As I will examine the representation and discursive construction of cosmetic procedures, this chapter provides an essential overview of the cosmetic surgery market. Before examining the cosmetic surgery industry, however, it is necessary to explore the concept of ‘cosmetic surgery’ and provide a definition that will be used in this thesis (see Section 2.1). Moreover, a brief history of cosmetic procedures as well as an outline of the current state of the cosmetic surgery industry will be presented (see Section 2.2). Following this, previous literature on the topic of representations of cosmetic procedures, particularly in the media, will be discussed (see Section 2.3). As most of the literature discussed in these first three sections relates to cosmetic procedures for women, Section 2.4 concentrates on previous research that has investigated the cosmetic surgery market for men in particular.
Cosmetic Surgery - Towards a Definition
Since there is widespread confusion surrounding the use (and perhaps usefulness) of the terms ‘plastic’, ‘cosmetic’, ‘aesthetic’, and ‘reconstructive’ surgery, several definitions are considered here in an attempt to provide a working distinction. As will be explained below, the ambiguities that exist between the usage of the different terms within the field are most likely related to the procedures’ shared basis and the (relatively arbitrary) distinction between ‘necessary’ and ‘elective’ surgery.
The term ‘plastic’ has its origins in the Greek word лХасттТк-ос; [plastikos], “fit for moulding”1, and has traditionally been used not only in its adjectival form but also as a noun denoting “the arts of moulding”, “a modeller, a moulder, a sculptor”, or even “a fashioner, a creator” (“Plastic”). This link to the arts, to the creative, is still used in some contemporary marketing communications by cosmetic providers (cf. Haiken 1997: 4). The term ‘plastic’ surgery was proposed in the late 18th century by French anatomist and surgeon Pierre Joseph Desault to refer to “procedures that repaired deformities and corrected functional deficits” (Gilman 1999: 9). Generally, ‘reconstructive’ and ‘plastic’ (surgery) are used interchangeably and, as the American Board of Cosmetic Surgery claims, refer to procedures that “[reconstruct] facial and body defects due to birth disorders, trauma, burns, and disease” (“Cosmetic surgery vs. plastic surgery”).
In contrast to plastic or reconstructive procedures, which are often considered necessary due to their restorative nature, ‘cosmetic’ or ‘aesthetic’ surgery procedures are generally regarded to be elective since “they revise or change the appearance, colour, texture, structure or position of bodily features to achieve what patients perceive as more desirable” (Khoo 2009: 237; cf. Gilman 1999).
The differences between ‘plastic/reconstructive’ and ‘cosmetic/aes- thetic’ surgery, as outlined above, appear deceptively straightforward. The distinction between ‘normal’ and ‘abnormal’ and the notions of necessity and desirability are, in fact, highly problematic and it has proved challenging to determine whether procedures should be classed as reconstructive or cosmetic (cf. Mendelson 2013).
In an attempt to overcome the construction of an absolute divide between cosmetic and plastic surgery, alternative interpretations of the terms in the field have been suggested. The American Medical Association (AMA), for example, proposes that the specialty of plastic surgery encompasses both cosmetic and reconstructive surgery as subcategories (cf. Olesen & Olesen 2005: 10). Although perhaps less conventional, I adopt this conceptualisation of cosmetic and reconstructive surgery as subcategories of plastic surgery as introduced by the AMA (also see Jones 2008). The adoption of this overarching category of plastic surgery can be justified on the basis that it captures the broad, shared basis of cosmetic and reconstructive procedures. After all, the essence of procedures such as rhinoplasty or liposuction is consistent; the sole difference here concerns a perceived medical necessity - if operated on ‘abnormal’ tissue, the procedures are classed as reconstructive, whereas they are classed as cosmetic when applied to ‘normal’ tissue.
Cosmetic Surgery - Brief History and Current State
The first comprehensive documentation of a reconstructive procedure dates back to circa 600 BC and details a procedure in which a new nose is constructed from flaps of skin (Haiken 1997; Jones 2008; Mendelson 2013). However, despite early experiments, plastic surgery, and especially cosmetic surgery, remained a niche specialty until fairly recently. Even when anaesthesia was developed and procedures could be performed with less risk of infection in the 19th century, only a few surgeons would undertake cosmetic surgery, as the Hippocratic Oath - which dictates not to intervene unless the potential benefits outweigh the risk of harm to a patient - “stopped most physicians from engaging in surgery for purely cosmetic purposes...” (Gilman 1999: 9; cf. Sullivan 2010: 407).
During the First World War, reconstructive surgery as a medical specialty came to the fore as soldiers returned from the battlefield with
24 Cosmetic Procedures severely scarred faces and bodies (Gilman 1999:157). Moreover, industrialisation, urbanisation, technological advancements, the growth of consumer culture, and personal wealth in the Western world all contributed to the popularity of cosmetic surgery. Haiken (1997:7, 129) has pointed towards the significance of the inter-war years (1918-1939) for cosmetic surgery; the growing interest in psychology at the time and especially the concept of the inferiority complex, which “offered a compelling explanation and justification for the practice of cosmetic surgery”, caused an increase in the demand for cosmetic procedures as “cosmetic surgery, once associated with lack of mental balance and over-weening vanity, came to be seen as a step toward mental health”. In contemporary culture, cosmetic surgery is still often framed as a form of psychological help that promotes ‘inner well-being’ (cf. Gilman 1999; Mendelson 2013; Moran & Lee 2013; Pitts-Taylor 2007). This focus on healing a person’s (sense of) ‘self’ is evident in current marketing campaigns for cosmetic procedures, which, as will be shown in subsequent analyses, emphasise a procedure’s effect on people’s self-confidence.