The Beauty-Industrial Complex

There have been a lot of reviews lately of Alex Kuczynski’s Beauty Junkies: Inside our $15 Billion Obsession with Cosmetic Surgery. Kuczynski writes for the NYT’s Thursday Styles section, and has a journalist’s flair for finding the most bizarre instances of consumer trends (such as an $11,000 South African surgery/safari package). I found Rebecca Mead’s take particularly insightful:

“We have begun to think of our bodies as something like an accessory that can be modified when necessary, discarded when it is worn out, and upgraded when required, a leathery sack to transport us from one medical specialist to the next,” Kuczynski writes; and the analogy is apt . . . . The new idea offered by the contemporary culture of cosmetic surgery is that it is the vessel itself that we must value, rather than the soul or spirit that it contains.

Mead also focuses on an underreported aspect of Kuczynski’s analysis: how business pressures and laws governing health care and insurance are spurring the trend:

Kuczynski argues that the soaring incidence of cosmetic surgery—a nearly fivefold increase in the number of cosmetic procedures performed on Americans during the past decade—has been driven by market forces rather than by the measurable health needs of the nation. Surgeons exhausted by the medical-insurance morass are flocking to the field. “If you’re a doctor working in this kind of environment, do you want to spend an hour removing a freckle and get paid $12 in two months by some insurance company? Or do you want to spend fifteen minutes putting Botox into someone’s face and get $1,000 in cash five minutes later?” one attendee at a convention of plastic surgeons asks.

Indeed, many moves to “high end health care” are driven by frustration with insurance providers. Some argue that a move to “free up” the health care field from regulation might help restore a balance. But a book on plastic surgery far more critical than Kuczynski’s suggests there is a deeper “market based” method to the industry. . .

Sheila Jeffreys’ Beauty and Misogyny is a provocative comparison between cosmetic surgery in the developed world and far more widely criticized “beauty practices” in less developed countries. Jeffreys admits that practices like FGM are forced onto women, but questions whether “market autonomy” is more than illusory:

There is, however, a major difference in the way that harmful beauty practices are inscribed in culture and enforced on women in the west. This is the fact that they have been constructed into major industries that make large fortunes for transnational corporations and are a significant force in the global economy. The profitability of these practices to the cosmetics, sex, fashion, advertising and medical industries creates a major obstacle to women’s ability to resist and eliminate them. There is so much money in these industries based on commercializing harmful cultural practices that they constitute a massive political force that requires the continuance of women’s pain. (172).

One need not accept Jeffreys’ larger critique of capitalism in order to take seriously her questioning of the degree to which surgeries like the ones described by Kuczynski really arise out of “free choices.” A literature on beauty and workplace competition suggests that those who don’t “get ahead” on this plane can be “left behind.” Jeffreys’ forceful indictment of the industry may shock us into recognition of this point from Carol Rose, on the need to supplement monadic economic models of preferences with a broader awareness of how preferences arise:

Economists generally tend to accept preferences as simply given, or in the economic lingo, ‘exogenous,’ and to refer most decisions to a kind of core of self-interest that aims to satisfy preferences as ‘exogenously’ given. But where do people’s preferences come from? . . . [W]hat makes people change their minds about preferences, and about working with others? What, in short, persuades? Those questions open the door to expressive issues–that is to say, the humanities.

If for no other reason than helping us understand the origins of preferences for cosmetic surgery, Kuczynski’s book does a service. Consider this passage:

Extreme Makeover crystallizes in prime time the belief that our looks and our notions of self-esteem are matters of life and death and that change should not stop short of complete transformation. . . .The term ‘self-esteem’ is a mantra that is repeated, yogilike, throughout the episodes [of Extreme Makeover]. Through it all, there is never a question that beautiful is good, a way to convey the true identity of the soul underneath, lost behind pounds of fat, submerged by a lifetime of bad habits. Being beautiful is the final path to confidence and to the life that ought to have been lived for so many years.

Given these unmistakable cultural signals, it should come as no surprise that many “Americans are willing to fork over the money, even if that means putting the surgery on a credit card or borrowing from a so-called beauty bank-an agency that loans money to cosmetic surgery patients who are willing to pay interest rates that make the Mafia’s vig look like a great deal.” Kuczynski notes that “More than two-thirds of Americans who now choose elective cosrnetic surgery make less than $50,000 a year.”

Something is amiss here, and I can only hint at the ultimate issue here; suffice it to say, “happiness is in the eye of the beholder.” But for now, let me recommend Kuczynski’s book as both a symptom of, and an indictment of, a sea-change in our culture deserving some form of legal (or at least tax) intervention.

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