Surgery Junkies: Wellness and Pathology in Cosmetic Culture

Introduction

1 Introduction Dr. James McCullen, a plastic and reconstructive surgeon in New England, believes that Lydia Manderson , one of his former patients, is a “cosmetic surgery junkie.” Dr. McCullen is a well-regarded, board-certified plastic surgeon who once specialized in reconstructive surgery of the limbs, and now devotes much of his practice to body contouring, which includes body lifts, breast implants , and liposuction. His patient Lydia is an affluent widow who is very enthusiastic about cosmetic surgery.1 Over several years, Dr. McCullen performed multiple surgeries on her face and body. But he has come to believe that Lydia is never satisfied; she is always seeking more beauti- fication or rejuvenation. As he put it in an interview: “She has the money and she wants every little thing done and she’s never going to stop.” He believes that no matter how much surgery she gets, there will always be another part of the body she will want lifted, tucked, or transformed. Eventually, McCullen decided to end his doctor-patient relationship with Lydia. The last straw for him came when Lydia, as he put it, “went off to New York and had an arm tuck done.” When she was unhappy with the resulting scars, she asked Dr. McCullen to do another surgery to fix the problem. He refused, because he no longer saw Lydia as a good patient. As he put it: “I don’t see her anymore. I don’t want my signature on her body.” Dr. McCullen believes that it is important for the surgeon to be discerning about his patients. “You make your reputation,” he said, “as much on who you turn away as on who you operate on.” But how are cosmetic surgery patients sorted? Why was Lydia Manderson considered a surgery junkie by her own surgeon? Since he had performed multiple surgeries on other patients, what made her different ? What prompted Dr. McCullen to decide, after a series of procedures, that she’d had one surgery too many? Dr. McCullen worried aloud whether his patient was psychologically unwell. McCullen’s assertion that she is a “junkie” means that she has a pathological addiction to cosmetic surgery. In fact, Dr. McCullen told me that he believes she may have Body Dysmorphic Disorder (BDD), a mental disorder characterized by a person’s obsession about a slight or imagined flaw in her or his appearance to the point of clinically significant distress or dysfunction. In the past twenty years, the cosmetic surgery junkie has become a social problem, identified from a variety of perspectives as representing the worst-case scenario of cosmetic surgery. The cosmetic surgery junkie might be the patient who has been turned away by the surgeon as a so-called “poor candidate” for a cosmetic procedure, or one who is considered chronically unhappy, litigious, or difficult by her surgeon. In psychiatry, she is increasingly given the diagnosis of BDD and is prescribed an antidepressant and cognitive-behavior therapy. In the media, the surgery junkie might be a celebrity who seems to have had too much cosmetic surgery or someone who has unusual taste in body modification. In the courtroom, the surgery junkie may enter as a plaintiff, arguing that she is a victim of medical malpractice. In feminist writings, surgery junkies are 2 Surgery Junkies women who, in their desperation to adhere to the standards of beauty culture, become “surgical.”2 And for some feminist critics of cosmetic surgery, anyone who undergoes an elective cosmetic surgery is a victim who will eventually get hooked on surgical beautification. The rise of public concern over cosmetic surgery excess and addiction parallels cosmetic surgery’s astonishing expansion . Cosmetic modifications of the body have expanded dramatically in number, type, and scope. For instance, in theUnited States in 2005, there were nearly two million aesthetic operations—more than quadruple the number in 1984—along with over eight million nonsurgical procedures like Botox and skin resurfacing.3 And with the vast expansion in the number of cosmetic procedures, cosmetic surgery has been democratized, with the majority of patients now in the middle class. There has also been surgical innovation , from new approaches to the face-lift to surgery on new areas of the body, such as rib removal, buttocks implants , and genital surgeries such as labiaplasty. In addition, patients getting cosmetic surgery increasingly have multiple procedures during the same...