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>> 47 3 Making Faces Life Makeovers through Facial Work Face, of course, is a metaphor. But it is a very powerful metaphor. —Thomas Holtgraves, “The Linguistic Realization of Face Management” (1992) In 2002, ABC introduced Extreme Makeover, an innovative and controversial reality television show that chronicled makeovers facilitated through cosmetic surgery.1 In each of the fifty-five episodes that aired over the course of three seasons and in subsequent syndication on the Style Network, real-life people (most often women) moved to Hollywood to begin surgical, exercise, dietary, and other cosmetic regimes. Under the supervision of the Extreme Team (comprised of cosmetic surgeons, dermatologists, cosmetic dentists, eye surgeons, hair restoration specialists, physical trainers, stylists, make-up artists, and hair stylists ), participants’ appearances were radically altered—in many cases making them unrecognizable to family, friends, and themselves.2 While the format of episodes changed slightly over each of Extreme Makeover’s three seasons, the basic structure of the show remained consistent, indeed formulaic. In fact, while the participants vary, each episode is startlingly similar.3 As cultural critic Brenda Weber puts it, the “strict formula” of Extreme Makeover allows a viewer to anticipate what is coming in each successive episode, establishing a solid narrative about “disfigurement” and aesthetic intervention.4 The show opens 48 > 49 line-up.5 While Extreme Makeover aired on a major network for only three seasons, it irrevocably changed American discourse about aesthetic intervention—and, by extension, Americans’ relationships to these procedures.6 Specifically, Extreme Makeover animated public debates about cosmetic surgery, reality television, and America’s enduring pursuit of personal transformation. Reviews of Extreme Makeover revealed both an infatuation with and contempt for self-improvement measures that are far beyond what is generally attainable.7 The outcomes of the makeovers were considered astounding, but most critics agreed that the show made excessive use of cosmetic interventions . In a scathing review, New York Times television critic Caryn James wrote, As a reality show it’s a flop, with bad casting and the tackiness of a cheap syndicated series . . . As a cultural barometer, though, Extreme Makeover is fascinating. It displays both the voyeuristic excess of reality shows and the cultural ideal of creating a purely artificial personality (everyone goes to Hollywood) . . . We all fantasize about changing something, but these Frankenstein dreams seem spooky . . . television is shifting our idea of what cosmetic revisions seem normal.8 When ABC added the show to its regular line-up, even the Academy of Cosmetic Surgery condemned the show, releasing a statement objecting to the glamorization of radical cosmetic intervention parading as entertainment .9 Critiques centered on the fact that while participants wanted to improve their appearance, they did not “need” surgery. The disgust with Extreme Makeover relied on a shared sensibility that cosmetic interventions for “normal” faces should be kept to a minimum, the assumption being that only in the case of “real” disfigurement would it be appropriate to try to effect such radical, transformative results.10 While most of the show’s participants are not exceptionally goodlooking (based on Western notions about what constitutes attractiveness ), neither are they extraordinarily unattractive. In short, the faces that appear on Extreme Makeover would likely go unnoticed in public spaces. But not incidentally, the show’s narration and the candidates’ self-description routinely reflect the disfigurement imaginary. Participants on Extreme Makeover, prior to intervention, are described using 50 > 51 Yet doctors and patients alike may understand elective procedures as “needed,” and of course those with facial difference often “elect” to undergo reconstructive surgery. Indeed, the line between what constitutes reconstruction and what counts as cosmetic is not altogether clear. This messiness is telling: When is intervention restoration? When is it optimization? When is it both? What are the stakes of claiming that something is reparative or enhancing? How is the project of healing related to the project of optimization? And how do both the disfigurement imaginary and consumption in a for-profit health care system factor into the decisions? In this gray area, then, a face deemed merely unattractive may be redefined as disfigured, and thus in need of intervention. So while cosmetic and reconstructive surgery are technically similar, examining reconstructive interventions alongside sites positioned as cosmetic allows us to unpack the ways in which these distinctions are deployed, and with profound consequences. Characterizing faces as disfigured refigures them in relation to need, and thus animates the imperative to repair. In this way, the disfigurement imaginary can be deployed to transform cosmetic intervention into...

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