Trend Line is Clear: Decline since 2004
It was a shock to find after I had a squamous cell carcinoma removed from the side of my nose that I needed cosmetic surgery. I trusted my surgeon, and I trust she did as good a job as she could. But as I feared, the repair didn’t go well: the scar is still red, with a “pincushion effect,” so common it has a name. My face is no longer as symmetrical. I can’t believe anybody undergoes this voluntarily.
It may be hard to believe, but like me, American culture is turning against cosmetic surgery. Even in the movie business. An award-winning producer named Melanie Coombs observed after attending the Oscars that it was “like being at Madame Tussaud’s except they were live people.” The facial procedures called “non-invasive” are also a no-no. Martin Scorsese and Baz Luhrmann have publicly voiced their opposition to the use of Botox, frustrated by difficulties in finding actors able to express nonverbal emotion, especially anger, according to cultural critic Grayson Cooke.1 As Luhrmann notes, “their faces really can’t move properly.”
“Natural” is beginning to look good. Websites make fun of botched surgeries, showing photos of people’s unwanted post-op appearances–men as well as women. People report they look worse After. Characteristic consequences–the “wind-tunnel look,” the mismatched tiny chin, “waxworks,” skin like plastic wrap–are now uncool, according to many nonusers interviewed by sociologist Abigail Brooks of Boston College. America the Beautiful, one scary documentary, let’s a former anchor describe how facial surgery gave her permanent neuralgia, destroying her health and career. Many users do it only once. “Never again.”
Potential clients rationally fear death. When Kanye West’s mother and Olivia Goldsmith, author of the First Wives’ Club died, the lethal consequences began been piling up. Although there is still no register of mortality statistics, there are more exposés, like HBO’s special, “Plastic Disasters.” Even finding a surgeon who is certified and experienced is no guarantee of survival. The author of How We Die, Sherwin Nuland, pointed out the irony that “doctors who choose to perform an operation that is solely cosmetic are willing to accept mortality and complication rates significantly higher than those who restrict their interventions to those required for the treatment of disease.”
Ageism is a killer in this as in other ways. Most cosmetic surgery is driven by fear of aging-past-youth. In 2007 the average age of those receiving cosmetic surgery in the United States was 42.6. “Passing” as younger was promoted for decades by surgeons who didn’t have enough reconstructive work. The Federal Trade Commission under Nixon and then the Supreme Court made it illegal for the AMA to forbid surgeons from advertising. Third-party financing of procedures brought operations within the reach of lower-income women.
Fashion and celebrity magazines made seeking slender youthfulness seem obligatory. “Forcibly lowered self-esteem looks to the sufferer like real ‘ugliness’,” Naomi Wolf explained. It began to be said that every narrow departure from the ideal, including normal processes of female maturity (e.g., change in size after pregnancy, wrinkles) could be sold to consumers as a deformity. Other kinds of doctors without appropriate training or certification moved to supplement their practices by pursuing anxious patients’ discretionary income. Promoters said, gaily, this is an unstoppable trend. Feminists, gagging, agreed.
The promotion of plastic surgery constitutes an ethical crisis of national dimensions, since the ugliness effect impinges on people only because they are growing older. People who would never visit a surgeon are thrown into some degree of self-hatred; and younger people may look with disfavor on faces and bodies that are simply doing what comes naturally.
Trend Finally Going the Other Way
Yet the good news is that the trend is finally going the other way. Fact: The number of total cosmetic procedures reached a peak in 2004 (at 11,855,000), and has dropped every year since, according to data from ASAPS, which extrapolates the data from those of its board-certified surgeons who respond. (Perhaps the ones who write in are still in business and doing well). In 2010 the total was down to 9,336,000–a decrease of over 20% from 2004.2 (The numbers dropped even before the economic crisis of 2008.)
Surgeries–the most dangerous procedures–have also dropped, from 2.1 million in 2004, to 1.6 million in 2010–a drop of almost 25%. Breast augmentation was 334,00 in 2004; now only 318,000 in 2010. Lipoplasty was 478,251 in 2004; now only 289,016 in 2010.
The numbers for breast augmentation, the highest in invasive surgeries, dropped 11% from 2007 to 2008 and are lower in 2010. There is new evidence of cancer surrounding the breast in women with implants, which surgeons in both ASAPS and ASPS had been told in a webinar to downplay, Public Citizen’s Health Letter reported in February.3
Seeing the trend away from their invasions, surgeons now pay for ads offering “unfixed”-looking procedures. The top five procedures for women 35 to 50 in 2010 were all skin-related, like Botox.
After the age of fifty, the percentage of women obtaining any procedure drops dramatically, from 44-47% depending on the year, to about 25%. And fortunately for everyone but surgeons seeking trade, the older half of the “Boomers” has aged beyond the high-risk period–ages 35-50–at which women are most vulnerable. They have grown up and turned away.
Contrary to the myth, people are not going abroad for procedures. Brandon Alleman and his colleagues of the University of Iowa Carver College of Medicine in Iowa City, conducted a survey of businesses engaged in facilitating overseas medical travel for U.S. residents. The companies that completed the survey–representing around 70 percent of the market–had referred about 13,500 U.S. patients for care overseas, a number far lower than prior reports of between 500,000 and 2 million.4
Growing popular distaste also involves heightened aversion to danger and care for health. “First, do no harm,” critics enjoin cosmetic surgeons.
Why is “natural” looking better, aside from the fear of pain, deformity, death, and looking unfashionable?
Nonusers told sociologist Abigail Brooks that they not only find the “fixed” looks of others repugnant, they resist the ideologies behind the ageist beauty myth. They may be inspired by feminist theory, women’s-health activists, or the positive-aging movement. “Natural” to them means accepting and appreciating the body’s own processes and valuing maturity on many other measures.5 Maybe some female Boomers are indeed changing, aging-past-youth in America, one refusal at a time!
In 1992, despite normalizing trends, the number of cosmetic surgeries in the US was still relatively small. By 2004 it had grown vertiginously. Since then it has started to drop. There are still powerful forces promoting the procedures to women of a certain age–including the companies that fire employees in their middle years on the assumption that they are “too old.” Women sue for age discrimination ten years younger than men. As sexist ageism gets worse, surgeons and magazines and yes, even friends, falsely promise a response by calling the procedures “anti-aging.”
Newspapers still publish articles based on statistics from the surgeons’ self-serving organizational press-releases, emphasizing what rates are up (as the New York Times did recently, in an article by Tara Parker-Pope with the headline, “A Decade of Boosting Breast Size”).6 Rates for some procedures may go up in any given year, but the trend line is clear, as the article was forced to note. Journalists can be guilty not only of implying that getting fixed is popular and “normal,” they are missing the real story.
Make no mistake, millions still go under the knife. The number of surgeries still constitutes a public health emergency that needs to be addressed with a registry of deaths and disfigurements and with better certification. But eventually we may say that the Era of Normalized Sexist Ageism lasted not much more than 12 years.
© 2011 Margaret Morganroth Gullette
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Margaret Morganroth Gullette is the author of Agewise: Fighting the New Ageism in America (U of Chicago Press, April) and is a Resident Scholar at the Women’s Studies Research Center, Brandeis University. She is the author of four books in age studies. Aged by Culture (also University of Chicago Press), was chosen a Noteworthy Book of the year by the Christian Science Monitor. It was nominated for a Pulitzer and received an Honorable Mention from the Gustavus Myers Center for the Study of Bigotry and Human Rights. Declining to Decline: Cultural Combat and the Politics of the Midlife won the Emily Toth award in 1998 for the best feminist book on American popular culture. Her first book in age studies is Safe at Last in the Middle Years. To read about Margaret Morganroth Gullette’s Free High School for Adults visit www.newtonsanjuan.org and click on “Adult Education.”
1. Cooke, Grayson, “Effacing the Face: Botox and the Anarchic Archive,” Body & Society 2008 14:23.
2. My data is all from ASAPS: http://www.surgery.org/sites/default/files/2009trends.pdf surgery.org/sites/default/files/2007/Surgical_nonsurgical.pdf and Quick Facts for many of the years under investigation (2004-2010). Other references are in the chapter “Plastic Wrap” from my book Agewise.
3. Public Citizen, “Health Letter,” February 2011 (Vol 27 #2).
4. Reported by Peeples, Lynne, “Few Americans travel overseas for medical care,” Reuters, Dec. 31, 2010. Retrieved at http:/ /uk.reuters.com/article/2010/12/31/health-us-travel-overseas-idUKTRE6BU28C20101231.
5. Brooks, Abigail, “Growing Older in a Surgical Age: An Analysis of Women’s Lived Experiences and Interpetations in an Era of Cosmetic Surgery,” Ph.D. diss., Boston College, 2007.
6. Parker-Pope, Tara, “A Decade of Boosting Breast Size,” New York Times, March 21, 2011. Retrieved at http://well.blogs.nytimes.com/2011/03/21/a-decade-of-boosting-breast-size/.