Cosmetic surgery is a fast-growing medical practice. In 1997 surgeons in the United States performed the four most common cosmetic procedures443,728 times, an increase of 150% over the comparable total for 1992. Estimated total expenditures for cosmetic surgery range from $1 to $2 billion. As managed care cuts into physicians' income and autonomy, cosmetic surgery, which is not covered by health insurance, offers a financially attractive medical specialty.

Leading feminist scholars have been brought together for the first time in this comprehensive volume to reveal the complexity of feminist engagements with the exponentially growing cosmetic surgery phenomenon. Offering a diversity of theoretical, methodological and political approaches Cosmetic Surgery: A Feminist Primer presents not only the latest, cutting-edge research in this field but a challenging and unique approach to the issue that will be of key interest to researchers across the social sciences and humanities.

Recently, there has been a shift in attitude among some feminists towards the practice of cosmetic surgery away from that of outright rejection. Kathy Davis, for instance, offers a guarded `defence' of the practice as a strategy that enables women to exercise a degree of control over their lives in circumstances where there are very few other opportunities for self-realization. Others, such as Kathryn Morgan, Anne Balsamo and Orlan, though highly critical of the current practice of cosmetic (...) surgery, go even further than Davis in advocating its redeployment as a tool to subvert the dominant patriarchal ideals of feminine beauty. In this article I critically appraise this `rehabilitation' of cosmetic surgery, arguing, in the case of Davis, that she leaves unchallenged the social structures of inequality responsible for women's dissatisfaction with their bodies. The proposal to use cosmetic surgery as a tool of political critique is equally problematic insofar as it shares with the cosmetic industry its instrumentalization of the body as mere matter, which is almost infinitely transformable, and also effaces the economic inequalities within which such body transformations occur. (shrink)

In this paper, I analyse the issue of conscientious objection in relation to cosmetic surgery. I consider cases of doctors who might refuse to perform a cosmetic treatment because: (1) the treatment aims at achieving a goal which is not in the traditional scope of cosmetic surgery; (2) the motivation of the patient to undergo the surgery is considered trivial; (3) the patient wants to use the surgery to promote moral or political values (...) that conflict with the doctor's ones; (4) the patient requires an intervention that would benefit himself/herself, but could damage society at large. (shrink)

The market for cosmetic surgery tourism is growing with an increase in people travelling abroad for cosmetic surgery. While the reasons for seeking cosmetic surgery abroad may vary the most common reason is financial, but does cheaper surgery abroad carry greater risks? We explore the risks of poorly regulated cosmetic surgery to society generally before discussing how harm might be magnified in the context of cosmetic tourism, where the demand for (...) cheaper surgery drives the market and makes surgery accessible for increasing numbers of people. This contributes to the normalisation of surgical enhancement, creating unhealthy cultural pressure to undergo invasive and risky procedures in the name of beauty. In addressing the harms of poorly regulated surgery, a number of organisations purport to provide a register of safe and ethical plastic surgeons, yet this arguably achieves little and in the absence of improved regulation the risks are likely to grow as the global market expands to meet demand. While the evidence suggests that global regulation is needed, the paper concludes that since a global regulatory response is unlikely, more robust domestic regulation may be the best approach. While domestic regulation may increase the drive towards foreign providers it may also have a symbolic effect which will reduce this drive by making people more aware of the dangers of surgery, both to society and individual physical wellbeing. (shrink)

I argue that the televisual cosmetic surgical makeover is usefully understood as a contemporary manifestation of normalization, in Foucault’s sense—a process of defining a population in relation to its conformity or deviance from a norm, while simultaneously generating narratives of individual authenticity. Drawing on detailed analysis of “Extreme Makeover,” I suggest that the show erases its complicity with creating homogeneous bodies by representing cosmetic surgery as enabling of personal transformation through its narratives of intrinsic motivation and authentic (...) becoming, and its deployment of fairy tale tropes. (shrink)

The paper identifies the phenomenal rise of increasingly invasive forms of elective cosmetic surgery targeted primarily at women and explores its significance in the context of contemporary biotechnology. A Foucauldian analysis of the significance of the normalization of technologized women's bodies is argued for. Three "Paradoxes of Choice" affecting women who "elect" cosmetic surgery are examined. Finally, two utopian feminist political responses are discussed: a Response of Refusal and a Response of Appropriation.

As our knowledge of the functional and pharmacological architecture of the nervous system increases, we are getting better at treating cognitive and affective disorders. Along with the ability to modify cognitive and affective systems in disease, we are also learning how to modify these systems in health. “Cosmetic neurology,” the practice of intervening to improve cognition and affect in healthy individuals, raises several ethical concerns. However, its advent seems inevitable. In this paper I examine this claim of inevitability by (...) reviewing the evolution of another medical practice, cosmetic surgery. Cosmetic surgery also enhances healthy people and, despite many critics, it is practiced widely. Can we expect the same of cosmetic neurology? The claim of inevitability poses a challenge for both physicians and bioethicists. How will physicians reconsider their professional role? Will bioethicists influence the shape of cosmetic neurology? But first, how did cosmetic surgery become common? (shrink)

In the UK, female genital mutilation is unlawful, not only when performed on minors, but also when performed on adult women. The aim of our paper is to examine several arguments which have been advanced in support of this ban and to assess whether they are sufficient to justify banning female genital mutilation for competent, consenting women. We proceed by comparing female genital mutilation, which is banned, with cosmetic surgery, towards which the law has taken a very permissive (...) stance. We then examine the main arguments for the prohibition of the former, assessing in each case both (a) whether the argument succeeds in justifying the ban and, if so, (b) whether a parallel argument would not also support a ban on the latter. We focus on the following arguments. Female genital mutilation should be unlawful because: (1) no woman could validly consent to it; (2) it is an oppressive and sexist practice; (3) it involves the intentional infliction of injury; (4) it causes offence. Our view is that arguments (3) and (4) are unsound and that, although arguments (1) and (2) may be sound, they support not only a ban on female genital mutilation, but also one on (some types of) costmetic surgery. Hence, we conclude that the present legal situation in the UK is ethically unsustainable in one of the following ways. Either the ban on female genital mutilation is unjustified because arguments (1) and (2) are not in fact successful; or the law's permissive attitude towards cosmetic surgery is unjustified because arguments (1) and (2) are in fact successful and apply equally to female genital mutilation and (certain forms of) cosmetic surgery. The people of the countries where female genital mutilation is practised resent references to ‘barbaric practices imposed on women by male‐dominated primitive societies’, especially when they look at the Western world and see women undergoing their own feminization rites intended to increase sexual desirability: medically dangerous forms of cosmetic plastic surgery, for instance …. (shrink)

The concept of ‘accounts’ (Scott and Lyman, 1968) – or linguistic strategies for neutralizing the negative social meanings of norm violation – has a long history in sociology. This work examines British and American women's accounts of cosmetic surgery. In the medical literature, feminist writings and the popular press, aesthetic plastic surgery has been associated with narcissism, psychological instability and self-hatred. Given these negative connotations, cosmetic surgery remains a practice requiring justification even as its popularity (...) increases. Drawing on interview data, I argue that respondents' efforts to account for cosmetic surgery vary according to the ‘repertoires of evaluation’ (Lamont and Thévenot, 2000) made available by their own nation and, particularly, by its healthcare culture. In the market-based US healthcare system, women justify cosmetic surgery by referring to their personal and financial ‘investments’ in physical attractiveness and well-being. Such explanations are less legitimate in Britain, where healthcare is considered a social right rather than a consumer good. In the latter context, women employ narratives that medicalize the pre-surgical body by stressing the physical pain and emotional distress that it caused. (shrink)

The commitment of transplant physicians to protect the physical and psychological health of potential donors is fundamental to the process of living donor organ transplantation. It is appropriate that strict regulations to govern an individual’s decision to donate have been developed. Some may argue that adherence to such regulations creates a doctor-patient relationship that is rooted in paternalism, which is in drastic contrast with a doctor-patient relationship that is rooted in patients’ autonomy, characteristic of most other operative interventions.In this article (...) we analyze the similarities between cosmetic plastic surgery and living donor surgery as examples of surgeries governed by different ethical principles. It is interesting that, while the prevailing ethical approach in living donor surgery is based on paternalism, the ethical principle guiding cosmetic surgery is respect for patients’ autonomy. The purpose of this article is not to criticize either practice, but to suggest that, given the similarities between the two procedures, both operative interventions should be guided by the same ethical principle: a respect for patients’ autonomy. We further suggest that if living organ donation valued donors’ autonomy as much as cosmetic plastic surgery does, we might witness a wider acceptance of and increase in living organ donation. (shrink)

Pathologizing ugliness refers to the framing of unattractive features as a type of disease or deformity. By framing ugliness as pathology, cosmetic procedures are reframed as therapy rather than enhancement, thereby potentially avoiding ethical critiques regularly levelled against cosmetic surgery. As such, the practice of pathologizing ugliness and the ensuing therapeuticalization of cosmetic procedures require an ethical analysis that goes beyond that offered by current enhancement critiques. In this article, I propose using a thick description of (...) the goals of medicine as an ethical framework for evaluating problematic medical practices. I first describe the goals of medicine based on Daniel Callahan's account. I then propose that the goals work best in conjunction with ancillary ethical concepts, namely medical knowledge and skills, standards of practice and medical duties and virtues. Next, I apply the thick description of the goals of medicine in critiquing the practice of framing ugliness as disease. Here, I demonstrate ethical conflicts between aesthetic judgments that underpin the practice of pathologizing ugliness and medical judgments that inform ethical medical practices. In particular, the thick description of the goals of medicine helps reveal ethical conflicts in at least three key domains common to clinical practices, which include (a) disease determination, (b) diagnostic evaluation and (c) establishing clinical indications. My analysis offers a novel way of critiquing the practice of pathologizing ugliness in cosmetic surgery, which tends to be neglected by enhancement critiques. (shrink)

This article considers matters of narration and intersubjectivity in cosmetic surgery by drawing from interviews with 80 British and American women who have had an aesthetic procedure and 16 British and American cosmetic surgeons. It explores constructions of the ‘surgical other’ — that is, the woman who has cosmetic surgery with little consideration of its risks, is motivated by vanity rather than need, has unreasonable expectations regarding its outcome and/or is obsessively concerned with her appearance. (...) It shows that constructions of surgical otherness are deeply contextual and interactive. They involve the production of narratives that reflect individual experience, are shaped by cultural imagery and incorporate narratives provided by other people. They also function as a form of identity work, as patients and surgeons draw upon them (and assist in reproducing them) in their performances of self. As part of that process, physicians not only confirm the patient’s self-presentation as a ‘good surgical candidate’, but also aid in producing her as such. Practitioners too engage in their own presentations of self; their negative commentary on surgical others implies a criticism of — and thus an effort to differentiate themselves from — the surgeons responsible for their production. (shrink)

Is Female Genital Cosmetic Surgery for an adolescent with Body Dysmorphic Disorder ever ethically justified? Cosmetic genital surgery for adolescent girls is one of the most ethically controversial forms of cosmetic surgery and Body Dysmorphic Disorder is typically seen as a contraindication for cosmetic surgery. Two key ethical concerns are that Body Dysmorphic Disorder undermines whatever capacity for autonomy the adolescent has; and even if there is valid parental consent, the presence of (...) Body Dysmorphic Disorder means that cosmetic surgery will fail in its aims. In this article, we challenge, in an evidence-based way, the standard view that Body Dysmorphic Disorder is a contraindication for genital cosmetic surgery in adolescents. Our argument gathers together and unifies a substantial amount of disparate research in the context of an ethical argument. We focus on empirical questions about benefit and harm, because these are ethically significant. Answers to these questions affect the answer to the ethical question. We question the claim that there would be no benefit from surgery in this situation, and we consider possible harms that might be done if treatment is refused. For an adolescent with Body Dysmorphic Disorder, the most important thing may be to avoid harm. We find ourselves arguing for the ethical justifiability of cosmetic labioplasty for an adolescent with Body Dysmorphic Disorder, even though we recognize that it is a counter intuitive position. We explain how we reached our conclusion. (shrink)

This review aims to identify (1) sources of knowledge and (2) important themes of the ethical debate related to surgical alteration of facial features in East Asians. This article integrates narrative and systematic review methods. In March 2014, we searched databases including PubMed, Philosopher’s Index, Web of Science, Sociological Abstracts, and Communication Abstracts using key terms “cosmetic surgery,” “ethnic*,” “ethics,” “Asia*,” and “Western*.” The study included all types of papers written in English that discuss the debate on rhinoplasty (...) and blepharoplasty in East Asians. No limit was put on date of publication. Combining both narrative and systematic review methods, a total of 31 articles were critically appraised on their contribution to ethical reflection founded on the debates regarding the surgical alteration of Asian features. Sources of knowledge were drawn from four main disciplines, including the humanities, medicine or surgery, communications, and economics. Focusing on cosmetic surgery perceived as a westernising practice, the key debate themes included authenticity of identity, interpersonal relationships and socio-economic utility in the context of Asian culture. The study shows how cosmetic surgery of ethnic features plays an important role in understanding female identity in the Asian context. Based on the debate themes authenticity of identity, interpersonal relationships, and socio-economic utility, this article argues that identity should be understood as less individualistic and more as relational and transformational in the Asian context. In addition, this article also proposes to consider cosmetic surgery of Asian features as an interplay of cultural imperialism and cultural nationalism, which can both be a source of social pressure to modify one’s appearance. (shrink)

In her paper ‘Cosmetic surgery and conscientious objection’, Minerva rightly identifies cosmetic surgery as an interesting test case for the question of conscientious objection in medicine. Her treatment of this important subject, however, seems problematic. It is argued that Minerva's suggestion that a doctor has a prima facie duty to satisfy patient preferences even against his better clinical judgment, which we call Patient Preference Absolutism, must be regarded with scepticism. This is because it overlooks an important (...) distinction regarding autonomy's meaning and place in clinical practice, and it makes obsolete the important concepts of expert clinical judgment and beneficence. Finally, we discuss two ideas which emerge from consideration of cosmetic surgery in relation to conscientious objection. These are the possible analogy between clinical judgment and conscientious objection, and the possible role the goals of medicine can play in defining the scope of conscientious objection. (shrink)

Until recently, cosmetic surgery was associated almost exclusively with women. However, men appear to be altering their appearance in increasing numbers. Both the media and the medical profession have seized upon this phenomenon as just one more example of the growing equality between the sexes, arguing that it is just a matter of time before men are having just as much cosmetic surgery as women. In this article, I take issue with the notion of the `new' (...) sexual equality in the realm of appearance and women and men's involvement in the practice of cosmetic surgery. To this end, representations of the male cosmetic surgery patient in the media and in medical texts will be analyzed. Drawing upon contemporary theories of masculinity, I will show why, contrary to popular belief, we have every reason to expect that cosmetic surgery will remain a predominantly feminine practice. (shrink)

Book reviewed in this article: Reshaping the Female Body: The Dilemma of Cosmetic Surgery. By Kathy Davis.

A recent clinical literature on the psychology of cosmetic surgery patients is concerned with distinguishing good from bad candidates. Body Dysmorphic Disorder (BDD) — a mental disorder marked by a pathological aversion to some aspect(s) of one’s appearance — is typically understood in this context as a contra-indication for cosmetic surgery, as it marks those with inappropriate motivation who are unlikely to be satisfied by the surgery’s outcomes. This article uses Foucault’s genealogical work to argue (...) that both the attempt to provide diagnostic conditions for BDD itself, and the broader attempt to demarcate normal and psychopathological concern with appearance are, in part, effects of disciplinary power. Although often presented as a way of making cosmetic surgery more ethical and restrained, this epistemic project inadvertently defends cosmetic surgical interests. Specifically, it contributes to legitimizing the image of an ethically suspect sub-specialty of medicine, and supports its commercial expansion and effective profit-making by displacing its negative sequelae onto patient psyches. (shrink)

Contemporary scholarship examining clinical outcomes in medical travel for cosmetic surgery identifies cases in which patients traveled abroad for medical procedures and subsequently returned home with infections and other surgical complications. Though there are peer‐reviewed articles identifying patient deaths in cases where patients traveled abroad for commercial kidney transplantation or stem cell injections, no scholarly publications document deaths of patients who traveled abroad for cosmetic surgery or bariatric surgery. Drawing upon news media reports extending from (...) 1993 to 2011, this article identifies and describes twenty‐six reported cases of deaths of individuals who traveled abroad for cosmetic surgery or bariatric surgery. Over half of the reported deaths occurred in two countries. Analysis of these news reports cannot be used to make causal claims about why the patients died. In addition, cases identified in news media accounts do not provide a basis for establishing the relative risk of traveling abroad for care instead of seeking elective cosmetic surgery at domestic health care facilities. Acknowledging these limitations, the case reports suggest the possibility that contemporary peer‐reviewed scholarship is underreporting patient mortality in medical travel. The paper makes a strong case for promoting normative analyses and empirical studies of medical travel. In particular, the paper argues that empirically informed ethical analysis of ‘medical tourism’ will benefit from rigorous studies tracking global flows of medical travelers and the clinical outcomes they experience. The paper contains practical recommendations intended to promote debate concerning how to promote patient safety and quality of care in medical travel. (shrink)

Although consumers and physicians alike have long described the goal of aesthetic surgery as the production of an “improved” but still “natural-looking” body, interviews with women who had cosmetic surgery between 1990 and 2007 suggest that the “artificial” is becoming increasingly prevalent within consumers’ narratives of breast enlargement. This article explores that change in relation to processes of conspicuous consumption, the growing cultural emphasis on continual self-transformation, and the increasing normalization of cosmetic modification. Following Fraser, it (...) treats consumers’ accounts not as the reflection of “reality” or a “true self” but instead as indicators of the kinds of options, expressions, assumptions, and perspectives that are available for use in communication about cosmetic surgery. The analysis also draws on feminist writings about the social construction of “breastedness” in femininity. In so doing, it seeks to conceptualize the cultural significance of breasts that are “too good to be real.”. (shrink)

This paper will examine the experience of and drive for bodily invisibility in women through the theoretical approaches of phenomenology and social constructionism. An examination of the social disruptions of bodily invisibility and the compulsive avoidance of such instances, particularly with respect to the fastidious maintenance of body comportment and appearance within the narrow parameters afforded by social norms, will lead to an exploration of the conflation of biomedicine with the beauty industry.

The contemporary rise in the West of cosmetic surgery as a cultural practice expresses the story of the late modern self as autonomous renovator, and the body as disenchanted raw material and individual possession. Technological biomedicine offers itself as the institution ready to assist this reflexive self in aligning the body to an individual’s inner identity. A Christian body politics, however, challenges this narrative of the human person, by claiming that gift and dependence more aptly represent human being (...) than possession and autonomy. The rite of footwashing, particularly as articulated by Jean Vanier and practised in the communities of L’Arche, represents a sacramental practice which forms Christians in a different narrative of the body and being human. Footwashing reminds and trains members of the Body in a non-violent gentleness towards all bodies, and a recognition of humans as creatures of a good God rather than mere possessors of inert flesh. (shrink)

How should a practice, subservient to a public good, be regulated in order to guarantee fair access without encouraging improper claims? In the first place, a clear understanding of the goal of the practice is indispensable for knowing what criteria the regulation must contain. As to the purely formal aspect, the regulation of any practice must include both general rules and particular instances. Finally, to resolve conflicts, committees in which different kinds of expertise are represented should be installed. These three (...) theses are illustrated by the Dutch regulation for cosmetic surgery. (shrink)