Victoria Pitts-Taylor. Studies in Gender and Sexuality. Volume 10, Issue 3. July-September 2009.
Against approaches that center the subject—the cosmetic surgery patient—as the primary site of inquiry regarding the “truth” of cosmetic surgery, I argue that we must rethink the positioning of the subject in considering cosmetic surgery’s meanings. Here I offer a brief discussion of various feminist theories of the cosmetic surgery patient, as well as an account of my own experience of cosmetic surgery, to explore how the cosmetic surgery patient is semantically unstable, named and identified through a variety of discourses and social relations. This semantic instability suggests a need to examine the ongoing processes by which cosmetic surgery comes to have meaning and by which the subjectivity of the cosmetic surgery patient is produced.
Much investigation of cosmetic surgery, including a good deal of feminist scholarship, has focused on examining the deep motives, mental health, or political consciousness of women who undergo cosmetic surgery. If one looks to what various critics have said about the cosmetic surgery patient, she can be historicized as an individual with deep psychoanalytic problems, various psychiatric disorders, a variety of moral weaknesses, or a politically oppressed consciousness. These approaches have often centered the subject—the cosmetic surgery patient as the primary site of inquiry regarding the “truth” of cosmetic surgery. Feminist researchers have contributed to this discussion partly by debating the agency of the cosmetic surgery patient. But I believe that we must rethink the positioning of the subject in considering cosmetic surgery’s meanings. Here I offer a brief discussion of various feminist theories of the cosmetic surgery patient, as well as an account of my own experience of cosmetic surgery, to explore how the cosmetic surgery patient is semantically unstable, named and identified through a variety of discourses and social relations. This semantic instability suggests a need to examine the ongoing processes by which cosmetic surgery comes to have meaning and by which the subjectivity of the cosmetic surgery patient is produced.
My broader project has investigated the interrogations of female subjectivity in contemporary discourses on cosmetic surgery, including feminist, psychiatric, and medical discourses (Pitts-Taylor, 2007). I argue that these, along with other discourses interested in the deep identity of the cosmetic surgery patient, are epistemologically problematic to the extent that they have generated what Foucault (1989) called a hermeneutics of the serf. That is, they are not simply revelatory but rather productive and inscriptive, lending a deep interiority to cosmetic surgery that locates its meanings as adhering in significant ways in the individual. For example, for decades, psychiatrists and psychotherapists have argued that cosmetic surgery patients were prone to a whole range of mental health problems. These range from a variety of sexual neuroses, when Freudian analysis was more in vogue, to body dysmorphic disorder, the latest psychiatric label for cosmetic surgery addiction. I have argued elsewhere that in psychiatric discourse, the cosmetic surgery patient is not simply being understood; rather, the truth of her identity is also being produced (Pitts-Taylor, 2007).
Feminist discourse can also constitute a hermeneutics of the self in the Foucaultian sense. In feminism, the female cosmetic surgery patient has been the object of an intense debate over the possibility of her agency. While linking cosmetic surgery directly to the social problem of patriarchy, feminists have also questioned the mental health of individual female cosmetic surgery patients. This approach was largely unchallenged until 1995, when Kathy Davis (1995) sought to use the voices of cosmetic surgery patients themselves to explain why women undergo it. Davis argued that women’s decisions to get cosmetic surgery were rational given the extensive social pressures women faced. Despite Davis’s work, feminists like Virginia Blum (2003) and Eve Ensler (2004) have continued to portray women who get cosmetic surgery as self-hating and self-mutilating.
The Structure-Agency Debate and Beyond
The so-called structure-agency debate, centered on the character of women’s subjectivity, has shaped a great deal of feminist scholarship on cosmetic surgery in the past several decades. The cultural or radical feminist responses to cosmetic surgery, where the cosmetic surgery patient is enacting bodily self-hatred as an outcome of patriarchal pressures, represents one side of the debate. Writers like Blum, Ensler, and Sheila Jeffreys offer contemporary examples of the decades-long view that women’s desires to get cosmetic surgery are evidence of self-hatred. Some of these writers, like Blum (2003), have identified women cosmetic surgery patients as self-mutilators and have theorized that female patients have body image problems that can be comparable to, if not equated with, mental illness. Blum describes a process of “becoming surgical,” where women begin to see themselves through the narcissistic, technological lens of perfectionism. Once they experience one cosmetic surgery, they will want others because they will have become obsessed with the promise of a perfect body. Addiction to cosmetic surgery is part of the practice, she argues, and women cosmetic surgery patients are always in danger of being perversely addicted. Other radical feminists, including Eve Ensler, have emphasized problems with the consciousness of female cosmetic surgery patients on a political level, depicting them as male-identified or as having false consciousness. In her play The Good Body, for example, Ensler (2004) depicts a woman who undergoes numerous plastic surgeries as a surgery junkie entirely under the influence of her husband, a cosmetic surgeon. The woman undertakes surgery after surgery in order to keep him interested in her. Although she appears to be indifferent to her health, she sees her body as a zone of perfectibility.
Liz Frost (1999) points out, however, the essentialism implied in such treatments of cosmetic surgery. The idea that women’s bodies are authentic only when they are left alone—Ensler, for example, wants women to “love the body … stop fixing it” (Ensler, 2004, p. xv)—problematically constructs a natural, essential, authentic body to be contrasted to a technologized, “unnatural” body. Further, Frost sees an essentialist idea of an “authentic” consciousness at work: an authentic subject would not undergo cosmetic surgery, and cosmetic surgery cannot be seen as an authentic choice. As many critics of radical feminism have pointed out, such views of the body/self are falsely dichotomous and homogenizing. They universalize and fix women’s embodied subjectivity and treat cosmetic surgery patients monolithically. In this logic, cosmetic surgeries are pretty much all the same, and so are the women who get them: to greater or lesser degrees victimized, self-hating, and estranged from their authentic selves and bodies.
Kathy Davis’s seminal 1995 work, Reshaping the Female Body, represented a departure from what was then the expected feminist condemnation of cosmetic surgery, and in particular, from the view that there was something wrong with the subjectivity of female cosmetic surgery patients. She has been called an “agency” feminist for this view, and her work sparked a structure-agency debate that had already been, or would be, rehearsed in relation to other controversial practices like pornography, sex, work, and body art. What motivated Davis to examine women’s experiences with cosmetic surgery is what she calls her “moral dilemma” as a feminist, wherein she felt a need to criticize the practice of cosmetic surgery without treating women cosmetic surgery patients as “cultural dupes.” Based on her interviews with cosmetic surgery patients in The Netherlands, Davis argued that cosmetic surgery does not modify the body as a passive object. For her, practices like cosmetic surgery are expressions of the self’s dynamic relation to and with the body rather than instances of extreme bodily objectification. They are instances of women’s negotiations of their embodiment and of the social pressures regarding appearance. Moreover, she suggested that women who chose cosmetic surgery were exercising rationality rather than self-hatred. Women saw their surgeries as reasonable given their awareness of how much beauty and youth are socially valorized.
Although Davis’s (1995) work created a considerable stir at the time, more recently a number of feminist scholars writing on cosmetic surgery, including Frost (1999), Rebecca Ancheta (2002), Suzanne Fraser (2003), and others have identified this debate as a dead end, oversimplifying and polarizing the matter, in Ancheta’s terms. One of the problems shared by both sides of the structure-agency divide is that they insist on the centrality of women’s subjectivity in problematizing cosmetic surgery. For instance, she is either rational or she is self-hating; the status of a female cosmetic surgery patient’s subjectivity offers the answer to most of the questions we are asking about the practice. Either way, this debate assumes a fixed individual subject, the “truth” of whom can explain the real essence of cosmetic surgery. I make the case that we ought instead to think of the subject of cosmetic surgery as shaped in and through the process of becoming and being a cosmetic surgery patient (Pitts-Taylor, 2007). Similarly, Suzanne Fraser has pointed out that aiming to figure out the “‘true’ interior of the subject” reifies and fixes her (Fraser, 2003, p. 28). Instead, Fraser argues that we ought to look at the political and ideological underpinnings to any understanding of agency and think through the agency of the subject as something that is shaped in the processes of the subject being created. Meredith Jones (2008), too, displaces the subject of cosmetic surgery from the center of analysis. She looks at cosmetic surgery through the lens of actor-network theory, displacing the patient as the center of inquiry and positioning her as only one of multiple “actors,” including the surgeon, the technologies, the media, and other aspects of cosmetic culture. For her, the world of cosmetic surgery is one in which agency moves through various relationships between humans and technologies. All of these approaches might be termed “postessentialist” in that they refuse to valorize an authentic, natural female body or a proper female subjectivity, and they insist that we must think of the meanings of bodily practices like cosmetic surgery as neither solely internal nor external but rather as intersubjective.
I see the urgent need for such a move. Although they identify patriarchy and heteronormativity as the root problems of cosmetic surgery, the meanings of cosmetic surgery in “structure-agency” analyses ultimately rest on making sense of the cosmetic surgery subject. But this is problematic to the extent that both sides assume a cosmetic surgery subject that precedes the experiences of surgery itself. She is either rationally seeking empowerment, as in Davis’s (1995) account, or irrationally pursuing suffering, as in Blum’s (2003) account. Along with Suzanne Fraser and others, I argue that instead of looking at an oppressed or liberated cosmetic surgery patient, we ought to think about cosmetic surgery in process to understand its significance. As Fraser (2003) puts it, we must shift “the object of analysis from the ‘true’ interior of the subject to the ideological and political implications of the subject’s use of language” (p. 28). Further, as Jones (2008) suggests, the patient/subject should be considered only one of many involved in producing that language. The meanings of cosmetic surgery and of the patient are produced by multiple actors and forces and unfold through the processes of cosmetic surgery.
In personal narratives of cosmetic surgery, such as those found in interviews, we can find evidence of deep social interaction between the subject and the cultural and social context. For example, in recent interview accounts by Debra Gimlin, Liz Frost, and Rebecca Ancheta, women’s narratives reveal complex grappling with stigma, pathologization, and the judgment of others, and they suggest that women use narrative strategies in order to be heard (Frost, 1999; Ancheta, 2002; Gimlin, 2002). The broader social and medical context might influence these strategies. For example, women desiring coverage from a national health service (like Davis’s interviewees) might emphasize how much they suffer from feeling ugly or abnormal, and women speaking in an American context might emphasize liberal goals like personal empowerment and equal opportunity.1 The ways in which cosmetic surgeries are represented and sold to women in these different contexts may also be significant factors influencing their meanings, as are other prominent discourses circulating around what cosmetic surgery means and about whom cosmetic surgery patients are. These contexts can shape not only the social climate in which they are undertaken but also the personal significance of cosmetic surgery for women themselves.
My own cosmetic surgery experience underscored the need to think about the narrative of the self in such temporally complex and intersubjective ways. From my patient’s-eye view, cosmetic surgery is a very personal experience, but it is also incredibly social, public, and semantically unstable, one that is not static but unfolds through various processes of imbuing the body and self with symbolic meaning.
Becoming/Being a Patient
I became a cosmetic surgery patient in the midst of researching my book Surgery Junkies: Wellness and Pathology in Cosmetic Culture (2007). After having spent many months in cosmetic surgery clinics as a researcher, I decided become a patient.
I was significantly motivated by my curiosity about cosmetic surgery. I was fascinated by the physical processes of cosmetic surgery—would a rhinoplasty really transform my whole face, for example?—and even more by the social contests that stormed around the cosmetic surgery patient. Having spent considerable time in cosmetic surgery clinics, I had already felt sympathy for the women and men I encountered there. Most of them seemed to be enthusiastic about their surgeries and the results they achieved, with the exception of those who were still in bandages, who were generally miserable. Some were thinking of having another surgery at some point. But they did not seem to be the crazy junkies one might expect from media accounts, nor did they seem to be the self-hating victims depicted in some feminist descriptions. They were in many ways unremarkable, but their world was filled with social tensions, scrutiny, and advice that each of them had to negotiate. With magazines, advertisements, television and media accounts presenting strong opinions about cosmetic surgery, and family, friends, and colleagues debating each of theirs in particular, they seemed to be surrounded on all sides with conflict. When I became a patient, so was I.
Although the experience of having cosmetic surgery was fraught with social conflict, which I describe in more detail later, the personal decision to transform my face was not an agonized one. The technological achievements of cosmetic surgeons are impressive, even if they do not live up to the exaggerated promises of the industry. I was attracted to the possibility of being better looking, normatively speaking. My nose seemed a good candidate for transformation; submitting it to aesthetic judgment, it was not what I would have called a beautiful nose. And I did not feel the moral weight of the decision as many do; as a scholar of body practices for the past decade, I frankly disagreed with the reigning moral imperatives surrounding the “natural” body. Bodies, it seems to me, have always been transformed, in every culture and period, including indigenous ones; there simply are no “natural”—in terms of pristine bodies to emulate.
Surely, it is useless to argue on my own behalf against theories that would describe my decision as an act of self-hatred; my own ability to speak for myself is rendered mute by theories of false consciousness. At the same time, I hesitate to use the liberal terms of empowerment and choice employed by so-called agency theorists. This language is sometimes used by many women describing the decision to undergo major body transformation, but it makes me uneasy that the same language, borrowed wholesale from liberal feminism, is used by the cosmetic surgery industry to trumpet their products and procedures. It is a language that is easy at hand and that is culturally legible in a society like ours. Moreover, it is often offered after being asked to give an account of oneself, to defend one’s decision. Altering my face through surgery may have been an act of agency, in the sense of my having willfully acted, but I can’t argue that it was an attempt to empower myself any more than getting a new hairstyle is. I neither hated myself nor thought I might truly have more power.
Although many will disagree with me, I want to argue that there was no central or fundamental cosmetic surgery patient inside of me waiting to be given the opportunity to express herself through surgery; my being a cosmetic surgery patient can be understood only through examining the various processes involved in getting cosmetic surgery. It seems obvious when put this way, but only in getting cosmetic surgery was I a cosmetic surgery patient.
In January 2005, I shopped for surgeons; was interviewed by doctors and nurses to determine whether I was a “good candidate” for surgery; read books, magazines, and brochures about rhinoplasty; debated with my friends and family about permanently altering my face; and went under the knife in an ambulatory clinic in Manhattan. When I emerged, my face was bandaged, one eye was swollen shut, and the pain seemed unbearable for 8 or 9 hr. Over the next few days I dealt with bleeding, swelling, and bruising. I went to my doctor’s appointments in taxis wearing a scarf around my head, which was the best I could do to camouflage the state of my face. Otherwise I spent a lot of time in bed and also looking in the mirror examining my new face, with which I was eventually pleased. In a week or so I went outside, met strangers and friends, and taught my first class of the semester wearing a bandage on my nose. I wore bandages of various sizes for several weeks and watched my face transform over months of healing.
The physical aspects of cosmetic surgery are worth relating, but the social experience of becoming and being a cosmetic surgery patient is more to the point. Cosmetic surgery is coded on the one hand as a sign of empowerment and self -enhancement and on the other hand as a sign of moral, political, or mental weakness. In getting cosmetic surgery myself, I saw firsthand how in cosmetic surgery, the body and self become a zone of social conflict. The media and the advertisements I read urged me to transform myself, to constantly improve, and presented images of cosmetic surgery that were saturated with heteronormative promise. The doctors to whom I presented myself as a prospective patient expected a certain set of attitudes about me and my body. Others I met liked to identify cosmetic surgery’s junkies and fools, the Joan Rivers and Jocelyn Wildensteins of cosmetic surgery. My students, my friends, and a few of the strangers who stared at me on the subway asked for explanations, and many of them offered strong opinions that implicated me in one way or another.
Becoming a cosmetic surgery patient begins with, among other things, being positioned as a prospective patient, where one’s looks, motivations, and psyche are examined by cosmetic doctors. For me this included an evaluation of my nose and my profile. I did not enjoy subjecting my face to intense scrutiny. I had thought that my nose was unremarkable. It was ordinary; I didn’t love it or hate it. Even though I suspected that falling on it once while learning to ski might have changed it a bit, no one had noticed. In any case, I’d never heard anyone comment on it in a negative way. It seemed to me that even so, it was not a perfect nose, in normative terms. Rather than a straight nose, which seemed to me to be the ideal, it was shaped with a bump on the bridge. All but one of the five doctors I consulted was ready to pathologize it. The exception, an otolaryngologist originally from Central Europe, said, “Your nose is fine. It has character; you shouldn’t change it.” He said that he would do the surgery if I “really wanted” it, giving me the feeling that he would be indulging me.
The four others, however, insisted that my nose needed to be changed. They saw a clear case for cosmetic surgery. Following are some of my notes after seeing a doctor on Long Island, who wanted to operate not only on my nose but also my chin:
Me: I was thinking about the bump on my nose, getting a straighter nose. But I don’t want a turned-up nose. Nothing obvious.
Dr. J: You need a smaller nose with more definition at the tip. Not turned up but refined. You could get a chin implant, too. It’s something to think about. Your profile could be more balanced.
Me: Just my nose. I don’t want anything implanted.
Dr. J: It’s often the case that we suggest a chin implant with a rhinoplasty because we’re looking at the whole profile. But it’s just something to think about. Your chin is not bad.
Another doctor, the one I picked to do the surgery, was a man in his 60s who treated me paternalistically. He was likeable, matter-of-fact, and arrogant about his role as a beauty doctor. More than anyone, he disliked my nose. He said that he needed to “straighten out the bump, refine the tip, make it look nice,” and added that “your nose is wrong for your face.”
The sorting of patients into good and bad candidates is now a significant part of the cosmetic surgery process. Although it was disagreeable to hear someone describe my nose as “wrong,” I understood that in his view, the aesthetically problematic status of my nose rendered my desire for cosmetic surgery reasonable. This is important because in addition to my face being scrutinized, so was my psyche. Although cosmetic doctors champion the practices as life-empowering and self-caring, prospective patients are not automatically embraced as empowered. Patients’ aesthetic aims must correspond to doctors’ opinions. In addition, patients generally need to appear to be pliant, amenable to suggestions, and, above all, willing to accept cosmetic surgery’s risks. All the surgeons I consulted screened me psychologically to varying degrees, usually informally. In one case, I was also given a written survey that included psychological questions. All of them asked me to define what might be a good result. Some also asked if I had ever been on antidepressants or been depressed. As I learned from the research interviews that I had done with cosmetic surgeons, these informal conversations were occasions for the surgeon to get a “gut feeling” about my personality and psyche, to quote one New England doctor. They wanted to know whether I’d be a happy patient or an unhappy one, likely to pleased or likely to be picky, difficult, or even litigious.
There are many other people, beyond doctors, who are ready to make a series of distinctions between good and bad surgery patients. I had countless conversations with friends and acquaintances about cosmetic surgery “junkies.” For example, there was a woman named Andrea who had a conversation with me about breast implants. She wanted to discuss how common it is for women to get “huge” breasts that are “inappropriate for their size,” including her sister-in-law, who has a tiny body but chose DD implants. The contradiction between Andrea’ s criticisms of her sister-in-law and her general approval of cosmetic surgery was by now to me familiar. In the clinic, we were surrounded by fashion magazines depicting surgically modified celebrities and brochures advertising Botox and breast implants. The rhetoric in these advertisements suggests that cosmetic surgery is something a woman does to treat herself well. On television, we are shown countless examples of positive, life-fulfilling extreme makeovers. But we are also inundated with warnings about bad or botched cosmetic surgery, discussions of cosmetic surgery addiction, and images of supposedly ugly or overprocessed consumers of cosmetic surgery. Thinking of Andrea’s sister-in-law, I pondered how much pressure lands on the shoulders of the patient: she must not be a junkie or too extreme, but she should recognize how much her body needs improvement. The discourses of cosmetic surgery operate in part pedagogically, training women about which aesthetics and attitudes are acceptable and which are not.
In my academic milieu, cosmetic surgery carries a charge of victimization, pathology, or vanity. Most of my friends and colleagues tried to talk me out of the surgery. One said that I would lose all my character if I changed my face. Some said that if my nose had been ugly, they may have understood my decision more. Several suggested that I had been seduced by spending too much time in cosmetic surgery clinics. Others worried that I would become addicted. Before and after the surgery, I was asked to explain and defend my surgery a great deal. Some of my students, who immediately noticed the bandage on my nose, were aghast at the idea that someone they saw as a feminist would have cosmetic surgery. They openly debated my surgery. Some of them wanted to defend me against suspicions of vanity or false-consciousness. Of course, in many social milieus, cosmetic surgery is acceptable and even expected; some of my more affluent students knew many people who had had cosmetic surgery, and they were morally indifferent.
My own sense of self has changed, of course, as my body has. Without endorsing cosmetic surgery in general, I can say that am more pleased with the look of my face than I was before. This is an aesthetic issue but it also matters; it is, I could say, deeply superficial, with all of the contradictions that term might imply. I also now have a different biography. I am a person who has had cosmetic surgery, which changes the way people who know this might view me and influences the way I evaluate myself and my choices. For example, the process of surgery rendered me even less sentimental than I might have been about the material fact of my body as an indicator of self while paradoxically underscoring the social investment in my body as an indicator of self. Despite the horror with which some people received my surgery, it left me less worried about the existential and moral implications of self-transformation.
What surprised me most about my experience was the following irony: people were so bent on finding a deep reason for my interest in cosmetic surgery that they overlooked the practice’s inherent superficiality. Both the superficiality and fluidity of cosmetic surgery—its skin-thinness and its changing meanings—seem to violate our collective desire to understand our inner selves as stable and fixed, true and authentic. Cosmetic surgery raises not only the issue that the body has become, in a postmodern world, a primary sign of one’s identity but also that our bodies are malleable sites for change. That malleability is discomforting.
Cosmetic Surgery as Semantically Unstable
Cosmetic surgery is semantically unstable. It is aggressively advertised and championed by cosmetic surgeons and others involved in the industry. It is represented in the media as fabulous and necessary and also as horrifying and potentially sick. It is seen by people in various social milieus as unacceptable, immoral, and risky and in others as normal and ordinary. The woman who becomes a cosmetic surgery patient does so in the context of popular and medical pedagogies, moral pressures, and medicalized scripts that create a contested social and symbolic terrain. My experience, for example, points to the influence of beauty culture and gender norms. It shows a wrestling with the political debates about cosmetic surgery, both conceptually and interpersonally, with my friends and students. It suggests the influence of doctors, their ability to accept or reject my cosmetic desires and to judge the quality of my body image. It shows the specter of pathology haunting my interactions with doctors, who are screening me, as well as with others who make distinctions between good patients and bad.
This context needs to be examined when we try to understand how women might variously experience and describe themselves and their surgeries. The cosmetic surgery patient is a subjective role that unfolds through being a prospective patient, an operated-upon body, a person in recovery, and as someone with a cosmetically transformed face or body part. Such unfolding happens in deeply social and intersubjective ways. Women are becoming and being patients in the face of forces that both sell the practices to them and that seem to demand explanation of cosmetic surgery. We are expected to employ methods of description that make sense to others, thus complying with already scripted codes of meaning that are set out before us. We are asked to address what are established as generic aspects of cosmetic surgery and the issues that are already raised as significant: the pain, the beauty norms, the political debates, and the doctor-patient relationship, among others.
The subjectivity of the cosmetic surgery patient is not fixed but rather fluid and created in the process of becoming and being one. I call myself a cosmetic surgery patient, but this identity has no meaning outside its continual creation by the interactions between me, others, and the social world. It is an identity that is produced as the cosmetic surgery is happening, as it is planned and undertaken and narrated. The self of cosmetic surgery is continually constituted by the self and others, even though stories of selves often mask this temporal and ontological complexity.
Feminist scholarship on cosmetic surgery that focuses on women’s interiority is problematic when it, too, masks the temporal and ontological complexity of the cosmetic subject. Along with psychotherapeutic perspectives, feminists have often pursued the notion that the status of a woman’s psyche, her consciousness, or some other aspect of her interiority will help explain the cosmetic surgery patient along with cosmetic surgery’s apparent problems. But these approaches ignore the processes by which one becomes and is identified as a cosmetic surgery patient and the various ways in which the meanings of her cosmetic surgery are contested.
I argue for decentering the subject of cosmetic surgery. Repositioning the subject is partly a matter of thinking differently about how the personal is implicated in the larger social relations of cosmetic surgery. An alternative, intersubjective approach does not mean that we are limited only to macrolevel analyses of cosmetic surgery’s power relations or of abstract, discursive constructions of meanings. Neither does it mean that we cannot consider the personal experiences of women themselves. What we can do is understand women’s experiences, and their subjectivities as cosmetic surgery patients, as being created in and through the interactive experiences of cosmetic surgery. We can look at the ways cosmetic surgery comes to have meaning in a complex set of social and symbolic interactions rather than having meaning that is primarily generated out of the patient’s (fixed, predisposed) sense of self. In pursuing cosmetic surgery this way, we may avoid the kind of hermeneutics of the self about which Foucault warned us, and we can be more critical of the power relations that work to produce the cosmetic surgery subject.