May 7, 2005

COSMETIC SURGERY AND THE Cultural Construction OF Beauty

Throughout history, certain members of nearly all cultures have deliberately altered their body's natural appearance. Padaund women use rings to elongate their necks, Victorians constricted their waists with corsets, and other cultures have practiced foot binding. When we look closely at each activity, we quickly uncover the junction of ideology of beauty held by members of these societies and the technology available to achieve that ideal.

Today, we live in a time when medicine can cure the body and also reshape it. Hence, many people use biomedical means, such as steroids and hormones to alter their bodies. Additionally, cosmetic surgery is becoming increasingly available and affordable to people of all ages, including teenagers. According to journalist Alissa Quart (2003), "Teenagers now alter their bodies extremely and proudly" (p. 115). She reports, from 2000 to 2001, the number of cosmetic surgeries on teens ages 18 and under rose nearly 22%.

In this article we explore the growing popularity of cosmetic surgery. Our work is inspired and informed by many of the articles contained in the March 2003 issue of 'ArL Education, which encourage art educators to address visual culture (Villeneuve, 2003). Specifically, we adopt an instructional approach to our subject as advocated by Karen Keifer-Boyd, who recommends we begin with what is meaningful in our lives today and then look for representations of those issues in visual culture (Keifer-Boyd, Amburgy, and Knight, 2003, p. 48). We draw examples from reality television, advertising, dolls, and films made for children. Next, we examine the work of Orlan, a performance artist who repeatedly underwent cosmetic surgery in a quest to challenge dominant standards of beauty. By discussing examples from both popular culture and fine arts, we hope to achieve the goals of art education as posited by Arthur Efland (2004) who writes that art education should provide "the freedom to explore multiple forms of visual culture to enable students to understand social and cultural influences affecting their lives." (p. 250).

The Construction of Beauty in Visual Culture

Myths and beliefs about beauty are deeply embedded in our culture and are transmitted from early childhood onward. Consider how fairy tales, movies made for children, and dolls reinforce the notion that beauty is a prerequisite for happiness. Traditionally, the hero or heroine is portrayed as young, beautiful, and white while the villain is depicted as old, ugly, and dark. One such example is Disney's Little Mermaid (1989), an animated version of the Hans Christian Andersen fairy tale about Ariel, a mermaid who has fallen in love with the handsome prince, Eric.1 Ariel makes a deal with Ursula, a squid, to trade her exquisite voice for a pair of legs in order to pursue Eric. Henry Giroux (1998), a long-time critic of the Disney corporation, points out that Ursula, the "large, oozing, black and purple squid in the Little Mermaid, gushes with evil and irony" while the mermaid Ariel appears to be "modeled after a slightly anorexic Barbie doll" (p. 58). Although there are exceptions, generally in these stories, only a beautiful princess and her prince live happily ever after.

While many dolls, such as Bratz and American Girls, may communicate standards of beauty to the children who play with them, critics who want to comment on cosmetic surgery most often cite Barbie, Mattel's best selling doll. In one such instance, Cindy Jackson, an American talk show celebrity, had more than 20 surgical procedures in an attempt to resemble Barbie (Goodall, 1999). Much has been written about the Barbie doll, which according to Shirley Steinberg (1998) "celebrates whiteness-blond whiteness in particular- as a standard for feminine beauty" (p .217). Susan Jane oilman (2000), reflecting on her own childhood experiences of playing with Barbie, writes, "We urban, Jewish, black, Asian and Latina girls began to realize slowly and painfully that if you didn't look like Barbie, you didn't fit in.... You were less beautiful, less valuable, less worthy" (p. 17). oilman's comments are particularly apt when we consider the history of cosmetic surgery.

Sander oilman (1999), in his book, Making the Body Beautiful: A Cultural History of Aesthetic Surgery, explains that the growth of cosmetic surgery coincided with the spread of so-called race science that linked one's physical appearance to one's temperament, character, and intelligence. For example, those considered racially inferior to the English middle class, such as the Irish, Welsh, and the lower classes, were thought to have protruding jaws. Men of intelligence were considered to be those with less prominent jaws. Some cosmetic surgeons now consider the face of Catherine Zeta- Jones, a Welsh actress, as the representation of ideal beauty. Early scientists also believed that physical and mental illness, prostitution, and signs of criminal behavior were thought to be perceptible on the exterior of the body as a symbolic reflection of one's inner state. Early cosmetic surgery held the promise of curing one's inner condition by transforming one's outer appearance.

Today, advertisements frequently carry the suggestion that cosmetic surgery will enhance self-esteem and improve one's quality of life (Sarwer & Crerand, 2004). These ads appear on television, billboards, and in magazines, where young beautiful models are frequently used to depict postoperative results. Prior to 1982, the American Medical Association prohibited all advertising for medical services (Sullivan, 2001). The Supreme Court over turned this ruling and paved the way for cosmetic surgeons to actively solicit customers. Generally, advertisements for cosmetic surgery differ from other medical ads in that they often resemble ads typically found in fashion and beauty magazines.

Deborah Sullivan (2001) regards women's magazines as one of the most important sources of information about cosmetic surgery. She examined 171 magazine articles about cosmetic surgery from 1985 to 1995 to determine how magazines participate in the cultural construction of appearance. Sullivan (2001) found that, "Articles about cosmetic surgery in women's magazines provide readers an opportunity to learn physicians' ideology about the problematic nature of body parts that fall short of the ideal" (p. 156).

The many makeover-based reality shows have, in part, contributed to the demand for cosmetic surgery. In 2003, the ABC television show, Extreme Makeovers, was the second highest rated program for adults under 50 (Sarwer and Crerand, 2004). Another example, The Swan, featured 18 women who all described themselves as "ugly ducklings." In this show each woman was given an individualized team, which consisted of a personal trainer, a therapist, a dentist, and a surgeon, to help her transform into a beautiful person. During the final episode, one woman was crowned the "Ultimate Swan."

For a younger audience, teenagers Mike and Matt Schlepp, starred in I Want a Famous Face, an MTV cosmetic-surgery reality show. The MTV crew followed Mike and Matt through two months of countless surgeries where they spent $37,000 of their own money to look like Brad Pitt. The Schlepps, as well as the winners of The Swan and Extreme Makeover were later featured on talk shows such as Oprah, and Dr. Phil. Television, like magazines and children's toys and movies, provides visual examples of beautiful individuals. People become dissatisfied with their appearance when they perceive a discrepancy between their actual appearance and an ideal, whether that ideal is that of a doctor, celebrity, or a toy manufacturer.

Cosmetic surgery involves aesthetic judgments, and when we closely inspect those judgments, we can see that standards of beauty are largely culturally determined. The artist Orlan, whom we discuss in the next section, critiques dominant norms of beauty. Her Reincarnation of St-Orlan specifically comments on current cosmetic surgery practices.

Challenging Dominant Standards of Beauty Through the Art of Orlan

The French artist Orlan is regarded as one of the more important artists of the late 20th century. She uses her face as her primary medium and cosmetic surgery as her sculpting method. On May 30th, 1987-her 40th birthday-Orlan embarked upon a project that married cosmetic surgery with performance art. The Reincarnation of St- Orlan, which entailed nine separate operations, involved re- sculpting (Man's face according to ideals of female beauty established by male artists throughout history. Orlan first created a computer-generated self-portrait based on features taken from women in famous artworks. Her forehead, for example, was taken from Da Vinci's Mona Lisa; her chin from Botticelli's Venus, and her mouth from Boucher's Europa (Ince, 2000, p. 6). Orlan then turned to cosmetic surgery to sculpt her face to match the computer-generated image.

Orlan's art is not the completed operation, but rather the process of the operation, during which she remained fully conscious and in communication with her remote audience of gallery visitors via satellite (Goodall, 1999). Orlan talked animatedly to her audience or read to them from texts chosen to serve as commentaries on what is taking place. One key text read by Orlan durin\g her performance was from Lacanian psychoanalyst Eugnie Lemoine- Luccioni's book (1983), LaRolte (The Dress). LemoineLuccioni, who devotes a chapter to Orlan's early performances, writes poetically about the discrepancy between the way in which one appears versus one's own self-perception. She states, "Skin is deceptive... I have black skin, but I am a White person; the skin of a woman but I am a man. I never have the skin of what I am" (Lemoine-Luccioni, 1983, p. 95, translation). Although Orlan's first performances were concerned with ideals of Western beauty, the seventh, eighth, and ninth operations involved placing implants into her upper cheeks and the sides of her forehead to give the impression of budding horns (Goodall, 1999). After the seventh operation, Orlan displayed 41 self-portraits consisting of photographs taken on the day the surgery was performed, and on each subsequent day after until the healing process was complete (Moos, 1996).

Orlan's work has been sensationalized by the media, and critics often write that she is uncritically accepting socially imposed ideals of beauty by using cosmetic surgery to become the "ideal woman" (Hirschhorn, 1996, p. 117). Moreover, according to Ince (2000), "Orlan has been called a publicity freak and a surgery junkie, and had her mental equilibrium repeatedly called into question" (p. 45). Others hail her work as a radical feminist critique of beauty practices. Anthony Shelton (1996), for example, writes that Orlan's goal is to spare women from cosmetic surgery by showing its graphic and horrible side (p. 107). Orlan, however, states, "My work is not a stand against cosmetic surgery, but against the standards of beauty, against the dictates of a dominant ideology that impresses itself more and more on the feminine flesh" (Brand, 2000, p. 293). Davis (1997) posits that for Orlan, cosmetic surgery is a way for women to regain control over their bodies, but she believes Orlan's intention was never meant to reflect the surgical experiences of "ordinary" women (p. 176). Davis conducted in-depth interviews with women who had or planned to have cosmetic surgery and found that the women did not have surgery to become more beautiful. Davis writes, "Cosmetic surgery was an intervention in identity. It enabled them to reduce the distance between the internal and external so that others could see them as they saw themselves" (p. 175). Others, such as Naomi Wolf (1991), are not as optimistic about women's motivation to have surgery. She posits that women are pressured to have cosmetic surgery in order to obtain the ideals promoted by the male-dominated fashion industry and its advertising campaigns. Moreover, while more women than men have cosmetic surgery, the number of men having surgery is increasing (Sarwer & Crerand, 2004).

Technology has given us safer, less invasive surgical procedures, and advertising has increased media awareness about those procedures. We are witnessing a greater willingness of people to have surgery to enhance their appearance, in reality as well as on reality television. There is no consensus on the meaning of enhancing the body. Some condemn it, while others celebrate it. We may hold strong opinions, but like KeiferBoyd (2003) we believe our role as art teachers is to guide students to construct their own meanings by critically examining how their immediate concerns are represented by others, particularly through mass media and popular culture, and contemporary art.

Reconstructing Notions of Beauty in the Art Classroom

Art educators Charles Garoian and Yvonne Gaudelius (2001) argue that teachers can use the work of Orlan as a critical metaphor to question the aesthetic impact of technology and to critique the discourse that normalizes cosmetic surgery. They write, "The rigorous documentation of her surgeries and her performances of canonical 'beauty' function technologically to enable us to question various ways in which the body makes and carries meaning" (p. 342). Orlan acknowledges the ways in which our choices about appearance are social and historical (Pitts, 2003) and may share common ground with teenagers who are exploring and experimenting with their identity through fashion, tattooing, and piercing. Admittedly, Orlan's work is provocative and not all teachers will be comfortable discussing her work. However, discussions around Orlan's art can address questions raised by Peg Zeglin Brand (2000), in the introduction to her book, Beauty Matters. She asks, "What is beauty and how does it operate within the context of our particular culture? What are the ideals of feminine beauty and are they relevant to portraying beauty in art?" (p. 4).

Teachers can help students carefully examine "before and after" images used in cosmetic surgery and consider how these images rely on "photographic truth." Sturken and Cartwright's (2001) book, Practice of Looking: An Introduction to Visual Culture, is particularly helpful to teachers. Their work can enable teachers to lead discussions on the role these photographs play as scientific evidence. Sturken and Cartwright (2001) write, "The photographic image has often been seen as an entity stripped of intentionality, through which the truth can be told without mediation or subjective distortion" (p. 280). As viewers, we are apt to accept an image as reality, since as Sturken and Cartwright assert, "Scientific imagery often comes to us with confident authority behind it... we often assume it represents objective knowledge" (p. 279). Through the use of "before" and "after" images, the media attempts to provide scientific evidence that surgery has not only improved appearance, but has provided happiness. Students can be led through discussions to see that "before and after" images, like other visual images, are in need of interpretation.

According to Barrett (2003), "If the messages carried by visual culture are not interpreted, we will be unwittingly buying, wearing, promoting, and otherwise consuming opinions with which we may or may not agree" (p. 12). Advertisements for cosmetic surgery images carry ideology, but may appear neutral. We asked students enrolled in a course on visual culture to collect and discuss ads for cosmetic surgery. Using a variety of ads, students pointed out that reproductions showing people prior to surgery were dimly lit, whereas "after" images were brighter. Others noted that "after" images showed people with better posture and with smiling faces. One student located an ad in which a woman of color was shown with lighter skin after her surgery, even though the ad was for a liposuction procedure. We also viewed and discussed how art and aesthetics were used to advertise cosmetic surgery. A number of ads, like Orlan, appropriated images from Renaissance paintings, such as Botticelli's Venus. Elevate, a magazine devoted entirely to cosmetic enhancement, proved to be good source for images that demonstrate the symbiotic relationship between art and cosmetic surgery.

Sturken and Cartwright remind us that all ads are about transformation in that they are designed to offer people who are in some way dissatisfied with a product that will alleviate their dissatisfaction. According to Sturken and Cartwright (2001), ads offer "figures of glamour that consumers can envy and wish to emulate, people who are presented as already transformed, bodies that appear perfect and yet somehow attainable" (p. 213). Orlan's work is in direct contrast to the "before-and-after" images of people who have undergone cosmetic surgery used so pervasively by media. Orlan's photographs of her bruised and swollen postoperative face highlight the process of cosmetic surgery and not its end result. When examining advertisements, television, or the work of Orlan, students can consider ways in which changing one's appearance changes one's identity. "Where is your identity located? Is it visible or invisible?"

With younger students, we can examine notions of beauty prevalent in popular culture, starting with fairytales. Many cosmetic surgery based reality shows are updated versions of fairy tales that offer magical and instant transformation. Books such as Robert Munsch's (1980) The Paper Rag Princess provide an alternative to the typical tale. Munsch's book begins with the usual tale of Elizabeth, "a beautiful princess, who lived in a castle, had expensive princess clothes, and was going to marry a prince named Ronald" (p. 2). Her plans are changed after a dragon smashes her castle, burns her clothes, and carries off Prince Ronald. In Munsch's tale, however, it is Elizabeth who cleverly outsmarts the dragon and rescues Ronald. When the prince rejects Elizabeth because of her dirty clothes and messy hair, she leaves him, dancing off into the sunset, joyfully and alone. The film, Shrek (2003), also parodies traditional fairy tales. Stories such as this inform students that women should not feel that the only quality they have to offer is their appearance, or that it should be the primary means through with they will be evaluated by others.


We echo Orlan and do not take a stand against cosmetic surgery. We wish to help students consider how their notions about beauty are socially constructed and to provide them with tools for promoting the respect and appreciation of inner qualities and individual strengths. We are aware, however, that for those students who are teased unmercifully by classmates, cosmetic surgery holds great promise to end their suffering. We also do not want to alienate students for their choice to elect to have cosmetic surgery. Perhaps, in the near future, cosmetic surgery will be considered as common as cutting or dying one's hair or wearing make-up. On the other hand, it may be regarded with contempt, in the same manner as foot binding. Regardless, our intent is to help students critically examine the messages put forth by popular culture, as well \as the fine arts, and to make informed choices to accept or reject those messages.

People become dissatisfied with their appearance when they perceive a discrepancy between their actual appearance and an ideal, whether that ideal is that of a doctor, celebrity, or a toy manufacturer.

Through the use of "before" and "after" images, the media attempts to provide scientific evidence that surgery has not only improved appearance, but has provided happiness. Students can be led through discussions to see that "before and after" images, like other visual images, are in need of interpretation.


1 The authors thank reviewer Deborah SmithShank for her suggestion to use the example of Disney's Little Mermaid(TM) to help "make the case for cultural icons of beauty and ugliness."


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Lorrie Blair is associate professor in the Department of Art Education, Concordia University, Montreal.

E-mail: [email protected]

Maya Shalmon is a graduate student at Concordia in Creative Arts Therapies.

E-mail: [email protected]

Copyright National Art Education Association May 2005