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Under the Influence: Does Reality TV Promote Cosmetic Surgery?

Under the Influence: Does Reality TV Promote Cosmetic Surgery?


Sarina, a 36-year-old from Denver who describes herself as a “plain Jane,” has found it difficult to move on after divorcing her husband for cheating on her. She thinks that cosmetic surgery will provide the boost of confidence she needs. After undergoing numerous procedures, including an endoscopic brow lift, eyelid surgery, and liposuction of the abdomen, calves, and ankles, Sarina finally discovers the ability to love herself.

Does this scenario seem unusual? To one of the millions of people who tune in to any of the reality TV programs focusing on the cosmetic surgery field, it probably doesn’t seem that out of the ordinary. Cosmetic surgery has received so much attention from shows such as The Swan, Extreme Makeover, MTV’s I Want a Famous Face, and Dr. 90210 that fans of this TV genre are casually slinging around terms like “abdominoplasty,” “blepharoplasty,” and “capsular contracture.” (Well, they sure didn’t learn to talk that way in high-school science class.)

Certainly these shows have increased the average American's knowledge of the many cosmetic upgrades available. But has reality TV actually played a role in influencing people like Sarina to undergo plastic surgery? Experts believe it has.

Education or Imitation?

Recently, the American Society of Plastic Surgeons studied the possible effects that cosmetic surgery reality TV shows could have on viewers. Published in the ASPS journal Plastic and Reconstructive Surgery®, the results of the study revealed that “plastic surgery reality television plays a significant role in cosmetic surgery patient perceptions and decision making.”

The 42 cosmetic surgery patients who participated in the study were grouped according to “program viewing intensity.” The group of “high-intensity” viewers, which included more than half of the participants, thought that cosmetic surgery reality shows were more true to life than did their “low-intensity” counterparts. They also felt more cosmetic-surgery savvy than those who did not watch the shows. Furthermore, four out of five of the “high-intensity” viewers confided that plastic surgery reality TV influenced their decision to seek cosmetic care.

Is there a monkey-see-monkey-do phenomenon at work here? Or is the issue more complicated?

A Social Affair

Social comparison – the idea that people are predisposed to comparing themselves to other members of society – is not a new concept. Publishing his theory of upward social comparison in the 1950s, psychologist Leon Festinger saw people’s tendency to compare their appearance to those of people deemed superior in some way as detrimental to their sense of self-image.

It is not surprising, then, that modern women – and men – affected by the constant barrage of images of beautiful people still go to great lengths in their attempts to attain the looks idealized by society. We see pictures of “perfect” people perhaps more often than photos of our own family members. The result is that the ideas of beauty portrayed in these images, according to the Social Issues Research Center, become the norm.

However, is the desire to have a new nose or firmer belly enough to cause people to undergo uncomfortable treatments, all in the name of beauty?

No Pain, No Gain

Considering that “suffering for beauty” – to quote my grandmother – is not a new concept, it's not all that surprising that people are willing to undergo surgery to improve their appearances. Picture, if you will, the tightly-laced corsets that fashionable women used to wear in 19th-century England. It turns out that swooning, made to seem alluringly feminine in period romance novels, was actually caused by restricted air flow. Women were prone to flopping about because their shape-enhancing equipment wasn’t letting them breathe properly.

On the other side of the world, it wasn’t the binding of ribs and waistlines but of feet that was a sign of beauty. By the time corsetry achieved its heyday in Victorian England, the practice of foot binding had been the norm in China for nearly 900 years. Around the age of four to seven, Chinese girls began to undergo a particularly painful rite of passage. A little girl’s foot was soaked in hot water and tightly wrapped so that all but her largest toe was pressed against the bottom of her foot. The bandages were tightened each day until the ideal “lotus” foot was created. Her feet now approximately three inches long, the girl could totter around in her fashionable tiny silk shoes. Although the process to create the desired foot shape lasted around three years, the pain and disability from having deformed feet lasted a girl her entire life.

For whatever reason foot binding became part of Chinese culture (and there are various theories regarding its origin), it remained a mark of beauty and status for almost 1000 years. Though foot binding was banned by the Republic of China in 1911, the concept of suffering for beauty lives on in some respect as cosmetic surgery in China has become a billion-dollar business.

A World-Wide Phenomenon?

If you’re thinking that plastic surgery reality TV and its influence on the lives of average people is a peculiarly American phenomenon, apparently you haven’t watched Beauty Coliseum, a prime-time makeover show in Japan. The show features topics such as “Kindergarten teachers whose faces frighten their students,” “Aerobics instructors that can't smile,” and “A 5-year-old girl that wants to become just like [Japanese pop singer] Ayumi Hamasaki.” In addition to make-up and new hairdos, participants of the show receive cosmetic surgery.

Meanwhile, in China, where cosmetic surgery currently is a 2.4-billion-dollar-a-year business, the government recently banned plastic surgery reality television shows because of their graphic content. One such Chinese show, Lovely Cinderella, modeled after Fox network’s The Swan, presented cosmetic surgery makeovers to worthy candidates. The “winners” of these makeovers were individuals received negatively by society because of their appearance. The show documented their remarkable transformations – without excluding any of the gory details. An estimated 30 million viewers tuned in to watch the final episode of the popular program.

Back in the United States, the creator of The Swan, Nely Galán, believes that reality shows such as hers have had a positive influence on people. By bringing plastic surgery into the public eye, Galán says, much of the stigma surrounding cosmetic surgery procedures has disappeared. According to Galán, cosmetic surgery reality TV viewers are now able to see that a lot of hard work goes into looking good – and that it’s okay to want to feel better about your appearance.

Age of Enlightenment

Galán and others who are banking on the success of their reality TV projects have good reason to speak about their contributions to society in such glowing terms. But how do members of the medical community – the talented cosmetic surgeons who perform the abdominoplasties, the breast augmentations, the endoscopic brow lifts, the various cosmetic procedures now floating around as household phrases – view this form of entertainment?

“The important thing is to consider each one individually,” says Dr. Scott Miller, a La Jolla, California plastic surgeon and voluntary clinical instructor of plastic surgery at the University of California, San Diego, of the stream of plastic surgery reality shows that have flooded the airwaves over the past few years. Neither condemning nor embracing plastic surgery reality television, Dr. Miller believes that the shows “can either have value or be misleading.” He concedes that Extreme Makeover, as the first program to bring plastic surgery to prime time, did enlighten people as to the possibilities of plastic surgery. “It allowed many people to make informative decisions for their own care and improvement,” Dr. Miller explains.

Yet, with the debuts of shows such as The Swan and I Want a Famous Face, a “game-show” aspect was introduced into the budding genre. Dr. Miller feels that such an approach trivializes what should be considered a serious and important subject. Ultimately, though, he places the responsibility of helping patients understand both the possible risks and the rewards of cosmetic procedures in the hands of plastic surgeons. “Patients,” cautions Dr. Miller, “may not realize the amount of the show which is staged and what is left on the ‘cutting room floor.’”

After all, the ultimate goal of television show producers is to get ratings. Perhaps actor, producer, and screenwriter Rod Serling had it right when he said, “It is difficult to produce a television documentary that is both incisive and probing when every twelve minutes one is interrupted by twelve dancing rabbits singing about toilet paper.”

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