Under the skin

Flesh Wounds: the culture of cosmetic surgery

Virginia L Blum <em>University of California Press,

In America, plastic surgeons routinely recommend that women have their first facelift at the age of 35. Apparently, early "interventions" improve the result of a facelift because the skin is still nicely elastic: you can tighten it a little and no one will notice. The younger patient, having taken action in the nick of time, won't suffer from the "wind tunnel" effect, her saggy visage stretched so tightly that she looks like an alien (or, worse, Joan Rivers). "People are going to start having cosmetic surgery done like going to the dentist," says one of the surgeons quoted in Flesh Wounds. "Every two to three years, you'll have a little endoscopic tightening done to keep up."

I read this and bridled with feminist indignation (in the US, 85 per cent of cosmetic surgeons are men and 89 per cent of their patients are women, so there is no use trying to argue that an addiction to all things nip and tuck has nothing to do with sexual politics). I told myself that I do not give a damn if my nasolabial folds - the creases that run from the corner of the nose to the mouth - are "recalcitrant". Nor do I care that my upper lip is well on its way to being "senile". I huffed and I puffed and I ate a packet of Giant Smarties by way of consolation. Then I went upstairs and smeared my moisturiser of choice - Clarins Beauty Flash Balm - all over my face.

You see, however much this book is stuffed full of National Enquirer madness - roll up, roll up, I give you a 94-year-old woman with the pubic region of a 19-year-old - it is impossible to read it without anxious recourse to one's bathroom mirror. Its author, an English professor who has had two nose jobs and is now considering a facial peel, is not disapproving. She thinks that most plastic surgery looks good, that it gives women agency in a world in thrall to youth and beauty. I examined the angry groove that, by degrees, has etched itself above my left eyebrow, and I wondered . . . Would getting rid of it compromise me any more than the brace I wore on my teeth as a child? After all, a girl can get too hung up on authenticity. As Virginia Blum says: "When identity is incessantly refashioned in relation to cultural images, how can we speak of any premediated body? What authentic body is left to preserve?"

Then again, this way madness lies. We've all seen the pictures. (Melanie Griffith, anyone?) Blum was encouraged to have her first nose job by her mother, when she was a teenager. The result was one of those noses surgeons display as the "before" picture for botched surgery. Later, as she was about to have an operation to correct this hateful hooter, she heard the surgeon say to a nurse: "Look what some joker did to this poor girl's nose." Yet alarmingly, she retains a strange susceptibility to the heady promises - the visual blandishments - made by the piranha-like surgeons she encounters while researching her book. They have only to stand behind her and pull at her cheekbones for her to start feeling tempted all over again. When her friends tell her that the dignified, natural contours of age look better than surgery, she cannot agree.

Perhaps this is why she has produced such a thoroughly disappointing work. If you are in search of gore, this is not the book for you (although there is an exciting account of a full trunk lift, in which the patient's skin is literally split in two and then yanked tight, resulting in a monstrous circular scar around the bikini line). Nor are there many freak shows, a la Michael Jackson. (Although Blum's celebrity surgeons remind me of certain hairdressers - you see them approaching, sharp instruments in hand, and wonder: why would anyone trust you?) Instead she focuses on the idea of transformation as sold to us by Hollywood. We long to wear celebrity skin; how else to do that but by going under the knife?

Yet unpicking All About Eve or Being John Malkovich does not really help to explain the frantic rush to surgery (5.7 million procedures were carried out in the US in 2000, up from 2.8 million in 1998) and it doesn't inform us about the long-term consequences of our growing fondness for painful and risky operations such as liposuction. Blum knows a lot about Barthes and Baudrillard but she is not, alas, in the business of writing a wake-up call in the manner of, say, Fat Land, Greg Critser's recent treatise on obesity in America (amazingly, she seems to have no interest in the bizarre coexistence in the US of the oh-so-sculpted and the oh-so-greedy). Her prose, suffocated by the deadening language of the literary theorist, is so sleepily elliptical that there were times when I felt like I had been under anaesthetic myself. If only the bags under my eyes had not still been there when I woke up.

Rachel Cooke writes for the Observer

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