Plastic surgery puts focus on women's psyches

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Victoria Pitts-Taylor could be seen as a contradiction.

As women's studies coordinator at the City University of New York, she has sharply criticized the beauty industry and written books about tattooing, piercing and plastic surgery.

She has also had a nose job.

Dr. Pitts-Taylor doesn't see the two things as contradictory at all, however, and she used her experiences as a cosmetic surgery patient as part of her 2007 book, "Surgery Junkies: Wellness and Pathology in Cosmetic Culture."

She believes her 2004 nose operation, known as a rhinoplasty, gives her a unique perspective on the cosmetic surgery industry, allowing her to analyze it both as an observer and a participant.

She underwent the rhinoplasty after she broke her nose in a skiing accident, but is quick to note that it wasn't just a repair.

"Some people try to get me off the hook by saying, 'Oh, you broke your nose so you deserved to get cosmetic surgery,' but I say, 'I didn't get the same nose I had before.' "

Dr. Pitts-Taylor, 38, decided to get the work done after she had interviewed several cosmetic surgery patients for her book. "I realized they didn't seem crazy and they didn't seem like junkies and the way they described their cosmetic surgery didn't seem that unreasonable to me."

Once she decided to refashion her nose, having doctors make it straighter, shorter and removing a bump on the bridge, she learned it could be a lonely choice.

"There wasn't one person in my life who encouraged me to get this surgery," she said. "I faced a lot of resistance from family and friends. I remember a colleague coming in and saying, 'Victoria, you can't do this -- you're going to lose all your character,' which was funny, because I never knew my character resided in my nose."

Her journey through plastic surgery helped her understand that no matter what people think of cosmetic operations, they tend to put the blame or the praise on the patients, and often ignore the industry that is driving the process.

There are still many people in America who look down on plastic surgery, she said.

"In the best scenario, women who get cosmetic surgery are vain and superficial and spend their time and money and energy on how they look. At worst, it reflects poor values, lack of stability, poor self-esteem, or they're trying too hard or there's something really wrong with them."

This bemuses her.

"I'm really interested in how quickly we're willing to diagnose women who get cosmetic surgery with mental pathologies, despite how obvious it is that the cosmetic surgery industry is really aggressive in selling its product."

Figures from the American Society for Aesthetic Plastic Surgery show that the number of cosmetic operations in America grew from 973,000 in 1997 to 1.5 million in 2009. When nonsurgical procedures like Botox injections are added in, there were nearly 10 million cosmetic interventions last year.

And discussion of cosmetic surgery -- especially among celebrities -- is increasingly prevalent, characterized by such programs as VH-1's "Top 30 Celebrity Plastic Surgery Blunders" and ABC's "Extreme Makeover."

Despite this greater visibility, the acceptability of cosmetic surgery still varies widely by region, said Dr. Pitts-Taylor and Leo McCafferty, a well-known Pittsburgh plastic surgeon and spokesman for the aesthetic plastic surgery society.

Dr. Pitts-Taylor said that when she gives talks in most parts of the country and mentions her nose job, "I get a social reaction that suggests surprise," but when she speaks in southern California "the reaction is totally blase."

And Dr. McCafferty, who trained in Los Angeles and Miami, said, "I tell people that in LA, plastic surgery is a bragging right; in Miami, they do it but don't like to talk a lot about it; and in Pittsburgh, people do it but never say a word."

While Dr. Pitts-Taylor points to the beauty industry and the media as the engines behind the growth in cosmetic procedures, Dr. McCafferty said the consumer health movement has played a role, too.

The boom in plastic surgery, he said, "is an extension of the healthy lifestyle emphasis that developed in the '80s, with its focus on exercise and diet. And at the same time, there has been an increased willingness by people to talk among themselves about procedures, and also a willingness by plastic surgeons to publish studies and talk more about this field."

In her book, Dr. Pitts-Taylor said two starkly different stories are often told about women who get plastic surgery.

One comes from certain feminists, she said, who have "described female cosmetic surgery patients as sick women" who are "victims of internalized oppression or false consciousness."

The other story is the empowerment saga, she said.

"Women who get cosmetic surgery are pressured to have the right reasons for doing so. So women are not supposed to be especially vain. They're not even supposed to say they're being competitive.

"Instead, they're supposed to use this liberal empowerment language -- 'I'm doing it to do something positive for myself.' The cosmetic surgery industry has really capitalized on this and has kind of sold cosmetic surgery back to women through the language of liberal feminism."

Mixed into this debate recently has been a focus on an illness called Body Dysmorphic Disorder, in which people have "an excessive concern over a slight physical anomaly," as one description puts it.

When people with this condition seek plastic surgery, they either don't need it or won't be satisfied by it, experts say.

Even though fewer than 5 percent of the population is estimated to have the disorder, it has received a disproportionate amount of publicity, Drs. Pitts-Taylor and McCafferty said.

"I've been practicing for over 20 years and I think I've encountered maybe two patients," Dr. McCafferty said, "and in those cases, you immediately want to refer them back to their family physicians, because surgery is not going to do them any favors."

He estimated that overall, he turns away about 5 percent of the people who come to him, either because they are overly worried about a perceived flaw, or because plastic surgery can't fix the problem that bothers them.

And while he acknowledged that many cosmetic surgeons advertise their services, "I don't think that this is something that is peculiar to plastic surgery. Wherever there is this direct-to-consumer marketing, it can be a problem.

"What we try to do [at the aesthetic plastic surgery society] is to make sure there is some element of truth in the advertising and some element of realism."

He said the society will discipline plastic surgeons who are unethical in their ads or clinical practices, but could not cite figures on how often that happens.

While acknowledging the influence that marketing can have, Dr. Pitts-Taylor also said that many women, like her, end up going through with cosmetic surgery simply because they want to look better.

She remembers a woman in one of her lecture audiences "trying to ask me what my deep reason for having plastic surgery was, and I said, 'I really didn't have one.'

"And she said, 'You're really telling me there was no deep-seated self-hatred going on?' I said, 'You know, maybe it seems to you this was this enormous step I took, but for me, it really wasn't that bad and I recovered fairly quickly and I really liked the results.' "

In the end, it was just about appearance, she said.

"I think cosmetic surgery is superficial, and when it tries to sell itself as more than that, it's overselling itself.

"I don't think it can fix self-esteem."


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