Being a person who can now consider myself among those who have sought and received plastic surgery, and considering seeking additional intervention (some, but not all possibilities of which, are detailed in “What is Transitioning?”), I have been thinking more about the effect this shift in perspective has had on myself and on what role it (“it” being both my thoughts and plastic surgery more generally) has had (or will have) on the world around me.
Stigma
When I was younger, plastic surgery seemed to hold an unambiguous place among the unspeakable shames that the shallow, vapid, and inauthentic among us cradled in their quivering and spider-like grasp, as if it were some fragile and paper-thin totem that when carried would protect the bearer from time, age, decay, and — perhaps most sinisterly — from themselves, as if someone had folded up Dorian Gray’s portrait and bestowed it upon some wistfully unwitting victim like a kind of monkey’s paw. The Journal of the American Society of Plastic Surgeons tends to agree that this perspective is fairly prevalent, although perhaps expressed with a little less vitriol.
But this disdain is conditional. As much as it seems appropriate to contemptuously whisper about someone who we may know or suspect has undergone some expensive and unnecessary procedure purely for the purpose of vanity — or worse, because of either a sense of superiority or inferiority on either their or our parts — if the circumstances fell within a thin criterion the narrative would quickly change: if what for one person was purely aesthetic were for another reconstructive, the collective story would quickly change to one of sympathy and extolled bravery of the recipient. And this story of reconstruction seems to have extended to include those pursuing gender transition (at least among trans-affirming people).
But why is this? Why has “Plastic Surgery” (notably named after “plastikos,” Greek for “to mold” or “to shape,” as opposed to synthetic polymers, despite how it almost feels like such surgery is to replace an authentic human being with a fantastical simulacrum made of plastic) been divided into the sub-genres of “Reconstructive,” “Gender Affirming,” and… “Cosmetic,” implying — respectively — healing, authenticating, and frivolous?
Harm
It is generally and widely known that portrayals of women often emphasize form and beauty over accomplishment or capability. It seems that even with the shift away from heroin chic to a revitalized body positivity movement (although this may be shifting back after the introduction of Ozempic), attitudes are still largely centered around physical bodies, which of course does little to prevent women's worth from being directly correlated to their appearance (Rachel Cohen, Lauren Irwin, Toby Newton-John, and Amy Slater; and separately Amber E. Kinser).
This harm has been widely discussed in our culture since at least the 1970s by people like Jean Kilbourne (Killing us Softly), specifically on how public and ubiquitous images of “ideal” bodies can shape and affect people’s perceptions of others — and, of course, themselves. This seems to create (or, more likely, help perpetuate) an impossible double-standard: we must all be [impossibly] beautiful, but by doing so we are participating in the deprecation of other people’s inherint self-worth and furthering the very destructive systems from which we, ourselves, are trying to escape. To put plainly: not being beautiful is to be subjected to harm; to be beautiful is to direct the harm to others.
Actualization
Hot Take: The same pressures for women to be — or at least to feel — beautiful are the pressures that lead people to seek reconstructive surgery or gender affirming care.
For the person who has suffered some injury, the record of which is literally marked physically and visibly on their body, taking action to “normalize” themselves can be an important part of the healing process. The desire to look the way they once did — to look “whole”… or to look “normal” again — is profound for many people. But that framing: “normal;” is perhaps a product of the same pressure that people spared from such injury feel anyway — the “injury” they may feel is one of not understanding themselves to be “good enough,” or “beautiful,” or even “normal”… although what those each comprise is largely manufactured in our minds from the narratives crafted to entice our aesthetic sensibilities so particularly as to be unattainable or even unreal.
For the person who has the misfortune of experiencing a puberty unaligned with their identity, that offense is similarly etched into their physical being. Despite the self-proclaimed virtues of post-genderism, the experience of many transgender people is that the actual physical representations of sexual dimorphism in their bodies is cause for distress (Julia Serrano). For these people, seeking intervention to align their physical bodies with that which they consider “normal” for their gender identity is often critical. But this, again, is likely a product of the same cultural expectations of physical embodiment.
So what then for the cisgender person who hasn’t experienced some body-altering accident or illness? Where is an appropriate place to delineate between the purely-cosmetic and the reactualizing? How different can we say the internal experience really is for a transgender man who is seeking a double-mastectomy from that of a cisgender woman who is seeking a breast reconstruction after cancer treatment? What about someone seeking fractional CO2 scar reduction laser therapy as compared to someone seeking laser hair removal? What about someone having a mommy makeover in contrast to someone entering each and every meal into cronometer.com and following a strict body-building regimen?
Participation
For me, I wonder how much I am affected by these pressures to be the embodiment of health, youth, and beauty. I also wonder how much my participation in surgical interventions and behavioral curation furthers these same insidious images, ideas, and narratives.
Perhaps it is unknowable.
But not knowing hasn’t really ever stopped anyone yet.
