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Putting Vanity on Hold

The Cerebral vs. the Somatic Narcissist

Narcissism and Body Dysmorphic Disorders

Histrionic Personality Disorder


Skin Deep
Putting Vanity on Hold
Published: December 17, 2008
WITH hindsight, the first decade of this century may come to be viewed as the era of the mass medicalization of attractiveness.

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Extreme Makeover
The advent of cosmetic Botox in 2002 posited the eradication of wrinkles as an affordable luxury amid a booming economy.

On television, reality shows like “Extreme Makeover” and “Dr. 90210” normalized vanity medicine, making cosmetic operations seem cuddly and carefree. Meanwhile, lenders rushed in to offer specialized lines of credit for cosmetic procedures.

And, somewhere along the way, the body became the new attire, a mutable status symbol subject to trends in proportion, silhouette, technology and disposable income.

But now, as the country plunges into recession, will financial hardship demote the pursuit of physical perfection?

Will the vogue for a smoothed face in which only the mouth moves, or a mix-and-match body of mature breasts atop boyish hips become outmoded? Will aesthetic values loosen up, allowing the occasional wrinkle to take on a certain measure of authenticity?

“There comes a point when you are putting too much time and money into your vanity,” said Peri Basel, a practice consultant in Chappaqua, N.Y., who advises cosmetic doctors on marketing strategies. “For me, the vanity issue is: Where does it stop? If you are going for buttock implants, do you really need that?”

Indeed, a few indicators suggest that financial constraints are beginning to interrupt the narrative of better living through surgery — at least temporarily. Sixty-two percent of plastic surgeons who responded to a recent questionnaire from the American Society of Plastic Surgeons said they had performed fewer procedures in the first half of this year compared with the same period last year, according to the latest anecdotal information from the group.

At the society’s annual meeting last month in Chicago, some prominent surgeons said they had openings and for the first time agreed to negotiate fees with patients.

More recently, a quarterly earnings statement from Mentor Corporation, a breast implant manufacturer, reported that the number of breast implants sold in the United States decreased 5 percent during the three months ending Sept. 26 over the same period last year. In the last month, two manufacturers of cosmetic medical devices have closed.

“In Orange County, where plastic surgery is a part of their culture, doctors told me business is down 30 to 40 percent,” said Thomas Seery, the president of, a site devoted to reviewing vanity-medicine procedures. “That tells me something is fundamentally changing there.”

Even a few celebrities, those early adopters of appearance technology, have started to deride the plasticized look that sometimes accompanies cosmetic interventions, a harbinger perhaps of a new climate of restraint in which overt augmentation seems like bad taste.

Call it a Botox backlash. Last month in interviews with different magazines, the actresses Courtney Cox and Lisa Rinna said that they did not like the look of excessive facial injections.

“It’s not that I haven’t tried Botox — but I hated it,” Ms. Cox said in an interview in Marie Claire. “You know you’ve messed up when people who are close to you say, ‘Whoa, what are you doing?’ ”

Meanwhile, Ms. Rinna, late of “Dancing With the Stars,” said that she had gone overboard with skin-plumping injections and planned to cut back.

ACADEMICS who study body image and body modification said it is too soon to know how financial constraints might alter attitudes toward beauty maintenance. But several researchers forecast how consumers might reappraise the idea of appearance upkeep in light of basic needs, family obligations, romantic aspirations, professional status and personal values. Although a recession may propel some people to seek more procedures, many consumers will reduce or forego cosmetic treatments, they said.

In uncertain times, people tend to re-evaluate their priorities, dismissing aspirational purchases as frivolous, said Victoria Pitts-Taylor, a professor of sociology at Queens College and the Graduate Center of the City University of New York.

“Cosmetic surgery is going to become the new S.U.V., something that you can do without, that is less justifiable for you and your family,” said Dr. Pitts-Taylor. She is the author of “Surgery Junkies: Wellness and Pathology in Cosmetic Culture.”

J. Kevin Thompson, a professor of psychology at the University of South Florida, theorized that people might reduce spending on their appearance after reassessing their immediate needs. “It would be a rational decision to put the safety of your home first,” said Dr. Thompson, who has studied body image disorders and obesity for 25 years. A psychological theory called Maslow’s hierarchy of needs, in which physical necessities like food, health and security trump conceptual needs like self-esteem, may account for people who choose basics over beauty, he said.

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Extreme Makeover
Dr. Thompson, who emphasized that he was speculating in the absence of survey data, suggested that people may also make decisions about their appearance by scrutinizing the grooming practices of their friends, acquaintances, and even celebrities, a behavior called social comparison.

“In terms of body image, they look around at their friends,” Dr. Thompson said. “If everyone is cutting back, they may change the norm based on what others are doing.”

Meanwhile, fence-sitters who were contemplating but had never undergone a cosmetic procedure may now lose interest.

“Looking at the economy and their bank balances, they might now be saying ‘No’ and be glad to have a reason to resist the beauty imperatives of cosmetic surgery,” Dr. Pitts-Taylor said.

And what about people who already consume cosmetic medicine on a regular basis?

Ms. Basel, the practice consultant, said she had amended her beauty routine, but had not relinquished her desire to manage her appearance.

“Let’s face it, if you don’t look great, you are not going to your reunion and you are not going on Facebook,” said Ms. Basel, who blogs about beauty at She described her cosmetic cutbacks: out went the personal trainer, in came the gym classes; antiwrinkle injections are a must, but major operations have gone by the wayside.

Amy Krakow, the president of Propaganda Marketing Communications, a public relations firm in Manhattan, who had been interviewed for an article in 2007 about high-maintenance beauty routines, has also made some concessions. She recently changed her hairstyle to include bangs — a camouflage technique that allows for fewer Botox injections, she said.

“I’ll change my hair colorist,” Ms. Krakow said. “I’ll give up my crazy Japanese hair straightening. I’ll stretch out my Botox. I’ll even go for fewer plastic surgeries. But I do have to look good in my business. I look younger, therefore I can represent younger and hipper clients.”

Although economic constraints may cause some people to hit the pause button on beauty interventions, financial uncertainty may impel others to try it.

After all, body modification is more than a desire to increase attractiveness. It is an attempt to impose control over life by molding the flesh.

Deborah A. Sullivan, a sociology professor at the School of Social and Family Dynamics at Arizona State University, said that people who feel forced to forgo cosmetic medicine might experience a loss of control in their lives.

“I think it will intensify the sense of downward mobility: ‘I can’t even get my wrinkles treated,’ ” Dr. Sullivan said. She is the author of “Cosmetic Surgery: The Cutting Edge of Commercial Medicine in America.”

Against a tide of people eschewing cosmetic medicine in the new economy, she also predicted a counter current of consumers having procedures to feel proactive.

“People who would not have considered it, when they get laid off at 45, 50, 55 and are back on the job market, might consider it as they try to enhance their human capital,” she said.

Cosmetic surgery has weathered other cataclysms. For example, consumers cut back on beauty operations after the terrorist attacks of 2001, a year in which procedures like liposuction, tummy tucks, nose jobs and eye-lid procedures declined, according to estimates from the American Society of Plastic Surgeons.

Dr. Pitts-Taylor predicted that cosmetic procedures will experience a resurgence when the economy eventually recovers. “It is absurd to suggest that cosmetic surgery is dead or will not be used by the middle class in the future,” she said.

Doctors and manufacturers are counting on it.

On Dec. 1, Johnson & Johnson said it planned to buy Mentor Corporation, the breast implant manufacturer, for about $1.1 billion.

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