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
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
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
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
technologies like breast implants; rather, her work enables feminists to
consider new technologies as discursive sites for the deployment of power.
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 ). By the nineteenth century (perhaps
in response to the prevalence of tuberculosis), lips were reddened through the use of
mercuric sulfide, and belladonna used to make eyes sparkle (feverishly?) (Boyd ).
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
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
Differences in perceptions of biotechnological treatments are not insignificant,
either, nor are they ungendered. Laser eye surgery (for example) is a common practice
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
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
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
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
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
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
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
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,’)”
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
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
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
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
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.
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