Skintight: An Anatomy of Cosmetic Surgery, and: Self-Transformations: Foucault, Ethics, and Normalized Bodies, and: Surgery Junkies: Wellness and Pathology in Cosmetic Culture
It is one indication of the breadth and fascination of plastic surgery and its increasing presence as both an elective medical practice and a subject for countless forms of representation that three recent books could all engage with it as a topic of analysis, generating studies that complement, rather than reproduce, one another. Victoria Pitts-Taylor's Surgery Junkies: Wellness and Pathology in Cosmetic Culture; Meredith Jones's Skintight: An Anatomy of Cosmetic Surgery; and Cressida Heyes's Self-Transformations: Foucault, Ethics, and Normalized Bodies are each committed to offering a reading of plastic surgery within a broader theoretical context of feminism and cultural studies. All three authors approach the subject of plastic surgery using a blended methodological approach that allows them to make good use of human-subject interviews (with patients and surgeons in the case of Jones and Pitts-Taylor, with friends and colleagues in the case of Heyes, with fascinating and important self-reflexivity from all three). The authors also include complex schools of thought (such as postmodern and poststructural, Foucauldian, and actor-network theories) and punctuate their analyses with representative examples from the current mediascape, such as reality TV, advertisements, Internet sites, and magazines. And each, I believe, succeeds in offering a useful and intelligent reading of plastic surgery as a cultural practice that speaks of and shapes our present contemporary moment, in which image functions as indexical to identity. Because all three authors offer extended readings of Extreme Makeover, commenting on television's role in making body-modification practices intelligible, I will address their treatments collectively [End Page 289] at the end of this review after looking more specifically at each book on its own terms.
Victoria Pitts-Taylor offers a fascinating journey into the exigencies of perceived excess in Surgery Junkies. She argues that in the context of plastic surgery's increasing prevalence, those who seek body modification through surgical means are often wrongly dubbed—through academic feminism as well as popular and medical pronouncements—as misguided and delusional subjects who do not have and cannot exert autonomous agency (individuals who in feminist circles have been called dupes of the patriarchy). Her research helps establish a broad archive of culturally relevant texts—from patient and surgeon interviews to newspaper articles, legal documents, television shows, and medical discourses. Pitts-Taylor starts from an avowedly poststructuralist and postmodern position, wherein meaning is a consequence of aggregated discourses. In this respect, as she notes, she does not believe that "body practices bring out who we are" but rather that "meanings of neither our bodies nor our selves are as fixed as we often assume them to be" (7). Even more important, she notes, is the degree to which "social forces are interested in declaring the meanings of our bodies and selves for us," leading to a plethora of messages urging us to "transform, improve, update, or change ourselves" (7). By identifying as her prime subject the surgery junkie—the patient who engages in plastic surgery to the point of a vaguely defined excess—Pitts Taylor trenchantly asks the reader to question how the hazy boundaries of normal and aberrant, of experimentation and addiction, are maintained, managed, and transgressed. In narrating in the book's final chapter her own decision to have rhinoplasty, she expands the scope of academic discourse even further—though had Pitts-Taylor really wanted to create a new heuristic for the reader's imagination, she really should have pressed the surgery junkie envelope by engaging in more than a nose job. Still, I think we can give her a pass for this lapse.
Pitts-Taylor structures the book into many useful sections—including a comprehensive overview of academic feminists and their response to plastic surgery, a thoughtful discussion on the limits of a legal system pushed to its epistemological limits when dealing with issues of medical malpractice and plastic surgery, and an incisive reading of cosmetic surgery television (as a form of disclosure, I met Pitts-Taylor as she worked to finish Surgery Junkies, and I had a very small hand in offering feedback on her chapter analyzing Extreme Makeover). To my way of thinking, Pitts-Taylor's analyses are most compelling when she unpacks the language surrounding body dysmorphic [End Page 290] disorder (BDD), or, as psychologists have characterized it, a disease of the psyche that makes its sufferers unable to accurately read the morphology of the body. BDD is often one of the diagnoses that hang on the frail frames of anorectics or the hypermuscled torsos of steroid addicts. In this case, as Pitts Taylor notes, BDD "renders its victims vulnerable to obsession with and addiction to cosmetic surgery" (105). Once the meaning of BDD is established, Pitts-Taylor does a masterful job of deconstructing that meaning by showing BDD's imprecise, and often gratuitous, use in popular and medical accounts, as well as by indicating that cosmetic surgeons often use BDD as a medical diagnosis that allows them to skirt responsibility in decisions about whether to offer a patient services. Pitts-Taylor argues that as a diagnostic catchall, BDD contributes to the social construction of the surgery addict. This, she cautions, does not mean that BDD "isn't also a lived, embodied reality for some people" (123), but discursive uses of BDD also indicate a more subtle pathologizing of the very people heeding social messages to modify the body in search of a "more perfect" iteration of identity achieved through the malleability of the body-self.
Throughout Surgery Junkies, Pitts-Taylor ably provides complex theoretical readings of events and practices in language that is accessible and interesting. It is rare to find an academic text that is smart and compelling and that can be read with equal rigor by undergraduate and graduate students—or that might have crossover appeal to a more popular audience. Indeed, when reading her book in a public space in my college town, I fielded a dozen curious questions from people who were intrigued by the title as well as by the book's cover picture of a heavily made-up woman's face swathed in bandages (think America's Next Top Model meets The Mummy). I actually inadvertently left the book behind after lunch with a friend, and when I went back to the restaurant four servers were reading it and wanted to engage me in a discussion about whether identity manifests from the inside of the body out, or from the outside inward. This, as you can well imagine, is an academic's dream, and any book that gives rise to such thoughtful enthusiasm is a good choice for the classroom.
In Skintight, Meredith Jones offers an expansive multidisciplinary reading of what she calls "makeover culture," a generalized mode of thinking where-by "the process of becoming something better is more important than achieving a static point of completion" (1; her emphasis). As starting evidence, Jones opens her book by referencing the case of a female participant on The Jerry Springer Show who dresses in a provocative manner. The audience is initially [End Page 291] hostile toward the woman, but when they learn she has lost more than a hundred pounds, the crowd quickly becomes supportive. "The large woman was suddenly praiseworthy," Jones writes, "because she was undergoing transformation: she was no longer horribly fat but was now 'losing weight.'" Jones explains that people in the grips of "makeover culture improve and transform themselves ceaselessly" so that "success is judged on the display of the never-ending renovation of the self " (12). As we saw with Pitts-Taylor's analysis of surgery obsessions, however, such renovations of (or perhaps more accurately toward) the self, walk a fine line, since a true commitment to a never-ending quest often qualifies as addictive pathology.
Unfortunately, in both the specific case of the fat-to-thin participant on The Jerry Springer Show and more broadly across the book, Jones can sometimes insufficiently consider the one-way teleology invested in bodies as social texts. For instance, gaining weight is also a form of embodied becoming, and so would fit Jones's definition of makeover culture, yet weight gain would not be applauded on television, nor, I'd venture, would Jones consider it an example testifying to the ubiquity of makeover culture. Further, as Susan Bordo's work has informed us, transformation is bounded by certain limits, so that both the skeletally thin and the grossly overweight body signals as deviant, not willing to follow rules demarking the normative (though clearly, the thin body must travel to a much further extreme than the overweight body before it signifies its deviancy). The key point here, it seems to me, is accentuating, even more than does Jones, the language that modifies transformation: improvement, betterment, renewal. These are all value-laden terms that link to rich connotative narratives about class, upward mobility, racial uplift, and social evolution. It is not change for the sake of change alone, then, but alteration always toward a vague but never fully reachable "better place" obtained through the beautiful body that might more broadly be understood as makeover culture.
Jones identifies plastic surgery as the prime location where makeover culture manifests, expressing itself through varying sites, from actual surgery patients to mediated texts, such as those of television and advertisements, to the enigmatic but persuasive domain of architecture. She also offers incisive readings of high-profile celebrity plastic surgery consumers, people like performance artist Orlan (who uses plastic surgery to shape her body and face into what she calls "carnal art"), socialite Jocelyn Wildenstein (who is determined to make herself look like a lion), porn star Lolo Ferrari (who had the world's largest breast implants), and Michael Jackson (who probably needs [End Page 292] no description). Jones argues that all these people, as well as a good number of entertainment celebrities, such as Farrah Fawcett and Cher, exist in the public imagination as "beautiful aliens." And indeed, to my way of thinking, Jones's reading of Michael Jackson exactly identifies the slipperiness of race, sexuality, age, sex, and gender that makes him the go-to poster boy for plastic surgery gone wrong. If Jones's treatment at times heightens the alien aspects of these "monstrous celebrities," she suggests that their aberrance functions as a yardstick to calibrate the normal, so that excesses in makeover culture participate in regulating "acceptable modes of abjection and hybridity" among and in contrast to a more generalized mainstream (107).
Throughout the book Jones sustains a persuasive argument that plastic surgery is a complicated and often contradictory practice that, in turn, functions as an ideological complex, which asks us to renegotiate the exigencies of both dominance and subordination. Such negotiations lead, she argues, to a necessary movement away from thinking in terms of power modalities that are overly reliant on binaries of agency and victimization. In this vein, I particularly appreciated her insightful readings of websites, such as Awful Plastic Surgery (http://www.awfulplasticsurgery.com), with its slogan "The good, bad, and ugly of celebrity plastic surgery," that mock botched operations even as they lobby for stars to get eye lifts or tummy tucks.
Through the use of her many well-chosen examples, Jones argues that plastic surgery has become "popular and commonplace" to such a degree that in the brave new world of finding identity through the aid of the scalpel, to actively remain "cosmetic-surgery-free may well become a brave and rebellious act" (6, 189). But I'm not so sure I fully agree, either that plastic surgery can be experienced wholly free of a symbolic and affective price tag or that it is an act of subversion to "retain" the natural body. Surely, for some people—women as well as men—plastic surgery will continue to factor as a form of conspicuous consumption meriting attention, display, and (hoped-for) praise. But the more plastic surgery trickles into a mainstream of bodies and values, the more its meanings are opened to a heterogeneous field of interpretation.
As just one example, during the course of time in which I read each of these three books, I toted them along from hairdressers to gyms to restaurants. When cutting my hair, my stylist offered the quite intriguing definition that plastic surgery was fine if it took things away (through such subtractive procedures as liposuction or breast reduction), but anything that left something in the body (through additive operations such as breast implants) [End Page 293] was wrong. This, it seems to me, is a fascinating reconfiguration of how we understand the value structure that underpins the judgments intrinsic to notions of the normative, for it suggests that merit is not established by whether one engages in surgery, but through the sorts of operations one selects. More important, this reading opens cultural values to interpretive and personal input—not everyone needs to agree in order for my stylist's reading to be accurate. This would suggest, moreover, that in the primacy of personal choice where satisfying the soul's desires counts as "brave and rebellious," it is electing to defy your own needs/desires/opinions that signifies moral downfall. Plastic surgery and makeover culture both become critical as a means to a more important end—achievement of the ineffable sense that through technologies of personal renovation, be they surgical, stylistic, or psychological, one can lay claim to and perfect a sense of selfhood.
Indeed, Cressida Heyes's Self-Transformations develops this idea of honing in on the self through normalizing the body. Heyes's book branches out from more conventional considerations of plastic surgery by also including engaging analyses about transgendered identities and weight-loss subjects. Using a feminist Foucauldian theoretical frame that is also tempered by Wittgenstein's theories on privacy and language, Heyes offers a rich conversation about the social meaning of the body and how we conceptualize its connection to identity. I particularly appreciated an overarching metaphor of the book, more specifically discussed in the introduction and chapter 1, that images or pictures often "hold us captive," in Wittengenstein's words, offering us an intelligible way of visualizing concepts that often limits our ability to move beyond these very pictures. Heyes notes that the "grammar of the self," bound as it is by a psychoanalytic model of depths and surfaces, locks us into such a picture, and because of it we are often led to believe that our inner self holds "unique authenticity," as reflected through and sometimes augmented by the visible expressions of the body (3–4). Given this, Heyes argues, using Nikolas Rose's essay "The Politics of Life Itself," that the self is "discovered or developed through transformations of the flesh" (4). We thus understand and constitute identity through manipulations of the body, becoming what both Heyes and Rose call "somatic individuals."
From this epistemological beginning, Heyes then moves through three primary points of consideration, each of which identifies people who use body modification to achieve different identity-enhancing means: transgendered subjects, weight-loss dieters, and plastic surgery patients. She makes an important point that these three foci are not analogous in desire or form—so [End Page 294] to lose twenty pounds is not established as the equivalent of sexual transition. But people within each of these groups to differing degrees negotiate with the uneasy sense that a more authentic version of themselves is trapped within a recalcitrant body, and only the alteration of that body will allow for the emergence of the authentic self. Since Heyes, like Pitts-Taylor and Jones, comes from a poststructuralist position, she is dubious about the possibility of an authenticity of the self, even as she is sympathetic to its appeal. Much as my own work on makeover TV has revealed, though we as academic feminists celebrate the multiple proliferations of identity through the machinery of performativity, popular and mediated discourses are often geared toward "recapturing" a more stable and coherent sense of identity, where a subject can finally say with relief, "I'm me now!"
If Heyes's language and analysis sometimes veer too much toward stage managing other peoples' arguments rather than showcasing her own (as is particularly the case with her discussion about trans-bodies), she very helpfully provides a concrete demonstration of the way in which ideology is not totalizing, so that the very processes that can seem to create "docile bodies," to quote Foucault, also allow for "enabling moments" (64). I think Heyes makes the case for these opportunities for empowerment best in her introduction and conclusion, where she lets herself speak with declarative confidence. In her application chapters that constitute the core of the book, I sometimes found her self-conscious positionality statements about her own body, sexuality, and relative degree of privilege more distracting than helpful, since it seemed she was doing battle in her head with a bevy of grumpy feminists (and probably some stern philosophers), who didn't think she had the right to talk about "trivial" topics in a serious way—or that, as she incessantly reminds us, as a nontrans, bisexual woman she has no right to theorize about trans-identity. To be clear, my issue isn't one of using life experience in academic texts. As my own writing in this review indicates, I find personal interactions very helpful for illustrating certain points. My concern is with the manner in which personal information functions as an apologia that ultimately works to deauthorize the scholar's credibility by calling her right to speak into question. While it's important to be aware of and candid about our own embeddedness in acculturated desires and practices—so yes, as feminists we can be concerned about sexed identities, chunky thighs, or crooked noses—when we write about these topics, I do not believe we need to be (or apologize for not being) a member of a social group or identity location in order to speak intelligently and respectfully about it. (Indeed, though Heyes [End Page 295] expressed anxious awareness about being a nontrans but bisexual and a not-fat but wanting-to-be-thinner woman, she never considered that perhaps she should be a participant on a reality TV program before she could write about it.) These matters, I believe, are more indicative of feminist preoccupations more generally than of any serious issues I have with Heyes's work more specifically. Still, I both empathized with and was frustrated by her frequent verbal contortions that kept asking, "Where is the author?" (40).
That being said, I highly recommend this book as a piece of fine scholarship that adroitly offers very helpful applications of complex terminology and concepts in ways that I consider both poignant and thought provoking. I found the chapter on Heyes's own experience as a participant in a Weight Watchers group interesting, and I could imagine pairing it with other commentaries on body size and identity in courses I teach on gender and the representation of the body. It is in her chapter on cosmetic surgery, however, where I really felt Heyes's brilliance assert itself. As she notes, "Cosmetic surgery bears a peculiar burden of justification unlike other medical subspecialities" (90). It is because these operations must be argued for and rationalized that our collective conversations about their appeals and ills so powerfully testify to the texture of our own cultural moment. Much like Pitts-Taylor and Jones, Heyes neatly negotiates the tricky terrains of ordinary versus extraordinary, outside versus inside, optional versus necessary, and cosmetic versus reconstructive that make plastic surgery such a fascinating site of analysis. In the context of plastic surgery's competing demands and promises, feminists, she argues, are compelled to accomplish two tasks: "We need to understand contemporary institutions and discourses of cosmetic surgery in a novel and rapidly evolving social landscape," and "We need to have something helpful to say to individual women contemplating cosmetic surgery about that choice" (92). I would expand her referendum to include men as well as women, since feminism has much of value to say about how all social actors, no matter how gendered, experience embodiment. In the context of these discussions on the social implications of plastic surgery and an analysis of two feminist linchpins in the body-agency debate, Kathy Davis and Susan Bordo, I wish that Heyes had not moved so quickly into an extended analysis of Extreme Makeover, if only because doing so suggests parity between real lives and reality TV, a topic I will take up in the following paragraph. Overall, however, I believe that Heyes offers an important recontextualizing of several debates that center on somatic identity, showing why Foucault's theories [End Page 296] on normalization give increased resonance to feminist considerations of the workings of power, discourse, and identity that manifest through the body.
And now, television. As I have mentioned, each of the authors under review in this essay use representations of plastic surgery on television, citing Extreme Makeover as a key site of investigation. Pitts-Taylor reads EM as a signal text that has popularized extreme surgical procedures and that offers a forum where audience members can "empathize with the participants to a much greater degree than they can with actors" (41). In the context of her analysis of what constitutes and constructs the surgery junkie, Pitts-Taylor uses EM as critical evidence for thinking through cultural conversations about what might factor as "appropriate" risk-taking in order to achieve the inner self. Jones considers EM to be one of the primary cultural texts in makeover culture. I particularly found useful her discussion on the way that a program such as EM reveals the labor of change, in effect highlighting the "during" that is commonly elided in the relation between before/after. This emphasis on effort appears in the context of truncated time, so while the multiple operations of EM often take upward of twelve hours, they are compressed into only a few minutes of screen time. Jones argues that this way of treating surgery makes television a "cultural anaesthetic through which we experience virtual surgery, making that small step to real surgery a bit easier," even while plastic surgery is "associated with hard work and sacrifice" (53). I'd disagree on that point, if only because shows that air on expanded cable, such as Dr. 90210 or even I Want a Famous Face, often spend far more textual time on surgeries and can actually work as deterrents to viewer desires for plastic surgery. Heyes's use of EM comments more on the raced and classed imperatives that are embedded in the text, as well as the more overt and covert narrative structure that mimics fairy tale tropes (Cinderella's rags-to-riches story is a common one, though Horatio Alger's transformation story is not). As Heyes rightfully observes, how these shows position the need and reason for changing the body's exterior is in direct, if often tacit, conversation with discourses about social power. Ultimately she determines, however, that the "perfectibility the show hopes for," whereby a subject's "essential goodness" can live happily ever after, is "ethically empty" (105).
As these readings indicate, television has become a dominant means of cultural transfer, offering viewers extended tutorials and advertisements for what Pitts-Taylor calls "cosmetic wellness." Initially airing on ABC in 2002, Extreme Makeover leads a bevy of reality TV shows that feature plastic surgery operations, including The Swan, Dr. 90210, Miami Slice, I Want a [End Page 297] Famous Face, Plastic Surgery: Before and After, and Plastic Surgery Beverly Hills. In Britain, shows such as 10 Years Younger, Brand New You, and Bride and Grooming further extend the surgical-transformation-as-entertainment trope. (In the U.S. version of 10 Years Younger and the Canadian Style by Jury, by contrast, technologies of bodily modification are limited to more minor procedures such as dermabrasion, Lasik eye surgery, and teeth whitening.) These shows are also prime products for format export, as, for instance, in the case of The Swan, which was sold to more than fifty international television markets. The televisual mediascape is clearly crowded with makeover TV, particularly if we factor in other transformation-themed shows, for example, What Not to Wear, Dress My Nest, Supernanny, or Pimp My Ride that suggest a real self can only be revealed through the intervention of an expert/designer/surgeon/nanny/mechanic, who will alter the terms of the exterior body/car/home so that the inner self can triumphantly emerge in a "big reveal" moment of revelation. If television is incessant in its production of these narratives about change, it is also quite prolific in its dissemination of cautionary tales warning of danger. Consequently, in the context of plastic surgery shows, in particular, we have documentaries and E! Entertainment specials called things like Plastic Disasters or Drastic Plastic Surgery.
My point in rehearsing all of this detail is to suggest that in reading Extreme Makeover as a representative text that testifies to a larger cultural moment reflecting and shaping attitudes about plastic surgery, as the authors under review do, it is important to remember that this self-same moment is equally saturated by competing discourses that extend, affirm, and sometimes contradict the messages we see articulated in Extreme Makeover. Indeed, one of my gravest concerns is the frequency with which reality TV is often used by scholars as a transcript of the real, rather than as a constructed and ideology-infused cultural artifact that is edited, designed, and scripted for a particular effect. To be fair, Pitts-Taylor acknowledges such concerns and Jones and Heyes use televisual materials toward interesting narratological ends, but they all three sometimes verge into a regard for EM as a case study more than as a cultural text. Although clearly television influences real people and reality TV showcases the stories of real people, it is important that we remember these are aesthetic narratives, representations of the real. In some ways, the distinction I'm making is a fine one, since, as theorists such as John Fiske have told us, representation creates its own reality. But representation equally engages with and makes use of other materials—myth, fairy tale, stereotype, fear—to accomplish its ends. When representation is showcased [End Page 298] through filmic means, then lighting, editing, sound, and camera movements are all critical elements in the text's construction of meaning. So basically, we cannot read narrative outside its narration, and we cannot analyze television outside its mediation.
In sum, each of these new books offers an important contribution that helps us make better sense of the uses of plastic surgery for intervening in the ongoing relationship between identity and body modification in a post-millennial moment, when the use of surgery accentuates a postmodern hybridity of identities and forms. If the authors' collective treatment of plastic surgery tends to be intensely presentist, such focus on the present day strikes me as entirely understandable and necessary. Such attention is merited, given the rise in plastic surgery technologies and demands, as accompanied by an adjacent cultural archive of television shows and advertising materials, all of which make cosmetic surgery's present-day iteration quite distinctive. Pitts Taylor, Jones, and Heyes each play a powerful role in helping us broaden the applicability of our feminist analyses, and thus I believe that these books offer an important provocation to feminism as a field of study that it continue to interrogate its own process of self-making. In this regard, it may well be that feminism, like plastic surgery, is itself increasingly an interdisciplinary arena in which competing complementary and contradictory actors, theories, and political positions must all be folded into our notions of a collective and malleable body. [End Page 299]
Brenda R. Weber is an assistant professor in gender studies at Indiana University. She is the author of Makeover TV: Selfhood, Citizenship, and Celebrity (Duke University Press, 2009) and "Figuring Fame: Women, Gender, and the Body in the Transatlantic Production of Literary Celebrity" (unpublished).