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       EXTREME MAKEOVERS: CRITIQUING COSMETIC CULTURES


       One Sunday in February, 1993, Law & Order: Criminal Intent introduced an

episode that centred on botox treatments. The crime of the week featured a woman,

found dead in her bathtub, with a blistered forehead (indicating a recent botox treatment).

As the coroner determines the cause of death, she explains how the woman died from

“thirty vials [of botox] jammed into her neck”; the injection paralyzed her, and facilitated

her drowning. At this point, the coroner wryly comments: “Death by botox: live slow,

die old, leave a good-lookin’ corpse.” As they track down the murderer, Detectives

Goren and Eames attend a botox party—relatively common events, now, which feature

alcohol, music, and, of course, botox treatments—and arrest the cosmetologist who runs

the party. When he exclaims: “But it’s only botox,” Goren sagely reminds him: “This

stuff was derived from something developed for germ warfare in the ’50s. A jury might

not see it that way.” The plot concludes with the apprehension of the daughter, who uses

botox for migraine relief, and who had begged the drug from the sympathetic

cosmetologist.

       This particular episode is significant for a number of reasons. As a highly-rated

television show, the programme is watched widely on both sides of the Atlantic, and thus

influences the ways in which the public views botox. And, indeed, there are

consequential undercurrents in the episode to which I want to draw attention. First, the

construction of botox treatments largely is figured as frivolous: the procedure comprises

a dangerous undertaking, one in which women (especially wealthy women) engage.

Second, botox itself is suspect, since it involves “something from germ warfare”--at least

according to Detective Goren, the Sherlock Holmes figure of the programme, who clearly
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knows more than anyone else about the new biotechnological technique. His sidekick,

Eames, goes along with his assessment, seemingly sharing his view that botox users are

somewhat addled.

       The Law & Order: Criminal Intent episode suggests that, despite all the

assurances of plastic surgeons, dermatologists, and happy customers, botox is not as

harmless as it is presented. And while this may well be the case, it is easy, and not

especially productive, simply to mock a procedure that many people (and not just

women) desire. Indeed, plastic surgery, in any of its cosmetic forms, is often mocked,

and often mocked, as in the case above, at the expense of women.

       As Mary Thompson asks, in an article on silicone breast implants: “What is a

feminist politics of plastic surgery?” (273), or, to extend her question--of cosmetic

biotechnological procedures? Citing Anne Balsamo’s book, Technologies of the

Gendered Body, Thompson contends that Balsamo offers the potential of a new means of

critique, when she notes:

               I am reluctant to accept as a simple and obvious conclusion that cosmetic

               surgery is simply one more site where women are passively victimized. . .

               . Like women who get pierced-nose rings, tattoos, and hair sculptures,

               women who elect cosmetic surgery could be seen to be using their bodies

               as a vehicle for staging cultural identities. (78; qtd. in Thompson 275)

Building upon Balsamo’s admission, Thompson argues that this work

               offers a useful lens for considering the discourses of the body, gender, and

               identity in the context of postmodern technologies. Her work suggests

               compellingly that feminists cannot uncritically dismiss or embrace new
                                                                                            3


               technologies like breast implants; rather, her work enables feminists to

               consider new technologies as discursive sites for the deployment of power.

               (274)

Do biotechnological cosmetic treatments involve a process of victimization, a site for the

deployment of power, or both? These questions underpin the following pages, for, using

Thompson and Balsamo’s suggestions as a starting point, I want to explore the various

technologies that have been and are being used to augment the body’s appearance—while

trying not to fall into the trap of merely dismissing women’s concerns for their

appearance as “trivial.”

       Although the botox bonanza is new, the search for youth (or its fountain), as well

as the hunt for new and improved beautification methods is hardly unique to the

contemporary era; on the contrary, they are virtually as old as written history. The

“fashion of beauty,” like other aspects of fashion, has changed dramatically over the

years. In ancient Egypt, Cleopatra apparently bathed in milk and ground pearls for a

perfect complexion, while the sixteenth-century Elisabeth Bathory preferred blood

(especially that of young virgins) for her toilette. Queen Elizabeth I wore extremely

heavy makeup and a wig to hide her smallpox scars, sparking new makeup trends

amongst her contemporaries (Tucker 14). The eighteenth century witnessed the

application of beauty mark patches, in addition to the use of a facial whitening agent,

“composed of carbonate, hydroxide, and lead oxide. These agents, cumulatively stored in

the body with each use, were responsible for numerous physical problems and resulted in

some cases in muscle paralysis or death” (Boyd [1]). By the nineteenth century (perhaps

in response to the prevalence of tuberculosis), lips were reddened through the use of
                                                                                             4


mercuric sulfide, and belladonna used to make eyes sparkle (feverishly?) (Boyd [1]).

Clearly, youth, beauty, and their accoutrements have been coveted for centuries.

     At the fin de siècle, new technologies enabled different approaches to age and

beauty. The Steinach glandular operations, for example, performed on such luminaries as

William Butler Yeats (Abrams 2344), were essentially vasectomies (in women, they took

the form of x-ray irradiation of the ovaries [Sengoopta 1]). The reasoning behind the

surgeries lay in Eugen Steinach’s belief that “closing off the passage of semen out of the

testicles, [and] absorbing it instead into the body . . . [would] supposedly increase energy

and retain youth” (9).

     Certainly, Yeats was not alone in his desire to try Steinach’s vasectomy: Gertrude

Atherton, and even Freud (in search of a cancer cure) both chose to undergo the

procedure (Sengoopta 1). Indeed, so popular was the technique that Steinach became “a

household word for a while; his very name became a verb in the 1920s: ‘people did not

simply have the Steinach operation, they were ‘Steinached’” (Sengoopta 2). Accordingly,

“more than a thousand men, most of them in America, received testicular grafts from

humans, sheep, monkeys, goats, and deer for the treatment of a range of disorders, from

the debility of old age to schizophrenia” (Sengoopta 5).

     As the twentieth century advanced, so did its technology, effecting all number of

beautification measures. Plastic surgery, as a profession, began with the treatment of

wounded soldiers, although it was rapidly applied to facial enhancement, giving rise to

the popularity of rhinoplasty—particularly, as Sander Gilman argues in The Jew’s Body,

among Jewish women wanting to appear more gentile (184-93). At mid-century, the new

sophistication of plastic surgery meant that cosmetic procedures were more available than
                                                                                             5


ever before; plastic surgeons found a new market amongst middle-class women, who

found it easier to alter their own faces than to alter the cultural norms and expectations

surrounding aging. In doing so, the two groups “became both producers and products of

the modern ‘culture of narcissism’” that is “still in place today” (Haiken 136).

       Misogynistic cultural forces contributed to women’s search for youth and beauty.

Surgeon John Conley actually charged women with being the instruments of their own

destruction. In 1968, he wrote:

               The constantly enforced and exaggerated smile in vogue today is a major

               offender in causing wrinkles about the commissures of the mouth, the

               nasolabial fold and the eyes. . . . This habit is so deeply ingrained in some

               persons that it is not possible for them to order a dozen bananas at the

               local grocery store without staggering the clerk with a Hollywood smile.

               This is certainly conducive to the production of wrinkles at an early age.

               (qtd. in Haiken, 151)

As Elizabeth Haiken succinctly concludes: “Ironically, women learned, it was femininity

itself that caused aging” (151). And, undoubtedly, the pressure was on to stay young: in

1956, Lily Daché exhorted her Glamour Book readers: “all you have to do is stretch out

your hand to receive the magic bounty of glamour that modern science has prepared for

you” (qtd. in Haiken 145). Of course, modern science’s bounty is not always magic, and

daily talk shows are filled with women whose procedures have gone awry—with

devastating results.

       Differences in perceptions of biotechnological treatments are not insignificant,

either, nor are they ungendered. Laser eye surgery (for example) is a common practice
                                                                                              6


for football players, airplane pilots, and numerous other (male) athletes. Although people

may cringe at the thought of eye surgery, few dismiss it as a silly or impractical aesthetic

procedure. Yet, botox, as the Law & Order: Criminal Intent episode suggests, is a

harder sell.

        Undoubtedly, botox is a peculiar form of treatment, utilizing, as it does, a bacteria

that has been called “the most toxic substance known to science” (Regis 68). But, placed

in context with other current beautification measures, it begins to seem somewhat less

toxic. The “rejuvenating” procedures presently available on the market bring to mind

those treatments undertaken by youth-seekers at the fin de siècle. As a result, collagen

and fat implants, dermabrasion, and laser peels, all bare scrutiny before turning to botox.

        Collagen treatments have become a popular from of “anti-aging,” largely because

they are non-surgical procedures that can be performed in a doctor’s office. When the

FDA and Health Canada approved collagen therapy in the 1980s, the substance consisted

of a protein extracted from cow skin, which was then injected into a patient’s face.

Acting as a “filler,” collagen can reduce wrinkles, smile lines, crow’s feet, plump up lips,

and so on. Bovine-based collagen, however, can produce “immunologically related

adverse events” (“Summary”), as well as abscesses, visual loss, a reactivation of latent

herpes simplex infection, and necrosis (leading to scarring and changes in skin

pigmentation) (“Guidelines”). One of the major drawbacks of collagen is that it “can be

felt with palpitation” (“Guidelines”), and is eventually absorbed into the skin, requiring

that shots be repeated regularly for similar results. The long-term effects of collagen are

unknown.
                                                                                                7


        The FDA describes: “Alternative therapies for dermal soft tissue augmentation

[which] include . . . autologous fat transfer, and cadaveric-based products” (“Summary”).

While information is difficult to find on what specific cadaveric-based products are being

used, Time magazine reported in May 19, 2003 that Cymetra, which is used to fill deep

wrinkles, is one of the culprits, consisting of “ground-up human skin” (Kher 43). The

article observes:

                Perhaps the creepiest substance being used to smooth wrinkles is

                Cymetra—a gel made from the skin of human cadavers. The

                manufacturer claims that Cymetra harnesses the body’s own skin-building

                machinery to fill its wrinkles. (“Beyond” 43)

Synthetic bone material (“Radiance”) is also being utilized as a deep-wrinkle filler (Kher

43).

        Less gruesome than “cadaveric-based products” are human fat implants, or

lyposculpturing. A popular procedure, lyposculpturing involves removing fat from

patients’ bodies (usually from hips or thighs), and then injecting it into their faces.

Obviously, immunological issues do not apply to fat transplants, but “because of its bulky

nature,” fat is “more difficult to use in finer wrinkle lines” (“Collagen”). Like collagen,

fat is also reabsorbed into the body, and the procedure must be repeated. One panel of

doctors in Canada, who met in 1997, commented: “Repeat injections are usually

necessary. . . . [Often a clinic] stores excess fat cells in the deep freeze. ‘Fatcicles’ are

thawed before a patient comes in for a tune-up” (“Doctors). As with collagen treatments,

fat reabsorption is not uniform, so as the wrinkles resurface, so might lumps and bumps.1
                                                                                              8


       One is reminded of Goldie Hawn’s overly-collegened lips in the First Wives’

Club, lips that make it near impossible for her to smoke, and even render speech difficult.

This is an extreme case, to be sure, but it is not the only dramatization of such

beautification measures. Samantha, in one Sex and the City episode, starts to feel old,

and opts to try fat implants. While she is delighted with the ability to eat whatever she

wants, since the fat is being removed from her hips, and she likes the facial results, when

her surgeon indicates how many other aspects of her body need work, Samantha, always

proud of her body beautiful, is horrified, and decides to forego other procedures, at least

in this episode (“Freak”).

       Dermabrasion, sometimes called “skin planing,” is a curious practice involving a

high-speed wheel, similar to a rotary sander using fine-grained sandpaper, which is used

to abrade the skin (Begoun 217). It smooths the face, and is “recommended” for people

with severe sun damage or pock-marked skin. Unfortunately, scarring and permanent

pigment changes are not uncommon (“Cosmetic”).

       Alternatively, chemical peels involve the application of an acidic solution that

causes upper layers of the skin to peel off, along with pigmentation marks. The so-called

“lunchtime peel” (“Superficial”) consists of “an alpha hydroxi acid solution . . . painted

on the face and left on for a number of minutes. Skin will feel warm and prickly as the

solution eats away at dead skin cells. Patients will experience temporary redness and

skin flaking” (“Doctors”). There are also “stronger peels” available, which require “five

to seven days of downtime, during which time skin will redden and crust before it heals”

(“Doctors). After the dead skin is “eaten away.” the underlayers come to the surface,

presumably with a “smoother, fresher look” (“Doctors”). While the long-term effects of
                                                                                            9


chemical peels are unknown, in another episode of Sex and the City, Samantha chooses to

refresh her skin with a chemical peel for Carrie’s book-launch party. Unfortunately, her

skin takes longer than expected to heal, and her red face literally illuminates the party

(“One”).

       Newer on the market are laser peels, which function much like chemical peels,

although lasers are used to peel off the top layer of skin “like an onion,” “while the

collagen underneath is coagulated” and “re-formed (think of how a steak’s texture

changes when you cook it)” (Begoun 220). Laser beams can also be directed at a problem

area (such as scars, moles, tattoos, etc.), where they will “vaporize targeted skin”

(“Cosmetic”). The risks include skin discoloration, scarring, and poor results. Laser

treatments can also trigger skin sensitivities (Begoun 220). Once again, there is not

enough information available to assess the long-term effects of laser peels.

       Botox is, at least superficially, much less radical than the above procedures.

Comprised of the secretion of botulinum toxin, this non-surgical treatment temporarily

paralyzes facial muscles, and as these muscles relax (due to their immobility), the face

assumes a more youthful appearance. Each injection is effective for three months, with

“diminishing returns for another three” (Kane 163).

       Botox is derived from the bacteria responsible for botulism poisoning. If a person

ingests botulinum bacteria (usually from ill-prepared canned goods), the bacteria

replicate in the stomach and begin to secrete a toxin that ultimately paralyzes the host

body, leading to death when the lungs cease to function. Specifically, “‘botulism’ (which

comes from the Latin ‘botulus,’ meaning ‘sausage,’)”
                                                                                            10


                was so named because it affected people who ate spoiled sausage. In

                those days, the symptoms of double vision, slurred speech, drooping

                eyelids, and muscle weakness soon progressed to muscle paralysis

                throughout the body, and death was often the result of paralysis of the

                muscles necessary for breathing. (Mitchell 51)

The toxin secreted by the bacteria is the basis of botox--in a much-diluted form. Since

muscles respond as a result of nerve secretion (that is, the nerves tell the muscles to

move), botox is injected into the nerve; the nerve then ceases to command the muscle to

perform, in effect, immobilizing that particular site. Eventually, the nerve will find

another passageway through which to alert the muscle, and the effects of botox begin to

wear off (see Kane, Mitchell, Shelton).

         Since it does not require surgery or healing time, botox has become the preferred

plastic surgical procedure, even though it needs to be replenished periodically. It is also

often used, now, in conjunction with other surgical treatments to assist in the healing

process (skin heals quicker when it is immobilized). Botox can be used to relax crow’s

feet, raise or lower eyebrows, erase frown lines, straighten smiles, and smooth chins and

necks.

         Although botox was approved for cosmetic purposes in Canada in 1991 (cnews),

and in the U.S. in 2002, its long-term effects are unknown. Among the side effects

recorded thus far are facial paralysis, droopy eyelids, bruising, potential muscle atrophy,

drooling, inability to swallow or talk, and headaches (in addition, note the similarities

between botox symptoms and those of botulism). Moreover, botox “may be associated

with an increased risk of upper respiratory infection and dysphagia,” and some studies
                                                                                            11


indicate further “action of the toxin at a third, central, or unidentified site,” which “may

indicate spread of the toxin via circulation” (Zeman 226). Ned Zeman, in an article for

Vanity Fair, cites one biochemist who argues: “‘There’s no way it stays in that spot only.

. . . It works by causing damage to the nervous system. . . . They say ‘minute’ quantities

are given for cosmetic purposes, which is true. But quantity is not the only issue when it

comes to toxins’” (226). Similarly, two disease specialists at the Pasteur Institute fear

that botox might eventually seep into the spinal cord, causing paralysis in its users

(“Thema”). As Zeman reminds his readers, Allergan (the company that makes botox)

notes in its own literature that there have been

               “rare spontaneous reports of death . . . and/or other significant debility,” as

               well as rare instances of “muscle weakness” that, while usually brief, may

               last several months.” Also there have “been rare reports of adverse events

               involving the cardiovascular system . . . some with fatal outcomes” (226).

For the privilege, patients can pay $500 to $1500 (U.S.) per botox session, with a price

tag of $3000 per year for repeated injections.

       Already, botox has made its debut on broadcast TV. I discussed earlier the

episode of Law & Order: Criminal Intent that focused on the treatments, and other

programmes often reference the procedure. For example, an ER episode, “Foreign

Affairs,” includes, in an aside, a dismissive comment by a paramedic, advising a doctor

about an incoming patient: “Just another botox case--she can’t swallow.”

       Hence, Thompson’s argument about performing gender through plastic surgeries

seems to breakdown with products like botox. It is difficult to argue that one is

performing youth, although certain patients may feel that this is precisely what they are
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doing. On the one hand, if people seriously are disturbed by their wrinkles, there really is

no reason why they should not attempt to alleviate them. On the other, a potential future

looms, in which Stepford-like individuals walk the planet, neither smiling intensely, nor

frowning dramatically, but rather serenely and emotionlessly floating through life. Even

now, actors like the late Katherine Hepburn, Charlotte Rampling, or Jeanne Moreau, who

have worn their age proudly (and gracefully), are rarities. Indeed, it has been rumoured

that Hollywood producers are having a difficult time finding actors who can portray rage,

since their botoxed foreheads will not allow them to frown. Perhaps the ultimate in

extremities can be found in ABC’s Extreme Makeover, a programme that chooses

“needy” candidates and treats them to whatever procedures they might desire (as the

cameras roll and a voiceover explains exactly what is being done). For now, this is the

wave of the future, at least until biotechnologies live up to their promise and make this

entire discussion academic—once the age gene and/or the obesity gene are located and

engineered (see Kass, Wolfson), there will be no market for quick-fix cures, since aging

will be a thing of the past and we will all live forever, maintaining our youth and keeping

our figures without effort.

       Until this ageless utopia is achieved, however, cosmetic enhancement is a

feminist issue, and one that requires the feminist politics that scholars like Thompson and

Balsamo seek. There may well be room for play in the constructed technologized body,

and biotechnologies do offer the possibility of gender transgression. Concomitantly, it

cannot be ignored that the biotechnological procedures most often mocked are those that

affect women. At the moment, what is of most pressing concern is how treatments for

women are marketed without sufficient research, scrutiny, or testing. This issue provides
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a crucial jumping off point for a feminist politics of biotechnological enhancement, and,

at the same time, foregrounds the critical need to unpack both the normalization of

potentially dangerous products in the public sphere, as well as their attendant derision.

Caveat Emptor, indeed.
                                                                                      14




                                 LIST OF WORKS CITED

Abrams, M.H. et al. The Norton Anthology of English Literature. Third Edition. New

       York: W. W. Norton & Company, Inc., 1975.

Alcorn, Kerrie. “About Face.” Vogue. July, 2003. 88-91.

Balsamo, Anne. Technologies of a Gendered Body: Reading Cyborg Women. Durham:

       Duke University Press, 1996.

Begoun, Paula. The Beauty Bible. Seattle: Beginning Press, 1997.

Boyd, Lydia. “Brief History of Beauty and Hygiene Products.” Duke University. http://

       Scriptorium.lib.duke.edu/adaccess.

“The Beauty Business: Pots of Promise.” The Economist. May 24-30, 2003. 69-71.

“Breast Implants on Trial.” Frontline. WGBH Educational Foundation. http://

       www.wgbh.org.

Bren, Linda. “Saline Breast Implants Stay on Market as Experts Warn About Risks.”

       FDA Consumer Magazine. U.S. Food and Drug Administration. July-August,

       2000. http://www.fda.gov/fdac/

Canadian House & Home. February 2003.

Capital XTRA! April 20, 2003. 2.

Châtelaine. Février, 2003: 103-4.

Cnews. March 6, 2003.

“Collagen Implants and Fat Injections in Chicago Illinois.” Chicago Plastic Surgery

       and Breast Augmentation Online.

       http:// www.chicagoplasticcosmeticsurgery.com/chicago_collagen.htm
                                                                                      15


“Cosmetic Procedures.” Agingskinnet. American Academy of Dermatology Association.

       http://www.aad.org.

De la Pena, Carolyn Thomas. “Powering the Body?” Favourite Edition. The New York

       Academy of Medicine. 2 (Spring): 2000: 8-11.

       http://www.nyam.org./publications/online/favedition/pdf/Fev1n2.pdf.

“Doctors Discuss Face-Saving Options.” North Shore News This Week. August 18,

       1997. http://www.nsnews.com

Extreme Makeover. ABC. 2003-.

“Foreign Affairs.” ER. Broadcast on France 2, November 9th, 2003.

First Wives Club. Dir. Hugh Wilson. Paramount Pictures. 1996.

Gardening Life: Canada’s Magazine for the Gardener. January/February 2003.

Gilman, Sander. The Jew’s Body. New York: Routledge, 1991.

“Guidelines of Care for Soft Tissue Augmentation: Collagen Implants.” Practice

       Management. American Academy of Dermatology Association.

       http://www.aad.org.

Haiken Elizabeth. Venus Envy: A History of Cosmetic Surgery. Baltimore: Johns

       Hopkins UP, 1997.

In Style. July, 2003. 194-95

In Style. August, 2003. 256-25l.

“It’s Your Health: Breast Implants.” Health Canada. http://www.hc-sc.gc.ca/english.

Kane, Michael A.C. The Botox Book. New York: St. Martin’s Press, 2002.

Kass, Leon. “Why not Immortality.” In The Future is Now: America Confronts the New

       Genetics. Eds. William Kristol, Eric Cohen. New York: Rowman & Littlefield,
                                                                                    16


       2002. 321-332.

Kher, Unmash. “Beyond Botox.” Time. May 19, 2003. 42-43.

Law & Order: Criminal Intent. NBC. February, 2003.

Mitchell, Deborah. The Botox Miracle. New York: Pocket Books, 2002.

Neergaard, Lauran. “FDA Panel Accepts Silicone Implants.” The Arizona Republic

       Online Print Edition. Oct. 27, 2003.

       http://www.azcentral.com/arizonarepublic/news/articles/1016implants16.html

Naiman, Eric. “Injecting Communism: A.A. Zamkov, Soviet Endocrinology and the

       Stalinist Body.” http://www.virginia.edu/~crees/Naiman.

“Orlan.” ” (http://www.caipirinha.com/ Collaborators/ orlan.html).

Peiss, Kathy. Hope in a Jar: The Making of America’s Beauty Culture. New York:

       Henry Holt & Company, 1998.

Regis, Ed. The Biology of Doom: The History of America’s Secret Germ Warfare

       Project. New York: Owl Books, 1999.

Sengoopta, Chandak. “Tales from the Vienna Labs: The Eugen Steinach-Hary Benjamin

       Correspondence. The New York Academy of Medicine. 2 (Spring): 2000. 1-7.

       http://www.nyam.org./publications/online/favedition/pdf/Fev1n2.pdf.

Sex and the City. “The Freak Show.” Created by Darren Star. HBO, 2000.

---“Plus One is the Loneliest Number.” Created by Darren Star. HBO,

       2003.

---. HBO, 1998-2004.

“Sex over Sixty.” Expression. Bulletin of the National Advisory Council on Aging.

       15.2 (Spring), 2002.
                                                                                    17


Shelton, Ron M. Botox. New York: Berkley Books, 2002.

Skin Deep. Life Network. 2002-.

“Summary of Safety and Effectiveness Data: Dermal Collagen Implants for Aesthetic

       Use.” FDA. http://www.fda.org

“Thema.” Broadcast on Arte, November 30, 2003.

Thompson, Mary. “The Construction of Public Health in the FDA Hearings on Silicone

       Breast Implants.” In Body Talk: Rhetoric, Technology, Reproduction. Eds. Mary

       M. Lay, Laura J. Gurak, Clare Gravon, and Cynthia Myntti. Madison:

       University of Wisconsin Press, 2000. 262-276.

Two Voices. Dir. Peter Levin. Hearst Entertainment Productions, 1997.

Tucker, Jonathan B. Scourge: The Once and Future Threat of Smallpox. New

       York: Atlantic Monthly Press, 2001.

Wolfson, Adam. “Biodemocracy in America.” In The Future is Now. 333-345.

Zeman, Ned. “The Botoxed and the Boldfaced.” Vanity Fair. 513. May 2003.

       194-97; 223-227.
                                                                  18




1
    Information taken from Begoun, Kane, Shelton, and Mitchell.

				
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