What Plastic Surgery Looks Like Today

It's hard to get by as a woman in America without developing some kind of hangup about your face, body, and its perceived flaws. Scratch that — it's hard to get by as a human person with access to mass media, a mirror, or even a well-polished window without noticing a few things you'd like to change about yourself. In the same way that we fill in swamps and put golf courses in the desert, surgical procedures that alter the landscape of the human face and body are a hallmark of most technologically advanced societies.

According to the American Society of Plastic Surgeons, 1.6 million invasive surgeries were performed in the U.S. in 2012. It's obvious that this is becoming more and more of a norm, but the subject itself is still a controversial one. For all the talk of body positivity and feminism as a movement for choice above all, there's still an all-too-common note of judgment when we talk about women who've "had work done."

So, where does that leave the women who are making the seemingly monumental choice to actually go under the knife? They're no more immune to the prejudices and pressures than those of us watching the Oscars and commenting on so-and-so's neck or what's-her-name's nose. Most of the women we approached for this piece preferred to remain anonymous and several even stated that if directly asked by friends, family, or acquaintances about surgery, they would lie.

One woman in her early 20s, whom we'll call Nancy, has never told anyone other than her mother about the surgery she got as a teenager. Nancy had one "droopy" eye since birth, and though it didn't affect her vision in any way, she said she always felt there was something "wrong" with her. "People would ask me if I was awake...I think I was kind of obsessed with it. I would look at myself in the mirror and lift my eyelid and picture myself normal," she explains. It was, naturally, the glorious Internet that clued her in to a procedure called blepharoplasty.

Nancy says that getting her eyelid lifted was, in many ways, something that she needed internally to feel comfortable. "I know that I don't have a perfect looking face," she said, "but my motivations were more to look normal than to look beautiful." But, she still wonders whether she made a healthy choice. In addition to the typical teenage body-image woes, she was subject to a fair amount of what she describes as standard criticism from her Chinese family. She muses: "I did feel pressure to look like a certain Asian ideal...I used to use lightening soap in high school. I would get really tan, and my parents or relatives would make comments. My grandma said, 'Your skin is so dark, you look like you're from the nóngcūn!' — basically saying I look like a Chinese farmer's daughter. Maybe those comments kinda got to me, and I wanted to fit that ideal."

Aside from American and Chinese beauty standards, when it comes to attitudes toward cosmetic surgery, Nancy has had similar experiences that make her very private about her surgery. "I think there's a huge stigma about this surgery in the East Asian community. A blepharoplasty is typically done to get the double eyelid when you don't have it," she explained. Though Nancy herself isn't convinced this is true, she's acutely aware of the fact that "people associate the surgery with wanting to get the double eyelid to look whiter. People think you're betraying your culture or giving into this pressure of wanting to be white. I think it's less about people knowing that I had cosmetic surgery and more about the connotation of wanting to be white."

Whatever Nancy's true reasons were, it seems like there's almost a presumption that any woman who gets cosmetic surgery must be insecure or unhappy. In fact, we saw that very debate play out in the comments section of this article that appeared on R29 in January. One commenter wrote that people often tell her she was "fine the way she was" before getting rhinoplasty, in some odd combination of both pity and a lack of respect for her decision to get the surgery. Yet, for every Nancy who does question her choice and her motivations, there is someone like Jeanne. Jeanne, a mother of two and a real estate agent, had a breast augmentation when she was 49 years old. She had been considering the procedure for nearly 35 years — "Now I wonder, what took me so long?"

The answer to that question lies in some deeper transformations in Jeanne's life. Most of her adulthood was spent working from home and raising her two children. Having kids didn't help her complaints about her body (let's just say the phrase "suck the life out of you" was used). Once the kids left the house, Jeanne says the focus shifted inward, where it hadn't been for a long time. "That strength was there on the outside for my children. I think I sort of hid my inner demon, my inner go-getter, and filtered it onto the kids. Once they were gone, that's when things started to change." So, while it was a decision several decades in the making, she admits that waiting was probably the right choice: "I don't know if I could have had this surgery 20 years ago. I don't know if I would have been ready."

Jeanne is remarkably conscious of the forces that shape our societal consciousness of what is and what isn't attractive. She cites a "Barbie mentality," and though she felt like she was "missing something, that hourglass shape that should be there," Jeanne quickly corrects herself, adding "should be — in my mind."

Whether you're more of a Jeanne or a Nancy in your attitude toward cosmetic surgery, anyone considering a procedure has to go through a certain level of screening with their chosen doctor. Though it varies on a case-by-case basis, most doctors, like Dr. Samir Pancholi, the president of the American Board of Cosmetic Surgery, take that aspect of the process rather more seriously.

While there isn't a rigidly standardized set of guidelines dictating how doctors should approach patients' mental health, Dr. Pancholi says, "there's always some element of asking questions and digging into the patient's history. A dialogue and a relationship must be formed." While more conflicted patients will generally be referred to a counselor, even just starting that conversation can be enough for Pancholi to detect certain red flags. He brings up a story of a recent patient who wanted to change her nose, but couldn't quite explain why. It turned out that "about three years ago, she had been in an abusive relationship, and her boyfriend at the time had punched her in the nose. Every time she looks in the mirror, she remembers that incident. If I were to operate on her, I would have no idea what I was changing, or if it would even help. Even if I make her nose perfect, she's still going to have that memory and that association, until she gets that psychological aspect addressed."

In cases like this, doctors have to have a "very candid" conversation and recommend further counseling before operating, if the surgery is even done at all. But, generally, it's not as clear-cut as that.

"I can't tell you what the right attitude to have is, Pancholi says. "Generally, we want to see if the surgery is internally or externally motivated — if it's motivated by external factors like ridicule, it's very simple: That's not a good reason to have surgery. If it's internal, there are different problems that can crop up, including body dysmorphic disorder."

Beyond what society might see as the typical motivations fostered by mass media and misogyny, there are women who come to cosmetic surgery from a different context entirely. In fact, you really can't have a relevant discussion about cosmetic surgery today without addressing the transgender experience. Facial cosmetic procedures can be an integral part of the deeply personal process of transition. That was the case for Kari Nebhut, a transwoman who, in addition to breast augmentation, had a face lift, lip implant, cheek implants, chin implant, brow shave, and lip shortening in order to feel more comfortable in her body and more effectively "pass" as a woman. "I was concerned primarily with passing," Kari explains, and "there was no vanity involved, though I am happy with how I look now." When speaking with her doctor, her only explicit direction was that she didn't want to look male — a gender to which she hadn't related on any level since the age of four.

Jeanne and Nancy both described their surgeries as something that gave them a huge boost in confidence and, in many ways, changed the way they lived their lives. For Kari, it was "something I needed to survive, the only way I could live my life correctly. I don’t doubt that there are ciswomen that have felt the same, but for me it was either have the surgery or live in fear."

The fact that Kari had already been in therapy for years doesn't mean there weren't some deep psychological changes that accompanied her physical transformation. In fact (and get ready to have your heart warmed), she says that her relationship to her body evolved in a significant way before and after her cosmetic surgery. "I had never had any connection to my appearance prior to my surgery. Looking in the mirror was like looking at a photograph in a magazine," she said of her life before the surgery. After, though? It was "the first time I looked in the mirror and felt a connection to who I saw."

Indeed, though many of the women we approached for this story were reluctant to be quoted and a few even expressed minor regrets about their decision, Jeanne and Kari in particular have staunchly positive attitudes about their surgery — and why shouldn't they? Even Nancy, who acknowledges some self-described "hypocritical" prejudices of her own that label cosmetic surgery as something for the vain and shallow, seems determined not to let her own self-esteem fall prey to that tendency.

These stories leave us with a nuanced view of how complex the issue of cosmetic surgery is in American culture today. On the one hand, beauty continues to be a double-edged sword (not to mention a double standard) for women in theory and in practice. On the other, the past few years have seen a massive surge of female-led conversations about body positivity and self-love. The reality? The vast majority of women — including people like Jeanne, Nancy, and Kari — live somewhere in between those two things. Yes, we want to love our bodies as they are, and we want to celebrate them. And, yet, we can't deny that we are affected by the standards of beauty and what a "true woman" looks like that have been aggressively present since birth on television, in magazines, and on the shelves at the toy store. If asked about the intersection between badass, inward-leaning, progressively minded feminism and cosmetic surgery, we would say that it is a complicated question that asks us to unpack a lot of our deepest hangups about beauty and femininity and feminism itself. Or, maybe, we'd just direct them straight to this Beyoncé-like quote from Jeanne: "My self-esteem skyrocketed. It had always been there, but not to this degree. Now I wake up in the morning and I say "I got this.'"