Aesthetic anti-ageing surgery and technology: women’s friend or foe?
Abigail T. Brooks
- Women’s Studies Program and Sociology Department, Boston College, Chestnut Hill, USA
Address for correspondence: Abigail T. Brooks, Women’s Studies Program and Sociology Department, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA
This study investigates women’s attitudes about, and experiences of, aesthetic anti-ageing surgeries and technologies against the contextual backdrop of the growing commercialisation of medicine in the United States. Drawing from 44 intensive interviews with a spectrum of women between the ages of 47 and 76 who use, refuse, and are currently undecided about whether or not they will have or use aesthetic anti-ageing surgeries and technologies in the future, this study asks the following question: in what ways does the increasing availability, accessibility, advertising, and use of aesthetic anti-ageing surgeries and technologies interact with and inform women’s perceptions and attitudes about growing older? Data analysis occurs in dialogue with the paradigms of successful ageing and agelessness and draws from, and contributes new readings of, contemporary cultural constructions of femininity.
Feminist ageing studies scholars and critical gerontologists highlight the need to examine ageing as a socially constructed phenomenon (Cruikshank 2003, Holstein and Minkler 2003) and to explore how the social meanings ascribed to ageing interact with individuals’ lived experiences of the ageing process (Oberg 2003, Woodword 1999, Featherstone and Hepworth 1991). Feminist ageing studies scholar Margaret Morganroth Gullette (2004) prompts us to ask: how are we ‘aged by culture’? This study explores some of the different ways that American women experience and construct understandings of ageing in an expanding and increasingly normalised culture of aesthetic anti-ageing surgeries and technologies. Television, internet, newspaper, and magazine coverage of women’s health and age-related illnesses (Covello and Peters 2002), and of age-related changes in the body such as the menopause (Gannon and Stevens 1998, Gonyea 1998, Topo 1992), are fast replacing the mutual communication of shared experience as women’s primary source of information about ageing (Davis 1997). The recent overturning of the American Medical Association’s longstanding ban on soliciting business by advertising or otherwise, combined with the Food and Drug Administration’s eroded capacity to regulate the pharmaceutical industry, has produced a culture of commercialised medicine in the United States (Relman 2005, Sullivan 2001, Cohen 2001).1 Fierce competition between medical professionals who advertise their products and services to solicit patients, direct-to-consumer pharmaceutical advertising, and the fast-track approval process for new pharmaceutical drugs means that older Americans are increasingly targeted as potential recipients of anti-ageing technologies and medications.
Recent scholarship analyses the cultural messages contained within anti-ageing advertising (Croissant 2006, Calasanti and King 2007, 2005, Marshall 2002a, 2002b) and investigates the impact of the marketing and use of anti-ageing technologies, particularly Viagra, on women and men’s perceptions of gender identity, ageing, and sexuality (Loe 2004, Potts et al. 2003). With the exception of the work of Meika Loe, Annie Potts et al. and several others, however, there remains little empirical research to date that explores the influence of the growing advertising, availability, and use of anti-ageing surgeries and technologies on living, breathing individuals. Empirical scholarship on the content and impact of women-centred anti-ageing advertising, and on how women’s use of aesthetic anti-ageing surgeries and technologies interacts with their understandings and experiences of the ageing process, is near to none.2 In the tradition of the scholarship of Meika Loe and Annie Potts, my research aims to contribute to our general knowledge of ‘how the design and marketing’– and I would add, use –‘of technologies reproduce and, at times, reconfigure cultural understandings of ageing’ (Joyce and Mamo 2006: 110) in the United States. More specifically, through illuminating what women themselves have to say about their relationship to the growing field of aesthetic anti-ageing surgeries and technologies, I hope to enlighten our understanding of how aesthetic anti-ageing surgeries and technologies inform women’s attitudes about, and experiences of, growing older.
Successful ageing and agelessness
The ‘successful ageing’ paradigm, part of a larger movement in gerontology and geriatrics termed the ‘new gerontology’, focuses on health and active participation in life, and counters traditional conceptualisations of ageing as a time of disease and decline (Calasanti et al. 2006, Bayer 2005, Holstein and Minkler 2003). Successful ageing, according to Rowe and Kahn (1998, 1997, 1987), is dependent upon individual choice, effort and behaviour, and can be achieved through the positive influence and adoption of several extrinsic factors, from psychosocial aspects to personal habits. Diet and disciplined physical activity – the embodiment of what Stephen Katz terms ‘busy bodies’ (Katz 2000) – are two essential methods by which individuals can age ‘successfully’ and increase the likelihood of a healthy, active old age (Holstein and Minkler 2003: 787). Successful ageing mirrors our contemporary era of late consumer capitalism in which individuals are free to shape, mould, design, and choose their bodies (Giddens 1991), and finds fertile ground within our increasingly individualised discourse on healthcare (Williams and Bendelow 1998) whereby ageing is portrayed as a private problem that individuals are responsible for fixing (Debert 2003). Indeed, the individualist focus of successful ageing mirrors the rhetoric of choice and self-determination that permeates late consumer capitalism, finding easy resonance with a contemporary American popular and media culture in which we are constantly told that we can choose our own bodies (Bordo 2003 : 247).
A practice that counters prevailing ‘decline narratives’ (Gullette 2004, 1997) and challenges widespread cultural equations between age and decay, successful ageing can empower women to re-define ageing beyond limiting, negative, ‘identity stripping’ (Gullette 2004: 9) stereotypes. For members of marginalised groups, self-definition can be an act of resistance and power (Brown 1998: 220, cited in Morrell 2003: 71). Older women who track-run for example, refute the notion that older women’s bodies are weak and should be hidden from view (Hayles 2002). In her interviews with women in their nineties, Carolyn Morell (2003) found that her respondents’ identities centred on the defiance of decline – of able bodies and sharp minds, her respondents’ experiences contradicted old-age stereotypes.
‘Successful ageing’ engenders resistance towards the stigmatisation of old age; however, it may also contribute to it. As successful ageing is increasingly equated with anti-ageing (Bayer 2005: 14), with ‘not aging, not being ‘old’ or, at the very least, not looking old’ (Calasanti et al. 2006), the process of ageing itself is reviled. Further, the characteristic aspect of successful ageing – that of individual choice and responsibility – can increase the likelihood of blame and shame placed upon older individuals (simply for being and growing old). Carolyn Morell (2003: 83) argues that the individualistic ethic of successful ageing provokes antagonism towards signs of physical ageing. Martha B. Holstein (2006) echoes this concern, particularly as it applies to women:
If we older women fail to care for our bodies so that we can meet normative expectations to ‘age successfully’, we may be viewed askance – at the simplest level for ‘letting ourselves go’ when ‘control’ is putatively within our grasp – and, more problematically, as moral failures for being complicit in our own aging (Holstein 2006: 316).
The women in my sample exhibit a shared commitment to taking good care of their bodies through healthy eating and physical exercise and, thereby, embody key aspects of the successful ageing paradigm. But how, and in what ways, does the growing prevalence of aesthetic anti-ageing surgeries and technologies interact with women’s successful ageing ideologies and practices? And how does it inform their understandings of ageing more generally? Are aesthetic anti-ageing surgeries and technologies experienced as a new and welcome method for ageing successfully? Or are they creating more stringent requirements for successful ageing and restricting women’s capacity to equate ageing with a broad range of positive elements? These questions provide the context for my data analysis below.
Some ageing studies scholars suggest that ‘successful ageing’ increasingly connotes a quest for agelessness, or what Molly Andrews (1999) calls the ‘seductiveness of agelessness’. Stephen Katz and Barbara Marshall (2003) argue that the optimistic cultural imagery of successful or ‘new ageing’ reflects the postmodern fantasy of constructing and re-constructing the self and body outside time, in the continuous present, and the posthuman desire to live in bodies that are ‘never really born and never really die’ (Katz and Marshall 2003: 4–6). The ‘seductiveness of agelessness’ informs my respondents’ attitudes about, and experiences of, anti-ageing surgeries and technologies in myriad ways. For some, the seduction of agelessness merges with the seduction of technology – technology becomes a means-to-agelessness – as they speak of age-touched flesh being ‘whisked away’ and ‘cheating mother nature’. For others, this seduction is met with suspicion, ambivalence, and doubt. Still others reveal an underside of this seduction, an underside rife with increased anxiety about, and vulnerability to, biological age-related changes that remain beyond technology’s influence. Zygmunt Bauman (1992a: 18) argues that the modern/postmodern obsession to deny the body's limits makes confronting death particularly difficult; Chris Shilling (1993: 189) articulates the related assertion that our increasing belief in our ability to control and discipline our bodies leaves us uncertain and socially unsupported when it comes to dealing with death. My respondents’ anxieties and vulnerabilities mark a fundamental contradiction that I will analyse against the backdrop of Bauman's and Shilling’s hypotheses.
Successful ageing and femininity
The individual choice, effort, and responsibility that the paradigm of successful ageing demands – particularly as directed towards the maintenance of a healthy and active body – parallel the cultural expectations of individual responsibility and effort that inform the ‘disciplinary practices of femininity’ (Bordo 1993, Bartky 1990). A woman engages in daily work on her ‘defective body’ to achieve a feminine appearance (Smith 1990: 189); the feminine beauty ideal in the United States – White, heterosexual, thin, young – makes its attainment difficult – and impossible – for many. In a culture wherein women’s femininity, a ‘chief marker’ of which is the ‘capacity to draw admiring glances from others’ (Bartky 1999: 67), serves as a significant measure of their worth, aesthetic anti-ageing surgeries and technologies offer women new choices and opportunities (or pressures and responsibilities) to mould and shape their faces and bodies in compliance with the feminine imperative of a youthful appearance. Because women’s value is more commonly rooted in their physical appearance and sexual attractiveness than men’s (men’s value is determined more by ‘what they do then how they look’) and because women’s sexual eligibility depends on meeting much ‘stricter ‘conditions’ related to looks and age’, women are ‘more heavily penalised than men’ (Sontag 1997: 23) for the normal changes that age inscribes on the human face and body. It is not difficult to imagine, then, how successful ageing for women can come to signify not only healthy body practices, but the successful ‘doing of femininity’ (Smith 1990) as well.
Women’s naturally ageing faces and bodies – deviations from the dominant youth/beauty imperatives of femininity – provide a particularly lucrative market for aesthetic anti-ageing surgeries and technologies in the United States: ‘Let’s face it. Older women are a growth industry!’ (O’Beirne 1999: 114).3 Medical/pharmaceutical/cosmetic advertising that targets older women projects a powerful youth/beauty/sexual desirability imperative, reinforcing the equation between a woman’s societal value and worth and the sexual attractiveness and reproductive viability of her body. Older women are taught about what to do, what to buy, and what to put in and on their bodies in order to remain young, beautiful, and sexually desirable. In my analysis below, I explore how the growing availability, advertising, and use of aesthetic anti-ageing surgeries and technologies both challenge and strengthen dominant cultural assumptions about ageing and femininity in the United States. In what ways do aesthetic anti-ageing surgeries and technologies inform women’s understandings of their own physical attractiveness? Does the growing availability of these surgeries and technologies fuel new desires (or pressures) among women to continue to meet and comply with feminine beauty norms as they age? Do women find the growing availability and accessibility of aesthetic anti-ageing surgeries and technologies empowering or oppressive or both? These are some of the questions that are addressed through my respondents’ articulations of their perspectives on and experiences of aesthetic anti-ageing surgeries and technologies.
Data and analyses of the study
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My research is based on 44 in-depth interviews, ranging from one and a half to four hours in length, with American women between the ages of 47 and 76. My sample is purposive (Neuman 2000, Gamson 1992) and strategic (Rubin 1992). The women in my sample share a common concern for the health of their bodies and a commitment to taking good care of them through physical exercise; yet they also inhabit a variety of attitudes and approaches to growing older. I utilised the snowball sampling technique (Neuman 2000, Ostrander 1984) to recruit women who participate in some type of physical exercise on a regular basis – including gym workouts, walking, running, yoga, and pilates – and to select women who have different views on aesthetic anti-ageing surgeries and technologies. My sample consists of 16 women who are having and using aesthetic anti-ageing surgeries and technologies, 22 women who have not had/used aesthetic anti-ageing surgeries and technologies and articulate an active resistance to having them in the future (these women often describe themselves as growing older ‘naturally’), and six women who are undecided about whether they will or will not have/use aesthetic anti-ageing surgeries and technologies in the coming years. For the purposes of this study, aesthetic anti-ageing procedures, including plastic surgery (i.e. neck lifts, eye lifts, brow lifts, face lifts, tummy lifts) and what have come to be known as the ‘injectables’ (i.e. Restylane, Botox, Collagen, Perlane, Juvaderm).
Most of the women in my sample reside in the Northeastern United States, with the exception of two who live in the Midwest, and one who lives on the West Coast. They have a diversity of lifestyles (some live in urban centres, others in suburbs, still others live in small towns in rural settings) and livelihoods (some are retired and some are stay-at-home mothers) and work in a variety of professional fields, from education to business, from social work to psychology, from real estate to journalism, from art and music to physical fitness and dance. All but one of the women in my sample, who is Latina, are White. Approximately three-quarters of the women enjoy financial security – some inhabit upper and middle-upper class positions, others can be described as comfortably middle class; approximately one-quarter are less economically privileged, and fall within the socio-economic categories of middle, to lower middle, to working class. The cost of aesthetic anti-ageing surgery and technologies, like most cosmetic surgery procedures in the United States, is not covered by medical insurance – they range in the hundreds of dollars for injectables to the thousands of dollars for surgeries.4 While there are no official statistics on class and cosmetic surgery in the United States, the monetary expense of cosmetic procedures tells us that their use is a predominantly privileged practice. On the other hand, the widespread advertising and marketing of aesthetic anti-ageing surgeries and technologies in print media, on television, and in doctors’ offices, and the availability of long-term financing and payment plans, means that more women are aware of these surgeries and technologies and makes these procedures more accessible to greater numbers of women across class lines. The majority of the women in my sample who are having and using anti-ageing surgeries and technologies are easily able to afford them. Yet others with lower financial means, including a musician, a childcare worker, and a woman who is currently unemployed, also partake of them, albeit at considerable financial sacrifice: they have scrimped and saved money over a period of years, borrowed money from family, friends, and/or lending institutions, utilised long-term payment plans, and incurred financial debt as a result of their anti-ageing surgery and technology use.
Despite the growing normalisation and mainstreaming of cosmetic surgery in the United States, however, it continues to be practised overwhelmingly by Whites: Hispanics account for only nine per cent, African Americans six per cent, Asians five per cent, and other non-Whites two per cent, of the total number of recipients of cosmetic procedures (American Society for Aesthetic Plastic Surgery 2007). The demographics of the women in my sample who are having and using anti-ageing surgeries and technologies (all are White) reflect the reality that cosmetic surgery, at least at present, remains largely the prerogative of Whites in the United States. The medicalisation of non-White facial and bodily features in the discourse and publications of American cosmetic surgery practitioners (Eichberg 2000), combined with the popularity of surgeries that promote a White aesthetic among women of colour (Kaw 1993), suggest that the practice of cosmetic surgery in the United States reinforces cultural ideals of whiteness and conflations between whiteness, heterosexuality and femininity (Wepsic 1996). The themes of race and body image among older women are starting to be explored (see, for example, Reel et al. 2008) and the intersections of gender, race, and class in the contexts of ageing and cosmetic surgery are ripe for further analysis. Race is not an explicit focus of my study; yet, the fact that all my respondents who have and use aesthetic anti-ageing surgeries and technologies are White bespeaks the powerful absent-presence of race that haunts the cultural phenomenon of cosmetic surgery in the United States.
Faith and comfort in new technologies
Many of my respondents represent themselves as empowered consumers who can access an increasingly appealing range of new and exciting technologies with which to fight, and even conquer, the ageing process. As Maya, a homemaker, aged 49, puts it:
I feel like ‘oh, there’s a whole arsenal out there, great, no problem!’
Maya also finds comfort in the increasing advertising of new anti-ageing products and technologies. First, the advertisements reassure her that many other people are suffering the same ageing ‘symptoms’ that she is:
I think that so much more advertising is being done, marketed towards, you know, the older ageing population. Which I think is very helpful in terms of being more comfortable, knowing that many more people in this world have, you know, reflux or bladder control or… it’s so helpful knowing that other people are going through the same thing that we might be going through.
Secondly, these new products and technologies being advertised offer her a constructive course of action to ‘do something’ to conquer the symptoms of ageing:
Yeah, I think it’s great. So you got reflux, so does everybody else. You know, deal with
it. Isn’t it great, we can, some of these drugs aren’t even prescription anymore, you know, it’s like ‘okay, we can take care of this ourselves’.
Julia, a homemaker, aged 47, also feels comforted by increasing availability of anti-ageing technologies, and the power of these new technologies to ‘fix’ aspects of her ageing face that she is unhappy with:
I feel like it’s comforting in the back of my mind to know like, okay, if I get to the point where I’m horrified by something, I can go fix it.
Caroline, a radio producer, aged 47, is reassured not only by the increasing availability of anti-ageing surgeries and technologies, but by the fast pace of technological advancement. She expresses faith and confidence in on-going user-friendly innovations that will enable her to stave off ageing without having to do any ‘major work’:
I think it’s great that they [cosmetic surgeries and technologies] are out there. We [my friends and I] always say, ‘yeah, it’s great, who knows what they’ll have in 10 years’. I think the less invasive the better. All these little advances mean that you can keep tweaking, without really, you know, having to do major work. You know, why not? ‘Keep working in your labs, that’s all I have to say! Keep at it!’.
Technological power, magic, and seduction
Some of my respondents express an almost heady excitement as they recount their past experiences and future hopes for new anti-ageing surgeries and technologies. Amy, aged 48, who recently left the business world to become a stay-at-home mother, describes, with wonder and amazement, the way her surgery made her ‘sagging stomach’ like new again:
I was very pleased with the results. I mean I just felt like a million bucks. I mean I felt like, ‘oh my god, it’s amazing this thing that I never could get rid of is gone!’
While Amy resisted the surgeon’s pressure to have ‘a lot more done’ at the time – including liposuction on her hips, thighs and vaginal area – she explains that she certainly will take advantage of more anti-ageing surgery and technology in the future:
It’s almost like magic and I totally can see how women, especially as we age, get seduced into ‘oh, let me do a little bit of this’, because it is very enticing… Going in [to surgery] my line was ‘this is all I’m ever going to do’ like I’ve drawn the line and that was it. [But] afterwards I kind of sat there and thought, ‘oh, you know, I might get an eye job at some point’ and ‘yea, I mean, never a full face lift, but I can see, you know, a little bit here and there…’
In the recovery room, in fact, Amy experienced some pangs about not having had more surgery done. She muses that maybe if her husband hadn’t been opposed to her having surgery in the first place (due to his worries about the potential health risks of surgery, Amy’s husband was against her having plastic surgery of any kind) she would have woken up to the pleasure of even more of her age-touched flesh having been magically ‘whisked away’:
But I do remember when I was recovering in the recovery room, there was a woman next to me who also had the same doctor operate on her in our drugged state and had had a tummy tuck, and she said, ‘you know what? I did the full thing.’ She did the thighs, she did the hips and everything…And I don’t know how she looked because I was too drugged and I never saw her afterwards. But to a certain extent, if Daniel [Amy’s husband] hadn’t been so adamant about ‘I don’t even want you to do it’, to a certain extent I could see it. You’re under [anesthesia], it’s not that much more in terms of money, I mean just, the recovery I can’t imagine is that much worse. So, I don’t know. I could've, afterwards I definitely sort of thought, hmmm maybe I…I mean, you know, cause it is nice to think of this notion that it can just sort of be all whisked away.
For Janet, a retired airline ticket agent, aged 68, the power and magic of anti-ageing surgery and technology equals, even surpasses, that of Mother Nature. Through accessing these new technologies, Janet feels confident that she can almost cheat, or at least get a handle on, and ultimately reverse, the natural ageing process:
You don’t exactly cheat on Mother Nature, but you kind of, you know, get a handle on this particular aging process by getting rid of all that skin. And I felt like I could go back a few years and look the way I used to look, you know.
Technology as life-renewing, death resistant
My respondents often equate their surgeries and technologies with the achievement of a more youthful, more healthy, more rested, more energised look. Outside the achievement of more youthful look, however, ‘going back a few years’ or ‘turning back the clock’ can also signify a belief in actually becoming younger. Some of my respondents experience anti-ageing surgery and technology as energy producing and life giving; they come out of surgery feeling pleased not only with their younger look, but also with their literally de-aged faces, bodies, and souls. Amy, aged 48, (quoted above), is especially excited by the reversal of the ageing process that her surgery has engendered – surgery has re-charged her body and changed its direction:
All of a sudden something feels drastically better and it’s kind of like ‘wow I can keep going’. With the ageing process you feel like you’re going in a good direction from many respects, but from your body’s respect, it’s tough. And all of a sudden something’s been reversed and it’s like ‘wow, I can really go off in this direction!’
Anti-ageing surgeries and technologies contribute to a general optimism among several of my respondents about an increasingly realisable potential for eternal youth. As Maya puts it:
I love the idea that, you know, 60 is the new 50. I think that’s the best attitude going… It’s a really great way of thinking. And people do live longer and, you know, there’s so much more you can do [referring to anti-ageing surgeries and technologies].
Faith in contemporary technological and surgical advancements and progress is also evident in the way several respondents favourably compare their own generation to that of their parents. Unlike their parents, who were ‘old before their time’, these women strive to look and feel young for as long as possible – fitness, surgery, and other advancements in medicine and health awareness make extended youth possible. Nora, aged 62, a restaurant owner who has had eye-lift surgery, distinguishes herself from her parents at her age, and even from when they were younger than she is now:
My mother already started acting old…well, actually they both [her mother and her father] did, like when they were 40. Oh, you know, you just didn’t do certain things [at a certain age] then.
Lisa, a retired financial planner, age 58, who has had neck-lift and eye-lift surgeries, also distinguishes herself, and her generation, from that of her mother’s. While Lisa describes her mother as someone who ‘always looked nice’, ‘made herself look attractive’, and didn’t ‘totally let herself go’, she stresses that, unlike herself and her friends, her mother ‘never worked on her body’. In contrast to Lisa and her friends, her mother did not have facials or manicures or pedicures – she cut her own hair and did her own nails – and she let her hair go gray. Lisa identifies her mother’s lack of ‘work’ on her body as evidence of her mother’s acceptance of growing older and compares this acceptance with her own (and her friends’) resistance to it:
I think of my mother talking much more like ‘okay, now we’re old’. I always got the sense she was much more accepting. For years, she would say, ‘I’m ready to die, I’m ready to go’. Whereas everyone I know is like ‘can we just stop the clock here?’.
Lisa also understands her mother’s lack of interest in plastic surgery as a reflection of her mother’s comfort with growing older and wonders aloud whether she and her friends’ embrace of anti-ageing surgeries and technologies signifies the opposite:
My mother would never, I mean she would never, she wouldn’t have done that [have plastic surgery]. She would have thought it was unnecessary… She was more accepting of ‘that’s just the way I am’. I mean, there is something about this [having anti-ageing surgery] that I’m sure that has to do with, you know, you’re almost 60 years old. And my mother’s generation thought 60 was old. And my generation is primarily trying to make 60 young.
Although Lisa’s initial explanation for her neck and eye-lift surgeries is that she didn’t like the way she looked, the more she thinks about it, the more she is convinced that her surgeries also represent her desire to stay young, her desire to fight off ageing for as along as possible. Indeed, upon greater reflection, Lisa admits that perhaps what she hated most about her face was simply that it looked old:
So I mean I talk about it [her surgery] in terms of, I didn’t like the way I looked. But the way I looked is a normal ageing process for some people.
Lisa’s neck and eye-lift surgeries have come to serve as a buffer between herself and her fears of growing older. Her surgeries obscure the facial changes that, in her mind, signify ageing, deterioration, even death:
There is no question that my friends will say ‘hey I’m not old’ and we hate the fact that we are, hate it. I really, really don’t like thinking about the fact that in twenty years I’ll be 80. I mean I really don’t like thinking about that. I really don’t want to die. I really don’t want to get old… I think that it’s [her surgeries] about not wanting to become frail, not wanting to become, not wanting to die. Not wanting to leave, not wanting to have things end. I don’t like things ending…What I mind is that it’s going to end. I’m not accepting of that in a way that I think my mother was.
Several other respondents also express a visceral hatred of ageing and, like Lisa, link aesthetic, exterior changes to physical deterioration and death. Claire, a physical trainer, aged 49, who has on-going Botox treatments and claims she will take advantage of anti-ageing surgery later on, puts it like this:
There’s not one good thing about it [ageing]. It completely 100 per cent sucks. I mean, what’s good about everything ageing? I mean, what’s good about it? I’m not talking mentally and spiritually, I’m talking about physically. I mean your internal organs are ageing – I mean nothing’s going in the positive direction. …So, um, what I’m not okay with is I have a huge fear of death. And it’s something I’m trying to work on. It’s like one of my biggest goals right now, to work on doing some work around that. In that regard I can’t totally separate ageing from the fear of death.
Claire struggles with the tension between warding off visible signs of ageing and overcoming her fear of death so that she can fully experience and enjoy the present moment:
I’d like to be able to embrace that [fear of death] a little bit more so that I can let that go. And, you know, fully be present in the age that I’m at.
And yet, it may be harder for Claire to confront her fear of death and let it go when she is ever more distracted by the noise and youthful promises of anti-ageing surgery and technologies.
The technological imperative
Many of my respondents find the increasing availability of anti-ageing surgeries and technologies (and their capacity to choose these increasingly user-friendly surgeries and technologies as consumers) comforting and empowering. For others, however, the increasingly inevitable exposure to anti-ageing surgeries and technologies, through media coverage, television/print advertising, and even billboards in doctor’s offices, makes them uncomfortable. Such exposure can lead women to feel worse about ageing and to feel increasing pressure to ‘do something’ about the age-related changes in their faces and bodies. What had been felt and perceived to be a natural, normal, and even universal process (ageing) is increasingly experienced as pathological, as a problem in need of fixing and repair. The existence of these surgeries and technologies – the very fact that women can make the choice to have and use them – makes some women feel personally responsible for their ageing faces and bodies. Ageing becomes their fault.
For Lucy, a recently retired shop owner, aged 62, it seems that the advertisements for new anti-ageing technologies are ‘in your face a lot’ and are pointing out problems ‘I didn’t know I had’. Lucy also talks about being bombarded with new anti-ageing procedures at her local doctor’s office. She understands that doctors make a lot of money from these procedures and therefore have an incentive to pressurise women into having them. Even so, seeing the billboards in the waiting room makes her feel worse about her own ageing body and worry that everybody else is doing it – should she be doing it too? As she puts it:
You go in [to her local doctor’s office at her Health Maintenance Organization] and there’s this huge sign in the hall about all the cosmetic surgeries they offer now… It makes you stop and think about ‘oh, my God, everybody must be doing this’.
Mia, a real estate agent, aged 59, offers a nuanced critique of direct-to-consumer anti-ageing advertising, describing it as creating an ‘artificial demand’ and as ‘morally wrong’. Despite portraying herself as ‘fairly immune’ to such advertising, however, she begins to wonder whether she should be worried about her naturally ageing face and body as a result of her exposure to it:
You see it all the time and it makes you think: ‘Oh, is that something I should be thinking about?’ Or, ‘Am I so out of the mainstream or am I so weird, that I don’t care about this?’
Knowing that she could ‘do something’ to ‘fix’ the age-related changes in her face and body makes Mia feel ‘apologetic’ for what was once simply a natural process, beyond her control:
I think it [anti-ageing product advertising] does make one aware of what the possibilities are. And I think that now one has to make a conscious choice not to use them. Whereas before it wouldn’t have been on one’s radar screen. I think it does make one feel worse about getting older, because these products are designed to make one look younger. I think it makes one feel either apologetic or gee, I’m getting older and things are just getting worse. It does not help one’s self esteem.
Laura, an education advisor, aged 51, laments the fact that she doesn’t live in a culture that ‘supports her’ and just allows her to ‘relax’ about ageing. Instead, modern science harasses her with formulas to look younger, with ammunition to fight the ageing disease, and it becomes harder and harder to age without stigma, without guilt:
It’s hard to feel good about ageing, having your body do what it naturally does around this age, when the culture is telling you that that’s not necessarily so. It’d be much easier if I had a culture supporting me, saying relax, women your age are supposed to look like that. But no, modern science tells me no, that’s not true, that it could be otherwise. And there’s a sense of guilt, an added sense of guilt for women, I think, to say you’re choosing this because we’ve proven otherwise.
Laura continues to assert her belief in ageing as a ‘normal’ process that is ‘happening to me’ and that ‘happens to everybody’:
I think things like your face growing lined, and the thickening of the middle if you’ve had children, and all that stuff is normal.
And yet, increasingly, Laura feels that American culture ‘doesn’t allow aging’ and teaches her that ‘aging is not good’. She wistfully wonders about other cultures, outside the United States, where perhaps you can simply ‘get old’ and ‘slow down’ because that’s just ‘what happens’:
The choice in all the matter can be a burden because we constantly feel that when we age, or get older looking, it’s partly our fault and there are things that you can do to undo effects of ageing. And so there’s just more guilt there. I don’t think other cultures have that. You get old, that’s what happens. You slow down. But we have this feeling that it’s bad to do that.
Laura, Mia and Lucy have not had or used anti-ageing surgeries or technologies; Mia and Lucy are fairly convinced they will not partake of them in the future, whereas Laura is ‘on the fence’ about whether she will or will not have/use anti-ageing surgeries and technologies in coming years. Discomfort with the growing prevalence and accessibility of aesthetic anti-ageing surgeries and technologies is not limited to my non-user respondents, however. Several of my respondents who are generally embracing these surgeries and technologies articulate ambivalence about the increasingly ubiquitous nature of these surgeries and technologies, and the subsequent pressure they feel to use them. These women convey feelings of nostalgia (if only they could ‘just accept’ the natural ageing process) as well as exhaustion and frustration with the constant expectation to resist and fight the ageing process that the widespread availability and advertising of anti-ageing surgeries and technologies promotes.
Julia, a homemaker, aged 47, has had several rounds of sclerotherapy (varicose vain removal treatments via laser), laser treatments to remove age spots on her face, and plans to move on to Botox, collagen, and probably even surgical anti-ageing procedures in the future. She struggles to sort out whether her motives for having these procedures are self-driven or whether her negative feelings about her face and body stem from her increasing exposure to anti-ageing surgeries and technologies:
What I resent is that I can’t look in the mirror and just be happy. I have to look and think, ‘Oh, Are these too saggy?’‘Do you think I should be doing something down the road?’ Or, ‘Should I fix this?’… I can’t read the Boston Globe magazine without seeing all these ads: Before, After. So I don’t know what comes first, the chicken or the egg. Am I dissatisfied with myself and I want to fix it? Or, am I minding my own business, the media is showing me all these ads, and I’m thinking, ‘Oh, maybe I need to do this?’.
The more she talks about it, the more Julia seems to become convinced that she wouldn’t be so worried about her ageing face and body if she wasn’t surrounded by a plethora of anti-ageing technology options and choices. If the ‘products and services weren’t available’, she posits, ‘I wouldn’t be thinking about it’. Even when she goes in for routine check ups at her gynecologist’s office she is bombarded (and tempted) by new anti-ageing procedures: it is her gynecologist, she explains with some incredulousness, who performs her laser hair and age spot removal treatments.
Like Laura (quoted in the preceding section) Julia appears to feel some wistfulness for what her ageing process might be like if she didn’t have the choice of having and using anti-ageing surgery and technologies. She explains that ageing could really be a ‘beautiful process’ and that she would be more likely to accept looking in the mirror and seeing wrinkles – to feel like that’s just what happens – if everybody else would just let her ‘be okay with it’. Yet, even the reality of several ‘wonderful’ women role models who are ageing ‘naturally’, including her own mother, fails to insulate Julia from the cultural pressures to look young and to interrupt her pull towards anti-ageing surgery and technologies:
I’m lucky that I have wonderful role models. My mother is so adorable. She’s 71. She’s kind of dumpy. She doesn’t do any exercise, her body is all flab and she’s a little overweight. And she’s…everybody says, ‘Oh, she’s so young looking’. And I think that’s because of her personality, she’s so happy and twinkly. And so I feel like she’s beautiful. And I go to committee meetings and there are older women. I see the most beautiful women that are white haired lately. They’re fit, they twinkle, they’re alive. So I think that it [ageing] could be a really beautiful process and I think it’s mostly the culture around us that makes us feel badly. Because I could look in the mirror and see these wrinkles and think okay, that’s what’s happening, if everybody else would let me be okay with it.
My respondents’ sentiments and experiences discussed here, and in the preceding section, illuminate some of the conflicts women face as they encounter anti-ageing surgery and technologies. Even among some of my respondents who use/have anti-ageing surgery and technology, and/or are convinced that they will have and use them in the future, feelings of ambivalence surface. And yet, it seems that most are somewhat resigned to being caught up in the anti-ageing surgical and technological cycle. As Julia puts it: ‘I’ve seen those barriers [to anti-ageing surgery and technologies] break down in me.’
The feminine imperative
As women grow older, most confront a ‘double standard of ageing’ (Sontag 1997 ). Unlike men, who are valued for capacities such as individual agency and for unique thoughts and actions, women’s value is more likely to be linked to their sexual attractiveness and reproductive viability. A man’s social value, and even his perceived physical desirability, often increases with age, while a woman’s decreases. As Sandra Bartky explains:
The loss of an admiring gaze falls disproportionately on women. We need to see but also to be seen and to be seen as attractive… a woman’s worth, not only in the eyes of others, but in her own eyes as well, depends, to a significant degree, on her appearance (1999: 67).
Women can experience shame when they ‘lose their ability to conform to dominant standards of femininity’ and when their bodies no longer represent ‘important feminine qualities, such as sexual attractiveness, youth, and slenderness’ (Furman 1999: 10). Aesthetic anti-ageing surgeries and technologies offer older women new opportunities to embody the youthful characteristics of traditional femininity and thereby to challenge the stigma, shame, and invisibility that many encounter as they age. Certainly, for some of my respondents, feelings and experiences of being ignored, negatively stereotyped, and cast aside as older women influenced their decision to have and use anti-ageing surgeries and technologies. For these women, looking more youthful after surgery can be an empowering and self-esteem building experience. Achieving smoother skin, flatter stomachs, and perkier breasts makes them feel more ‘attractive’ and ‘sexually desirable’, and means receiving increased attention from others, helping, therefore, to lessen the painful invisibility they endured as naturally ageing women. Yet others resent the prospect of continuing to meet the ‘disciplinary practices of femininity’ (Bordo 1993, Bartky 1990) just at a time when they are beginning to enjoy some freedom from the pressures to conform to traditional feminine aesthetics. Further, while anti-ageing surgeries and technologies make the ‘doing of femininity’ (Smith 1990) possible at an older age, more time, work, money, and pain is required to mould the older face and body in compliance with feminine beauty standards. The opportunity for re-claiming, or maintaining, feminine beauty and sexual desirability via anti-ageing surgery and technology increases the pressure some women feel to conform to feminine norms and practices they find limiting and confining.
The potential, as a woman, to look younger, and therefore more ‘attractive’, through anti-ageing surgery and technology use can translate into a kind of moral, feminine imperative. According to Mary, aged 72, a semi-retired commercial property agent who has had a face lift, it is a woman’s responsibility to look as physically attractive as she can, within her power (especially if she hopes to attract and hold on to a man), and for women of a certain age this means having surgery:
I think it’s stupid not to do everything you can, particularly if you’re single. You just have to do what you can with what you have… I mean, why not [get a face lift]? You might as well do what you can.
Laura, however, feels differently:
Why should an older woman be expected to be sexually attractive and have a hot body? I shouldn’t feel badly if people don’t find my 91-year-old mother-in-law sexually attractive. She is attractive, just in a different way.
Laura, like many of my respondents who are resisting anti-ageing surgeries and technologies, and who are on the fence about whether or not they will have/use anti-ageing surgeries and technologies in the future, strives to re-conceptualise attractiveness outside the rigid youth/beauty confines of traditional femininity. In addition to re-defining physical beauty to include age-related characteristics, and finding beauty in realms outside appearance altogether, these respondents also begin to explore and develop new aspects of themselves, and to find value and self-worth in their capacities beyond physical attractiveness and reproductive viability. Yet, realising the potential for new freedom with age (a freedom, that, in part, can be attributed to the release from the admiring/objectifying male gaze) becomes more difficult as anti-ageing surgeries and technologies gain ground and offer more and more avenues for older women to continue to comply with, and conform to, the normative and disciplinary practices of femininity.
My data suggest that the growing availability, marketing, and use of aesthetic anti-ageing surgeries and technologies in the United States both ‘reproduce’ and ‘reconfigure’ (Joyce and Mamo 2006) mainstream American cultural attitudes about women and ageing. As my respondents’ experiences and perspectives illuminate, aesthetic anti-ageing surgeries and technologies project a new paradigm of ageing, one that echoes the successful ageing directives of individual responsibility, effort, and work on the body, but also intensifies and expands these directives and contributes more ambitious goals. Ageing successfully, in light of the increasing prevalence of aesthetic anti-ageing surgeries and technologies, comes to mean not only maintaining a healthy, active body through diet and exercise, but a young-looking body (and face) through surgery and injectables. My respondents articulate an aesthetic anti-ageing surgery-and-technology-driven paradigm that edges out successful ageing in favour of a kind of feminised agelessness – health work on the body in the context of ageing is subsumed into youth/beauty work on the body that aims to minimise, reverse, and even prevent signs of ageing altogether.
The prospect of being able to shed age-related characteristics in the face and body, and thereby to conserve traditional feminine attributes – to conform to the feminine norm of youthfulness despite growing older – explains much of the appeal that aesthetic anti-ageing surgeries and technologies hold for the women who have and use them. Through achieving younger, tighter-looking skin, flatter stomachs and perkier breasts, my respondents seek to lessen some of the (unjust) invisibility and stigma they encountered as naturally ageing women. The increased attention and praise my respondents receive for their (post-surgeried, post-injected) appearance is a confidence and self-esteem booster; such attention and praise also debunks the belief that older women cannot be sexy and physically attractive. Finally, aesthetic anti-ageing surgeries and technologies offer women the opportunity to assert some control over the biological process of natural ageing. (My respondents commonly describe once familiar faces and bodies becoming alien due to age-related changes – it’s as if they are no longer at the helm of their own faces and bodies but instead, nature, or the ghost of ageing, is.) Many express heady excitement about these surgeries and technologies as a means to erase age-related changes in their faces and bodies, as a means to fight back against nature with the power of technology. In this way, aesthetic anti-ageing surgeries and technologies enable my respondents to inhabit new agency in and through their bodies. As Kathy Davis explains, cosmetic surgery can provide women with an empowering ‘different starting position’ in relationship to her body:
Cosmetic surgery can provide the impetus for an individual woman to move from a passive acceptance of herself as nothing but a body to the position of a subject who acts upon the world in and through her body. It is in this sense that cosmetic surgery can, paradoxically, provide an avenue toward becoming an embodied subject rather than an objectified body (1997: 114).
The capacity for maintaining a youthful appearance engendered by aesthetic anti-ageing surgeries and technologies proves agenic for many; yet, the controllability of the body made possible by aesthetic anti-ageing surgeries and technologies also pathologises the naturally ageing female body with new virulence. The older woman’s face and body has always been rejected for failing to meet the feminine cultural expectations of sexual attractiveness and reproductive viability. However, with the increasing availability and accessibility of aesthetic anti-ageing surgeries and technologies, with the possibility to continue to mould, shape, and discipline their faces and bodies in accordance with feminine youth imperatives as they age, older women are penalised not only for having faces and bodies that exhibit natural signs of ageing but also for failing to do something to repair them. Despite the fact that age-related changes, in one respondent’s words, ‘happen to everybody’, and are a reflection of the body ‘doing what it naturally does’, the growing prevalence of aesthetic anti-ageing surgeries and technologies can make women feel they are ‘choosing’ the inferior path of natural ageing over and above the superior route of femininity-maintenance and age-prevention. Aesthetic anti-ageing surgeries and technologies are contributing to a culture that, as she puts it, ‘doesn’t allow ageing’. Women are made to feel ‘guilty’ for failing to uphold their femininity (or social value) and culpable for the age signs on their faces and bodies. As another respondent proclaims, ‘if women can afford to do it [have anti-ageing surgery] they should do it’.
My respondents’ articulation of an aesthetic anti-ageing surgery-and-technology-driven ideology of agelessness and femininity (whether they subscribe to this ideology through embracing these surgeries and technologies, or resist it through refusing them, all express a keen awareness of its existence) echoes Martha Holstein’s prediction that anti-ageing medicines will ‘devalue old age and intensify [negative] cultural attitudes about aging’ (2002: 38). Aesthetic anti-ageing surgeries and technologies make women who are growing older naturally feel worse about their ageing faces and bodies. Women who have and use these surgeries and technologies feel better about ageing precisely because they are able to minimise the age signs on their faces and bodies. Only when we understand that the body is ‘not controllable’, Carolyn Morell (2003) argues, ‘will those who cannot control their bodies no longer be perceived as responsible for their limitations or as examples of ‘unsuccessful ageing’’ (2003: 80). But aesthetic anti-ageing surgeries and technologies connote an increasing controllability of the body and, with that, the perception of the ageing body as the ‘rejected body’ (Wendell 1996, 1999) and of old bodies as ‘problem bodies’ (Oberg 2003) intensifies, particularly if they belong to women.
Aesthetic anti-ageing surgeries and technologies reinforce the cultural understanding of growing older – and for women, specifically, looking older – as an inherently undesirable and negative experience. To feel better about ageing means minimising age signs on the face and body; in short, looking younger. Women are empowered in and through their use of aesthetic anti-ageing surgeries and technologies as they slow, stop, and even reverse what had previously been endured as unwelcome age-driven changes beyond their control. These women realise the role of technogenarian as they reconstruct their naturally ageing bodies with age-erasing technology, replacing undesired ageful faces and bodies with youthful ageless ones. The recent cultural ascendance of the successful ageing paradigm – with its focus on the maintenance of active, healthy bodies through diet and exercise – restricts not only popular understandings of how to age ‘successfully’, but limits understandings of positive ageing to the directives of successful ageing as well (Holstein 2006, Gergen and Gergen 2001). The technogenarian model of ageing (via anti-ageing surgeries and technologies) narrows understandings of positive ageing yet further; indeed the ‘positive’, ‘successful’, pay off for adopting this model connotes wiping out indicators of ageing altogether.
Aesthetic anti-ageing surgeries and technologies are welcomed by many as a cheering alternative to natural ageing (‘who wouldn’t take advantage of surgery?’ one woman asks, incredulous at the thought that any woman would not do just that). There are women, however, who reject the anti-ageing technogenarian model in favour of ageing naturally, and who gain new freedom, agency and empowerment in and through their embodiment of natural ageing – women, in short, who resist negative and limiting ageist and sexist stereotypes, who ‘redefine old’ as inclusive of positive aspects, ‘without adopting the normative rubrics of ‘successful’ and ‘productive’. (Holstein 2006, Holstein and Minkler 2003). My respondents who are ageing naturally enjoy a wealth of positive benefits as a result of being liberated from the feminine mandates of youth and beauty and from the socially prescribed feminine roles of sex object, nurturer and reproducer. Technogenarians may lose out on many benefits of natural ageing – less anxiety about physical appearance and about attracting the male gaze and, therefore, less effort and pain caught up in beauty work; more freedom to observe others; more diverse and inclusive definitions of beauty; re-claiming the body for oneself after years of making it available for the pleasure and nurturance of others; discovering and developing new parts of oneself outside the role of sex object/wife/mother – yet, perhaps most detrimental, is the erasure of age signs from the face and body that mark the inevitable passage of time. My respondents who are growing older naturally struggle, at times, with accepting and adapting to the age-related changes in their faces and bodies. These changes, however, signal the positive growth and memories that accompany life experience; they can also prove useful strategies that, as one woman puts it, ‘remind me of the preciousness of life’, and that ‘help me prepare for the next stage’, in the words of another. Technogenarians’ young-looking faces and bodies distract them from the reality of biological ageing and disguise its signs. While these (aesthetic anti-ageing surgery and technology produced) distractions and disguises are welcomed by many women, they may also leave them less able, in Lisa’s words, to accept the reality of ‘things ending’, than their naturally ageing counterparts.
In 1982, the Supreme Court upheld the Federal Trade Commission ruling overturning the American Medical Association’s ban on direct advertising and patient solicitation, initiating the deregulation of medicine in the United States. Federal Trade Commission rulings, Congressional mandates, and pressures from pharmaceutical companies throughout the 1990s have dramatically cut back on the time allotted to the Food and Drug Administration to test and approve new pharmaceutical drugs (drug approval times have been reduced 50% since the enactment of Congressional legislation in 1992) and have curtailed the power of the FDA to regulate the advertising and marketing of these drugs. Direct-to-consumer pharmaceutical advertising, in print media, on television, and on the internet, began in 1998. The FDA is not legally mandated, nor does it have the legal jurisdiction, to review the accuracy of these advertisements before they reach the public. (Please see Deborah Sullivan’s Cosmetic Surgery: The Cutting Edge of Commercial Medicine in America (2001), Jay S. Cohen’s Overdose. The case Against the Drug Companies: Prescription Drugs, Side-Effects, and Your Health (2001), and Arnold S. Relman’s ‘The Health Care Industry: Where is it taking us?’ (2005) in The Sociology of Health and Illness: Critical Perspectives, for more in-depth analysis of the history and current manifestations of the deregulation and commercialisation of medicine in the United States.)
The exception here is the recent scholarship of Clarke and Griffen (2007)
It is worth noting that women-centred products continue to make up the lion’s share of anti-ageing advertising in the United States, and that the vast majority of cosmetic surgery consumers are women. In 2007, women had nearly 10.6 million procedures, or 91% of the total number of cosmetic procedures performed, while men had nearly 1.1 million procedures, only 9% of the total number of cosmetic procedures performed (American Society for Aesthetic Plastic Surgery 2008.) Despite recent survey data that indicates that men increasingly approve of cosmetic surgery (according to the American Society for Plastic Surgery 38.8% of men have more favorable attitudes towards cosmetic surgery than they did ten years ago), the rate of increase in numbers of male patients remains strikingly low. In fact, the total percentage of male patients has decreased from its high of 13% in 2003. Finally, anti-ageing procedures continue to account for the majority of non-surgical procedures, and for half to two-thirds of surgical procedures, among women in the United States (American Society for Aesthetic Plastic Surgery 2008).
In the United States, the average cost of a Botox injection is $417, for an eye lift, $2,882, and for a face lift, $6,532. These figures do not include fees for surgical facilities, anesthesia, and other miscellaneous costs related to surgery (The American Society for Aesthetic Plastic Surgery 2006). The vast majority of cosmetic surgeries and injectables are not covered by medical insurance; several exceptions include eye lifts for visual improvement purposes, breast lifts for back pain, and Botox injections for migraines.
I am grateful to the anonymous reviewers for useful comments on an earlier draft of this article.
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- successful ageing;
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