Plastic perfection

Cosmetic surgery is skyrocketing in popularity, but what are the implications of all this nipping and tucking? As the RN&R learned, there are many unanswered questions

Photo By Larry Dalton

It’s not that Cindy didn’t like the way her body looked. Tall and blond, she had a body most women 20 years younger would envy. But after 40 years and five children, gravity was beginning to take its toll. And gravity, says Cindy, was doing particularly dramatic things to her size “G” cup breasts.

“I had huge breasts,” she says. “Because I’m blond, people make judgment calls. They think there’s nothing between here and here,” she says, pointing to her temples. “And as I aged and had children, things started to go to hell in a hand basket.”

Cindy researched plastic surgery options. She found out about health risks. She looked into prices. She evaluated the qualifications of doctors.

She ended up at a clinic in Utah where, she says, cosmetic surgery costs are far lower than in either California or Nevada. Cindy’s breast reduction and lift totaled $3,500—about half of the cost of the same operation in the Reno/Tahoe area at that time.

Cindy was on a plane home the day after the operation and back on the job five days after that. “When all the swelling [went away], I thought, ‘These look great.’ It’s amazing what [plastic surgeons] can do.”

Amazing indeed. Cindy returned to her job in retail management with a new, younger-looking body—and a new body image.

“People still look at me, but for different reasons … they glance from head to toe now,” she says, explaining that men no longer remain fixated on her bosom.

She pauses. “Maybe I became less self-conscious about it.”

Cindy was so impressed by the results of her surgery that she returned to the clinic a year later, this time for a full tummy tuck. After giving birth to five children, Cindy says, the stomach muscles “fall out” and never return to their maidenly tautness.

“People would say it’s about vanity, but I would say it’s about feeling good about yourself,” she says. “It’s the same thing as doing your hair every day, or wearing certain clothes, or getting a manicure. It’s the same principle.”

Is there a stigma?
No longer just for socialites and strippers, today the ordinary Sally—and Joe—is heading to the clinic for a little nipping and tucking. Or a lot of nipping and tucking. The rate of procedures performed rose 173 percent between 1997 and 2000, according to the American Society for Aesthetic Plastic Surgery.

Enamored by the ease with which we can reinvent, reshape and rearrange our bodies, it’s easy to forget what feminists have been reminding us—that beauty and desirability are not necessarily recipes for happiness. It can even be easy to forget what some medical researchers have told us—that plastic surgery, particularly breast implants, isn’t exactly the safest thing you can do to your body.

Plastic surgery is, by and large, no longer something that must be talked about in whispers. It’s becoming less and less stigmatized, especially in Las Vegas, says Dr. William Zamboni, chief of the Division of Plastic Surgery of the University of Nevada School of Medicine.

“I think that in some circles, if you’re not getting things done, you’re an outcast,” he says. “It’s an image-conscious society. It’s not unusual for a woman in her 60s to have body contouring to look better at the pool with her grandkids.”

According to Dr. Mary White Stewart, professor of sociology at the University of Nevada, Reno, there is a similar phenomenon in the Reno/Tahoe area, although it exists on a smaller scale.

“You would expect that any place that [has] a big entertainment industry would have a lot of plastic surgery,” she says.

Dr. Joseph Kiener, another local plastic surgeon, is even more emphatic about the increasing acceptability of plastic surgery.

“I don’t think it’s stigmatized at all,” he says. “I think it’s a badge of honor. It means you can afford it.”

And as figures would show, many can afford it. While the cost of other medical procedures has increased steadily, Kiener says, plastic surgery has not. Liposuction surgery costs, on average, less than $2,000, while Botox injection—a non-surgical procedure—costs $366.

One thing’s for sure: Whether or not there’s a stigma, and no matter the price, plastic surgery will not go away, and many questions about cosmetic surgery and its aftermath remain unanswered.

What is society’s role?
As a consumer, you can’t help but be aware of the opportunity for body modification. Plastic surgeons aren’t exactly shy about marketing their services. Drive to the grocery store, and you’ll be greeted by billboards that prominently display the most flawless of female bodies. “LIPOSUCTION!” exclaim the ads. “BREAST AUGMENTATION!” say others. Slap down a thousand bucks, or two or three, and get a whole new you.

Stewart says that plastic surgery advertisements alone don’t persuade us to seek the perfect body; the “advertisement” for this ideal is visual culture itself.

“It’s not hard to see why women get plastic surgery,” she says. “We see beautiful women in every medium.”

And we’re more aware today that many celebrities are not themselves “naturally.” Perhaps it’s comforting to know that Cher’s seemingly eternal youth is not just the doings of nature.

We are also fascinated by youth, particularly feminine youth. Biologically speaking, the young, healthy, radiant female represents—well, sex. As women marry later, or find themselves divorced and single once again, many perhaps fear that the world can almost hear their biological clocks ticking. No surgical knife can set back the clock, of course, but it can make others imagine that this clock reads a much “younger” time.

“Aging is seen as some kind of failure, especially for women,” says Stewart. “It makes sense that [women] would try to regain their attractiveness through whatever means they have available. After a while, the lipstick and mascara just don’t do it.”

And women not only have to look good for the “marriage market,” but for the job market as well, Stewart says. She adds that it is much easier for attractive, youthful-looking women to succeed in the workplace than homely, older-looking ones.

Stewart says that for men, power and status often stand in for aesthetics; for women, sexiness is almost never determined by status alone.

“Men’s value comes from what they can produce economically,” she says. “Like Henry Kissinger said, ‘Power is the greatest aphrodisiac.’ “

Throughout history in many cultures, a woman planned for her future and gained status through marriage; her greatest asset, and her greatest skill, was her power to attract a man. By grooming herself, a woman groomed her future.

Women today are, of course, far more autonomous economically, but according to Stewart, a woman’s looks still play heavily in her chances for success.

"[Plastic surgery is about] making yourself saleable, trading on looks, [making yourself] a financial asset,” Stewart says.

Cindy agrees.

“Whether we like it or not, there is a different standard on how [women] look,” says Cindy, who adds that she has used plastic surgery to work the system to her advantage. “You can say, ‘It’s not right,’ but I don’t fight it. It’s the way things are.”

Photo By Larry Dalton

Does surgery really offer “choices"?
Joanna Frueh, professor of art history at the University of Nevada, Reno, says that one of the major functions of feminist theory is its deconstruction of the idea of “choice.” She points to theorist Susan Bordo as an important voice in the gender-body discussion. According to Bordo, “choice” is never as simple as desiring a different body and then going about achieving it. We are not that free of cultural baggage.

“Popular culture does not apply any brakes to … fantasies of re-arrangement and self-transformation,” writes Bordo in Unbearable Weight. “Rather, we are constantly told that we can ‘choose’ our own bodies.’ “

Bordo goes on to say that “the very advertisements whose copy speaks of choice and self-determination"—the ones that lead us to believe that we can have control over our bodies by eating certain foods or wearing certain clothing—in fact “visually legislate” a specific ideal.

She cites a Nike ad that reads, “The body you have is the body you inherited, but YOU MUST DECIDE WHAT TO DO WITH IT.” The accompanying photo shows an almost impossibly firm young woman working out.

“We think in our culture that we can overcome anything,” Stewart says. “We don’t have to settle for what nature has dealt us.”

We can all, of course, decide what to do with our bodies, but there is no guarantee that our bodies, no matter what we put in them or try to remove from them, will make us happy. For one thing, “happiness,” like “choice,” is not as simple as it may first seem.

According to Bordo, attaining a slender, fit body may feel empowering: Women see fitness as their chance “to embody qualities—detachment, self-containment, self-mastery, control—that are highly valued in our culture.” It is not only the thin body itself, but also the process of attaining this body, that becomes empowering. Many anorexics and bulimics, for instance, commonly say that their unhealthy relationships with food are not simply motivated by desire for thinness, but also—and sometimes mainly—by the desire to have control over their lives.

“Our contemporary body-fetishism expresses more than a fantasy of self-mastery in an increasingly unmanageable culture …” Bordo writes. “It also reflects our alliance with culture against all reminders of the inevitable decay and death of the body.”

Is cosmetic surgery masculine?
Men, however, are not exempt from the pressure to look good, and are in fact going under the knife in increasing numbers. A 1999 Mother Jones article said “the fast-growing market for cosmetic procedures increasingly includes male baby boomers.” Plastic surgery is “being marketed to men the way sports cars and stereo equipment are sold—as accessories to make them more attractive, powerful and masculine.”

One Nevada plastic surgeon, who did not want his name used, says that 20 percent of his patients are male. The surgeon says he has done procedures on “prominent Nevadans in the casino industry, as well as Nevada’s academic and political figures.”

According to Sander L. Gilman, author of Making the Body Beautiful: A Cultural History of Aesthetic Surgery, the assumption that aesthetic surgery is a distinctly “female” phenomenon is false. He says that plastic surgery did not come to be “gendered female” until the 1990s. During the late 19th century, most individuals who underwent the primitive procedures were male. A major function of cosmetic surgeons during this time was to enable the marginalized to “pass” as white—to disguise a patient’s “real,” racial self. Many of the procedures done were “corrections” of “black noses,” “Jewish noses” and “Oriental noses and eyes.”

Local surgeon Kiener, however, says this desire to “pass” as white has shifted dramatically.

“We’re becoming more homogenized,” he says. “It’s no longer ideals of blond hair, blue eyes. The ideals of what’s attractive are much broader now.”

This trend is reflected, he says, in the increasing number of clients who want full, exotic lips. Yet when hearing stories like one reported in in February 2000, of Asian-American women who are using glue, tape and even toothpicks to make their eyes look “bigger and prettier,” one wonders just how dramatic that shift has been. Plastic surgeons say that blepharoplasty—otherwise known as the eyelift—is the most common procedure being done among Asian Americans.

“The traditional white looks are still very much the most attractive looks,” says Stewart, who says she sees a narrowing, not a broadening, “of the range of acceptability.”

Is it safe?
While the debate on plastic surgery’s psychological hazards continues in academic circles, plastic surgery is still involved in various safety-related debates in medical circles. For starters, there’s the problem of being able to distinguish qualified plastic surgeons from those less experienced.

“I think there’s reason for concern, because the average person can’t look in the phone book and detect a person with training,” Zamboni says.

Most physicians who practice cosmetic surgery have been “board certified” and belong to one or more medical societies. Not all the boards, however, have extensive plastic surgery-related training requirements.

“There are several different boards—some that require only a test, a weekend course,” Zamboni says.

Keiner agrees. “You can literally wake up and call yourself a plastic surgeon,” he says.

And all of these boards and societies—most which use the words “American,” “plastic,” “cosmetic,” “aesthetic,” or a combination thereof in their names—sound remarkably alike.

Some local doctors call the American Board of Plastic Surgeons the “gold standard.” If a doctor has been certified by the ABPS, he or she has had extensive training, including a minimum two-year plastic surgery residency, and he or she has taken both a written and an oral exam, says Zamboni. Such training, he says, is especially important when it comes to handling surgical complications.

Although the plastic surgery controversy is less ubiquitous in the media today than it was in the early 1990s, when the Food and Drug Administration ordered manufacturers to yank silicone-filled breast implants off the market, it is hardly absent from the news. Making headlines now is the prediction that a new and supposedly improved silicone implant known as Style 410 may available to the general public in the not-too-distant future.

The FDA banned silicone-filled implants in 1992 after hearing reports that implants may cause health problems, namely autoimmune diseases such as lupus. The FDA, however, decided that when a woman receives a breast augmentation for “reconstructive” purposes, she can still elect to have silicone-filled implants, although she must sign a lengthy document of “informed consent.”

Other women who want to enhance their breasts do so by way of implants filled with the more innocuous saline.

Even saline implants, however, are not completely problem-free. Local plastic surgeon Dr. Stephen Grace says localized problems can crop up, including scar tissue, implant deflation and the occasional infection.

A recent FDA study found that more than 20 percent of women who get saline-filled breast implants need additional surgeries within three years due to problems of painful scar tissue, leakage and infection.

And saline implants, many say, are simply not as aesthetically desirable as silicone ones. The softer, flesh-like silicone implants make for a more “natural” artificial bosom.

“Four in five of my [reconstructive] patients opt for [silicone] gel,” Dr. James Baker, a clinical professor of plastic surgery at the University of South Florida, told MSNBC reporters. “If silicone was offered to cosmetic patients, 80 percent of them would choose it, too.”

But not all are optimistic about the possible return of silicone implants—or even confident that they will return.

“There’s not a snowball’s chance in hell that the FDA would put silicone implants on the open market,” says Geoffrey White, a local attorney who has been involved in litigation against breast implant manufacturer Dow Corning and its parent company, Dow Chemical, since 1994.

“I think that [the implant controversy] has died down, and there are a lot of people who are just itching to make it legal to put silicone implants back on the market,” he says. “And I don’t think it’s going to happen. It’s wishful thinking on the part of the manufacturers and their well-oiled PR machines.”

A recent study, led by a member of the FDA, suggests an association between silicone leakage and fibromyalgia, a pain and fatigue syndrome. These researchers say that “women with silicone gel breast implants should be informed” of the possible link to fibromyalgia if and when their implants rupture and leak. But the study only suggests a connection; it does not definitively conclude that there is a tie between the two.

But for every study that suggests a link between silicone implants and a certain disease, there seems to be one that draws opposite conclusions. As surgeons, scientists, manufacturers, research groups, insurance companies and attorneys continue to debate whether silicone implants are linked to disease, the rest of us can only sit back and watch as the squabbles drag on.

The plastic principle
As plastic surgery becomes easier to obtain, the questions just get harder. Is it safe? It is ethical? Will it make us happy or, after reaching for a physical ideal, will something still be missing? Should we accept society’s expectations and pursue physical perfection, or should we simply believe, as Dolly Parton—ironically, who’s had plastic surgery herself—sang, “Everything’s Beautiful (In Its Own Way)"? Even for those who have chosen plastic surgery, beauty isn’t that simple.

While she has no misgivings about going under the knife, Cindy says that she is aware of the cultural baggage that comes along with plastic surgery. "If my daughter came to me and said, ‘I want breast implants,' I would say, ‘Why do you want that?' "