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“I’d literally gotten to the point where I’d rather be dead than to continue living life as a fat girl,” says Nicole Grays Owens. Co-founder of a multimillion-dollar payroll and staffing company, a media guru, host of two podcasts, and a fixture in Atlanta’s elite social scene, Owens hobnobs with celebrities as a wardrobe stylist and local personality. She’s also spent tens of thousands of dollars over eight years on plastic surgery and cosmetic procedures to become the woman she is today: “charismatic, sexy, and dope,” in her words.
Although body modification is not a new phenomenon, nor limited to western culture—the Mayans sharpened their teeth to show status, while tribes in Papua New Guinea practiced scarification to mark the passage into manhood—the types of elective cosmetic plastic surgery available in the West since 2000 have changed dramatically. According to the American Society of Plastic Surgeons (ASPS), overall, plastic surgery procedures have increased by 115 percent from 2000 to 2015. However, what’s significant is not just the growth in cosmetic surgery in the new millennium, but rather the shift in attitudes towards plastic surgery given the vast array of possible deletions, additions, and upgrades. Says ASPS President Dr. David H. Song: “Patients have more options than ever, and working closely with their surgeon, they’re able to focus on specific target areas of the body to achieve the look they desire.”
The ASPS reports 15.9 million surgical and minimally invasive cosmetic procedures performed in the United States in 2015. That adds up to US$12.9 billion (around UK£10 billion) spent on plastic surgery in America alone, according to the same ASPS report.
So the question becomes: with myriad ways to fix yourself under this divide and conquer design, how do you know when you’ve gone too far?
Before her initial lap band surgery, where Owens shed about 150 pounds (68 kilograms)—going from a size 24 to a size six (UK size 26 to UK size eight) in just 14 days—she spent years as a social recluse and suffered anxiety from the most mundane social interactions. If there was a fire drill at work, she’d wait for her peers to walk back up the stairs. She couldn’t let them see her struggle “with the walk back up.” Despite successfully spearheading million-dollar deals, Owens was shamed by “the sound my thighs made when walking up the stairs.” Seemingly innocuous group activities caused her paralyzing anxiety. “I was embarrassed by my weight gain, unable to find clothes that fit, not wanting to travel; those tiny airplane seats are no joke, and no one wants to sit next to the fat person. I was out of control. My body was like a runaway train. I basically hid out at home. Alone. Those feelings led to me becoming an ‘emotional eater,’ and it just kept getting worse, until I reached a little over 300 pounds.”
The control she was able to wield in the boardroom eluded Owens when it came to her body, until a friend suggested she talk to a doctor about gastric bypass surgery.
“I’m articulate and intelligent,” Owens tells me about the thoughts that went through her mind as she considered undergoing gastric bypass surgery in 2008. “But I felt subpar; I felt less than. At work, I wasn’t being treated like my counterparts were being treated. It hurt a lot.”
After the success of her initial gastric bypass (which was covered by insurance under a medical clause), Owens found new self-confidence—not unusual for people who undergo such severe weight loss. “I was healthy and gorgeous,” she says, claiming the recovery was a breeze.
But seven years later, in 2015, Owens’ personal life took a hit with the dissolution of a relationship and the passing of her mother. The stress manifested physically, and her body once again felt like a “runaway train.” However, because the lap band prevented her from gaining weight—making her physically ill if she were to overeat—Owens began to rapidly lose weight. Still suffering from disordered eating as a way to cope with trauma, she “completely lost [her] appetite.” Soon, she’d shrunk down to a size four (UK size six). This is when she started to notice the excess skin. “I was a saggy mess,” she says. “And all of a sudden, an A-cup.”
Many patients who lose a considerable amount of weight experience excess or loose skin, for which exercise, laser treatment, and surgery are medical solutions. But why did it take Owens seven years to be bothered by the excess skin? Certainly downsizing from a six to four isn’t that dramatic.
“It’s hard to remember,” explains Owens. “But at some point I started wondering, ‘where did this old lady body come from?’”
Before undergoing the initial gastric bypass, Owens’ insurance company required a psychological evaluation approving the surgery. For elective surgeries (not covered by insurance), many plastic surgeons make their own psychological assessments of patients when deciding whether or not to take them on. “I try to get a good handle on what their desired outcome is,” says Dr. Jeffrey Rockmore of the Plastic Surgery Group in Albany, whose trademarked motto reads “Confidence is Beautiful.” Rockmore continues, “If I think a surgery is going to take away from their natural beauty, I turn away patients; most people are appreciative of it.”
But what exactly does a psychological assessment measure in a patient seeking cosmetic plastic surgery?
Dr. Judith C. Kuppersmith, professor emerita of psychology and women’s studies at the City University of New York and a neo-Freudian psychoanalyst in private practice in New York City, says, “Body-changing has an ancient history, as many or all cultures do it, around issues of becoming adults from children or adolescents—for both men and women, boys and girls—so we alter to go back to something primitive and known.”
Kuppersmith continues, “We have vanity and self-worth at stake, and the anxiety we knew early in development returns to us as a way to save ourselves (falsely though, I think). However, I do understand the desire to alter in order to feel the promise of youth, which is full of promise but—much of which we don’t live out. So some of us go to irrational and primitive extremes to feel that rush of early body ego developmental promise.”
For her part, Nicole Grays Owens elected to undergo a new, three-phase round of plastic surgery that would total 14 different procedures and cost around US$50,000 (around UK£39,000). “Phase one took place in April 2016,” she says. “I had a brachioplasty (arm lift), a breast lift, breast implants, blepharoplasty (under-eye bags removed), and a tummy tuck where the doctor created an entirely new belly button, after removing so much excess skin. Phase two began in July 2016: I had an upper body lift, Brazilian butt lift, and a fat transfer to my buttocks, but there wasn’t much to transfer, so I knew I’d have to do it again in the last stage. Phase three took place in October 2016 … an inner and outer thigh lift with a fat transfer to buttocks and also labiaplasty. Throughout each phase, I added Botox to my forehead, between my brows, and at my crows feet, and filler around the laugh lines at my mouth.”
Recovery from these procedures tested Owens’ resilience, physically and mentally. However, she now saw her body as an investment—one that had to yield high returns.
“None of this was easy,” says Owens. “It wasn’t. I made it look easy. I took the pain medication and did what I had to do to get better. I felt that at any moment I could wake up and be that 300-pound chick again. That was terrifying.”
Nicole Grays Owens’ more recent procedures fall in line with what the ASPS reports are the latest plastic surgery trends, namely lifts. Since 2000, RealSelf statistics show considerable growth in buttock lifts (up 132 percent from 2000 to 2009). Supporting this data, the ASPS 2016 Statistics Report notes an increase of 26 percent in buttock augmentation using fat grafting. The aforementioned report notes upper arm lifts are up 5,184 percent from 2000 to 2016. The most common plastic surgery procedure remains breast augmentation, with 290,467 procedures performed in 2016. However, breast lifts have become increasingly common. 101,264 breast lifts were performed in 2016, up 92 percent since 2000.
Before 2000, the most common type of cosmetic lift was the facelift, which in the West, dates back to 1901, when Berlin surgeon Dr. Eugen Holländer nipped and tucked an aging aristocrat. In 1923, the famous Ziegfeld Follies star Fannie Brice had a nose job performed in her hotel room by Dr. Henry Schireson, which marked the birth of cosmetic surgery and the beauty business as it’s known today.
By 1990, Jane Scher was 37 and in the middle of a divorce when she sought the advice of a well-known plastic surgeon. “They talked me into having a facelift,” Scher, now 64, tells me. And despite her surgeon’s prominence, the facelift went horribly awry. “They made an incision in my scalp and lifted it to do a forehead lift, cut the top of my head from ear to ear, and cut out two inches off my scalp. They distorted my whole hairline.” Scher says that immediately following the surgery she could tell something was wrong: “The position of my scalp was unnatural. But they told me, ‘you look gorgeous.’”
For Scher, now Jane Scher, RN BSN, the results of her facelift left her feeling anything but beautiful, and since then, she has become a cosmetic nurse who specializes in non-invasive laser procedures for women who want to reverse the signs of aging without the risks of cutting and pulling the skin. “I’m still coping,” she says. “It’s not easy. I had a beautiful hairline like Angelina Jolie, and now … I just have to make adjustments. I never wear my hair in a ponytail.”
For RealSelf contributor Dr. Paul Nassif, a board-certified plastic surgeon in Beverly Hills, star of E! show Botched, and former cast member of The Real Housewives of Beverly Hills, helping patients like Scher “make revisions” to plastic surgery gone wrong has become his raison d’être, not to mention a lucrative business. “Many of these patients are traumatized and have PTSD. They’re fragile, suffering from stress, worry, as well as unrealistic expectations. There’s an array of things that makes doing a revision very complex. These patients are haunted.”
In terms of cosmetic surgery, is there a difference between surgery that goes wrong, versus surgical results that a patient feels just look wrong? And what of the surgeon’s opinion? Nassif considers plastic surgery that’s gone too far “something that looks unnatural, something that is too extreme. Cosmetic surgery has to make sense,” he says. “If it’s going to look weird or unnatural or is dangerous or weird, I don’t want to do it.”
When will Nassif perform a revisionist surgery? Like his colleagues, Nassif insists on a psych consult, and will also perform a virtual computer rendering of what the finished result will look like. Finally, Nassif explains the risks (there are always risks associated with any surgery) and potential negative outcomes. If the patient can in good faith live with potential negative outcomes, Nassif will proceed. Finally, he says, “If the physical change can help bring inner peace and can help someone to stop ruminating on this [perceived flaw] and move on to something more positive,” the Beverly Hills doctor deems the surgery not only acceptable, but possibly “transformative.”
Of course terms like “unnatural” and “too extreme,” are subjective. But the idea that “everything has beauty, but not everyone sees it,” is as old as Confucius—one of many ancient philosophers to suggest that people relate beauty to their own experiences.
Today, however, people’s experiences are being filtered, well, by filters—the Insta-worthy selfies and Snapchat modifications that virtually transform people into a fine-tuned version of themselves. And according to Nassif, the latest trend in cosmetic surgery is coming from patients under 30. “They want to mimic the filters on their phones.”
When you Google “how to get rid of a pimple,” or “how to erase crow’s feet,” you’re not only likely to find solutions to treating acne and fine lines in real life; you’ll also be provided with a series of apps and Photoshop tools to erase blemishes from your photos. The border between your virtual self and your flesh and bone is becoming harder and harder to recognize. Before Instagram and Snapchat filters exploded in pop culture circa 2013, for many people, living in a state of “normative discontent” was standard, and even served as glue to bring people together to bond over bodily flaws. Normative discontent refers to the mindset that finding flaws in your physical appearance is part of the modern human experience, substantiated by cultural norms about aesthetic ideals. In other words, it’s totally normal to find your appearance subpar, and chances are you’re not alone. According to the U.S. National Library of Medicine of the National Institutes of Health, a study published in 2011 revealed that men as well as women suffer from normative discontent because no one looks like the celebrities and models who infiltrate everyday lives—not only via traditional forms of media, but by mobile social feeds, where smartphones are the latest bodily appendage.
If technology didn’t piggyback on hegemonic beauty standards, there’d be no market for the hundreds of beauty apps that round eyes, slim waists, contour cheeks, lengthen legs, lighten areolas, and so forth. Photo apps with flattering filters might account for the fact that there is a 44 percent spike in cosmetic procedures among 18-35-year-olds, according to a press representative for RealSelf.
Certainly, there’s instant gratification—even fame and fortune—to be made by undergoing so-called virtual plastic surgery. Artist Leah Schrager, known for exploring “the digital life of the female body,” says, “as soon as a person takes a picture of themselves, edits it, and puts it on social media, it’s a performative act. Through posing, editing, and curation, the person is making a particular version of the self. Can you try to become that in real life? If you want! I frankly couldn’t be what I am online in real life. But I see some people who are. I’m into people being whatever filtered or non-filtered version of themselves they want to be.” Schrager created a sexed-up, ultra-filtered alter ego named ONA, a digital “celebrity” version of herself; ONA’s 450,000 Instagram followers (at the time of writing) have gotten the artist notoriety in the mainstream press as well as the art world—and have helped fund her work.
The latest trends in real-life plastic surgery cater to the type of bodily manipulation that Schrager capitalizes on in her work. Rather than requesting to look like celebrities, patients are bringing in pictures they’ve seen on social media which they want to resemble, according to Dr. Joseph Russo, a Harvard-trained and board-certified plastic surgeon who has been practicing plastic surgery in his Newton, Massachusetts, office for 25 years. These new options are being hailed as less invasive (and as such, no big deal), gender-inclusive, and endorsed by celebrities who also practice them.
“The beauty of plastic surgery is that every person is different,” says Dr. Jeffrey Rockmore, who comes from an art background. He says, “It’s the artistic component that drew me.”
But is plastic surgery art? “It makes sense to me that the doctors think of themselves as artists,” says Leah Schrager. “Plastic surgery is a process of modifying the physical body, whereas in my art I modify my digital body.”
Just like any form of modern art, cosmetic surgery is concerned with trends. Says Rockmore: “Breast size is going down, lip size is going up, and butts are getting lifted to create a bubble effect.”
In the dozen interviews I conducted with plastic surgeons, the two names that came up again and again were Jenner and Kardashian, from Kylie Jenner’s lips to Kim Kardashian’s butt. “I first started seeing an increase in the Brazilian butt lift in my practice around 2013, when Keeping Up with the Kardashians was at its most popular,” says Rockmore. Although they amass great wealth, affluence, and fame, the Kardashians are notorious for being famous, and vice versa. This thinking might make them seem more accessible—and their body parts more imitable—to everyday Janes.
As for Jane Scher, her experience is becoming an anachronism in the world of cosmetic surgery, as one of the latest trends is a move towards noninvasive surgery done with sculpting or skin tightening. Surgical facelifts are becoming a thing of the past. Says Rockmore: “It’s more important to work with the contours of the person’s face and customize a look with a skin-tightening procedure. It’s more natural [than a facelift], and the goal is to enhance what they already have and make it more in balance with the rest of their features.”
Many of these older procedures are being updated with new techniques that are less invasive, require fewer risks, and less recovery time. “Cool sculpting has replaced liposuction,” Rockmore says, because the procedure has no recovery time, with unwanted fat being “gradually reabsorbed and metabolized by the body through the urine and liver.”
Another trend is breast augmentation for men. According to the ASPS, “there were 68,106 aesthetic breast reduction surgeries in the United States in 2015, and for the first time, men accounted for more than 40 percent of those procedures.” As plastic surgery is becoming more mainstream and socially acceptable, male patients who face “genetic challenges” that affect the size and shape of their breasts are turning to plastic surgery as a way of transforming their bodies, and in doing so, bridging the gender gap within cosmetic surgery.
But not all patient requests fall in line with this newer, more natural, more accessible look when it comes to cosmetic surgery. Dr. Jonathan Kaplan, a board-certified plastic surgeon in San Francisco, tells me about a woman who requested cankles—a high concentration of fat around her ankles—because she felt her ankles in their natural state were “too skinny.” Says Kaplan: “She wanted me to capture the fat from around her abdomen or love handles (a procedure that’s used in the Brazilian butt lift, when the fat is subsequently injected into the rear) and inject it into her ankles. She wanted cankles.”
In the end, Kaplan discouraged the woman from this surgery because he felt some body dysmorphic disorder was at play. “As a doctor, I can appreciate what the patient is talking about and get the problem, and offer to address the concern safely.” However, even plastic surgeons have limits as to what they will perform. “When it comes to body modification, I don’t split tongues to make people look like a snake; I want to do something to improve self-image. There’s no real consensus about an aesthetic ideal, but I trust that most plastic surgeons wouldn’t have performed the cankles surgery.”
Body modification remains a subjective response to an equally subjective idea of beauty. Extremes of beauty or its absence are ultimately equally relative.
What makes someone want to go under the knife? Kuppersmith calls it “primitive contagion culture,” where easy surgical improvements are perceived as valid ways to legitimize ambition or control fears of inadequacy. Whether body alteration is an attempt to undo some of the early childhood anxieties laid down in the brain, where neural pathways form body identity and might explain this attempt to return to the body in its more primitive state, there’s a larger cultural scheme that underlies the quick-fix approach triangulating money, power, and beauty under the practice of plastic surgery.
Living in a “contagion culture” suggests that you’re subpar, lazy, or poor if you don’t take advantage of plastic surgery procedures that are increasingly common and accessible. Of course, that notion is just what the beauty industry is banking on—and has been since its inception. It may be problematic to appear judgmental of anyone’s reasons for altering their appearance, even in extreme cases. But this psychological terrain becomes troublesome when the quest for beauty at any cost limits your self-perception to your flaws and problems, equating your self-worth with how drastically you can change. After all, there’s always another option: you accept yourself “as is,” #NoFilter.
This story is part of the Culture Trip Special: Limits collection.