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The economics of appearances

Plastic surgery reinforces the ideal of the body as social capital

MARCELO CIPIS“Plastic surgery is a crime against religion and good customs. Changing the face that God gave us, cutting skin, sowing the breasts and who knows what else, vade retro [Get thee behind me, Satan] .” This is how Ponciana, a character in the novel Tereza Batista cansada de guerra [Tereza Batista: home from the wars], by Jorge Amado, reacts on seeing his neighbor, Dona Beatriz, “renewed,” with her “smooth face, without wrinkles or a double chin, high breasts looking as though they had no more than thirty hot-blooded springs, total effrontery, the walking glorification of modern medicine.” Imagine how she would react today, on knowing of the findings of a recent survey by Ibope, in conjunction with the Brazilian Society of Plastic Surgery (SBCP): one plastic surgery intervention is carried out every minute in Brazil; 1700 a day, for an annual total of 645,000, second only to the United States with 1.5 million surgeries. Some 65% of Brazilian plastic surgeries are cosmetic and women are the biggest customers: 82%. The national preference is for liposuction (30%), followed by a silicone implant (21%). Over the last five years the demand for cosmetic plastic surgery for men has also increased by 30%.

“What has made plastic surgery become almost an obligation, with growing demand in all regions and social segments? Brazil is the only country where plastic surgery is offered by the public health system (15% of the total) and private clinics even have installment plans,” says American anthropologist, Alexander Edmonds, from the University of Amsterdam and author of Pretty modern: beauty, sex and plastic surgery in Brazil, recently launched in the USA by Duke University Press. “In Brazil it’s not enough just to be thin. Women have to be ‘fit’, shapely and sensual. Over and above being a good mother, a competent professional and a caring wife, she has to face up to the ‘fourth shift’ at the fitness center in her pursuit for an always intangible body. Brazilian women are their own worst tormentors as they constantly seek the approval of other women. We have to think of a woman who lives with her faults, does not criminalize her body to escape from the normal standards and who takes advantage of times like maternity without wanting to go back quickly to her previous shape,” explains Joana de Vilhena Moraes, coordinator of the Beauty Disease Center at the Pontifical Catholic University of Rio (PUC-Rio) and author of Com que corpo eu vou? Sociabilidade e usos do corpo nas mulheres das camadas altas e populares (Editora Pallas/PUC–Rio), [What body am I going to have? Sociability and body uses in women from the upper and lower classes], a book that gives the results of her research and that was funded by Faperj on esthetic patterns in different social classes. “We discovered that whereas the demand for the perfect body is democratic, the desire of both rich and poor women, there are different concepts of beauty. Among the rich, any sacrifice is worth the trouble of becoming as thin as a model. Among the poorer women, what is really pretty is the fuller, curvaceous body of ‘pagode’ [samba-derived musical genre from Brazil’s Northeast] dancers. What is different between the groups is their suffering: the rich hide themselves under loose-fitting clothes; the poor show off their fat shamelessly, in microshorts and tight tops.” According to Ms. Moraes, this does not prevent them also working out and lining up in public hospitals to have their cosmetic surgery. “The media, with the support of medical discourse, encourages women to revert to these means to avoid them observing changes in their subjectivity. To do so they take advantage of the current stage of evolution in the biotechnological sciences in which the country is globally respected.”

Curiously, according to Edmonds, cosmetic surgery was for a long time not seen as legitimate medicine and to gain acceptance it needed to be transformed into a “cure,” by allying itself with psychology: concepts like “inferiority complex” gave the operation a therapeutic basis. “Surgeon Ivo Pitanguy was responsible for blurring the boundaries between cosmetic surgery and reparatory surgery, since both would cure the psyche. For Pitanguy, the plastic surgeon is a ‘psychologist with a scalpel’ and the true therapeutic object of the operation is not the body but the mind,” notes the American. But there are consequences for the profession. “Health is now a symbolic umbrella and is not restricted to remaining within the norms of medicine: it’s looking after, shape, weight and appearance.” Health “has become synonymous with beauty,” is the analysis of Francisco Romão Ferreira, a professor on the PGEBS (Post-graduate Program in the Teaching of Biosciences in Health at the IOC/Fiocruz) and author of the research Os sentidos do corpo – Cirurgias estéticas, discurso medico e saúde pública. [Body meanings – Cosmetic surgery, medical discourse and public health] “There is a pseudo-democratization of technology that leads people to think that the process is simple and with few risks, and those who have recently graduated in medicine migrate to this rich market vein, which makes these professionals warn of the trivialization of the surgery. It is a break with traditional medicine, where the body is the field of action. This medicine, on the contrary, is inscribed on the body surface, with subjective criteria outside the body. The illness is artificially created within the environment of the culture, outside the body, but that is beginning to form part of it.”

“Physical beauty has attached itself to the national and global imagination of Brazil and it is impossible to conceive of Brazilian identity without an esthetic component, a ‘cosmetic citizenship’, which does not mean real rights, but is a way of reproducing social and structural inequality,” says anthropologist, Alvaro Jarrin, from Duke University, author of the research, Cosmetic citizenship: beauty and social inequality in Brazil. This is what Edmonds calls “esthetic health,” a mixture of the right to health and consumerism. “If people didn’t realize their citizenship, at least they could ‘remake’ themselves as a ‘cosmetic citizen’. The socially excluded became ‘esthetic sufferers’. Health was always seen as beautiful; in Brazil, beauty has been transformed into something healthy.” For Jarrin, Pitanguy understood this need of the poor for citizenship of beauty when he created the first popular plastic surgery service in a teaching hospital as a philanthropic service and gained support from the State. “The government is an accomplice and indirectly capitalizes on the success of the development of cosmetic surgery,” he notes. “The right to cosmetic surgery was never directly authorized by SUS [Brazilian public health system], but through ingenious redefinitions of what health is, doctors carry out cosmetic surgery in public hospitals, where they can practice with little risk of being sued for errors, thus developing a ‘Brazilian style’ that has been exported to the whole world,” Edmonds believes.

“So the representations of the body of the Brazilian woman are no longer because of the ‘real lost nature’, an expression of the mixture of races, but a product of the association between this former notion and the most modern techniques, a dangerous intimacy between prosthesis and flesh. In a country whose image is ‘natural beauty’, valuing the surgical techniques of Brazilian doctors is a paradox,” is the assessment of historian, Denise Bernuzzi de Sant’Anna, coordinator of the research group, The Body Condition, at PUC-SP, and author of Corpos de passagem: ensaios sobre a subjetividade contemporânea [Temporary bodies: essays on contemporary subjectivity]. “But the freedom to construct one’s own body does not escape demands, like being young and the obsession with never-ending happiness and all in a very short timescale, in which each one is responsible for success or failure as a function of the body cult, or neglect of it,” she assesses. “The problem is not the care itself, but making of the body a territory that dispenses with contact with anyone who is different from us; not liking someone because of their body.” Segregation with defined objectives. “Suffering to have a body that’s ‘in shape’ is rewarded by the gratification of belonging to a group that has a ‘superior worth’. The body identifies the person with a particular group and distinguishes it from others. This ‘worked on’, ‘worked out’, ‘fit’ body is today a sign that indicates a certain virtue. Under the moral of good shape, ‘working on’ the body is an act of signification,, like dressing. Like clothes, it is a symbol that makes a visible difference among social groups,” observes anthropologist, Mirian Goldenberg, a professor from the Federal University of Rio de Janeiro (UFRJ), author of O corpo como capital [The body as capital] and who analyzed the phenomenon in the research Mudanças nos papéis de gênero, sexualidade e conjugalidade [Changes in the roles of gender, sexuality and conjugality], supported by the CNPq.


If adolescents are sexualized, older people also suffer with this. “Surgery means ‘staying competitive’ at any age. In the past a 40-year old woman felt old and ugly, ready to be changed for a younger one or condemned to solitude. Now this woman is in the market, competing with 20-year old girls thanks to plastic surgery,” says Edmonds. Plastic surgery has been responsible for major cultural changes. “As from the 1960’s, ugly women were accused of being that way because they did not love themselves. Being modern became cultivating the beautiful appearance and bodily well-being. Refusing beauty is a sign of negligence to be fought against, a psychic problem solved by plastic surgery,” observes Liliane. The impacts are strong on the elderly. “Surgery is a way of fleeing from the marks of time, denaturalizing the normal processes and preventing nature from following its destiny. Old age is transformed into a question of bodily negligence, denying the constraints imposed by the body’s biological limits,” is Guita’s assessment. “Aging is the monster that medicine tries to combat. Surgery should not be banned, but old age should not be restricted to a ‘hormonal imbalance’, comparing it with a disease, an esthetic question, magically solved with an operation, which only repeats the ancient form of control over women,” is Joana’s analysis.

After all, observed Guita, there is a tendency to transform old age into a question of bodily negligence and doctors make every effort to encourage the elderly to adopt strategies to combat the marks of aging, denying the constraints imposed by the body’s biological limits. “Operations show the aversion to what is different and surgery is an attempt to flee from the marks of time, denaturalizing natural processes and preventing nature from following its destiny,” advises the anthropologist. “Aversion to the old body organizes the technology of rejuvenation. The ideals of bodily perfection delight the media but all know that it is an image that can never be reached. It is the materiality of the old body that is transformed into a norm, by which the experienced body is judged and its possibilities restricted.” With the growth in the number of old people in the population, the market excels in showing how the young of an advanced age must behave to prepare themselves for repairing the marks of aging. “This projection of the young body on the materiality of the old body and the negation of the natural course of things prevents the creation of an esthetic of old age,” notes Guita. Mirian Goldenberg, in a recent piece of research carried out in Germany on the view of aging, encountered symptomatic differences. “Observing the appearance of German and Brazilian women the latter appear younger and in better shape, but feel subjectively older and more devalued than the former. This mistaken assessment made me perceive that here old age is a major problem, which explains the enormous sacrifice that many women make to appear younger,” says Mirian. “They build their discourses emphasizing the things they feel they are lacking, not their objective conquests. The freedom of Brazilian women appears like a late conquest after having fulfilled their roles as mother and wife. In our culture, in which the body is important capital, getting old is experienced as a moment of great loss (of capital), of a lack of a man and of social invisibility, going in the opposite direction of what older German women feel, who value their appearance less than new experiences, professional achievement and quality of life,” explains the anthropologist.

Not everything, however, is so thorny in esthetic surgery. “There is a democratizing element in all this. Plastic surgery, in emphasizing the naked body, in detriment to clothes and ornaments, naturalizes and ‘biologizes’ the body, since in this state it is less legible as a ‘social body’,” says Edmonds. “It incites a view of beauty as egalitarian, social capital that does not depend on birth, education or social networks to advance. When access to education is limited, the body relative to the mind is transformed into an important basis for identity, a source of power.” For the anthropologist it is this cultural context that makes Brazil unique in its use of plastic surgery. “It’s a country remembered for grace and sensuality and rarely for discipline. Perhaps that’s why plastic surgery in the country is not linked to an alienation of the body, a hatred of shapes, but to an ethos that is better adapted to the beauty industry: compulsory love of the body.”

“In Brazil, the body is capital, a model of wealth, most desired by individuals from the middle classes and the poorest classes, who see the body as an important vehicle for social climbing and as capital in the labor market, in the marriage market and in the sexual market. The search for a ‘fit’ body, for those who are followers of the cult of beauty, is a struggle against the symbolic death imposed on those who do not discipline themselves and adjust to the standards;” and with a right to geographical subtleties. “In São Paulo there is the culture of ‘light’, but clothes are still the important adornment. In Rio the body is unveiled. When they asked Adriane Galisteu how she knew when it was time to “close her mouth” she said: “If they call me ‘hot’ in the street, I know I’m fat’. This is Rio thinking,” says Joana. Everyone, however, wants to be well-evaluated by their peers. “A fat woman in the middle and upper classes is reason for derision; in the slum she need not get rid of her extra kilos to be admired. The very poorest spend more energy guaranteeing their basic survival rights, things that for richer women have been resolved. At least in this relationship with the body, slum-dwellers are happier,” she says.

In her research, Joana described how women from the better-off classes use a more sophisticated and individualistic discourse, saying that they make sacrifices for themselves, like plastic surgery and working out hard. Proof of a tense relationship with the mirror: the “work on” the body is never justified as wanting to be a greater object of desire. “In the slums they say quite openly that they have the surgery to ‘be hotter’, sexuality that is more fully experienced,” she observes. This does not mean that poorer women do not notice they are fatter and are satisfied with their bodies, because they have access to information, read magazines and watch the same soaps as richer women. “The difference is that they’re imprisoned by this process. Sacrifice and discipline are maximum values of the upper classes. In the popular classes, sacrifice is associated with poverty and fatness with prosperity. A woman from the slum told me that she was not going ‘to live on lettuce’ because they were going to think she was living in poverty.”

But to the disgust of Gilberto Freyre, who saw Brazilian beauty in the woman with small breasts and large buttocks, Brazil and the US today share the same bodily ideals. An American obsession, the increase in breast size, has been on the rise here since the 1980’s, to the point that the cover of Time (July 2001) had singer Carla Perez with prominent breasts, in the molds of American women, with the question of whether the new “tropical bust” was not “cultural imperialism.” But there are differences. A study by the International Society of Aesthetic Plastic Surgery (ISAPS) states that Brazilian women want bigger breasts, but also large buttocks, with sculpted hips in their search for the curvaceous “Brazilian” body. For Bárbara Machado, head of the medical team at the Pitanguy Clinic, breast reduction used to be more popular, but with the increase in the safety of implants and the fact that beauty icons have bigger breasts, Brazilian women have opted for bigger breasts but without giving up their curves.

Mere frivolity
Edmonds observes that beauty is fundamental, even in the labor market. “Appearance, color and sex appeal ‘add value’ to the service or are selection criteria. Attractive men and women have bigger salaries, because the worker becomes part of the product offered to the consumer.” Body culture is also the culture of productivity. “Appearance talks about your character. If you know how to manage your body well the interpretation of your character is that you know how to live, are a good professional, are not slovenly and administer your life in a competent way,” says Joana. “Women, however, need to think of another model of a successful person, because the current model is leading people to extreme sickness, since there is an enormous accumulation of tasks, the result of feminism, which gave women the freedom to work without taking into account that they also need to be beautiful and slim.” Feminist triumphs acquire another meaning in the plastic modernity. “The tyranny of the ideals of beauty was explored by the feminists in the 1970’s. But now the struggle of women to improve their appearance is legitimized as a victory of feminism and already the healthy egoism of the pleasure of looking after oneself is accepted, a pride in exhibiting desirable bodies in public. Imprudent optimism needs to be avoided. Plastic surgery allows new capacities to be acquired, but the use of technology has a perverse effect on women: hiding the effects of old age is promoting the reproduction of inequality,” analyzes Guita Grin Debert, a full professor in the Department of Anthropology at the State University of Campinas (Unicamp), author of the research study, Velhice e tecnologias de rejuvenescimento [Old age and rejuvenation technology] (supported by FAPESP).

Among such effects is the “attack” on motherhood. “The rhetoric of the industry is freedom from biological destiny, but the tensions between being a mother and continuing to be a sexual being remain. Surgery heightens the conflict, because it theoretically allows women to be mothers and to continue having sex appeal, correcting the ‘defects’ caused by maternity in the post-birth body and the vaginal anatomy,” observes Edmonds. Or, in the words of Diana Zuckerman, from the National Research Center for Women & Families in the US: “The dream of marketing men is to make women believe their bodies are repugnant after the birth of a child.” “The medicalization of the body by surgery is not legitimized by the biological discourse of the past, whose ideal beauty of the body of a woman comes from maternity, with the rounded, voluminous body, developed hips and generous breasts. Now everything is based on the ‘psi’ discourse, which brings submission to the medical order by affirming the desire of possessing a ‘perfect body’ as a function of self-esteem. In this discourse, everything is explained by the emphasis on inner self, which leads people to justify the need of everyone to adjust to esthetic models because of self-esteem,” is the analysis of anthropologist, Liliane Brum Ribeiro, author of the research study, A medicalização da diferença [The medicalization of difference]. This concern is happening at increasingly earlier ages and affects teenagers who “prepare” themselves for the future by correcting “defects” in their young bodies, and above all increasing their sex appeal; hence the growth in the percentage of young people who are operated on at 19 (25% of the total). “Surgery places women in competition for longer and even the generational differences disappear, with mothers and daughters ‘fighting’ among each other for men, increasing even more the ‘market value’ of the appearance of youth,” notes the American.