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Reflecting on Cosmetic Surgery

Cosmetic surgery represents an extreme form of modern grooming. It is the

fastest growing medical speciality, yet misconceptions abound about those
who undertake it and their reasons for doing so. With a grounded approach,
engaging thirty women through in-depth interviews, this study explores how
they chose cosmetic surgery as an option. Their accounts frame a theoretical
discussion, in which Jane Northrop proposes that cosmetic surgery is initiated
within the vulnerable and divisive relationship between the self and its poor
body image.
Poor body image and the attempt at its reparation are examined con-
ceptually through shame and narcissism. With compelling case studies and a
multi-disciplinary approach, Reflecting on Cosmetic Surgery demonstrates
that shame constitutes a framework through which we formulate appearance
norms and learn the art of becoming socially embodied. Shame concerns
the self, but manifests in response to perceived social phenomena. Through
the evaluation and amendment of body image with cosmetic surgery, notions
of self and social worthiness are played out.
Northrop argues convincingly for a review of the way in which we view
narcissism and proposes that shame, and the discomforts arising from it, are
implicated in its occurrence. This book will appeal to students and scholars
across the social sciences, and particularly in women’s studies and gender
studies.

Jane Northrop has been a midwife and nurse for most of her career, and is
currently combining part-time work in palliative care with a research position
at the University of Tasmania (UTAS). In 2002 she completed an Honours
degree in Sociology at UTAS, in which she examined the experiences of
people living with Hepatitis C. She was awarded First Class Honours and
received the TASA Award. In 2003 she was awarded an APA scholarship and
began a PhD in the School of Sociology and Social Work at UTAS, examin-
ing the motivations of those who undertake cosmetic surgery. She received her
doctorate in 2010.
Reflecting on Cosmetic Surgery
Body image, shame and narcissism

Jane Megan Northrop

First published 2012
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
Simultaneously published in the USA and Canada
by Routledge
711 Third Avenue, New York, NY 10017
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2012 Jane Megan Northrop
All rights reserved. No part of this book may be reprinted or reproduced or
utilised in any form or by any electronic, mechanical, or other means, now
known or hereafter invented, including photocopying and recording, or in
any information storage or retrieval system, without permission in writing
from the publishers.
Trademark notice: Product or corporate names may be trademarks or
registered trademarks, and are used only for identification and
explanation without intent to infringe.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
Northrop, Jane Megan.
Reflecting on cosmetic surgery: body image, shame and narcissism /
Jane Megan Northrop.
p. cm.
Includes bibliographical references and index.
1. Surgery, Plastic- -Social aspects. 2. Surgery, Plastic- -Psychological aspects.
3. Body image in women. I. Title.
RD119.N67 2012
617.90 5- -dc23
2011042466

ISBN13: 978-0-415-52139-0 hbk

ISBN13: 978-0-203-12151-1 ebk

Typeset in Times
by Taylor & Francis Books
In loving memory of my wonderful grandmothers,
Bonnie Allan and Jessie Northrop
Contents

Acknowledgements x

Introduction 1

1 Evolving appearance norms and cosmetic surgery 9

2 Women, appearance and cosmetic surgery 31

3 The mirrored self 57

4 Shame and the social self 80

5 Shame and subjective experience 105

6 Evaluating body image 134

7 Shame and cosmetic surgery 156

8 Just look at yourself 193

References 216
Index 224
Acknowledgements

First and foremost I would like to thank the women who took part in this
study. Their contributions were intimate, honest, intelligent and incredibly
thought-provoking. Their accounts formed the basis of the study and I am
extremely grateful to have encountered them and for their involvement. This
study is based on my Ph.D. The project took much longer to complete than it
was supposed to and it eventually became a labour of love more than any-
thing. My thanks are extended to Douglas Ezzy and Neil Apted for their
engagement with the original project. I would also like to acknowledge the
impact of the late Bob White on my formative experience of academic writ-
ing. He was always supportive and very passionate about sociology. I still
miss him, his enthusiasm and his razor-sharp mind. Meredith Jones and Chris
Shilling marked my Ph.D. and I would like to thank them for their encoura-
ging comments. My dear friend Trish Laddrak has been there from the
beginning, always ready for a chat, a generous and perceptive thinker who is
able to see through a jumble of ideas and miraculously know where the dots
need to be connected. My beloved children, Alexander and Magella, have
endured the many years it has taken to complete this project with patience
and extremely good grace. My parents, Jill and David, support us all in a
myriad of ways and I am eternally grateful for their presence in our lives. And
last, but by no means least, my final thanks are extended to my partner,
David. His untiring interest and unfaltering belief in the worthiness of the
themes under discussion made the experience of living in and alongside this
project more deeply pleasurable than it otherwise might have been.
Introduction

Whenever a woman is asked why she had cosmetic surgery, her short answer
is likely to be ‘I didn’t like the way I looked and I wanted to look better for
myself ’. To many people such a response is reasonable enough not to warrant
a great deal of further discussion. Given that the vast majority of women
living in the developed world are less than happy with their appearance,
‘wanting to look better’ barely raises an eyebrow. Indeed, finding women who
are entirely happy with their appearance is more unusual. They represent an
anomaly, a minority group who could technically be described as deviant, and
to whom other women look with a kind of wonder and, quite possibly, respect.
These women are extraordinarily fortunate since being content with one’s
appearance inevitably frees up time, energy and money that can be directed
elsewhere. While women who undergo cosmetic surgery want to change their
appearance, they are also aspiring to join that small group of women who are
satisfied with their appearance. They want, more than anything, to look in the
mirror and be happy with what they see.
Not insignificantly, as appearance dissatisfaction in women approaches
the level of norm, body image anxiety has surfaced as an essential variable
upon which the successes of grooming industries like cosmetic surgery
are reliant. It is, moreover, to this rising swell of discontent that hugely prof-
itable global organizations market an unprecedented range of grooming
products and services designed to redress and assuage the problem. The
media – with an unnerving and purposive agenda, accompanying us into our
bedrooms, bathrooms and seemingly infiltrating our very psyches – are
usually blamed for distorting the relationship women have with their bodies
and their perceptions of appearance. Whilst the effects of the media are
undoubtedly pervasive, how they exert an impact is far less certain. Like
many others who have examined the progressive acceptance of cosmetic sur-
gery, I assumed that tracking down the impetus behind turning to a surgical
fix would uncover the role played by the media, magazines in particular, and
of men. That was until I actually started speaking to women themselves and
found that those teleological formulas did not quite stack up. Indeed, what
I found in their long answers was an angst related to appearances born much
closer to home.
2 Introduction
This study comprised in-depth interviews with thirty women who had
engaged with cosmetic surgery on some level, including twenty-six who had
undertaken it, to explore their reasons for seeking surgery. Any suggestion
that the media may have encouraged them to undergo cosmetic surgery was
poorly received. A few were downright insulted, whereas others were clearly
irritated or disappointed with the simplicity, or predictability, of such a pro-
position on my part which not only roused their indignation but threatened
the ambience of the interview. This aside, the participants generally agreed
that the media play a pivotal role in disseminating information about cos-
metic surgery and in reporting new procedures as they become available,
which, they conceded, has normalized cosmetic surgery as a self-enhancement
option.
Despite its progressive normalization, cosmetic surgery remains a sub-
stantial undertaking. Electing to have a general anaesthetic, the recovery time
required, the financial costs involved, and the inherent risks associated with
any surgery, means that cosmetic surgery can never be considered as lightly as
a cosmetic procedure like a shot of Botox TM or collagen, administered in a
doctor’s surgery or specialist clinic during a workday lunch break. Choosing
to undertake cosmetic surgery, on the first occasion at least, still represents an
extreme in mainstream body modification technology. However, cosmetic
surgery is, at its heart, no more than an intentional and committed grooming
strategy enacted to ameliorate, improve or amend body image and, as the
interviews proceeded, I began to realize that the real opportunity this study
availed was not solely to examine cosmetic surgery as an event; rather, it
provided an occasion to consider the underlying appearance dissatisfaction
overwhelmingly articulated by participants undertaking cosmetic surgery. Pre-
surgical appearance dissatisfaction, albeit with varying degrees of emphasis,
was expressed across all interviews as the most consistent reason for under-
taking cosmetic surgery. Significantly, the participants in this study described
their appearance dissatisfaction as a cumulative process, played out in inti-
mate, self-scrutinizing ritual before a mirror, where the self differentiated its
loathed body image and rejected it as no longer acceptable to itself or to
others, concluding finally that surgically amending the body was the only real
option remaining. In a move that clearly disembodies the self, the self then
re-viewed its reflected image as something separate and, once detached from
it, the self re-evaluated its image as an object available for amendment.
Heightened appearance dissatisfaction and the fracturing of the self-concept it
appears to instate, plus determining how these processes emerge and are sus-
tained to the point where cosmetic surgery becomes the only conceivable
option, became central themes this study sought to examine.
It was in response to a general question asking whether appearance had
been an important issue in their lives when they were growing up that some of
the most important insights observed in this study were made. For example, it
was in the participants’ discussions of formative body image construction that
evidence of an alignment between the appearance values held by their parents
 Introduction 3
and those espoused in media were observed. Learning to inhabit the body in
the process of becoming socially embodied comprises the earliest learning,
and findings from this study indicate that when those closest to participants
share the same appearance values as those espoused in media, and afford
them particular emphasis, formative body image construction is likely to be
impacted. The participants confirmed their awareness of mediated fashions
surrounding the body, particularly those which signify social success, and they
did correlate to the ideals their parents and significant others admired during
formative and impressionable periods of body image construction. It was,
furthermore, through intimate familial interaction that those ideals were
communicated, in both subtle and overt ways, and then internalized and
woven into the seminal experience of body image. Many participants stated
that falling short of an appearance ‘ideal’ was something to which a parent
had initially drawn their attention. In addition, any failure in meeting the
ideal admired by a significant other was further compounded by the perceived
sense of ineptitude in meeting the very same ideal adorning the screens, bill-
boards and magazines to which the modern eye is consistently drawn. For-
mulating body image under the associated appearance constraints emanating
from both the intimate and socio-cultural domains makes it inordinately difficult
for any girl, teen or woman to ever feel content in her own skin.
The bodies of women are socially and libidinally significant to themselves
and to the world in which they engage. A woman’s appearance has always had
a bearing on how she will be evaluated and received in social terms and, as a
consequence, many women learn to evaluate themselves in the same ways
they imagine others will judge them. This study found that women who reject
their body image and seek its amendment with cosmetic surgery have often
experienced the rejection of their bodies by others, whether literally or intuitively,
in an intimate setting. Focusing on the contexts and interactions associated
with the initial foray into cosmetic surgery in particular exposed a specific
episode of heightened appearance dissatisfaction, and those participating in
this study accounted for their surgeries in a range of ways. At one extreme the
initiation of cosmetic surgery was articulated with an uncomplicated pragma-
tism, which stood in contrast to an opposing narrative that bestowed upon such
surgery a therapeutic function. Significantly, those who mobilized cosmetic
surgery as therapy sought not only bodily amendment, but self-amendment
through improved body image. More than half of those participating in this
study described a conflicted relationship with their appearance which emerged
in early childhood or adolescence, while the remainder described their dis-
contents and discomforts as having arisen in adulthood as they aged, lost or
gained weight, or attempted to amend the effects of pregnancy, lactation or
serious illness. This project focuses much of its attention on the experiences of
the former group and, therefore, does not attempt to provide an overarching
explanation that can be applied to all women who undertake cosmetic sur-
gery. Rather, it restricts its ambitions to exploring the most complex accounts
presented by those who took part in this study.
4 Introduction
The findings of this study evolved from thirty in-depth interviews with
women on the subject of cosmetic surgery. I was interested to know what had
shaped their decisions to have cosmetic surgery, how it came to be seen as an
option, who had supported them in proceeding with surgery, and how having
the surgery had affected their lives. As mentioned earlier, a general question
inquiring as to whether appearance had been an important issue when
growing up was also posed and the ensuing responses produced a range of
discussions, many of which were unforeseen and confronting. Twenty-six of
those interviewed had undertaken cosmetic surgery within ten years prior
to being interviewed, another two were booked to have surgery, and two
additional women were interviewed because of their expressed interest in
the project. Their contributions offer eloquence and insight into questions
of ageing and gender in the work setting. Prior to undertaking the interviews,
I reviewed literature on cosmetic surgery and found that few qualitative
researchers had actually engaged with women who had undergone cos-
metic surgery. In view of the overwhelming discontent voiced by participants
when describing their pre-surgical appearance, which ranged from
emphatic loathing to disdain, this study probes the impact of appearance
dissatisfaction on the self-concept in an attempt to further a sociological
understanding of the circumstances under which women engage in cosmetic
surgery.
Chapter 1 looks to the academic literature on appearance and the history
of cosmetic surgery to examine the convergence of social conditions and
disciplinary advances which have seen such surgery flourish. It draws
on the work of the social historians, Sander Gilman (1999) and Elizabeth
Haiken (1997), who direct their attention to the history of cosmetic surgery.
Their work illustrates the role stigma has played in framing modern appear-
ance regimes and exposes cosmetic surgery as evolving in response to the
inequities embedded within them. Chapter 2 considers the relationship
between women and their appearance by reviewing selected contributions
made by feminist scholars towards understanding women’s engagement with
cosmetic surgery. Insights gleaned from the authors discussed in these chap-
ters enabled me to orient the current study by identifying gaps in the work
already undertaken.
Methodologically, the approach used in this study borrows from grounded
theory (Corbin and Strauss 1990). Since there had been few qualitative studies
published when I began this project it made sense to begin inductively.
Such an approach engages participant contributions in formulating the
direction the study takes by facilitating the emergence of observable concepts
from the data. I approached each interview with a basic theme list, but
the interviews were intended to be conversational. At the commencement of
the interview, participants were offered the opportunity to tell their story or,
if they preferred, for me to ask questions. The questions were initially
general, enquiring about the types of surgery undertaken and whether the
participant had been happy with the results, but, as the interviews proceeded,
 Introduction 5
participants themselves added their own layers of information and additional
themes emerged that were worthy of exploration and introduction to
subsequent interviews.
An analysis of the earliest interviews directed my attention to the notion of
body image. It became increasingly apparent that when participants spoke of
improving their appearance with cosmetic surgery, they were not actually
speaking about their bodies; rather, they were referring to body image, their
own subjective experience of perceiving how their bodies appeared. This may
seem somewhat self-evident, but body image is a complex phenomenon which
draws on shared social experience, individual perception and emotion. Fur-
thermore, asking participants how they felt about their appearance had been
something of a conversation stopper, whereas asking participants how they
felt when they viewed themselves in the mirror prior to having surgery did
stimulate discussion.
Taking these observations from the interviews, I then directed my theore-
tical attention in Chapter 3 to understanding the role mirrors play in body
image construction in the lead up to cosmetic surgery. Drawing on the work
of Paul Schilder (1935), Jacques Lacan (1977) and Charles Horton Cooley
(1902, 1927, 1962), I found myself questioning whether the poor evaluation of
body image described by many participants was, as Cooley (1902) proposes,
related to shame. I reanalysed the interviews to substantiate this possibility
and was redirected back to the texts to broaden my understanding of shame
in relation to body image. While Cooley (1902) introduces shame, he does not
develop it conceptually. The work of Norbert Elias (1978), however, proved
insightful on the question of shame, as is discussed in Chapter 4. His reading
of shame is sociological, historical and demographic. Elias describes shame as
the human denial of our animalistic attributes encapsulated in the progressive
distancing of human social life from the natural world. He nominates these
processes as broadly cultural and social, but reproduced and reiterated
through childhood socialization. Elias takes as given that the modern rela-
tionship between the self, body and appearance is one increasingly imbued
with a specific form of anxiety which he nominates as shame. Shame, he
contends, has emerged from the fear of social exclusion which failed mastery
of the body almost surely elicits. Elias’ interest, however, lies in the broader
social dynamic. Gender is considered only in passing and any detailed
understanding of the subjective experience of shame is absent from his work.
In an effort to develop a theoretical understanding of the way shame is
experienced, I then turned to the work of the psychotherapist and psycho-
analyst Helen Block Lewis (1971), as described in Chapter 5. Lewis’ work
dovetails with Elias’ as she unpacks formative socialization and its role in the
development of shame. Her theoretical insight resonated with the experiences
of those observed in this study but, perhaps more importantly, my engagement
with her work facilitated the negotiation of the more difficult events partici-
pants disclosed about their formative lives and how these had subsequently
impacted their perceptions of body image.
6 Introduction
Findings from this study suggest that those who experienced their for-
mative body image as flawed continued to encounter ongoing problems with
body image construction, given that those who developed poor body image in
childhood clearly struggled with poor body image well into their adult lives.
In addition, they were consistent consumers of grooming products and ser-
vices, and tended to have the most cosmetic surgery. Chapter 6 explores how
participants themselves accounted for their body image in relation to their
childhood experience. Here the most pronounced discussions of poor body
image also described shame events in childhood and, notably, these partici-
pants’ attempts to construct body image were the most complex and their
self-concepts the most fragile. Findings from this study indicate that those
who grew up experiencing their body image as something shameful were more
likely to continue having poor body image as adults. Furthermore, these find-
ings suggest that developing poor body image in childhood or adolescence
potentially habituates women to a life-long consumption of specialist groom-
ing products and services, of which cosmetic surgery represents the newest
alternative.
Chapter 7 continues with the theme of shame but shifts the focus from
recalled early socialization to adult experience. This chapter utilizes the voices
of participants to examine the way in which particular contexts expose the
conceptual relevance of shame to the enactment of cosmetic surgery. Themati-
cally, the most significant contexts were related to specific interactions with
partners, the social integration of the post-surgical body, and the encounter
with cosmetic surgeons themselves. The final section in this chapter considers
how participants discussed cosmetic surgery in relation to their participation
in the workforce. Here participants spoke of such surgery as a strategy enac-
ted to ameliorate the gendered constraints of ageism, which they depicted as
an oppressive feature of their involvement within the workplace. They
described their workplaces as competitive and their positions threatened by
stereotypical assessments which assumed that because they were both female
and older, they had ceased to function competently in their professional roles.
Their discussions underline the ways in which women might experience
appearance, as something tenuous, vulnerable to the poor evaluations of
others and, therefore, potentially shameful. What is more, they described their
engagement with cosmetic surgery as a pre-emptive act of impression man-
agement, undertaken to avert a loss in status or to secure the confidence of
others, but their overarching concern was to maintain an appearance which
reinforced their professional viability within the workforce. Their accounts
demonstrate that women perceive their appearance to be a more significant
aspect of their overall social capital than is the case for men and, despite
women’s advances in the arena of paid work, their participation in the work-
force is subject to a much harsher set of appearance constraints than those
faced by men.
The final chapter presents an exploratory discussion on the contested theme
of narcissism. Narcissism emerged during the course of this study, somewhat