Book Review: American Plastic: Boob Jobs, Credit Cards, and Our Quest for Perfection

American Plastic:
Boob Jobs, Credit Cards,
and Our Quest for Perfection
By Laurie Essig
Beacon, 219 pp, $26.95

Among the reasons commonly cited for plastic surgery, trickle-down economics is rarely invoked. Yet the market forces unleashed by Ronald Reagan's laissez-faire policies may have helped set in motion one of the U.S.'s favorite avenues of upward mobility. In 2009, Americans spent about $10.5 billion on plastic surgery, according to the American Society for Aesthetic Plastic Surgery. That's about 20 percent less than they paid in 2007—a drop that can be attributed to the recession and Botox's migration down the price ladder from the doctor's office to the spa. And that's about as much money as governments and institutions pledged to the victims of the 2010 Haitian earthquake. At least we have our priorities straight.

While the root causes of this fixation may range from Pamela Anderson's bosom to Joan Rivers' cheeks, Middlebury College sociologist and author Laurie Essig starts with the Gipper's Economic Recovery Tax Act of 1981. "When more money was given to the rich," Essig writes in American Plastic, "they got richer, while average Americans were left with fewer and fewer social services and a labor movement that was consistently and purposefully opposed by the federal government." The result, Essig claims, was that many Americans assumed more debt, and suffered for it.

In 1982 a Supreme Court ruling allowed members of the American Medical Assn. to advertise their services—an opportunity that few cosmetic surgeons wasted. These promotions, Essig suggests, transformed many Americans' view of elective surgery from that of "a medical relationship between a surgeon and a patient to a commercial relationship between a consumer and a service provider."

Many also began to view surgery as a solution to their economic woes. Essig argues that America's love affair with liposuction, long considered a late-life pastime of the rich, was actually formed from long-term financial insecurity compounded by easier access to credit. By the 1990s, she suggests, the deregulation of the Clinton years permitted banks to extend credit to a wider population, and lower-income women came to see breast implants and tummy tucks as a sensible career-enhancement strategy—albeit at the risk of their future financial health. Subsequently, plastic surgery silently descended the social hierarchy from the lives once portrayed on Dallas to those on the now-defunct reality show, The Swan. According to a 2005 poll conducted by the American Society of Plastic Surgeons, 30 percent of plastic surgery patients earned less than $30,000 a year, while an additional 41 percent earned between $30,000 and $60,000. And many of their procedures, she notes, were financed with high-interest loans.

Splurging on a tummy tuck might actually be a sensible survival instinct. As Essig says, "Working-class bodies, which tend to be larger and have less access to things like braces for straight teeth or dermatologists for smooth skin, also elicit more disgust than the smooth, pampered bodies of the upper classes." Passing for rich is yet another bulwark against downward mobility, she notes, and sometimes that requires physical transformation.

Essig backs up these sweeping assertions with some provocative examples. Nearly all of the 140 potential patients she spoke with claimed they were planning to go under the knife as a response to economic insecurity. Some were afraid of losing their jobs; others felt they needed to disguise their age to secure a new position. Rita, a fiftysomething woman in the hospitality industry, told Essig that in today's workplace, "it's about how you look, not what you do. I do believe that nine times out of 10, women with the hot bodies get the best jobs." Essig also argues that women who sign up for face-lifts hoping to hold on to their husbands are acting out of a rational financial interest in avoiding divorce.

For many Americans, though, surgery obviously isn't the most sensible investment. Many would almost certainly get more bang for their buck by taking a class or eating better. As individuals have had to shoulder more responsibility for their own financial security—and as well-worn paths to prosperity have become less reliable, with markets and retirement accounts only now recovering—perhaps it isn't surprising that people have turned to more drastic options.

Some unabashed fans of capitalism may admire the cosmetic surgery industry's ability to broaden its clientele in leaner times—particularly since the future for the makeover trade looks even brighter. As Americans live longer, they'll continue to head to the doctor's office, which, Essig writes, many patients see as "an excellent solution to the crisis caused by an aging yet still youth-obsessed generation." In retrospect, perhaps that's how Reagan saw it, too.

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