Chapter 2

2. The Guilt and Shame over Plastic Surgery in America: For the Vapid, Vain, and Deformed

So why do Valerie and millions of people like her have such mental anguish about wanting to improve their appearance? Why such guilt and shame? When you think about plastic surgery or non-surgical procedures, what do you think about? Are the images and thoughts that occur to you positive or negative?

While the thoughts and opinions that individuals hold on the subject are as widely varied as any, the typical American view on plastic surgery is overwhelmingly negative. The general consensus is that plastic surgery is scary and macabre. Plastic surgery is for people who are vain and are not happy with the person they are inside. Plastic surgery is for vapid people who are superficial and care about their looks too much. Plastic surgery leads to people looking weird, and if you get it, you are going to look weird too.

I have worked in this field for over fifteen years and have heard these sentiments echoed again and again by more people than I care to count. In fact, some of these thoughts are the very first thing out of people’s mouths when they learn what I do. And I imagine people are holding back a bit when they express their opinions to me, a facial plastic surgeon who has made changing people’s faces his life’s work. I encounter negative opinions about plastic surgery even from the patients who are in my office pursuing cosmetic enhancement. I would imagine those who wouldn’t step foot in a plastic surgeon’s office have even stronger negative views. Given the generally negative consensus, it is not surprising that people considering cosmetic enhancement might run into a potential chorus of social condemnation and even shaming. In this chapter, we’ll explore the origins of the negativity and guilt surrounding plastic surgery.

What Does “Plastic” Mean to You?

Part of the public-relations problem for Plastic Surgery may be in its very name. People associate the word “plastic” with something manufactured, fake, or phony. Just like the material plastic, anything created with plastic surgery is, by extension, “manufactured,” man-made, inferior, or defective. The word has such a negative connotation that “plastic” is often used to refer to people who have had plastic surgery that others view as unnatural or over the top. But the “plastic” in plastic surgery has nothing to do with the material, a fake appearance, or being man-made. “Plastic” comes from the Greek word plastikos, meaning “to mold or change.” Plastic surgery is quite literally and simply the art of molding or changing the body through surgery.

American Values and Views

Beyond the name, what are some of the other reasons why Americans might have guilt or shame over plastic surgery? For one thing, as progressive as the United States can be, conservative, Christian values are still at the core of American culture. The influence of these values makes us, as a culture, a lot more uptight about the human body and conflicted about whether or not we should be allowed to change it. From the very founding of the nation, Protestantism and its offshoots (e.g., Puritanism, Presbyterianism, and Calvinism) became the dominant religions in the United States. Puritans believed in the doctrine of predestination. In this doctrine, God’s will, not human behavior, determines whether a person will be saved or damned. Calvinists believed in predetermination, meaning every event in the course of human history was purposefully orchestrated and “predetermined” by God.

In addition, the Protestant religions that dominated American culture were a lot more suspicious of the human body than their European counterparts. They covered it up and concealed it (think Pilgrim). They avoided beautifying and adorning it (think Puritan). They viewed the human form as a vehicle for the devil to lure them into sin. In Christian theology, the body is just a vessel, a mere piece of clothing to be eventually discarded. The soul is our elevated, true self. It is the only really important part of us, and it’s what continues to live on in the afterlife. The body and soul are separate entities. Christianity informs us that in all circumstances, our focus and intention should be on the soul and not the body.

How might our “Puritanical” views as Americans color our thinking about altering our bodies with plastic surgery? It makes us a lot more conflicted and guilt-ridden about altering what God gave us. If we were created by a God who is perfect, who are we to go and change that? If we have physical flaws, he or she may have done that with intention. The events of our lives related to those physical flaws may be part of a greater plan (predetermination). Perhaps those physical flaws are meant to present us with challenges in life that we are supposed to overcome. Being teased about a big nose, bat ears, or tires under our eyes may build stronger moral character. Perhaps these social challenges are ways of directing us to a greater good. If you are not capable of overcoming these physical flaws, you are vain; you’re not a strong or moral person.

To focus too much on outward physical appearance is human—even worse, the work of the devil (Puritanism). If you are focused on someone’s physical beauty, you are being lustful. If you focus on your own beauty, you are being vain. Our Christian values tell us the moral thing to do is to “see” another person’s soul and not their outward physical appearance. People should be capable of seeing beyond any physical flaw or external cue if they are good. If they are sinful and prone to the devil’s enticements, they make the body more important than it should be.

“It’s what’s inside that counts.” Ever heard that before? It is such a common expression in American vernacular that it’s hard to imagine its origins in religion. As Americans, we are more guilt-ridden and uptight about altering our appearance through plastic surgery, and that is partially because of our shared American values. These shared American values stem from our colonial beginnings as a predominantly Puritan society.

Reality TV: Plastic Surgery Is for the Vapid

Guilt over cosmetic surgery is also prevalent in America because of how plastic surgery is portrayed in the media. Plastic surgery is a favored subject of reality TV. After all, who does this stuff? The Real Housewives and the Kardashians, that is who. How do these shows represent these people? Drama, drama, drama. They are not real people. They are caricatures of real people. Now I do not know any of them personally, nor have I ever watched these shows for more than thirty seconds in flipping the channels, but I would say it’s a safe bet that some of the extreme behavior, the hedonism, the vanity, and the self-centered, self-absorbed displays are exaggerated, made for TV, and scripted. I would hope these reality TV stars are a little more centered than the shows paint them to be.

How are these stars viewed by the general public? Certainly not as pillars of normal, moral behavior, but as outlandish, spoiled, self-absorbed, and, well, vain. The entire entertainment value of these shows is for people to sit there and judge, and to make them feel better about themselves. “I may not have as much money as those people, but at least I’m normal. These people are crazy.” The regular visits of reality TV stars to plastic surgeons and the cosmetic treatments featured on their shows reinforce that they are the typical plastic surgery patient: vapid, vain, and “over the top.” Nothing could be further from the truth.

Some shows portray plastic surgery not only as vanity but downright insanity. Remember the show Extreme Makeover? Even the title says to everyone watching that plastic surgery is “extreme.” There was also a similar show called The Swan. On both of these shows, patients had a massive number of procedures with the goal of creating a radical transformation for the climax or “big reveal.” The point of these shows was for the contestant to come out looking completely different, like the ugly duckling who changed into the swan. These misleading portrayals feed into the macabre and creepy notion that plastic surgery radically changes people’s identity.

Reality TV: A Focus on the Sensational, the Negative Elements, and the Danger

Another negative plastic surgery stereotype reinforced by reality TV is danger. Reality TV focuses on the sensationalism and the danger in plastic surgery. Rock singer Gene Simmons showcased his facelift on an episode of Gene Simmons Family Jewels in 2007. In this episode, he had a complication following his procedure: a hematoma. A hematoma is a blood collection underneath the skin following a facelift. It rarely happens, but is more common in males and in people with high blood pressure. Complications, in general, are very rare following plastic surgery, and a hematoma is easily treatable and doesn’t affect the long-term outcome. The episode, of course, focused more on the gore, blood, and drains coming out of Simmons’s head than on the long-term result. I guess it was fun for everyone...