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Conscious During Cosmetic Surgery

I treat critical theory the way an evangelical preacher treats the Bible—as a set of texts that can help me figure out everything I need to know about the world around me. And yet sometimes, the world around me is so incomprehensible that I am left speechless.

Take the latest cosmetic surgery trend—awake surgery. You would think that after spending five years writing a book on cosmetic surgery, I could no longer be shocked by anything this industry has to offer. You would be wrong.  Awake surgery is cosmetic surgery without general anesthesia. The patient is numbed, but not so numb that she doesn’t feel pain, often excruciating and torturous pain. One patient says she

couldn’t stop screaming. Lying on her side on a gurney, wearing only a bra and panties, she felt as if she were being stabbed again and again.

“Please stop! You’re hurting me!” she cried to her doctor.  But the man performing the lipo, who turned out not to be the doctor but an assistant, told her to be quiet.

The boards that certify cosmetic surgery, like the American Society of Plastic Surgeons, think awake surgery is not a great idea because none of the surgeons doing it have a lot of training (usually two days) and because of the complications (including legal ones) that can arise.

But many of the surgeons performing awake surgery argue that it “empowers” women to make decisions, like what size breast implant they really want. According to Jeffrey C. Caruth, who performs awake breast implants at his office in Plano, Texas, his patients are “totally alert.”  Because they’re awake, Dr. Caruth can stop midway through the operation and allow the patient to see her breasts stretched to a particular size, then usher in her partner or family and everyone makes the “decision” about size together.

“It’s actually a lot of fun; we play music and talk… They want to have input. When you go shopping, you don’t take something off the rack, throw it in the sack and go home. You try it on first… Women are picky. It’s like shopping for a new dress or a pair of shoes.”

But as “empowering” as shopping for breast implants while heavily sedated and cut open might be, the real driving force behind awake surgery is it’s a lot cheaper for the surgeon, since no anesthesiologist is necessary and the surgeon doesn’t even need to have hospital privileges or a surgical center to operate.  The result—bargain-basement prices and some serious pain.

Cosmetic surgery is not well regulated. Any medical doctor can perform it, trained or not. A recent study in California found that 40 percent of those performing liposuction had no training whatsoever before entering the field. So clearly we need more state regulation of cosmetic surgery and commercial medicine generally. But that doesn’t really answer the question of why anyone would submit to what can only be described as torture?

When cosmetic surgery became a viable commercial enterprise a bit over a hundred years ago, it was in large part because surgeons had learned to put people out with gas. No one was willing to undergo surgery for purely cosmetic reasons unless the pain (and risk) could be minimized. Since then, these completely unnecessary surgeries have grown at a brisk rate to something like 12.5 million a year in the U.S.

But in 2011, as the requirements of the body project are ratcheted up to levels never before seen and the economic well-being of most Americans continues to decline, we are apparently willing to go under the knife without having the benefit of being asleep. This represents a relationship to the body—especially the female body and 91 percent of cosmetic surgery patients are women—that can only be described as alienated.

As Susan Bordo tells us in Unbearable Weight, the female body has for millennia been seen as out of control and in need of externally imposed limits. Whether it’s through self-induced starvation or cosmetic surgery, the unruly female body must be brought into line.  If I think about awake procedures as the abjection of the female body within consumer capitalism brought to its logical conclusion, then I find comfort and solace in the holy cannon that is critical theory. But I can’t help but wonder if even the formidable powers of critical theory are insufficient to explain this kind of self-destruction.

(Photo: Orlan from her performance art/cosmetic surgery series)

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