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The Body Consumed:
Reflexivity and Cosmetic
Surgery
Søren Askegaard
SDU Odense University1

Martine Cardel Gertsen and Roy Langer

Copenhagen Business School

ABSTRACT

We live in a time with increasing focus on the body and its

perfection. The marketing environment is replete with products and
services catering to the health, well-being, and beauty of bodies and,
it is implied, of our souls. One of the more drastic and consequently
also much debated and, at times, tabooed type of service and
consumption within this field is cosmetic surgery. This article is
based on interviews with 15 women who have had cosmetic
operations. It examines what motivated their decision to have
surgery; some of their thoughts and feelings before, during and after
the process; and the ways in which the operation has influenced
their life and self-identity subsequently. The material is analysed
within a theoretical framework resting mainly on Anthony Giddens’
work on self-identity in late modernity. This implies that cosmetic
surgery is understood to be part of the individual’s reflexive
construction of self-identity, and leads to a focus on issues such as
self-determination, self-esteem, and the relationship between body
and identity. Finally, some relations between self-identity and the
marketing institution are discussed. 䉷 2002 Wiley Periodicals, Inc.

The growth of cosmetic surgery obviously has something to do with the

development in medico-technical possibilities to change physical ap- Base of text
Psychology & Marketing, Vol. 19(10): 793–812 (October 2002)
Published online in Wiley InterScience (www.interscience.wiley.com)
䉷 2002 Wiley Periodicals, Inc. DOI: 10.1002/mar.10038
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pearance permanently. But such services would hardly have been de- Base of text
veloped independently of demand. Indeed, throughout the world, those
women — and, increasingly, men — who can afford it, seem to be more
and more willing to consider cosmetic surgery as a means to improve
their looks or solve various types of appearance problems. These may
be innate features or marks left on their bodies by the lives they have
lived — consequences of, for example, lifestyle, (over-)eating, childbirth,
or — presumably most often — the simple passage of time. Cosmetic sur-
gery has been around for several decades, but at least in Denmark it
only relatively recently has spread from narrow circles (in, for instance,
the entertainment industry or the upper classes) to other segments of
society. Indeed, cosmetic surgery seems to have gained widespread ac-
ceptance. Though still considered problematic by many and far from
being free of taboo, it is probably safe to say that much fewer people
today than, say, 15 years ago, would offhand spurn the idea of ever
resorting to surgery in order to gain or restore good looks. “Cosmetic
Surgery No Longer for the Few,” “Danes Lining Up for Liposuction,”
“Quest for the Perfect Body,” and “If in Doubt, Take the Biggest (Breast
Implants)” are some of the recent articles in the daily and weekly press
underlining this trend. The subject also prevails in televised debate pro-
grams and talk shows. The general attitude seems to be that whereas
most (still) do not plan any cosmetic surgery for themselves, it is now
mostly seen as legitimate to try to correct a problematic body- and self-
image through cosmetic surgery.
How might this development be explained? What makes more and
more healthy people willing — and sometimes even eager — to submit
themselves to costly (as well as potentially risky and painful) surgery
with the sole purpose of improving their physical appearance?

SOME BASICS FOR RESEARCH ON BODY IMAGE AND

COSMETIC SURGERY IN CONSUMER RESEARCH

Needless to say, these questions are not totally unanswered by the ex-
isting body of research. Most notably, research on body images relating
to their psychological constitution and their role in the construction of
human sexuality (Fisher, 1989; 1990) has contributed much to the basic
understanding of the relation between body and self. The generally mal-
leable nature of self-images points to the social conditioning of the self-
image, in the sense that attractiveness has been demonstrated to en-
hance the performance of social roles as well as self-estimation (Cash,
1990), and in the sense that the character and quality of self-images are
basically culturally determined (Fallon, 1990). This (perceived) impact
of body appearance in present Western (but globally spreading) culture
has led to a growing preoccupation with the body and its perceived flaws.
Although psychologists have tended to regard this as an unhealthy focus short
on what is perceived as the wrong problems, it is also generally acknowl- standard

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edged that cosmetic surgery may have a positive impact on self-image Base of text
(Pruzinsky & Edgerton, 1990). Furthermore, the cultural construction
of body images has led to an interest in the connection between mass-
media-promoted images of beauty and, especially, feminine self-imag-
ery and motivations for cosmetic surgery (Goodman, 1996). The role of
media in the formation of feminine self-images has also been pursued
within consumer research, especially by Hirschman (see Hirschman &
Stern, 2000).
The cultural history of cosmetic surgery, then, is basically the story
of those social and historical conditions and the Zeitgeist leading to the
rise to commonality of cosmetic surgery in the 20th century (although
as a practice it is considerably older) (Haiken, 1997). Her explanation
can be summarized in the rise of consumer culture, and in this context
especially the combination of a playful youth culture with the commod-
ification of beauty, leading to a general reluctance to accept signs of
ageing. Later on, the search for consumable bodily perfection has lead
to the spreading of cosmetic surgery from the realms of fighting signs
of age to more general corrections of what is perceived as bodily flaws,
even among very young consumers, as noticed by some of the profes-
sional informants. This has made cosmetic surgery one of the fastest-
growing industries in the United States (Haiken, 1997), and the ten-
dency is also spreading to European countries like Denmark.
In spite of this, the consumer research literature on cosmetic surgery
is extremely sparse. In the last decade, only two studies have emerged
from a literature search. Schouten (1991) investigated nine consumers’
experiences concerning the decision to undergo cosmetic surgery and
the consequences of the operations. He largely found a confirmation of
his hypothesis that cosmetic surgery is motivated by the search for a
positive (or avoiding a negative self) and, hence, related to poor body
images, and that cosmetic surgery is deeply linked to a wish to improve
performance in social key roles, especially in times after role transitions.
These role transitions turned out to be even more important than hy-
pothesized, either in the form of an adaptation of the self to a new role,
or as a catalyst of a pursued new role. Schouten employed the term
marketing character, borrowed from Fromm, to indicate the marketing
aspect of using bodily appearance as an asset in social relationships.
This idea of a marketed self will be explored further toward the end of
this article; it will be linked it to more recent thoughts on contemporary
identity formation. Furthermore, the body images at play were found to
be linked to ideas about sexuality and fantasies of romanticism, a key
feature of modern marketing (Brown, Doherty, & Clarke, 1998), and to
the search for control over one’s own body — another theme that will be
explored later. Schouten largely found that cosmetic surgery provided
satisfactory results for his informants in the sense that they found their
self-images and social role performances improved. His conclusion was short
that cosmetic surgery is best seen as a personal rite of passage in order standard

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to restore “harmony to an ambiguous, incongruous, or unsatisfying self- Base of text
concept” (Schouten, 1991, p. 422).
Some counterevidence to Schouten’s conclusions are presented in
Sayre’s (1999) introspective account of her own facelift. Her reflections
confirm the importance of role transitions as well as the decisive factor
of social environment dominated by “Hollywood standards’ — “Living [in
Southern California . . . ] necessitates fitness, and requires youthful-
ness” (Sayre, 1999, p. 179) — and the peer group of social influencers.
But her account of the acquisition process is much more tormented than
many other accounts. Although she admits to succumbing to the myth
of satisfaction of this non-exchangeable purchase, she also concludes on
a critical note that: “Ultimately, social norms and popular culture have
performed their own psychological surgery on American women such as
I who succumb to the beauty myth” (Sayre, 1999, p. 182).
Complementary to these psychological and social psychological ap-
proaches, sociological theory has become increasingly focused on bodily
issues in later years (cf. Schilling, 1993; Turner, 1991). The variety of
sociological stances on the body have mainly focused on the social con-
stitution of the body and its value as an asset in social relations, going
as far as seeing it as a physical capital that can be traded for economic
or social capital (Schilling, 1993; cf. also Bourdieu, 1979). This further
underlines the social psychological focus on the body’s significance in
social roles and relationships. Sociology, however, has had little to say
so far about cosmetic surgery.
The most significant macro-oriented approach to cosmetic surgery,
then, is found within feminism. However, the traditional feminist un-
derstanding of cosmetic surgery as repression (e.g., Wolf, 1990) may not
be complex enough to grasp what lies behind the explosive growth in
cosmetic surgery today, even though its relevance is not completely dis-
missed here. It is still true that most cosmetic surgery is purchased by
women (Pruzinsky & Edgerton, 1990), and that, generally speaking,
most women probably feel the need to look good more strongly than do
most men. On the other hand, there seems to be a more and more uni-
sexual beauty myth and still more men do undergo cosmetic surgery.
Anyway, the repressiveness frowned upon is built into all social con-
texts, because the body of the social lies in mutual limitations of freedom
to act, as new, less liberatory, contributions to feminism also have
pointed out (Bordo, 1992).
Other feminist sources, then, in both the United States and Scandi-
navia (Bordo, 1992; Kruckow, 1993) underline the linkage between the
feminist issue of liberation of the female body and the women’s liberty
to search for perfection of their bodies. This, of course, does not rule out
that on the average appearance may be more central and more pressing
to women’s self-identity projects than to men’s. But it does represent a
first step toward a more complex view on the issue of late modernity’s short
pressure on women as something both broader and more contradictory standard

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than previous approaches. The legacy of Bordo and other related femi- Base of text
nists has been discussed by Joy and Venkatesh (1994) in their attempt
to lay out the mutual benefits from a combination of feminist and post-
modernist approaches to the body, and its consequences for consumer
research. Among other things they underline the postmodern character
of Bordo’s notion of the “plasticity of the body” and the consequences for
the body as a consumable object.
Still, the discussions of Bordo (1992), Joy and Venkatesh (1994), and
most other approaches within feminism, draw heavily on Foucault as a
theoretical frame of reference with focus on the power structures lying
behind the “body politics.” The importance of such an approach is not
denied here; however, a different approach mainly inspired by Giddens
(1991) has been useful. The focus here is less that of power structures
and repression and more that of the role of social discourses in bodily
reflexivity and self-imagery as expressed in the consumers’ own expe-
riences of cosmetic surgery. Consequently, it is believed that an under-
standing of cosmetic surgery as part of the individual reflexive construc-
tion of self-identity provides a better point of departure for the analysis
of the interview material. This is definitely more in line with the in-
formants’ own view of the decisions they have made and the actions
they have carried out as benevolent to their selves. Giddens’ (1991) sem-
inal work on identity formation under late modern social conditions,
Modernity and Self-Identity, seems to combine the sociological contex-
tualization and the psychological process of identity formation to form
a social psychology contextualized in contemporary societal change.
Hence, though Modernity and Self-Identity may be qualified as a socio-
logical work, it has important bearings on psychology. It does allow more
insight into the underlying reasons for the growth of cosmetic surgery
in general and a deeper understanding of the deliberations behind an
individual consumer’s decision to purchase a cosmetic operation in par-
ticular. Hence, it provides a theoretical frame to link the motivational
studies of Schouten (1991) and Sayre (1999) with theories on the current
social context and a basis for understanding the interplay of the psy-
chology of self-images and the social institution of marketing.

SELF-IDENTITY AS A REFLEXIVE PROJECT

According to Giddens, much revolves around the individual selves of

members of late-modern societies. These selves, however, are not giv-
ens, but continuously created and recreated in laborious processes. Self-
identity has become a reflexive project that each individual must un-
dertake by him- or herself, but in interaction with other human beings
and with the institutions of society. In order to develop a self-identity
suited to life in late modernity, it is necessary to hold one’s past, present, short
and future together in a coherent — but ever changing and unfolding — standard

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autobiographical narrative. The ability to sustain such a narrative is a Base of text
person’s self-identity — it is not as such the behavior of a person or the
responses the person evokes in others, though of course a self-identity
is closely intertwined with these things.
The reflexive project of self-identity, then, consists of a constant, con-
scious monitoring of a biographical narrative. This implies that a con-
siderable number of choices must be made in social life — indeed, choice
is a key concept in late modernity. The individual is seen as being in
control of his or her life — or, rather, is expected to take control of his or
her life — to a much greater extent than former generations. Today, in
other words, the individual is seen as responsible for what it makes of
him- or herself. This makes it necessary for virtually everyone to engage
in what Giddens calls “reflexively organized life-planning” (1991, p. 5).
A life plan is not automatically handed to one at birth or through insti-
tutionalized life transitions — one must create it oneself, though still
based on certain social and biological givens and limitations, of course.
An important characteristic of social life in late modernity is that
more and more relationships between human beings assume the char-
acter of what Giddens (1991, p. 88ff.) calls a “pure relationship.” This
kind of relationship is one that is only maintained insofar as each person
involved finds it rewarding and derives benefits from it, that is, it is not
upheld by external social, economic, or moral obligations. Consequently,
there is little or no permanence in many human relationships, and this
tends to make one more self-centered and more preoccupied with one’s
own attractiveness in the broadest sense of the word. Psychologically as
well as physically people must present themselves to the world so that
other people will be interested in remaining in or engaging in mutually
advantageous relationships with them. Whereas such self-centeredness
was formerly mostly found in young people, it is not limited to any par-
ticular age group in late modernity. It cannot be expected that the re-
lationships formed in one’s youth will last throughout one’s lifespan —
one must be prepared for change and development.
Pure relationships, then, are not dependent upon anything outside
themselves. External bonds are substituted by self-chosen and poten-
tially temporary commitments. The pure relationship is an open and
reflexive undertaking that may be terminated at any time, if one or both
partners desire it. This means a great deal of freedom, probably less
repression and more possibilities for continued personal development,
but also a higher level of anxiety, because any problem — even a minor
one — may in principle bring the relationship to an end. Of course, not
all relationships in late modernity correspond to Giddens’ conception of
the pure relationship, but its characteristics become more and more
salient. This is particularly the case in sexual relationships, marriage,
and friendship, but also to some degree in relationships between parents
and (especially grown) children, as well as between other family mem- short
bers. standard

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These developments have bearings on the types of psychological prob- Base of text
lems experienced by individuals, to a greater or lesser extent. It seems
that the historically unprecedented, individual human liberty faced in
late modernity provokes particular kinds of anxieties that are linked to
the ongoing construction of self-identity. The growing therapy market
partly owes its existence to the widely felt need to come to terms with
these anxieties. It is also an expression of the increased reflexivity in
general: While in therapy, people are encouraged to work on their au-
tobiographical narratives in an organized way.
Whereas neurotic states (brought about by guilt and repression) used
to be common psychological complaints earlier in modernity, people to-
day tend to suffer more from troubles related to narcissism. This implies
that shame rather than guilt is coming to the foreground in late mo-
dernity. Guilt, which is the focus of Freud and traditional psychoanal-
ysis, is caused by the feeling of having done something wrong (or having
omitted to do something good) — by failing to live up to an internalized
norm for behavior. Shame, on the other hand, is less directly linked to
particular elements of behavior, but more closely connected to self-iden-
tity. It is brought about by feelings of personal insufficiency and may be
understood as anxiety stemming from doubts about the social accept-
ability of one’s own personal narrative — one’s self-identity. An individ-
ual feels shame when the discrepancy between him or herself (as per-
ceived by others and by the self) and his or her ideal self (positive
aspirations) has become painfully large. The more narcissistic an indi-
vidual is, the more likely it is that the feeling of shame — probably al-
ternating with feelings of self-esteem — will be activated in the process
of identity construction. One of Giddens’ (1991) main points on narcis-
sism is that it often entails attempts to control the risk of life through
development and conservation of bodily attraction and charm.
Pride or self-esteem is the opposite of shame: The individual feels
socially accepted and valued. Because self-esteem is deeply embedded
in social interaction, it is very sensitive to the response from others, and
it may turn into shame if this response is perceived as negative. But
still, self-esteem is a highly valued feeling, much sought for in late mo-
dernity. Interestingly, shame, in contrast with guilt, frequently has to
do with the part of the individual that is most clearly visible to others:
the body — though not so much its actions as its appearance.
Through one’s body one constantly and inevitably displays one’s self
to others. But there is still a distinction between inner and outer selves,
what Falk (1994) calls the body’s new duality of inner being and outer
manifestation, the latter seen mainly as an expression. One’s body is not
an accurate mirror of one’s feelings, thoughts, and inner qualities — in
most social situations there is a difference between self-identity on the
one side and behavior and appearance on the other side.
Just as the self has become a reflexive project, so has the body. The short
body used to be more of an aspect of nature, an almost fixed physiolog- standard

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ical entity that could only be changed or influenced by human action to Base of text
a limited degree. But now, Giddens (1991, p. 4) speaks of nature as
having “in a certain sense come to an ‘end’” — at least to the extent that
nature is understood as something that is different from and outside of
social life. This inevitably has implications for the body as well — the
body can hardly be seen as part of nature these days, either. The body
is less and less understood as something given, something outside one’s
control that one must live with, although it may not be entirely to one’s
liking. The body has become a site of reflexive construction. Its bound-
aries have been altered and have become more permeable.
More and more the body becomes a site of different choices and dif-
ferent possibilities, not only in terms of appearance, which is the prime
interest here, but also in terms of reproduction, genetic engineering, and
various ways of monitoring physiological processes and health in gen-
eral. It might perhaps be said that the body has moved further away
from the field of nature and into the field of human action. This is not
to say that human beings in all societies have not attempted to manip-
ulate their bodies in different ways — the body has never been under-
stood as entirely natural — but these efforts may have become a much
more common and more individual choice in late modernity.
As a consequence, the body becomes more central to the individual’s
reflexive identity project. The body becomes more and more integrated
in social life and is often quite central to the individual’s self-actuali-
zation, which implies increased awareness of the body. This tendency
is also supported by consumerism that presents appearance (bodily and
otherwise) as the prime arbiter of values and conceives of self-develop-
ment in terms of display. The individual is increasingly seen as respon-
sible — not just for its behavior — but also for the appearance and work-
ings of his or her body. People are seen as designers of their own bodies;
the “biological border” (Bauman, 1995) is no longer as closed as it used
to be.
This may be seen, for instance, in various bodily regimes undertaken
to improve health or appearance and in what people do to their bodies
in general — how they choose (not) to look after, control, or alter it — for
example, through cosmetic surgery. If such phenomena are interpreted
as expressions of narcissistic, bordering on the pathological, obsession
with one’s own body and looks, part of the picture will be missing. In
the reflexive light, such actions (e.g. dieting, fitness training, undergo-
ing cosmetic surgery), far from being symptoms of withdrawal from so-
ciety, actually express involvement with the social world. They are very
much part of the social reality that must be faced by individuals today
being more or less obliged to engage in the construction of inner as well
as outer aspects of self-identity.
Giddens (1991, p. 180) describes therapy as “an expert system deeply
implicated in the reflexive project of the self.” It seems that one could short
understand cosmetic surgery in a similar way. Though it may not al- standard

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ways entail as much or as deep conscious reflection and introspection Base of text
as psychotherapy, it is always part of an individual self-constructing
project. Like therapy, it is oriented toward control and self-determina-
tion, and as such is separated from extrinsic moral considerations. It is
a consumption process that involves buying a service on a market, prob-
ably at a price that makes it a fairly costly investment in most people’s
budgets. And like the process of going through therapy, the process of
going through cosmetic surgery is often experienced as emotionally de-
manding by the consumer.

METHODOLOGY

The purpose here is to obtain a deeper understanding of cosmetic sur-

gery with a point of departure in individual consumers’ understanding
of it, albeit analyzed from a social – psychological perspective. It was
assumed that a quantitative survey of consumer perspectives on cos-
metic surgery would pose a number of problems, because the topic is
still perceived as fairly sensitive and personal, and it was found that
most respondents presented complex and sometimes even partly self-
contradictory reflections when asked what plastic surgery meant to
them. The essences of such musings are hard to capture in a question-
naire. Hence, data collection based on personal depth interviews was
chosen. Initially, five interviews were carried out with cosmetic sur-
geons, industry suppliers, and health authorities to get an overview of
the industry in Denmark. These were completed by depth interviews
with a total of 15 informants — all of them women who had had cosmetic
surgery — some very recently, others several years ago. The informants
were selected at random and were contacted through friends, acquain-
tances, and doctors. No claims of representativeness are made, but the
informants had very different social, educational, and occupational
backgrounds, including, for example, a Ph.D. student, a prostitute, a
cleaning lady, a nurse, a teacher, a lawyer, a hairdresser, and a house-
wife. Their ages ranged from early 30s to mid-60s. They had had differ-
ent types of operations, including liposuction, nose correction, chin cor-
rection, eye correction, abdominoplasty, and breast implants. The
interviews took between 1 and 3 hours each; all were tape recorded,
transcribed, and coded according to analytical categories inspired by
Giddens’ (1991) approach to identity formation.

RESULTS

Self-Determination: “I Did It for Me!”

When asked why they decided to have a cosmetic operation, it is striking short
that most interviewees — without being provoked or asked by the inter- standard

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viewer — are anxious first and foremost to make it clear that they did it Base of text
for their own sake, not to impress or please anyone else. The following
statement is typical: “For me, it had nothing to do with what others
thought. For me, it only had something to do with what I thought. It
[what others thought] was virtually unimportant to me.” It is empha-
sized by several that the decision should be based on an inner need felt
by the person in question, and that the authenticity of this need should
be the crucial factor deciding whether to do it or not: “It must be some-
thing you do for yourself, not for others. I think you’ll get problems if
you only do it for someone else.” Cosmetic surgery is frequently de-
scribed as an act of self-determination; as a demonstration that a person
is free to do what she likes with her body: “I was on my own at that
time, so I didn’t have to ask anyone about it. And I wouldn’t ask, any-
way, because if I thought that I needed it and felt like it, then . . . It’s
still my body, isn’t it?”
Whereas most respondents explain at some length that they did not
have cosmetic surgery in order to attract men or to please their hus-
bands, there are exceptions to this: “. . . I’ve never had big breasts,
and [her husband] pestered me about it for years” is how one woman
describes what motivated her decision to have breast implants. She is
very clear about her wish to become more sexually attractive (especially
in the eyes of her husband, but also in public) as her main motive. An-
other woman says that, in retrospect, her decision to have breast im-
plants was related to her husband’s recent infidelity and her own con-
sequent feelings of sexual inadequacy. The need to remain sexually
attractive to one’s husband (or wife, or anyone, for that matter) is pre-
sumably felt as more pressing the more one perceives the relationship
as a “pure relationship” that may be terminated at any time if one of
the partners does not see it as satisfactory. Therefore, such a motive is
well in line with Giddens’ (1991) ideas, but it also seems likely that most
people would prefer not to say it so directly, because it conflicts with a
widespread ideal of self-determination and independence. In some cases
it may not even be a motive that people would admit to themselves, but
the fact that many respondents explicitly mention it only to dismiss it
(e.g., stressing that it had nothing to do with “undressing in front of my
husband”) indicates that it has at some level crossed their minds.
Giddens (1991) says of sexuality that it has become separate from
procreation, but central to self-realization and intimacy — a focus for
experience. It seems likely that this makes sexual attractiveness (or lack
of it) more central in people’s self-identities today. According to Giddens
the social attribution of identity in late modernity reaches into spheres
that were formerly considered private. This can be seen in one inform-
ant’s concerns with “presenting herself better” (i.e. with bigger breasts)
at fetish parties. Breasts are not as private as they used to be!
The concept of control is very important. Complete and constant con- short
trol over one’s body is normally routinely exercised in all social inter- standard

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actions and is an all-important framework for the interpretation of any- Base of text
thing said. It is crucial in the maintenance of the narrative of
self-identity. But this control may break down in situations of pressure
and thereby expose the individual to ontological anxiety. In such cases,
an appearance problem feels like a loss of control.
Other informants refer to anorexia or obsession with fat (cf. Aske-
gaard, Jensen, & Holt, 1999), topics related to cosmetic surgery. Gid-
dens (1991) sees eating disorders as pathologies of reflexive self-control,
related to shame anxiety: The compulsively controlled body creates the
illusion of safety in an open and changeable social context. The sufferer
feels shame if she does not follow a very strict bodily regime.

Self-Esteem: “Basically, It’s about Self-Esteem, Isn’t It?”

There is something paradoxical about the fact that on the one hand most
interviewees stress that they underwent surgery for themselves, not to
please others. On the other hand, they also claim that they did it to
obtain self-esteem, which is hardly a feeling that appears in a social
vacuum but at least partly dependent on the impression a person be-
lieves to make on others. Generally, the informants do not seem to ac-
knowledge the extent to which their own self-identity is socially deter-
mined — they present themselves as more independent of others’
judgement than they probably are. There are two possible explanations:
They may not realize that others’ perception of their appearance is im-
portant to them. Or they may not wish to admit (to themselves and/or
to the interviewers) that it is so, maybe because they find it more desir-
able to be self-reliant.
It is interesting that self-esteem in itself seems to be such a highly
valued inner quality rather than, for instance, goodness, wisdom, un-
selfishness, helpfulness, intelligence, or sense of humor. But if the self
is reflexive, it is less surprising, because self-esteem is indeed a crucial
quality in relation to, possibly even a prerequisite of, self-identity un-
derstood as the ability to sustain a meaningful autobiographical nar-
rative.
Not surprisingly, the opposite of self-esteem — shame — is expressed
by several respondents when describing their situation before the op-
eration. One woman, for instance, describes how she was treated in a
degrading manner and even brought to tears while trying to convince a
doctor in the public sector to do something about her sagging abdomen.
Another woman says she was “ashamed of them [her breasts that sagged
after childbirth] although it wasn’t my fault, you couldn’t really say that
it was . . . ” This quotation illustrates that shame, and not guilt, is at
stake here. Examples of expressions of self-hatred and disgust with
one’s own body are also found: “. . . I took great pains not to look at
my own reflection in the mirror, for it disgusted me . . . ” short
As for the results of the cosmetic operations, all interviewees say that standard

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they are glad they did it and most feel that it has actually given them Base of text
more self-esteem — one even says that it has “definitely given her more
happiness.” Furthermore, and consistent with Schouten (1991), the re-
lief of not having to employ camouflage techniques anymore was men-
tioned by several informants (“I learned to apply make-up to conceal it
[. . .] Before, I could not talk to people if they faced me sideways”).
However, another tells in a more guarded tone that though surgery did
solve her specific appearance problem, it did not enhance her feelings
of self-esteem in general — there are other problems “. . . wrinkles —
there’s always something, isn’t there?” (see also Sayre, 1999).

The Social Context

Some of the women refer to social pressure and explain that they did
not really have a choice. One says that in her social environment, ev-
erybody has cosmetic surgery and goes on: “I don’t want to be the only
one looking my age — especially not when all the men show up with
those young babes.” On the other hand, cosmetic surgery may be a sen-
sitive topic in other social circles. One informant says that she and her
female friends never discuss it openly — it is taboo. But when alone to-
gether they do talk about the operations of others in a critical manner,
as in the following quote: “They think it’s unfair competition if someone
suddenly looks younger.” Largely, there is a tendency that the younger
the informants, the less inhibitions they will have concerning talking
about their (or others’) cosmetic surgery.
The social context also appears in a different form than peer pressure.
One aspect of body issues related to consumption often evoked by over-
weight people is the issue of availability of fitting clothes. The mass
production of fashion and clothing leads to a dominance of normal sizes
in the stores’ selections, which in turn gives people problems, especially
women of nonnormal sizes (of which the large ones might actually rep-
resent the norm, cf. Bordo, 1992 and Klein, 1997) when shopping for
fashionable clothes. However, too small may also represent problems,
as pointed out by one informant: “I have been sad that I had to put all
sorts of things in my bras, and to buy underwear was simply hell. So I
couldn’t just wear a tank top without bra or just the bra itself. I think
I looked like a boy when I was wearing a t-shirt and wore nothing under
it, no bra. It was extremely annoying, also because I am short and tiny
and already found it difficult to find something that would fit me prop-
erly, right?”
Hence, it is seen how the market supply of, for example, clothing,
contributes to the necessity of bodily change. Needless to say, that also
the consumption of cosmetic surgery itself is inscribed in a market nexus
of production and consumption (cf. du Gay, Hall, Janes, MacKay, &
Negus, 1997). The economic feasibility of consuming cosmetic surgery short
is dependent on both an increased affluence and lower production costs, standard

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an interplay that once started may lead to a mutual positive feedback Base of text
and thus facilitate economic and social conditions for the production and
consumption of cosmetic surgery.

The Connection between Inner and Outer Qualities: “Beauty

Comes from the Inside” — Or Does It?
In spite of such better economic and social conditions and the conse-
quent growing acceptability of changing some unwanted feature of the
body, most informants are quite eager to stress that although they have
had cosmetic surgery, physical beauty is not what really matters to
them. The concept of beauty from the inside comes up several times, for
instance: “I believe that beauty comes from the inside. Of course you
can be lucky [!] and be all empty inside and be pretty, but then it is a
question of time. Because when you’re not young anymore, there’s no
big chance that you’re still pretty . . . But if you’re pretty from inside,
a really good human being, that is . . . then you don’t have to be a
beauty . . . you’re pretty even if you’re not pretty . . . ” Still, the
same person repeatedly emphasizes the importance of physical beauty
in herself and other persons in the rest of the interview. She says for
instance: “[I’d] rather look at people’s handsomely modified bodies than
at a reptilian, wouldn’t I? . . . I’d always have, maybe not respect, but
always be a little more positive towards people who, uhm, are prettier,
even if it is artificial.”
Several informants elaborate on the connection between inner and
outer values — self-esteem and beauty — and argue in an almost iden-
tical manner as follows: When they feel that they look good, they radiate
self-esteem. But if they are negatively preoccupied with their physical
appearance and feel that they look unattractive, they cannot either con-
vey a positive impression of their inner self, either. And this inner self,
they insist, is still what matters. One woman puts it like this: “We all
want to have a positive air about us and be self-confident. Because
really, it comes from the inside — you look better when you feel good
about yourself. And that’s easier when you are nice-looking.” At first
glance, it may sound reasonable, but on consideration, she is arguing in
a circle: What really matters comes from inside: A positive air and self-
confidence. The informant’s theory is that those qualities make you look
good. But she proceeds to reverse the causal relationship: When you
look good, you radiate (or at least find it easier to radiate) those positive
inner qualities. So the logical conclusion is the opposite of her initial
statement: What really matters, then, must be your looks.

The Problem Of Aging: “I Don’t Think It’s Disgusting To Grow

Old and Wrinkled, But . . . ”
Aging is — more or less explicitly — perceived as something intrinsically short
problematic by the respondents. A few openly admit their negative at- standard

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titudes toward growing older — one woman (41 years old) introduces Base of text
herself as “an old hag.” Others are more ambivalent — they feel that
they ought to see ageing as something natural that they must accept,
but it is hard: “I think it’s OK to show that you’re ageing, but . . . if
your skin becomes ugly, something has to be done . . . You get older,
but somehow you won’t recognize it, though somehow, you think that
you should recognize it, right?” Another woman says that one should
not have surgery to appear younger, but “wanting to look good for one’s
age — that’s natural.”
Another respondent expresses her ambivalence towards aging in this
way: “Of course there is no reason to hide one’s age. But it is just so
pretty to be young! There is no reason to appear older and less attractive
than you can be!” And she goes on about the importance of dyeing grey
hair: “And it is not because I’m afraid of death, not at all. But I don’t
think you should walk about for 20 years advertising that you are going
to die soon.”
As a consequence of this, and echoing Sayre’s (1999) introspection, it
seems safe to say that a contemporary cult of youth has led to a view of
aging as being problematic and undesirable. But, simultaneously, mar-
keting offers including health products of all kinds as well as medical
developments including cosmetic surgery, have inspired a view of aging
as an, at least partially, curable disease. Combining the dread of old age
with the distinction between inner and outer selves provides an inter-
esting twist, also evoked by Featherstone and Hepworth (1991). When
many aging people report feeling like a young, or at least youthful, self
trapped in an old body, this leads to the conclusion that the aging is the
abnormality whereas the real self has stayed young. Cosmetic surgery
can, as has been seen, help to restore equivalence between perceived
inner self and appearance.

Limits to Acceptability: “She Looked Like a Wax Doll”

Though none of the respondents in any way regret what they have done,
most express some concern with the general growth in cosmetic surgery.
Though most have already thought about other types of cosmetic sur-
gery that they might need later on, there are apparently limits to what
they are ready to accept. The concepts of natural (positively valued)
versus unnatural (negatively valued) are central to their assessment of
acceptability. At the same time, some described the features that they
have had corrected as unnatural and claim that this was why they could
not live with them. The word artificial is also used by some respondents
to describe surgery that is too much. Interestingly, the horror stories
are predominantly American, and Joan Collins, Michael Jackson, Cher,
Elizabeth Taylor, and other celebrities who have had extensive cosmetic
surgery are frequently mentioned. Almost all respondents distance short
themselves quite strongly from such heavy users. In addition to these standard

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celebrities, however, a couple of informants made interesting remarks Base of text
about the looks of nurses in the (American) clinic where they were op-
erated: One said: “. . . they had all had exactly the same operation;
they looked completely alike. They looked as if they had all been cloned
in a Mattel factory [where Barbie dolls are produced].”
When asked how they would react if their children would wish some
day to have cosmetic surgery, most are hesitant and would in some cases
discourage it. Still, most also believe that the growth in cosmetic surgery
will inevitably continue, and one says, worrying that her 6-year-old
daughter’s nose will grow “too big”: “Well, I’m sorry for her, but . . . no
doubt she’ll have to [have cosmetic surgery] like the rest of us.” Here,
the mother clearly refers to cosmetic surgery as a possibility developing
into a necessity. There is thus an awareness of the slide effect that the
expansion of cosmetic surgery may have. Informants, however, tend to
view it positively, as a transgression and liberation: “But I have trans-
gressed my own limits for a long time, right? First one got the nose
pierced, then the tongue and then the nipple. Then one got a couple of
tattoos. So all my life I have been transgressing my own limits.” It is
interesting to note how this informant speaks in the third person, mak-
ing her statements account not only for her personal biography, but for
a whole social group. Thus, it follows logically from such a point of view
that the present limits to acceptability may be challenged by future
developments.

Emotional Involvement: “I Cried. I Was Simply Completely

Crushed . . . ”
The strong feelings of distress that several respondents report to have
felt in connection with their looks demonstrate how closely their feelings
about their bodies are related to their identities, and also how fragile
this makes their self-identities. Therefore, appearance problems may —
at least by some individuals — be the cause of existential anxiety, not
just minor irritation. It is, however, also clear that several respondents
do not wish to give the impression that their appearance problems
cause/have caused emotional suffering, though they may indirectly in-
dicate it. One possible explanation could be that they feel that inner
qualities are what should count; therefore, it is embarrassing for them
to admit to have been seriously upset by an appearance problem.

DISCUSSION AND FUTURE RESEARCH

The results of the interviews point to the increasing reflexivity about

self-presentation in social relationships. The owner of the body increas-
ingly sees him- or herself as the manager of this body, assuming re- short
sponsibility for its health, fitness, thriving, and appearance. This re- standard

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sponsibility leads to the body as an object for a number of management Base of text
technologies, including cosmetic surgery. Interestingly, several respon-
dents refer metaphorically to their looks as their or even their husband’s
business card, alluding both to this managerial role and to the idea of
the marketed self, first evoked by Fromm and used by Schouten (1991)
to discuss the social psychological benefits of cosmetic surgery.
Indeed, the approach here is delimited by the fact that the article, if
the reader will excuse the pun, so to speak fleshes out empirically a
body of social theory already dealing with body images and modifica-
tions. An alternative and very interesting approach would be to take a
point of departure in the idea of managing the body as a processable
and customizable unit, drawing on literature on management technol-
ogies. For instance, it might throw new light upon the relationship be-
tween stability and change, which is crucial from a management per-
spective. After all, the problems of aging addressed here point to
the fact that much cosmetic surgery is not about change but about avoid-
ing it.
Furthermore, the idea of a (managed and) marketed self throws new
light on the classical point of Belk (1988) that possessions may be part
of an extended self, and that the loss of these possessions is equivalent
to a loss of selfhood. Rather than self extended to possessions, the
present results point to the notion of possession extended to the self, or
at least to its outer manifestation — the body as a means of expression.
Psychologically or cognitively speaking, this corresponds to an increas-
ing reflexivity in the symbolic consumption of bodily appearance already
evoked by Schouten (1991). The consuming body of Falk (1994) becomes
the body consumed.
With such an extension, another question for future research is
raised: How much of the self would have to be transformed before the
self is actually altered? Before it, so to speak, no longer is considered
the same self? This is a question that draws its relevance not only from
the upsurge of cosmetic surgery, but also from ever more sophisticated
transplantation techniques and, recently, from genetic technologies
such as cloning.
This linkage between the managed and marketed self and the ques-
tion of authenticity point in yet another direction. One might accept the
idea proposed by Laufer and Paradeise (1982) that marketing is basi-
cally similar to the philosophical position of sophism in that it deals not
with what is but with what appears to be. As such it is more linked to
argumentation referring to rhetoric than truth in an absolute sense, and
it becomes evident why the culture of appearances nurturing and nur-
tured by cosmetic surgery can be qualified as the epoch of the marketed
self. The language use of the informants witnesses the increasing role
of the marketing discourse as a way of looking at human interaction.
The reunification of body and mind into a self generated by bodily re- short
flexivity and cosmetic surgery also points to another recent discussion standard

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in marketing: The reintroduction of bodily processes in the motivational Base of text
domain in marketing and consumer research through the concept of
desire (Belk, Ger, & Askegaard, 2000). It seems that the linkage be-
tween cosmetic surgery and desire, with their common references to
body and sexuality, is an interesting path for potential research.
The results furthermore open the discussion of the difference between
Danish and American consumers concerning their approach to “the nat-
ural” reported by Askegaard, Jensen, and Holt (1999). In a study of
consumers’ relations to (consumption of) fat, one of the conclusions was
that whereas Danish consumers’ anxiety was oriented toward what
technology may do to naturally good food products (additives, unnatural
industrial food), Americans were more anxious about naturally occur-
ring constituents (fat, cholesterol) and regarded industrial attempts to
remedy these problems as beneficial. This well-known Scandinavian ori-
entation toward what is seen as untouched nature (a rare phenomenon
in Scandinavia and virtually nonexistent in Denmark) may be chal-
lenged by the results. Another interesting research question is whether
the reflections reported here indicate what may be an increasing Scan-
dinavian acceptance of the (benefits of the) malleability of nature, of an
acceptance of “the end of nature,” as it were. With the possible exception
of the (perceived) larger American limits of acceptability, the study does
not demonstrate any significant cross-cultural differences. Rather, it
points towards the globalization of the social formats of bodily reflexivity
and the consequent new attitudes toward cosmetic surgery. This is not
to say that the Danish or Scandinavian scene of consumption of cosmetic
surgery will be exactly like the American one, but it points toward the
fact that bodily reflexivity and cosmetic surgery have become one of
those “global structures of common difference” pointed out by Wilk
(1995). For Wilk it is the beauty pageant; here it is cosmetic surgery,
but both share the feature of being a “widespread and common form of
contest for the exercise of power over what to produce and consume”
(Wilk, 1995, p. 111). The Scandinavian and American differences in con-
sumption of cosmetic surgery, one might argue, are cast in a relatively
narrow and similar format of production and consumption, especially
compared to the multitude forms of bodily mutilation and change that
humanity has expressed. However, the informants of this study have a
need for expressing a distance between them (Americans ⫽ exaggerated
consumption of cosmetic surgery) and us (Danes ⫽ moderate consump-
tion of cosmetic surgery).
Another common dimension — the tendency to see and describe one-
self from the outside — illustrates the constant monitoring of life nar-
ratives, reflexivity. On the positive side it makes self-determination pos-
sible — if one cannot reflect upon one’s life, one can hardly change it for
the better, either. Seen here is a reflection of the fact that constraints
of liberty are seen, in the present-day society, as “the most heinous of short
crimes and the least bearable of conditions” (Bauman, 1995, p. 164). On standard

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the negative side. The emotional experience of happiness or fulfilment Base of text
is usually characterized by forgetting oneself — is it not? And is this
possible while at the same time watching oneself vigilantly, reflecting
on potential self-improvement, which people tend to do more and more?
As so often before, freedom turns out to be janus-faced. The freedom to
search reflexively for better life conditions for oneself sows the seed of
the enslavement of bodily perfection. People remain “hostages to the
imagery of ‘rational mastery’ over human nature, identity and fate and
of the artificial, designed, monitored and reflexively improved ration-
ality of life” (Bauman, 1995, p. 176).
This very gloomy perspective of the marketed self is spelled out by
Bauman (1995) when he points to the potential criminalization of bodily
deformities or abnormalities following the progress of genetic engineer-
ing, reproductive technologies, and the medico-industrial complex:
“What used to be the result of fate will become choice; and what is,
admittedly, a matter of choice is bound to turn, sooner rather than later,
into an obligation” (p. 179). On the other hand, the very same processes
engender a reflexivity that presents the necessity of reinserting moral
and ethic choices in daily existence — what Giddens (1991) calls “life
politics”.
Life politics, according to Giddens, is “a politics of self-actualization
in a reflexively ordered environment where that reflexivity links self
and body to systems of global scope” (1991, p. 214). Such life politics
does not replace, but complements the more traditional grand scheme
“emancipatory politics” characteristic of modernity. It inserts decisions
concerning self-actualization in a larger context and underlines their
moral and ethic dimension. Life politics is concerned with the reflexive
impact of macro-social changes, for example, concerning the impact on
self-image formation of genetic engineering or, perhaps less profoundly,
cosmetic surgery. But it also addresses the impact of personal decisions
(for example, concerning the acceptability and/or necessity of cosmetic
surgery) on the social environment, along the lines of, for example, Bau-
man’s reflections quoted above.
A life politics view of cosmetic surgery as part of the necessary re-
flexive self-identity project — in contrast to, for example, the feminist
view — acknowledges the individual actors’ self-determination to a
much greater extent. Also, such a view prevents cosmetic surgery from
being seen as something that is per se negative, forced, and maybe even
self-destructive. A completely unsympathetic or even censorious posi-
tion may well prove untenable or too narrow-minded as these surgical
services become more and more sought after. This is not to say that the
growing tendency to alter one’s body surgically is entirely positive, but
it has to be recognized that cosmetic surgery seems to enhance feelings
of self-esteem and well-being in some consumers — at least judging from
the way the consumers presented it in this research. It is, however, also short
clear that cosmetic surgery may in some cases be painfully intertwined standard

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with identity crises and feelings of personal inadequacy — without (not Base of text
surprisingly) being able to bring permanent solutions to these problems.
There may be a risk in such cases that a tendency to focus on appear-
ance-related aspects of identity and the ways in which these can be
improved could prevent individuals from looking into other, potentially
more rewarding, possibilities for self-development. If this is the case, it
increases the necessity to study the processes whereby the consumer’s
body is liberated from the tyranny of fate, only to be submitted to the
tyranny of management.

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Authors in alphabetical order. The authors would like to thank James Fitchett
and two anonymous reviewers for their comments on an earlier draft of this
article.
Correspondence regarding this article should be sent to: Søren Askegaard, De-
partment of Marketing, SDU Odense University, Campusvej 55, DK-5230
Odense M.

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