sense of internal mutilation. The delicate self-cutter becomes herself the agent of a mutilation she dreads passively experiencing. Psychoanalyst Louise Kaplan observes that “a perversion, when it is successful, also preserves the social order, its in- stitutions, the structures of family life, the mind itself from despair and fragmentation” (367). Like many who undergo cosmetic surgery, Kap- lan’s perverts experience a deep-seated shame that needs correcting and feel defiant rather than guilty about their perversion, which they never- theless take to be a violation of the moral order. The surgical patient’s shame is intolerable, the thing that drives her or him to the doctor—aging or ugliness or just not being quite beauti- ful enough. Just outside the operating room, a surgeon explained to me that the patient inside was the “ugly duckling” of her voluptuous family. She was now in the middle of divorce and wanted to improve her ap- pearance. Who can imagine her shame? How can I express the shame I 288 / Addicted to Surgery felt for her as her surgeon pronounced the shameful “truth” of her un- loveable body. The genetically blessed, hypertoned, strategically lit bodies of ac- tresses can induce shame in the woman with an ordinary flesh-and- blood body. But even the “real” actress’s incapacity to maintain such a body is humorously treated in Mike Nichols’s film Postcards from the Edge. Actress Suzanne overhears the head of wardrobe complaining to the director about the difficulties of tailoring clothing for the actress’s out-of-shape body. They can’t put her in shorts because the top of her thighs are shockingly “bulbous.” They can’t film her on her back during the love scene because her breasts are “out of shape” and will no doubt “disappear under her armpits.” They express regret that they hadn’t managed to cast in her place another actress whose body was supposed to be “perfect.” Many of the women I know, not actresses, just ordinary women, worry about being seen in public in bikinis or short-sleeved tops or shorts rising much beyond the knee, clothes that would disclose to all a shameful and secret part that we keep hidden from view— our flabby thighs, our postpartum middles, our middle-aged arms. Said one surgeon: “I know of many women whose husbands have never seen them nude. I know of women who never go to doctors because they don’t want to be seen by them.” So, finally they offer themselves up to the surgeon for aesthetic body work, and they are transformed. They can be seen, held, admired. Little by little, we are all becoming movie stars—inter- nally framed by a camera eye. “The little mutilations take up her mind and enable her to temporar- ily escape the frightening implications of being transformed physically and emotionally into a woman with the sexual and moral responsibili- ties of adulthood” (368–69). Kaplan is writing as though the transition is just one, from girlhood to womanhood, which, for the delicate self- cutter, proves intolerable. What if we were to rethink this universal transition (puberty to womanhood) through the terms of the twenty- first century, where we find the chronological body supplanted by a two- dimensional prototype that is an impossible combination of fashion- Addicted to Surgery / 289 centric transitions and age-defying stasis? This is a body always in flux. It can’t land on the other side. It can’t become and stay comfortably a woman, because it’s so difficult and there are always new challenges to face as well as perils to ward off. Princess Diana was a self-cutter, or so claims biographer Andrew Morton. “On one occasion she threw herself against a glass cabinet at Kensington Palace, while on another she slashed at her wrists with a ra- zor blade. Another time she cut herself with the serrated edge of a lemon slicer; on yet another occasion during a heated argument with Prince Charles, she picked up a penknife lying on his dressing table and cut her chest and her thighs” (qtd. in Favazza 241). Reminiscent of Elizabeth Taylor, Diana was a celebrity who seemed literally to embody the shift from flesh to image and back again. Her confessed eating disorder made her beautiful image seem more available, closer up, or rather heightened the exciting tension between flesh and image. 6 And so how different is going under the knife in search of youth and beauty from some ritual and hidden adolescent cutting? Just because the culture has normalized our pathology (of course, it’s thoroughly normal to want to look rested and vigorous enough to compete in the youth- centered workplace), it doesn’t mean that cosmetic surgery isn’t like any other practice that has us offering up our bodies to the psychical in- tensities that angrily grip us. Ballerina Gelsey Kirkland describes the experience of her initial round of cosmetic surgeries: “The operations found me laid out on a table, yielding to the touch of their probing fing- ers. I watched my life through the eyes of their needle, penetrating my heart as well as the outer layers of my skin. I would become hooked on the pain, addicted to the voluptuous misery that bound my sexual iden- tity to ballet, to an ever-increasing threshold of anguish” (58). On the operating table, face up, waiting for hands to crawl inside and tug out the ugliness that is like entrails that eventually regenerate and need to be taken out yet again. We struggle up from intolerable bodies vanquished in the exquisite moment of surgical battle in the theater of operations. I recall the scene of a face-lift. One minute she was lying in the swamp of 290 / Addicted to Surgery her aging and flaccid skin, and then slowly her face rose from the chaos, sleek, tautened—as though taking shape out of some primal sea—the shards of her outgrown and useless flesh left behind, spirited away by the surgeon’s magic. You will look in the mirror, smile back at the image reclaimed, and relish the grace period between this operation and the next one. The beast-flesh will grow back. NOTES 1. THE PATIENT ’S BODY 1. This question of chin size seems to be a vexing one among surgeons. Some surgeons routinely do chin implants with their face-lifts, for example, because they believe that the chin has atrophied. Other surgeons think this is a medical fantasy. I know one woman whose surgeon augmented her chin during her face- lift with very unsatisfactory results. It is clear that this, like so much of plastic surgery, comes down to each surgeon’s personal aesthetic. 2. See Phillips; Cash and Pruzinsky; Thompson et al.; Vargel and Ulusahin; Sarwer; Pertschuk et al.; Bower; Kalick; Castelló et al.; Ozgür et al.; Sarwer et al.; and Monteath and McCabe. Worse yet, there is evidence that even the presur- gical assessment of the mental stability of people whom the surgeon considers unattractive is influenced by appearance. As Michael Kalick implies, some “re- cessive” insecure types are rejected by surgeons who imagine they could have a psychiatric problem on their hands (251). Sarwer et al. recommend that sur- geons screen out patients with body dysmorphic disorder prior to surgery. First, they maintain that such patients typically do not respond well to cosmetic sur- gery. Second, “there is some concern that cosmetic surgery patients with body dysmorphic disorder may become violent toward themselves or the surgeon and his or her staff ” (368). 291 292 / Notes to Pages 15–34 3. See Clifford and Walster; Cusack; Dipboye et al.; Dion; Efran; Mc- Grouther; Dahlbäck; Gitomer. 4. For discussions of body dysmorphic disorder in men, see Pertschuk et al.; Nakamura et al.; and Edgerton et al. 5. Surgeons who operate on non-European patients have extensively dis- cussed the difficulty of using the surgical techniques developed in operations on white European skin and features. On surgery for nonwhite patients, see Ma- tory; and Hoefflin. One difference is the relative thickness of nonwhite skin, which doesn’t tend to redrape over the post-op feature in the way that white skin does. See also Farkas et al. 6. It is well known among surgeons that men make the worst cosmetic sur- gery patients. See Nakamura et al.; Guyuron and Bokhari; and Goin and Goin. 7. Many other surgeons discourage silastic implants. They often cause in- fection, or they move or leave a visible implant line demarcating the augmenta- tion area. 8. It is the fastest-growing surgical specialty for women, mainly, as I’ve been told, because they are operating predominantly on women’s bodies. Women coming in for breast implants or other bodywork often prefer women surgeons. Indeed, one woman surgeon compared it to gynecology, the other surgical spe- cialty open to women. 9. See Goin and Goin. 10. While one could make the same claim for the detachability of the penis in relation to assessment and penile-augmentation surgeries, male bodies aren’t fragmented into quite so many fetishized “part-objects.” 11. As James Kincaid reminded me, the penis is equally detachable. Any psy- choanalyst would agree with him, and it’s not surprising that the most talked- about male surgery (even though it’s certainly not common) is penile augmen- tation. Curiously enough, most penile augmentation patients claim to be doing it for display in the locker room rather than for female sexual partners, suggest- ing that we all (both men and women) see ourselves as being looked at and as- sessed by men! See Brooks; Rosenthal; John Taylor; Haiken; and Fraser. 12. As my argument about the effects of star culture makes clear, when it comes to a culture in the process of becoming surgical, more than gender dif- ference is at stake. Notes to Pages 37– 44 / 293 2. UNTOUCHABLE BODIES 1. See Zimmermann for an excellent account of the reported effects of silicone. 2. See Dull and West on the ideal surgical candidate. 3. Dull and West note this pattern as well in their own interviews of plastic surgeons. 4. An earlier study of Körperschema (schema of the body) was published in 1923 under the title Seele und Leben before Schilder’s major contribution on the topic, The Image and Appearance of the Human Body. 5. Of course, there are many psychologists who concede to the powerful psy- chological cure offered by cosmetic surgery. See Cash and Pruzinsky; the work of Goin and Goin; and Gilman’s Creating Beauty to Cure the Soul, which charts the relationship between becoming “happier” through external transformation. Specialists in body-image studies divide roughly into two quite different and at times contradictory camps: one evaluates and treats poor body image while the other focuses on the consequences of personal appearance. Attractiveness stud- ies typically prove that life is better in all respects for the good-looking; body dysmorphic disorder studies tend to pathologize individuals for their excessive concern with appearance. 6. Natural selection materials on beauty tend to differ with this perspective, generally arguing that similar canons of beauty have obtained always. See, for example, Nancy Etcoff ’s Survival of the Prettiest. In The Evolution of Allure, art historian George Hersey argues that not only are physical types of beauty more or less consistent through time and space but our idealized works of art partici- pate in raising the stakes on real bodies, thus motivating us to “breed . . . for beauty” (2). 7. Vivian Sobchack, Conference on Women and Aging, Center for Cultural Studies, University of Wisconsin–Milwaukee, Apr. 1996. 8. The average-income statistics tell as much. See Kalb 32; Kruger 56; and Kirkland and Tong 153. When I asked Leida Snow, director of media rela- tions for the American Society of Plastic and Reconstructive Surgeons, she re- sponded, “There are over five thousand board-certified plastic surgeons in this country, not to mention all the ear, nose, and throat doctors and opthamologists and gynecologists doing cosmetic operations. It stands to reason that they can’t just be operating on rich people.” 294 / Notes to Pages 45– 48 9. I interviewed only board-certified plastic surgeons. This means that they did their residency in plastic surgery and had to qualify to become members of the American Society of Plastic and Reconstructive Surgeons. There is consid- erable controversy over nonspecialists practicing plastic surgery. Many board- certified plastic surgeons are angry about the public ignorance—the fact that people don’t know the difference between, say, the Society of Cosmetic Sur- geons or the Society of Facial Plastic Surgeons and the two so-called legitimate plastic surgery societies, which are the American Society of Plastic and Recon- structive Surgery and the American Society for Aesthetic Plastic Surgery. See Deborah A. Sullivan’s excellent account (chapters 4 and 5) of the ethically tu- multuous turf wars taking place between board-certified plastic surgeons and physicians from other specialties. 10. By putting an advertisement in the newspaper, I was at risk of finding mainly disgruntled patients who wanted an opportunity to complain. For the most part, people who live in my region of the country, the Southeast, keep their surgeries to themselves if they are satisfied. I also looked at cosmetic surgery dis- cussion lists for a broader sense of patient experiences. An especially helpful web site is www.faceforum.com. 11. See Viner. 12. In reaction to ubiquitous representations of idealized female bodies along with the marginalization of postforty women, feminists have perhaps gone overboard in berating a concern with appearance; we risk overlooking the po- tential pleasures achieved through attention to the body. Moreover, why must the “real” female body (especially the “real” middle-aged body) be depicted as overweight or unscupted, as art historian and bodybuilder Joanna Frueh asks in Monster/Beauty. Frueh attempts to distinguish between culturally mandated and hence passive forms of beauty (“photogenic”) and the “erotogenic” forms in- volving the active pursuit of aesthetic and sensual pleasures on our own terms. “I posit the erotogenic as an antidote to the photogenic and as a feminist model of beauty, rooted in aphrodisiac capacity and not simplistically reliant on ap- pearance. The older aphrodisiac body does not strain for glamour that is only artifice, and it is not rabid with longing for youth” (67). What Frueh so impor- tantly recuperates for feminists is the critical distinction between what we do for pleasure and what we do out of shame. Given the degree to which the erotogenic has become reducible to the photogenic, however, I wonder if Frueh’s distinc- tion fades. [...]... Magazine 15 July 199 6: 30� Butler, Judith Gender Trouble: Feminism and the Subversion of Identity New York: Routledge, 199 0 318 / Works Cited Callé, Stuart C., and James T Evans “Plastic Surgery in the Cinema, 191 7– 199 3.” Plastic and Reconstructive Surgery 93 .2 ( 199 4): 422–33 Camp, John Plastic Surgery: The Kindest Cut New York: Henry Holt, 198 9 Campbell, Laurie “Roseanne: Plastic Surgery Saved My... Pruzinsky “Plastic Surgery and Psychotherapy in the Treatment of 100 Psychologically Disturbed Patients.” Plastic and Reconstructive Surgery 88 ( 199 1): 594 –608 EDTV Dir Ron Howard Perf Matthew McConaughey, Ellen DeGeneres, and Jenna Elfman Universal, 199 9 Ellis, John Visible Fictions: Cinema Television Video Rev ed 198 2 London: Routledge, 198 9 Etcoff, Nancy Survival of the Prettiest: The Science of Beauty... and so forth According to the American Society for Aesthetic Plastic Surgery (ASAPS), “There was a 25% increase in the total number of procedures performed between 199 9 and 2000 There was a 173% increase between 199 7 and 2000.” These statistics are now available on their web site: www .surgery. org 17 His expressed preference is atypical, by the way; for the most part, women are the preferred patient 18... (fiftyish in real life), “They have face-lifts, and then they come back to the show and have babies.” Having a baby on the show, she decided, is the best way to turn back the clock 5 See Zimmermann 6 Apparently on the way to becoming an actress just before she died, Diana has been called “Princess-Grace-in-reverse” (Dixon 33) “Shortly before the opening of his 199 7 film The Postman, director-star Kevin Costner... in contrast with the unattuned mother Stephen Mitchell describes it thus: The baby’s own impulses and needs are not met by the mother, and the baby learns to want what the mother gives, to become the mother’s idea of who the baby is” (10) 3 Although I am primarily discussing the effects of star culture in particular (meaning actors and even singers, who are also adored for the way they dress, physical... Warner Bros., 194 7 Davidson, Ros “Hollywood Lives Made Hell by the Celebrity Stalkers.” Scotland on Sunday, 8 Mar 199 8: 17 Davis, Kathy Reshaping the Female Body: The Dilemma of Cosmetic Surgery New York: Routledge, 199 5 Davis, Sally Ogle, and Ivor Davis The Good, the Bad, and the Ugly of Celebrity Plastic Surgery. ” Three parts E! Online 15 Nov 2002 ... another So much of what we take to be human lives on the surface of the face So, when you raise the skin, Adams argues, you realize the deception of the face—that underneath there is nothing at all (141– 59) 9 Hortense Powdermaker describes the “peep show” relationship of the fan to our film icons: “Fan magazines give details of the star’s domestic and so-called private life, with pictures of his home,... 199 7 59 80 Adams, Parveen The Emptiness of the Image: Psychoanalysis and Sexual Differences New York: Routledge, 199 5 All about Eve Dir Joseph L Mankiewicz Perf Bette Davis, Celeste Holm, Ann Baxter, Thelma Ritter, and George Sanders Warner Bros., 195 0 All about My Mother Dir Pedro Almodóvar Perf Penélope Cruz, Marisa Paredes, and Cecilia Roth Columbia / TriStar, 199 9 Allen, Jane E “Surgeon-to -the- Stars... Columbia UP, 199 4 Bransford, Helen Welcome to Your Facelift: What to Expect Before, During and After Cosmetic Surgery New York: Doubleday, 199 7 Braudy, Leo The Frenzy of Renown: Fame and Its History 198 6 New York: Vintage, 199 7 ——— The World in a Frame: What We See in Films Chicago: U of Chicago P, 197 6 Bray, Abigail, and Claire Colebrook The Haunted Flesh: Corporeal Feminism and the Politics of (Dis)Embodiment.”... Problems 38.1 ( 199 1): 54 –70 Durgnat, Raymond Franju Berkeley: U of California P, 196 8 Dyer, Richard Heavenly Bodies: Film Stars and Society New York: St Martin’s, 198 6 ——— Stars 197 9 London: BFI Institute, 199 8 ——— White London: Routledge, 199 7 Edgerton, M T., and N J Knorr “Motivational Patterns of Patients Seeking Cosmetic (Esthetic) Surgery. ” Plastic and Reconstructive Surgery 55 ( 197 1): 551–57 Edgerton, . prac- tical, indolently tongue-in-cheek (“‘Artificial beauty? Is there any other kind?’”) and armed with the most up-to -the- minute information on preserving their bodies intact forever. Even the. overhears the head of wardrobe complaining to the director about the difficulties of tailoring clothing for the actress’s out -of- shape body. They can’t put her in shorts because the top of her. vanquished in the exquisite moment of surgical battle in the theater of operations. I recall the scene of a face-lift. One minute she was lying in the swamp of 290 / Addicted to Surgery her