Surface Imaginations

SURFACE IMAGINATIONS

Cosmetic surgery is too complex a cultural phenomenon to be studied from the social or the psychical perspective alone. This book examines the two simultaneously, even while recognizing that these dimensions are often inchoate and in conflict with one another. This approach involves, on the one hand, holding together the complexities and uniqueness of individual cosmetic surgery experiences and respecting those who undergo and practise cosmetic surgery, and, on the other, formulating a rigorous critique of cosmetic surgery as an industry. I do not see those who have cosmetic surgery as naive victims, but neither do I see them as exercising unfettered agency in their decisions. Likewise, surgeons are neither benevolent miracle workers committed to a philanthropic project nor are they the despotic men of Ira Levin’s The Stepford Wives, manipulating women into their fantasies; instead, surgeons navigate a complex ideological and historical terrain, although they are not the focus of this book.

Through a decade of following cosmetic surgery in popular culture and having conversations with patients and others interested in cosmetic surgery, I have learned that while cosmetic surgery carries many psychical and social benefits, any engagement with the profession is far from utopic. This is the case for surgeons, but it is especially so for patients. Although most of the women I interviewed became comfortable in their own skins through cosmetic surgery, they were confronted with imperfect options that were the result of photographically dominated mandates and ideals pursued by the cosmetic surgery profession. They negotiated a profession that places all participants in rigidly gendered roles with few options for surgical outcomes, as well as a cultural context that trivializes and devalues femininity and the pursuit of beauty. As a consequence, even though the interviewees overall were very satisfied with the results of their surgeries, these results were not perfect and their stories are not uniformly positive. The complaints present in their narratives, and denoted by scars, numbness, and flaws in surgical outcomes, register as necessary failures to obtain a desired result.

Nonetheless, most of the women believed their lives had improved as a result of their procedures and therefore regarded these complications as a worthwhile compromise for attaining a social and psychical objective through surgery. They found greater enjoyment in their romantic, familial, and friend relationships, they were more successful at work, and their experience of inhabiting their bodies in this world was easier after their surgeries. This is consistent with large-scale psychological studies of cosmetic surgery conducted both within and outside the industry, which indicate that what might be considered a small cosmetic change can have significant effects on the lives of patients.1 These large-scale studies and the narratives in this book offer inklings into the contradictory conditions and outcomes of cosmetic surgery in contemporary North America.

This chapter is concerned with these contradictions, using them to better situate surface imagination fantasies within cosmetic surgery. In order to differentiate my analysis from prior work, I begin with a discussion of the diverse field of feminist cosmetic surgery studies. I then move into a more comprehensive discussion of the book’s central concept, surface imagination, elaborating on the insights that can be gleaned from psychoanalysis to flesh out the concept of surface imaginations, before moving on to explain the methodological innovations necessary to interpret the narratives of cosmetic surgery.

Feminist Cosmetic Surgery Studies

Feminist cosmetic surgery studies is a vibrant, complex, and interdisciplinary field.² Here I outline some important strands of debate within the field to situate and distinguish my work, since my approach draws on literatures and methodologies that differ from the majority of feminist works on cosmetic surgery.

Feminist researchers have understood cosmetic surgery as a “dilemma,” according to Kathy Davis, and many feminist analyses of the practice attempt a “feminist balancing act.”3 The industry and practice of cosmetic surgery is ripe for feminist critique as sexist, racist, ageist, and fatphobic, and has been roundly censured on these grounds. Yet such critical approaches, which tend to focus on the cosmetic surgery industry rather than on the individuals who undergo surgery, risk labelling all recipients of cosmetic surgery as naive victims of false consciousness and patriarchal culture. Take, for example, this excerpt from Susan Bordo’s “Material Girl: The Effacements of Postmodern Culture”: “The rhetoric of choice and self-determination and the breezy analogies comparing cosmetic surgery to fashion accessorizing are deeply mystifying. They efface not only the inequalities of privilege, money, and time that prohibit most people from indulging in these practices, but also the desperation that characterizes the lives of those who do.”⁴ This is an important critique of the ways in which the contemporary cosmetic surgery industry characterizes its work (as parallel to the work of fashion⁵), yet Bordo’s characterization of those who seek out cosmetic surgery as “indulgent” and “desperate” undermines the critique through its latent misogyny.⁶ What these analyses accomplish is a discerning critique of the oppressive underpinnings of cosmetic surgery’s proliferation; what they do less well is account for the ways in which individual women experience positive change in their lives through engaging with cosmetic surgery as a body practice.

On the other hand, the use of patient narratives of cosmetic surgery as evidence of patients’ agency and ability to negotiate with the system has not been wholly convincing either. In particular, there is a danger of overestimating the degree of autonomy patients possess when engaging with an industry that is thoroughly shaped by white supremacist-capitalistpatriarchy, to use bell hooks’s apt phrasing. Kathy Davis’s Reshaping the Female Body: The Dilemma of Cosmetic Surgery (1995) is emblematic of this approach.⁷ Here, she recalls the irritated and dismissive response to her work that she received at a feminist conference, which was in sharp contrast to the positive response that philosopher Kathryn Pauly Morgan received for her paper, which characterized cosmetic surgery recipients as “Stepford Wives” and the practice as a technological colonization of women’s bodies.8 According to Davis, presenting women who had undergone cosmetic surgery as active agents taking control of their lives was unthinkable and unacceptable within feminist scholarly communities of the early 1990s. While Davis’s work is sometimes critiqued as overly trusting of the patients’ accounts, privileging action and rational choice, and too optimistic about the effects of cosmetic surgery,⁹ her approach was groundbreaking in its time. It was the result of qualitative interview research (previous feminist writing about cosmetic surgery was not) and resisted the latent (and easy) misogyny of analyses that positioned women as “cultural dopes” (in Davis’s phrasing).¹⁰ The majority of feminist analyses of cosmetic surgery attempt to strike a balance between criticizing and listening to women who have undergone cosmetic surgery, but the more entrenched positions described above reveal the dilemma of cosmetic surgery for feminist scholars.

The 2000s marked a departure from the question “Why do women undergo cosmetic surgery?” toward conceiving of cosmetic surgery as a “culture” of its own, symptomatic of contemporary Western cultures, especially in terms of consumerism and globalization. Rebecca Huss-Ashmore, a medical anthropologist, argues that Western deference to medical expertise and scientific explanations makes cosmetic surgery an ideal “ritual setting.” Huss-Ashmore holds that women engage in the practice because it provides a “culturally meaningful” space for self-transformation and locating an authentic self.¹¹ Virginia Blum writes of a “culture of cosmetic surgery” or a “surgical culture” that fuels narcissistic pursuits and the overvaluation of the body through offering surgery as a response to the demand for attractiveness, while paradoxically dematerializing the body through refusing its vulnerability.¹² Cressida Heyes holds that cosmetic surgery is a method of self-transformation that is shaped by a conception of the body as failed within a culture of normalization, but that the individual can be vindicated through active work on the body to reveal the truth of the inner self.¹³ Meredith Jones situates cosmetic surgery within a broader “makeover culture” that values the process of becoming over the state of being and encourages individuals to engage in ongoing and visible work on the self.¹⁴ These approaches, which situate cosmetic surgery as a culture or as operating within cultural frameworks, offer valuable and necessary nuance to understandings of the practice. They avoid becoming enmeshed within a debate about whether cosmetic surgery is “good” or “bad” for women and, instead, attempt to grasp what cultural factors make cosmetic surgery a viable option for so many women (and increasingly, men).

In more recent works, Debra Gimlin and Bernadette Wegenstein attempt to bridge questions about why women undergo cosmetic surgery with cultural analyses of the practice. Gimlin’s Cosmetic Surgery Narratives: A Cross-Cultural Analysis of Women’s Accounts (2012) offers a comparative analysis of women’s experiences of cosmetic surgery in the United States and Britain, arguing that the strategies that American and British women use to justify undergoing a cosmetic surgery are shaped by their differing national health care systems in conjunction with local and global cultural values.15 She demonstrates that where American women’s narratives tend to be shaped by a consumer approach to health care,¹⁶ British women’s narratives are shaped by an understanding of healthcare as a means to level social differences and rely on local understandings of cosmetic surgery as an “entitlement” that is earned through moral living (being a “good” person or “suffering” from the body).¹⁷ Gimlin’s is one of just a few studies of cosmetic surgery that uses a cross-cultural approach.¹⁸

Wegenstein’s book, The Cosmetic Gaze, proposes the idea of a cosmetic gaze that structures modes of looking at bodies informed by techniques and discourses of body modification.¹⁹ The cosmetic gaze is obsessed with transformation of the body to match a fixed, true interior self, and imagines this transformation as possible only through practices of cutting by the scalpel or the cursor.²⁰ The “machinic suture” refers to the operation through which a true self is made visible through the “performative influence of augmented realities.”²¹ Wegenstein traces the history of the cosmetic gaze through practices such as physiognomy to demonstrate how the same gaze that was used to demonstrate racial superiority through composite photography is now being “repackaged by technology [e.g., cosmetic surgery] into a socially acceptable care of the self.”²² This incisive analysis of body modification helps explain why individuals might engage with an industry like cosmetic surgery, even as it diminishes their authority and agency. Wegenstein’s work complements mine, although I understand these patterns of looking to be situated in modern visual practices, an evaluation that is informed by the work of such historians as Elizabeth Haiken and Sander Gilman, and theorists such as Anne Anlin Cheng.23

Surface Imagination Fantasies and Psychoanalytic Possibilities

My engagement with the field is inspired by similar questions, particularly about the seductive qualities of idealized representations of beauty and the psychical suffering that women frequently report as a key cause of seeking out cosmetic surgery. However, while my work in this book is informed by debates and discussions within feminist cosmetic surgery studies, it takes a markedly distinct approach in order to ask these questions differently. Feminist analyses, particularly those informed primarily by sociology, are haunted by a gap between the narratives of cosmetic surgery offered by recipients, surgeons, and popular culture, and the visceral corporeality of surgery itself. To be blunt, cosmetic surgery is a physically traumatic experience for the vulnerable human body. It can be difficult to understand why someone would submit to its invasive and violent force. Narratives of cosmetic surgery, including television programs inspired by “makeover culture,” usually move silently past the technical and sometimes brutal details of these procedures. Although television shows like Extreme Makeover and The Swan contain segments that are filmed in the operating room and show some of the cosmetic surgery, these segments are carefully edited to reduce hours of surgery into a clip of two to three minutes. They do not linger over or zoom in on some of the most violent interventions of cosmetic surgery, such as forcing an implant underneath the chest wall or repeatedly ramming a metal tube into the body during liposuction.

When we compare the popularity of Extreme Makeover with the response to ORLAN’s surgical performances, in which viewers watched her surgeries in galleries worldwide via live satellite, we see a stark contrast. Few original audience members remained until the end of ORLAN’s forty-five-minute performance; they were simply too horrified and sickened to continue to watch as her body was cut open and operated upon.²⁴ In contrast, Extreme Makeover (2002–2007, four seasons) has inspired several other cosmetic surgery reality television series (Plastic Surgery: Before and After, 2002–2008, five seasons; Dr 90120, 2004–2008, six seasons; The Swan, 2004, two seasons; and Miami Slice, 2004, one season). Apparently, viewers cannot get enough of these televised transformations – it was even rumoured that the widely criticized reality show The Swan was planning a reunion show in 2014.

The most recognizable visual referent of cosmetic surgery is the photograph, especially the before and after images that depict the patient before her procedure and after she has recovered from it. The fixation on the before and after images, which are ubiquitous in cosmetic surgery culture, rather than the “in-between” space in which the procedures take place, is central to understanding contemporary cosmetic surgery, culturally and psychically. Shows like Extreme Makeover present the viewer not with an accurate representation of the work involved in cosmetic surgery but with simulacral images that diminish the corporeality of this work. As I discuss later, while my interviewees narrate their surgeries as a part of their embodied history, they do so not so much as a means of becoming but rather as a means of fixing the body into an idealized time and form.25

Consistent across many analyses of cosmetic surgery is an inability to bridge this gap between event and effect. This is because this gap is not a conscious one, but one that is structured by an unconscious logic. For this reason, psychoanalysis offers an incomparable approach to understanding this gap. It makes possible an ethical consideration of the relationship between the socio-cultural dimensions of life and the singularity of the individual’s experience within that socio-cultural milieu. An explanation of the social and cultural factors that shape the existence of a proliferating phenomenon like cosmetic surgery is essential to any discussion of the practice; however, this explanation alone is unable to hold narratives of cosmetic surgery without crushing the parts that resist socio-cultural interpretation through their singularity. A socio-cultural explanation can address only part of the interviewees’ narratives. This type of analysis is in danger of omitting or considering as aberrations the parts of those narratives that don’t fit within a conscious logic and appear inconsistent and incoherent; since the narratives shared in this book are about singular experiences of embodiment, it is often the case that they are non-linear and don’t make sense. These difficult parts of the narratives can be held more gently through a psychoanalytic approach.

This book holds that understanding the way in which fantasy sustains the practice of cosmetic surgery can bridge the gap between the event and the effect of cosmetic surgery, as well as between the socio-cultural and the individual. In psychoanalysis, the fantasy has been defined in two ways: first, as a conscious product of the imagination that represents a wish-fulfillment; and second, as a mental representation that is formed unconsciously through the subject’s relation to their internal and external worlds.26 The latter definition has often been distinguished as “phantasy,” through the German “phantasie,” although in North America the two meanings have merged into the same word: “fantasy.” My analysis is primarily concerned with the latter definition of fantasy, which has been taken up in Lacanian psychoanalysis as the means through which we “learn how to desire.”²⁷ Our fantasies are, paradoxically, a defence against the imagined desire of the Other. The Other exists within the dimension that Lacan called the Symbolic, which means it is a field structured by cultural ideologies and language; as such, the Other is structured around a lack that fantasy attempts to conceal. A psychoanalytic approach can address the unconscious processes that structure the cultural and individual narratives of cosmetic surgery. The psychoanalytic concept of fantasy also helps to collapse the binary between surface and depth that is implicit in those analyses of cosmetic surgery that situate the cultural milieu within which cosmetic surgery flourishes as superficial and catering to image ideals, and differentiate the superficial from the deeper issues of structural oppression and emotional distress.

What happens within this gap between event and effect, where a relatively undetectable alteration to the body effects a significant change in the life of the cosmetic surgery recipient? While the representations of cosmetic surgery in popular culture are increasingly focused on extreme transformations and multiple surgeries, in the case of most patients, their cosmetic surgical changes are difficult or even impossible for others to detect.²⁸ It is not the case that the majority of cosmetic surgery patients undergo a radical transformation in order to make themselves irresistibly attractive to others in their personal and professional lives. Rather, for the majority of people in her life, the cosmetic surgery patient remains the same in terms of her appearance. And yet most patients still report feeling that their lives have changed, often dramatically.²⁹ Cosmetic surgery is obtained by the individual and flourishes culturally in social and psychical circumstances that are shaped by what I term surface imagination.

Surface imagination is a concept that refers to the powerful fantasy that a change to the exterior can enhance or alter the interior; in other words, the exterior creates and takes precedence over the interior. It is the seduction of surface imagination fantasies that creates the conditions in which cosmetic surgery patients’ lives improve while their appearance remains relatively the same. Surface imaginations structure social and psychical life in the consumer-driven West where the condition and appearance of the exterior is seen as an indicator of interior qualities and values. Connected to the biopolitical imperative to care for the individual, hermetic self, surface imagination fantasies offer inspiration to, and proof of, the subject’s dramatic narrative of care and success in the project of self-creation. To say that in the current moment surfaces matter is not to make a moral judgment, and therefore the concept of surface imagination must be separated from the kinds of popular media analyses that critique contemporary Western societies as superficial or fake. The devaluing of a concerted and intentional interest in the body and its appearance has a long history in Western philosophy, which has privileged the mind and separated it from the body.30 Surface imagination takes the body’s surface seriously, as a medium that is neither interior nor exterior but continuous. Precisely because of that Möebian quality, the surface is a site of fantasy and projection. Joanna Frueh writes of the “soul-and-mind-inseparablefrom-body,”³¹ which has inspired me to theorize the surface not as shallow and trivial, but profound and vital – the very material out of which identities are fashioned.

Applied to cosmetic surgery, surface imagination shores up the fantasy that changing the surfaces of our bodies will change or improve our identities, and consequently, supports the possibility and promise of the cosmetic surgery industry that our bodies are infinitely transformable and controllable according to our desires. The mutable body promised and fantasized through the surface imagination of cosmetic surgery is first and foremost a controllable body.

Cosmetic surgery is a cultural effect of surface imagination, and we can learn more about how contemporary embodiment is broadly understood through individual experiences within the specific practice of cosmetic surgery. Particularly significant in current understandings of embodiment in North America is the persistent belief of advanced capitalism that psychical and social suffering can be alleviated through our body’s surface, especially through self-fashioning or transforming it. Cosmetic surgery exists alongside other cultural products of surface imaginations, such as ego psychology, pornography, and home renovation. These exemplify how surface imagination logic influences the understanding of the psychological, sexual, and domestic realms of contemporary life. Ego psychology, which assumes a rational and fully conscious subject, envisions transformations of the self through a manipulation of the psyche’s surface (the ego). If the subject can strengthen or re-route the ego’s functioning, the subject’s psychical life will become whole and unproblematic. The pornographic surface imagination creates sexual life as a repetition of sexual acts focused not on the touch-sensations of pleasure but on a stylized aesthetics of sex. Pleasure is visual, not tactile, in pornography, and thus the transformation of the body through pleasure occurs through the surface of the magazine, television, computer, or mobile phone. Home renovations, and the proliferation of popular media and cultural practices devoted to this activity, exist in a relationship with cosmetic surgery that is more obvious and parallel than pornography and ego psychology. Transforming one’s domestic space, whether through major structural renovations or minor changes to decor, is correlated with positive emotional and psychological responses. These responses occur because the interior of the home has been aligned with the inhabitants’ personalities and needs, which are projected out into the transformation of the home. Ego psychology, pornography, and home renovations are not the only cultural products of surface imaginations, but they are illustrative of the range and scope of surface imaginations in contemporary culture.

The question of the surface is important to understanding contemporary Western (and increasingly, non-Western) cultures. Anne Anlin Cheng argues that there is a profound ontological quality to the modern surface that is often overlooked or looked at with suspicion due to the devaluation of visuality within Western philosophy.32 Cosmetic surgery is a cultural phenomenon where this ontological quality can be observed, especially through its primary surfaces of the photograph and the skin. The photograph represents an idealized surface for the cosmetic surgery industry since it can depict whatever the patient or surgeon might desire, without pain or contingency. The photograph is thus a magical object, capable of representing the past, present, and future of the patient’s skin, which supports the fragmentation and objectification of the body necessary to imagine an aesthetic surgical intervention. In contrast, the skin is the textile surface upon which that surgical intervention occurs; but it is not as easily manipulated as the photograph. The skin is a de-idealized surface for the cosmetic surgery industry, because it is subject to the exigencies of time and healing. Both the photographic and dermal surfaces are sites where the socio-cultural realm of ideals and norms and the psychical realm of fantasy and seduction meet.

Within this milieu, skin is transformed from a house for the body’s contents into a garment or window dressing that displays the self to the world.33

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