Beauty standards: How cosmetic surgeons are ‘refashioning’ race

In 2011, Yale sociologist Alka Menon came across an article in The New York Times on the racial and ethnic differences in cosmetic surgery.

A plastic surgeon quoted in the piece explained that when he and his colleagues encountered patients of a certain ethnic background and age, they could predict what procedures the person would request based on “their cultural preferences and ideals of beauty.” One group might favor breast augmentation, while another was more interested in face lifts, and another in upturned noses.

“We are sort of amateur sociologists,” the surgeon told the Times.

Intrigued, Menon began researching what had come to be known as “ethnic” cosmetic surgery, poring over articles in medical journals about the best practices for achieving certain race-specific looks, such as an “ideal” African American nose. 

“I knew that I needed to talk to surgeons to figure out the full story,” said Menon, assistant professor of sociology in Yale’s Faculty of Arts and Sciences (FAS). “Do people use these standards and guidelines? Is this an American project or a larger transnational story? Questions like this launched me in a million directions.”

Years of research culminated in the recent publication of Menon’s book, “Refashioning Race: How Global Cosmetic Surgery Crafts New Beauty Standards” (University of California Press), which explores the world of cosmetic surgery through the lens of surgeons in the United States and Malaysia. Through interviews with practitioners, observations made during global medical conferences, and an analysis of the relevant medical literature, Menon demonstrates how cosmetic surgeons generate and apply knowledge using racial categories and how transnational clinical and economic exchanges influence this process.

Menon, who is affiliated with Yale’s Council on Southeast Asian Studies, the Department of Women’s, Gender, and Sexuality Studies at FAS, and the MacMillan Center for International and Area Studies, recently spoke to Yale News about cosmetic surgeons’ role as gatekeepers of race-specific beauty standards, how they interact with popular culture, and how the practice varies in different countries. The interview has been edited and condensed.

The book focuses on surgeons based in the United States and Malaysia. What led you to compare cosmetic surgery in those two countries?

Alka Menon: At first glance, the United States and Malaysia seem very different. They’re about as far away from each geographically other as possible and Malaysia is much smaller. What unites them, and what was interesting for a basis for comparison, is that they’re both avowedly multicultural countries home to multiple different racial and ethnic groups. They see racial and ethnic categories as discrete, rather than on a continuum, and people think they can perceive their neighbors’ racial or ethnic identity just by looking at them or asking some basic questions.

Comparing the two countries opens the doorway to a larger multicultural story concerning how we think about beauty ideals and the idea that people can be beautiful in different ways. People might want to alter their looks but do so within the framework of an existing racial or ethnic category.

Neither country is pushing the envelope when it comes to cosmetic surgery looks. South Korea or Brazil are the hotbeds for that kind of innovation. Surgeons in the U.S. and Malaysia were following trends more than creating them.

You describe cosmetic surgeons as “race brokers” or racial gatekeepers. How do they fill that role?

Menon: By racial gatekeeping, I mean that cosmetic surgeons are deciding what makes something racially legible and whether a patient’s request for change is something that they’re willing to do, believe is socially acceptable, and consistent with the racial or ethnic identity that the patient presents. The idea here is that the surgeons have some discretion. It’s not immediately apparent that all requests are bad ideas. Surgeons can flex their creative muscles and exercise a little bit of artistic and clinical integrity by saying, “This is a good idea. I want to be associated with that eventual look.” Or they can say, “That’s a terrible idea. I don’t think that’s beautiful at all. It may be popular now, but how are you going to feel about it in five years?”

Are their differences in how cosmetic surgeons Malaysia and United States serve in this gatekeeping role?

Menon: I found that in both the U.S and Malaysia, surgeons acted as race brokers, but they thought differently about boundaries and how to police them. In the U.S., surgeons were cognizant of a history of people wanting to look white or whiter in response to the racism they encountered here, which made the surgeons a bit careful concerning requests from different people of color that they perceived as attempts to look whiter. They questioned those kinds of requests and had varying degrees of comfort with granting them.

For example, there is an eyelid surgery for Asian people that makes the eyelid appear to have a fold in it and look bigger and rounder. It’s very popular worldwide and Asian patients in the United States sometimes request it. Some American surgeons would do it and others wouldn’t. Many of them saw it as a whitening procedure.

In Malaysia, the procedure is common. The surgeons talk to patients about the degree of change they’re seeking. The procedure’s effect can be dramatic or subtle. It can make clear that the patient has had cosmetic surgery to look white or Western, or it can be a change of a couple of millimeters to help them, say, look more like their mom. The surgeons’ perspective was that it’s a matter of degree.

Malaysians were also very invested in thinking about a natural Asian look that was broader than Chinese, Indian, and Malay. They were thinking, “Well, what does ‘Asian’ look like across all of that? What is an Asian sensibility?” The actual looks mattered to them, but they would group techniques that enable a broadly conservative approach, such as by using synthetic materials instead of grafting material from one part of the body onto another. It's gatekeeping but in terms of practices as well as beauty ideals.

What role does pop culture play in guiding cosmetic surgeons’ approach to these issues?

Menon: Cosmetic surgeons exist in some tension with pop culture. They contribute to and advance popular trends — by modifying patients’ bodies, and by sharing images of beauty themselves on social media or in their clinics. The surgeons I interviewed depended on popular culture for inspiration and to understand where patients were getting their ideas about what surgery could do for them. But they also sometimes felt subordinate to them, worrying that popular culture creates unrealistic expectations that might lead patients to want to change themselves endlessly or warp their understanding of what’s possible. They suggest that the airbrushed photos in magazines and on social media create expectations that surgery cannot achieve.

What was the prevailing beauty standard guiding cosmetic surgeons before race-specific standards developed?

Menon: When cosmetic surgery first took off in the United States, the aesthetic was one size fits all. One of the earliest features cited by historians for an American beauty ideal was a curved, upturned nose, which was called “the ski jump” nose. That shape is not very common naturally. It became a marker of conspicuous consumption seen on famous actresses and wealthy women. An upturned nose was a departure from big nose or nose with a bump that, at the time, was often associated with Eastern European immigrants, especially Jewish women. It was a sign that work was done.

But there was the sense that as the United States diversified, as different groups became wealthier and as trends changed, you could only do that ski jump nose once. What else can you offer? What else would be within the realm of beauty? And while those things were associated with a certain kind of whiteness, one of the things I discuss in the book is how there is an expansion of different ways of being white and looking “natural.” And that there is more than one way to look “white” and “feminine.” There’s the Southern belle — almost a Dolly Parton kind of look — but there’s also Kim Kardashian, who has an ethnically ambiguous look. In the 1970s, you start to see surgeons recognizing Black beauty ideals as a separate thing.

Today, we really do see a proliferation of beauty standards combined with the notion that people should have their own individual style. It’s a demand that surgeons have adjusted their services to meet.

Did you learn anything that surprised you? 

Menon: When I began the project, there was a general assumption that surgeons will do just about anything for the right price. I was surprised by the extent to which surgeons emphasized conditions under which they would refuse to grant patients’ requests. That’s part of their role as gatekeepers of beauty standards. It’s also part of their role as doctors. Arguably, they’re hurting their business by refusing patients or talking them down from an initial request.

There was more tension than I expected among surgeons concerning the business of cosmetic surgery versus its status as a medical practice. They felt that the stigma associated with cosmetic surgery — that it’s superficial and takes advantage of people’s vanity — is unjust. They are trained physicians dedicated to their vocations. We’d have conversations about what was socially necessary versus strictly medically necessary. Treating a burn patient to restore their past appearance genuinely improves that person’s life. But they are not always sure that’s true of the patient who requests and receives a Brazilian butt lift. And those are just two extremes, with a lot of gray area in between. The surgeons I spoke to are very aware of this gray area, which made for some interesting conversations.

Cosmetic surgery seems like a niche thing, but it is actually a great way to see changing trends in medicine, beauty, and how we think and talk about race in society. And you do not have to be a cosmetic surgeon or undergo procedures to be affected by it.