Is what happened to Linda Evangelista an anomaly?

This week in North Philly Notes, Samantha Kwan and Jennifer Graves, coauthors of Under the Knife: Cosmetic Surgery, Boundary Work, and the Pursuit of the Natural Fake, write about the potential perils of cosmetic surgery.

Linda Evangelistaan iconic 1990s supermodeldropped a bombshell on Instagram on September 22, 2021: “I was brutally disfigured by Zeltiq’s CoolSculpting procedure.” The procedure is an FDA-cleared “noninvasive body contouring technology” that “freezes and kills fat cells.” It promises to “reduce stubborn fat by up to 20-25% in the treatment areas, all with little to no downtime and no surgery.”

However, Evangelista reported to her million plus followers that the procedure “increased, not decreased, [her] fat cells,” leaving her ”permanently deformed” even after two corrective surgeries. She went on to explain that these complications have “not only destroyed [her] livelihood, it has sent [her] into a cycle of deep depression, profound sadness, and the lowest depths of self-loathing.”

Responses to her Instagram post from other celebrities have largely focused on her “bravery” and “courage” for sharing her story publicly. News coverage of her revelation has highlighted the $50 million lawsuit she filed against Zeltiq.

This focus, however, misses an important opportunity to point out that for millions of people who undergo cosmetic procedures each yearof which the overwhelming majority (92%) are womenthe experience of undergoing and living with the results of cosmetic surgery isn’t always a cake walk. In fact, our research with women who have gone under the knife for cosmetic reasons reveals that surgery can involve lifelong physical and emotional challenges. Even when women frame surgery as a success, many still struggle with their postoperative bodies.

For example, women in our study who had breast augmentationthe fifth most common cosmetic surgical procedure in the U.S. according to the American Society of Plastic Surgeonsreported a number of ongoing problems, many of which only revealed themselves with time. These included implants hardening, rupturing, sagging, and wrinkling. This is consistent with an FDA report on silicone-gel filled implants stating that complications and adverse outcomes increase over time and that women who have breast implants will need to monitor their breasts for the rest of their lives. Some also reported chronic back or shoulder pain, with some sharing that ongoing pain or discomfort even deterred them from performing activities they once enjoyed such as running.

Others revealed a permanent loss of sensation or feelings of numbness, tingling, and itching at the surgical site months or even years after surgery. Stubborn surgical scars, which many anticipated but some underestimated, were another source of consternation.

Fluctuations in weight also sometimes led to the dissipation of satisfaction. There were accounts of breasts that appeared disproportionately large after weight loss, as well as accounts of breasts being larger than what was desired after weight gain.

These disappointments with both the look and feel of one’s body ultimately mean that women have to manage their postoperative bodies. Management comes in many forms including revision surgery, the use of makeup and clothing to hide scars and body parts now deemed undesirable, and emotional work to address body anxiety or even feelings of regret. In her Instagram post, Evangelista openly admits to having undergone two revision surgeries and highlights the emotional toll and ensuing emotional work she has done to recover. Moreover, fans and the media alike have noted that she has been covering her face and neck in photos in recent years, clearly an effort on her part to hide the “deformity” caused by her procedure.

Evangelista’s very public experience with CoolSculpting and the emotional fallout she has experienced may seem like an anomaly. Yet her experiences mirror the experiences of thousands, if not millions, of women in America who in the wake of cosmetic procedures must use a variety of physical and emotional management strategies on an ongoing basis. While popular media coverage tends to showcase procedures, like Evangelista’s, that go dramatically wrong (think Botched) or to celebrate supposedly over-the-top success cases (think The Swan),for many women, post-surgical life is neither. Instead, regardless of the results, it is a lifelong process of body negotiation and management.

Evangelista’s experience also gives us an opportunity to ask ourselves what it is that drives women from all walks of life to undergo drastic procedures that frequently require long term management? Why do they do it despite stories like Evangelista’s that are splashed across the frontpage?

Simply put, beauty remains a central feature of femininity, and a beauty imperative rewards women who comply. Women who meetor at least attempt to meetoverwhelmingly unrealistic beauty standards are rewarded with psychological, social, and economic gains, while those who do not miss out or are penalized. It is long past time that we begin to sincerely question the cultural and social structures that put pressure on women to undergo potentially dangerous, and sometimes unsuccessful, procedures in the first place. Only when beauty is dethroned as a defining quality of successful womanhood will we have fewer experiences like Evangelista’s.

Is now the time to go Under the Knife?

This week in North Philly Notes, Jennifer Graves and Samantha Kwan, coauthors of Under the Knife, write about cosmetic surgery in the age of COVID.

Despite many states banning elective surgeries because of the COVID-19 pandemic, the cosmetic surgery industry is still booming. In fact, some cosmetic surgeons report a rise in patients amid the pandemic. This may be in part because many people are now working from home. Working from home allows people both more flexibility in scheduling procedures and the ability to work while healing. Some surgeons believe working from home has also led to an upswing in business because at-home workers have become increasingly self-conscious as they spend hours on end staring not only at their coworkers, but also at themselves, on various video call platforms like Zoom.

However, perhaps even more importantly, the ability to work from home, combined with the ubiquity of masks, has created an unprecedented chance for cosmetic surgery patients to hide their surgery. Specifically, working from home away from the prying eyes of coworkers and the opportunity to wear a mask in public allows people to conceal the fact that they have had surgery during the conspicuous post-operative healing phase. This ability to pass as surgically unaltered, we found, is paramount to those considering cosmetic surgery.

Under the Knife_smIn our interviews with 46 women who had cosmetic surgery in both Texas and California, it became clear that women who go under the knife are acutely aware of the potential stigma associated with cosmetic surgery. Specifically, they are aware that others may perceive them as fake, preoccupied with vanity, overly sexual, and more. Under the Knife: Cosmetic Surgery, Boundary Work, and the Pursuit of the Natural Fake explores the different ways women negotiate and manage this stigma.

Notably, one of the central ways women do this is by seeking out what we label the “natural fake.” Successful cosmetic surgery that embodies the natural fake means inconspicuous postoperative body parts that appear God-given. The natural fake enables women to pass as surgically unaltered while still conforming to hegemonic ideals of femininity, such as having a flat stomach, ample breasts, and a wrinkle-free face. This ability to pass as surgically unaltered, which is uniquely possible now in the age of COVID-19, helps women avoid any potential stigma they may encounter.

Alongside passing, our participants engaged in “boundary work.” For example, some defended their elective surgery as necessary, positioned their surgeries as “good surgeries” done by competent surgeons for the right reasons, and distinguished themselves from “pathological” cosmetic surgery junkies.

To expose the diverse meanings and experiences that come with cosmetic surgery, Under the Knife also explores the stories of women who exhibited a fraught relationship with cosmetic surgery. Their stories illuminate that cosmetic surgery is not always a cakewalk, and serves as a warning to those who might want to jump into surgery.

Ultimately, in addition to serving as an academic exploration of cosmetic surgery, our work serves as a resource for women contemplating surgery to help them understand the tensions associated with undergoing cosmetic surgery and the nuances of navigating the world in a post-operative body.

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