Medicalization of Racial Features

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Medicalization of Racial Features: Asian American Women and Cosmetic Surgery

Eugenia Kaw

Medical Anthropology Quarterly, New Series, Vol. 7, No. 1. (Mar., 1993), pp. 74-89.

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EUGENIAAWDepartment of AnthropologyUniversity of California, Berkeley

Medicalization of Racial Features: AsianAmerican Women and Cosmetic Surgery

This article pre sen tsjn din gs of ethnographic research in the Sun Fran-cisco Bay Area, exploring the recent phenomenon of Asian Americanwomen undergoing cosmetic surgeiy to have their eyelids restructured,their nose bridges heightened, and the tips of their noses altered. Thisresearch suggests that Asian Am erican wom en w ho undergo these typesof surgery have internalized not only a gender ideology that validatestheir monetary and time investment in the alteration of their bodies, butalso a racial ideology that associates their natural eatures with dullness,passivity, and lack of emotion. W ith the authority of scient$c rationa lity,

medicine effectively promotes these racial and g ender stereotypes andthereby bolsters the consumer-oriented so ciety, of w hich it is a part andfrom which it benejits. Data are drclwn from structured interviews w ithplastic surgeons and pa tien ts, medical literature and newspaper articles,and basic medical statistics. [cosmetic surgery, Asian Americans, gen-der , ethnicity]

Throughout history and across cultures, humans have decorated, manipu-lated, and mutilated their bodies for religious reaso ns, f or social prestige,

and for beauty (Brain 1979). In the United S tates, within the last decade,permanent alteration of the body for aesthetic reasons has become increasinglycomm on. By 1988, 2 million Am ericans, 87% of them female, had undergonecosmetic surgery, a figure that had tripled in two years (Wolf 1991:218). Thecosmetic surgery industry , a $300 million per year indu stry, has been able to meetan increasingly wide variety of consumer demands. Now men, too, receive ser-vices ranging from the enlargement of calves and chests to the liposuction ofcheeks and necks (Rosenthal 1991 a). Most n oticeably, the ethnic composition ofconsumers has changed so that in recent years there are more racial and ethnicminorities. In 1990, 20% of cosmetic surgery patients were Latinos, African

Medical Anthropology Quarterly 7( 1):74-89. Copyright 0 1993, American Anthropological Asso-

ciation.



Americans, and Asian Americans (Rosenthal 1991b). Not surprisingly, within

every racial gro up, w omen still constitute the ove rwhe lming majority of cosmetic

surgery patients, an indication that w omen are still expected to identify with theirbodies in U. S . society today, just as they have across cultures throughout muchof human history (Turner 1987:8 5).'

The types of cosmetic surgery sought by women in the United States are

racially specific. Like most white wom en, Asian American w omen who undergocosmetic surgery are motivated by the need to look their best as women. Whitewomen, however, usually opt for liposuction, breast augmentation, or wrinkle

removal procedures, whereas Asian American women most often request "dou-ble-eyelid" surgery , whereby folds of skin are excised from across their uppereyelids to create a crease above each eye that makes the eyes look wider. Also

frequently requested is surgical sculpting of the nose tip to create a m ore chiseledappearance, or the implantation of a silicone or cartilage bridge in the nose fo r amore prominent appearan ce. In 19 90 , national averages compiled by the Ameri-can Society of Plastic and Reconstructive Surge ons show that liposuction , breastaugmentation, and collagen injection w ere the most co mm on surgical proceduresamong cosm etic patients, 8 0 8 of whom are white. Although national statistics

on the types of cosmetic surgery most requested by Asian Americans specificallyare not available, data from two of the docto rs' offices in my study show that in1990 eyelid surgery was the most com mo n procedure undergone by Asian Am er-ican patients ( 4 0 8 of all procedures on Asian Am ericans at one doctor's office,

46% at anothe r), followed by nasal im plants and nasal tip refinement procedures(15% at the first doctor 's office , 2 3 8 at the ~ e c o n d ) . ~hile the features that whitewomen primarily seek to alter through cosmetic surgery ( i. e. , the breasts, fattyareas of the body, and facial wrinkles) do not correspond to conventional markersof racial identity, those features that Asian American women primarily seek toalter (i. e., "sm all, narrow" eyes and a "flat" nose) do correspond to such mark-ers.'

My research focuses on the cultural and institutional forces that motivate

Asian American women to alter surgically the shape of their eyes and noses. Iargue that Asian American women's decision to undergo cosmetic surgery is an

attempt to escape persisting racial prejudice that correlates their stereotyped ge-netic physical features ("small, slanty" eyes and a "flat" nos e) with negativebehavioral ch aracteristics, such as passivity, dullness, and a lack of sociability.With the authority of scientific rationality and technological efficiency, medicineis effective in perpetuating these racist notions. Th e medical system b olsters andbenefits from the larger consumer-oriented society not only by maintaining theidea that beauty should be every woman's goal but also by promoting a beautystandard that requires that certain racial features of Asian American women bemodified. Through the subtle and often unconscious manipulation of racial andgender ideologies, medicine, as a producer of norms, and the larger consumer

society of which it is a part encourage Asian American women to mutilate theirbodies to conform to an ethnocentric no rm.Social scientific analyses of ethnic relations should include a study of the

body. As evident in my research, racial minorities may internalize a body imageproduced by the dominant culture's racial ideology and, because of it, begin toloathe, mutilate, and revise parts of their bodies. Bodily mutilation and adorn men t



are symbolic mediums m ost directly and concretely concerned with the construc-tion of the individual as social actor or cultural subjec t (Turner 1980). Yet social

scientists have only recently focused on the body as a central com pon ent of socialself-identity (Blacking 1977; Brain 1979 ; Daly 1978; Lock and S cheper-Hughes1990; O'Neill 1985; Turne r 1987) . M oreove r, social scientists, and socioculturalanthropo logists in particular, h ave not yet explored the w ays in which th e body iscentral to the everyday experience of racial identity.

Method and Description of Subjects

In this article I present findings of an ongoing ethnographic research projectin the San Francisco Bay Area begun in April 1991 . I draw on data from structured

interviews with physicians and patients, medical literature and newspaper arti-cles, and basic medical statistics. The sample of informants for this research isnot random in the strictly statistical sense sinc e informants w ere difficult to locate .In the United Sta tes, both clients and their medical prac titioners treat the decisionto undergo cosmetic surgery as highly confidential, and practitioners d o not reveal

the names of patients w ithout their consent. In an effort to generate a sam ple ofAsian Am erican woman inform ants, I posted fliers and placed advertisements invarious local newspape rs fo r a period of at least three mo nths , but I received o nlyone reply. I also asked doctors w ho had agreed to participate in my study to asktheir Asian American patients if they would agree to be interviewed. The doctors

reported that most of the patients preferred not to talk about their operations orabout motivations leading up to the operation. U ltimately, I was able to conductstructured, open-ended interviews with eleven Asian American women, four ofwhom w ere referred to me by doctors in the stu dy, six by m utual acquaintan ces,and one through an advertisement in a local newspa per. Nine h ave had cosm etic

surgery of the eye or the nose; one recently considered a double-eyelid operation ;one is considering a double-eyelid operation in the next few years. Nine of thewomen in the study live in the S an Francisco Bay Are a, and tw o in the Los An-geles area. Five had their operations from the doctors in my stu dy, while four had

theirs in Asia-two in Seou l, Ko rea , one in Beijing, Ch ina, and on e in Taipei,

Taiwan. Of the eleven women in the study, only two, who received their opera-tions in China and in Taiwan, had not lived in the United States prior to theiroperations. T he two wh o had surgery in Korea grew up in the United State s; theysaid that they decided to go to Korea for their surgeries because the operationswere cheaper there than in the United S tates and because they felt doctors in Koreaare more "experienced" since these types of surgery are more com mo n in Koreathan in the United state^.^ Th e ages of the women in the study range from 18 to71; one wom an was only 15 at the time of her operation .

In addition to interviewing Asian Am erican wo me n, I conducted structured,open-ended interviews w ith five plastic surgeo ns, all of who m practice in the B ayArea. Of the eleven doctors I randomly selected from the phone b ook, five agreedto be interviewed.

Since the physicians in my study may not be representative of plastic sur-geons, I reviewed the plastic surgery literature. To examine more carefully themedical discourse on the nose and eyelid surgeries of Asian American wom en, Iexamined several medical books and plastic surgery journals dating from the



1950s to 1990. I also reviewed several news releases and informational packetsdistributed by such national organizations as the American Society of Plastic and

Reconstructive Surgeons, an organization that represents 97% of all physicianscertified by the American Board of Plastic Surgery.

To examine popular notions of cosmetic surgery and, in particular, of howthe phenomenon of Asian American women receiving double-eyelid and nose-bridge operations is viewed by the public and the media, I referenced relevantnewspaper and m agazine articles.

For statistical inform ation, I obtained national data on cosmetic surgery fromvarious societies for cosmetic surgeo ns, including the Am erican Society of Plasticand Reconstructive S urgeo ns. Data on the specific types of surgery sought by dif-ferent ethnic groups in the United Sta tes, including Asian Am ericans, are missing

from the national statistics. At least one public relations coordinator told me thatsuch data are quite unimportant to plastic surgeons. To compensate for this, I

requested doctors in my study to provide me with data from their clinics. Onedoctor allowed me to review his patient files for basic statistical information. An-

other doctor allowed his office assistant to give me such information, providedthat I paid his assistant for the time she had to work outside of normal work hoursreviewing his patient files. Since cosmetic surgery is generally not covered by

medical insurance, doctors often d o not record their patients' medical informationin their compu ters; therefore , m ost doctors told me that they h ave very little dataon their cosmetic patients readily available.

Mutilation or a Celebration of the Body?

The deco ration, ornam entation, and scarification of the body can be viewed

from two perspectives. On the one han d, such practices can be seen as celebra-tions of the social and individual bodies, as expressions of belonging in society

and an affirmation of oneness w ith the body (Brain 1979 ; Scheper-Hughes andLock 1991; Turner 1980 ). On the other han d, they can be viewed as acts of mu-tilation, that is, as expressions of alienation in society and a negation of the bodyinduced by unequal power relationships (Bord o 1 990; Daly 1978 ; O'Neill 198 5).

Althoug h it is at least possible to ima gine race-modification surgery as a ritede passage or a bid for incorporation into the body and race norm s of the "dom -inant" culture, my research findings lead me to reject this as a tenable hypothe sis.Here I argue that the surgical alteration by m any Asian Am erican w omen of theshape of their eyes and nose is a potent fo rm of se lf, body, and society alienation .Mutilation, according to Webster ' s , is the act of m aiming , crippling, cutting up,or altering radically so as to damage seriously essential parts of the body. Al-though the women in my study do not view their cosmetic surgeries as acts ofmutilation, an examination of the cultural and institutional forces that influencethem to mo dify their bodies so radically reveals a rejection of their "given" bod-

ies and feelings of marginality. On the one hand, they feel they are exercisingtheir Americanness in their use of the freedom of individual choice. Some denythat they are conform ing to any standard-feminine, W este rn, or othenvise-andothers express the idea that they are, in fact, molding their own standards ofbeauty. M ost agreed , howev er, that their decision to alter their features was pri-marily a result of their awareness that as women they are expected to look their



best and that this meant, in a certain sense, less stereotypically Asian. Even thosewho stated that their decision to alter their features was personal, based on indi-

vidual aesthetic preference, also expressed hope that their new appearance wouldhelp them in such m atters as getting a date, securing a ma te, or getting a betterjob.

For the w omen in m y study, the decision to undergo cosmetic surgery wasnever purely or mainly for aesthetic purposes, but almost always for improvingtheir social status as women who are racial minorities. Cosmetic surgery is ameans by which they hope to acquire "sym bo lic capital" (Bourdieu 1984 [1 9 7 9 ])in the form o f a look that holds more prestige. For exam ple , "Jane," who under-went double-eyelid and nose-bridge procedures at the ages o f 16 and 17 , said thatshe thought she should get her surgeries "o ut o f the way" at an early age since

as a college student she has to think about careers ahead:Especially if you go into business, whatever, you kind of have to hav e a Westernfacial type and you have to have like their features and stature-you kn ow , betall and stuff. In a way you can see it is an investmen t in your futu re.

Such a quest for empowerm ent does not co nfront the cultural and institu-tional structures that are the real cause o f the w om en 's feelings o f distress. In-stead, this form o f "bo dy praxis" (Scheper-Hughes and Lock 1991) helps to en-trench these structures by further confirming the undesirability o f "stereotypical"Asian features. Th ere fore , he alteration by many Asian American women o f heirfeatures is a "disciplinary" practice in the Foucauldian sense; it does not so much

benignly transform them as it "norm alizes" ( i. e ., qua lifies, classifies, judges,and enforces complicity in ) the subject (Foucau lt 1977 ). Th e normalization is adouble encounter, conforming to patriarchal defin itions o f eminin ity and to Cau-casian standards o f beauty (Bordo 1990 ).

Gramsci anticipated Foucault in considering subjected peoples' com plicityand participation i n , as well as reproduction o f their own domination in everydaypractice. In examining such phenomena as Asian American women undergoingcosmetic surgery in the late 20th-century United States , how eve r, one must e m -phasize, as Foucault does, how mechanisms o f domination have become m uchmore insidious, overlapping, and pervasive in everyday l if e as various forms o f

"expert" knowledge such as plastic surgery and surgeons have increasingly com eto play the role o f "traditional" intellectuals (Gram sci 1971) or direct agents o fthe bourgeois state (Scheper-Hughes 1992:17 1 ) in defining comm onsense reality.

Particularly in Western, late capitalist societies (where the decoration, or-namentation, and scarification o f the body have lost much meaning for the indi-vidual in the existential sense o f "W hic h people do I belong to? Wh at is the mean-ing o f my life?" and have instead become comm oditized by the media , corpora-tions, and even m edicine in the name o f fash ion ), the normalizing elements o fsuch practices as cosm etic surgery can become obscured. Rather than celebrationso f the bo dy , they are mutilations o f the bo dy , resulting from a devaluation o f theself and induced by historically determined relationships among social groups andbetween the individual and society.

Internalization of Racial and Gender Stereotypes

Th e Asian American women in m y study are influenced by a gender ideologythat states that beauty should be a primary goal o f wom en . Th ey are conscious



that because they are women, they must conform to certain standards of beauty.

"Elena," a 20-year-old Korean Am erican said, "Peo ple in society , if they are

attractive, are rew arded for their efforts . . . especially girls. If they look prettyand neat, they are paid more attention to. You ca n't deny that." "An nie," an-other Korean Am erican who is 18 years old, remarked that as a young w om an,

her motivation to have cosme tic surge ry was "to look better" and "not differen t

from why [other wom en] put on mak eup ." In fact, all expressed the idea that

cosmetic surgery was a means by which they could escape the task of having toput makeu p on every day . As "Jo," a 28-year-old Japanese Am erican who is

thinking of enlarging the natural fold above her eyes, s aid , "I am still self-con-

scious about leaving the house without any m akeup on , because I feel just reallyugly without it. I feel like it's the mask that enables me to go outside." Beauty,

more than character and intelligence, often signifies social and econom ic successfor them as for other women in U.S. society (Lakoff and Scherr 1984; Wolf

1991).

The need to look their best as wom en motivates the Asian A merican w omen

in my study to undergo cosmetic surgery, but the standard of beauty they try toachieve through surgery is motivated by a racial ideology that infers negative be-

havioral or intellectual characteristics from a group's genetic physical features.

All of the women said that they are "proud to be Asian Am erican" and that they"do not want to look wh ite." But the standard of beauty they adm ire and strive

for is a face with larger eyes and a m ore prominent nose . They all stated that aneyelid without a crease and a nose that does not project indicate a certain "sleepi-

ness," "dullness," and "passivity" in a pers on's character. "Nellee," a 21-year-old Chinese Am erican, said she seriously considered surgery fo r double ey e-

lids in high school so that she could "av oid the stereotyp e of the 'Oriental book -

worm' ' ' who is "dull and doesn't know how to have fun." Elen a, who had dou-

ble-eyelid surgery two years ago from a doctor in my stu dy, sai d, "When I lookat Asians who have no folds and their eyes are slanted and clo sed, I think of how

they would look better more awake ." "Carol," a 37-year-old Chinese Am ericanwho had double-eyelid surgery seven years ago and "Ellen," a 40-year-oldChinese American who had double-eyelid surgery 20 years ago, both said that

they wanted to give their eye s a "mo re spirited" look . "The drawback of Asian

features is the puffy eyes ," Ellen said. "Pam ," a Chinese American aged 44 ,who had had double-eyelid surgery from another doctor in my study two m onths

earlier, stated, "Y es. Of course . Bigger eyes look prettier. . . . Lots of Asians'

eyes are so small they become little lines when the person laughs, making the

person look sleepy." Likewise, Annie, who had an implant placed on her nasal

dorsum to build up her nose bridge at age 15, said:

I guess I always wanted that sharp look-a look like you are sma rt. If you have

a roundish kind of nose, it 's like you don't know what's going on. If you have

that sharp look, you know, with black eyebrows, a pointy nose, you look morealert. I always thought that was cool. [emphasis added]

Clearly, the Asian Ame rican wom en in my study seek cosmetic surgery for doubleeyelids and nose bridges because they associate the features considered charac-

teristic of their race with neg ative traits.



These associations that Asian American w omen make between their featuresand personality characteristics stem directly from stereotypes created by the do m -

inant culture in the United States and by Western culture in general, which his-torically has wielded the most power and hegemonic influence over the world.Asians are rarely portrayed in the U.S. popular media and then only in such rolesas Charlie Chan, Suzie W ong, and "Lotus Blossom Babies" (a .k .a . China Do ll,Geisha Girl, and shy Polynesian beauty). They are depicted as stereotypes with

dull, passive, and nonsociable personalities (Kim 1986; Tajima 1989 ). Subtle de-pictions by the media of individuals' minutest gestures in everyday social situa-

tions can socialize viewers to confirm certain hypotheses about their own natures(Goffman 1979). At present, the stereotypes of Asians as a "model minority"serve a similar purpose. In the mod el minority stereo type, the concep ts of dull-

ness, passivity, and stoicism are elaborated to refer to a person who is hard-work-ing and technically skilled but desperately lacking in creativity and sociability(Takaki 1989:477).

Similar stereotypes of the stoic Asian also exist in East and S outhea st Asia,and since many Asian A mericans are imm igrants or children of recent immigrantsfrom Asia, they are likely to be influenced by these stereotypes as well. U.S.magazines and films have been increasingly available in m any parts of As ia since

World War 11. Also , multinational corporations in Southeast Asian co untries co n-sider their work force of Asian women to be biologically suited for the most mo-

notonou s industrial labor because the "Oriental girl" is "diligent" and has "nim-

ble fingers" and a "slow wit" (On g 198 7:1 51) . Ra cial stereotypes of Asians asdocile, passive, slow witted, and unemotional are internalized by many Asian

~ m e r i c a nwomen, causing them to consider the facial features associated withthese negative traits as defiling.

Undergoing cosmetic surgery, then, becomes a means by which the womencan attempt to permanently acquire not only a feminine look considered moreattractive by soc iety, but also a certain set of racial features considered mo re pres-tigious. For them, the daily task of beautification entails creating the illusion offeatures they, as members of a racial minority, do not have. N ellee, w ho has notyet undergone double-eyelid surgery , said that at present she has to apply ma keup

every day "to give my eyes an illusion of a crease. W hen I don't wear makeu pI

feel my eyes are sm all." Likew ise, Elena said that before her double-eyelid sur-gery she checked almost every morning in the mirror when she woke up to see ifa fold had formed above her right eye to match the more prominent fold aboveher left eye : "[on certain morn ings] it was like any oth er day whe n you wake upand don't feel so hot, you know. My eye had no definite folds, because whenAsians sleep their fold s cha nge in and out-it's not definite." T he eno rmous con-straints the women in my study feel with regard to their Asian features are appar-ent in the meticulous detail with which they describe their discontent, as apparentin a quote from Jo who already has natural folds but wants to enlarge them: "Iwant to make an even bigger eyelid [fold] so that it do esn 't look slanted. I thinkin Asian eyes this inside comer of the fold [she was drawing on my notebook]goes down too mu ch."

The wom en expressed hope that the results of cosmetic surgery would winthem better acceptance by society. Ellen said that she does not think her double-eyelid surgery "makes me look too different," but she nonetheless expressed the



feeling that now her features will "m ake a better impression on people because I

got rid of that sleepy look." Sh e says that she will encou rage her daugh ter, w ho

is only 12 years old, to have double-eyelid surgery as sh e did , because "I thinkhaving less sleepy-looking eyes would help her in the future with getting jobs."The aesthetic results of surgery are not an en d in themselve s but rather a meansfor these women as racial minori t ies to at tain bet ter socioeconomic status.Clearly, their decisions to undergo cosmetic surgery d o not stem from a celebra -tion of their bodies.

Medicalization of Racial Features

Having already been influenced by the larger society's negative valuation of

their natural, "given" features, Asian American w ome n go to see plastic sur-geons in half-hour consultation session s. O nce inside the clinic, they d o not haveto have the doctor's social and medical views "thrust" on them , since to a great

extent, they, like their doctors, have already entered into a more general socialconsensus (Scheper-Hughes 1992:199). Nonetheless, the Western medical sys-tem is a most effective promoter of the racial stereotypes that influence AsianAm erican wom en, since medical know ledg e is legitimized by scientific rationalityand technical efficiency, both of which hold prestige in the West and increasinglyall over the world. A ccess to a scientific body of know ledge has given W esternmedicine considerable social power in defining reality (Turne r 1987: 1 I) . Accord-

ing to my Asian A merican informants who had undergone cosmetic s urgery, theirplastic surg eons used seve ral medical terms to problematize the sh ape of their eyesso as to define it as a medical condition. or-instance, many patients were toldthat they had "excess fat" on their eye lids and that it was "no rmal" for them tofeel dissatisfied with the way they lo oke d. "Lots of Asians have the sam e puffi-ness over their eye lid, an d they often feel better about themselves after the bpe r-

ation," the doctors would assure their Asian American patients.The doctors whom I interviewed shared a similar opinion of Asian facial

features with many of the doctors of the patients in my study. Their descriptionsof Asian features verged on ideological racism, as clearly seen in the followingquote from "Dr. Sm ith."

The social reasons [for Asian Americans to want double eyelids and nosebridges] are undoubtedly continued exposure to Western culture and the reali-zation that the upper eyelid without a fold tends to give a sleepy appearance, andtherefore a more dull look to the patient. Likewise, theJIat nasal bridge and lackof nasal projection can signify weakness in one's personality and by lack of ex-tension, a lack of force in one's character. [emphasis added]

By using word s like "without," "lack of," "flat," "dull," and "sleepy" in hisdescription of Asian features, D r. S mith perpetuates the notion that Asian featuresare inadequate. Likew ise, "Dr. Khoo" said that many Asians should have sur-

gery for double eyelids since "the eye is the window to your soul and having amore open appearance mak es you look a bit brighter, more inviting." "Dr. Gee"agreed:

I would say 90%of people look better with double eyelids. It makes the eye lookmore spiritually alive. . . . With a single eyelid frequently they would have a



little fat pad underneath [which] can half bury the e ye and so the eye looks smalland unenergetic.

Such powerful associations of Asian features with negative personality traits by

physicians during consultations can becom e a m edical affirmation of Asian Am er-ican wom en's sense of disdain toward their own features.

Medical books and journals as early as the 1950s and as recent as 1990

abound with similar metaphors of abnorm ality in describing Asian features. T hetexts that were published before 197 0 contain m ore explicit associations of Asian

features with dullness and passivity. In an article published in 195 4 in the Amer-ican Journal of Ophthalmology, the author, a doctor in the Philippines armedforces, wrote the following abou t a Chinese man o n whom he performed doub le-eyelid surgery:

[He] was born with mere slits for his ey es. Everyone teased him about his eyes

with the comm ent that as he looked constantly sleepy, so his business too wasjust as sleepy. For this reason, he underwent the plastic operation and , now thathis eyes are wider, he has lost that sleepy look. His business, to o, has picked u p.

[Sayoc 19.545561

The doctor clearly saw a causal link between the shape of his patient's eyes andhis patient's intellectual and behavioral capacity to succee d in life. In 1964 a whiteAm erican military surgeon who performed double-eyelid surgeries on Koreans inKorea during the American m ilitary occupation of that country wrote in the sam e

journal: "The absenc e of the palpebral fold produces a passive expression whichseems to epitomize the stoical and unemotional m anner of the Oriental" (Millard1964:647). Medical texts published afte r 1970 are more careful about associatingAsian features with negative behavioral or intellectual characteristics, but they

still describe Asian features with metaphors of inadequacy or excess. For in-stance, in the introductory chapter t o a 1990 book devoted solely to medical tech-niques for cosmetic surgery of the Asian fac e, a white Am erican plastic surgeonbegins by cautioning his audience not to stereotype the physical traits of Asians.

Westerners tend to have a stereotype d conception of the physical traits of Asians :yellow skin pigmentation . . . a flat face with high cheek bones; a broad, flat

nose; and narrow slit-like eyes showing characteristic epicanthal folds. Whilethis stereotype may loosely apply to the central Asian g roups ( i.e ., Chinese, K o-reans, and J apan ese), the facial plastic surgeon should appreciate that consider-

able variation exists in all of these physical traits. [M cCu rdy 1990:1]

Yet, on the sam e page, he w rites that the med icalization of Asian feature s is validbecause Asians usually hav e eyes that are too narrow and a nose that is too flat.

However, given an appreciation of the physical diversity of the Asian popula-tion, certain facial features do form a distinct basis for surgical interven tion. . . .These facial features typically include the upper eyelid, characterized by an ab-

sent or poorly defined s uperior palpebral fold . . . and a s mall flattened nose w ith

poor lobular definition. [McCurdy 1990:1]

Thu s, in published texts, doctors write about Asians' eyes and noses as abnormaleven when they are careful not to associate negative personality traits with thesefeatures. In the privacy of their clinics, they freely incorporate both metaphors ofabnormality and the association of Asian features with negative characteristics



into medical discourse, which has an enormous impact on the Asian Americanpatients being served.

Th e doctors' scientific discourse is made more convincing by the seeminglyobjective manner in which they behave and present themselves in front of theirpatients in the clinical setting. They examine their patients as a technician diag-nosing ways to impro ve a mechanical object. W ith a cotton sw ab, they help their

patients to stretch and measure how high they might want their eyelids to be andshow them in a mirror what could be done surgically to reduce the puffy lookabove their eyes. Th e doctors in my study also use slides and Polaroid pictures tocome to an agreement with their patients on what the technical goals of the op-eration should be. The sterile appearance of their clinics, with white walls andplenty of medical instruments, as well as the sym bolism of the doctor's white coat

with its many positive connotations (e.g., purity, life, unaroused sexuality, su-perhuman power, and candor) reinforce in the patient the doctor's role as tech-nician and thus his sense of objectivity (B lum hag en 1979).On e of my informants,Elena, said that, sitting in front of her doctor in his office, she felt sure that sheneeded eyelid surgery: "[D r. Sm ith] mad e quite an impression on me. I thoughthe was more than qualified-that he knew what he was talking about."

With its authority of scientific rationality and technical efficiency, med icine

effectively "norm alizes" not only the negative feelings of Asian Americanwomen about their features but also their ultimate decision to und ergo cosm eticsurgery. For example, "Dr. Jones" does not want to mak e her patients feel

"strange" or "abnormal" for wanting cosmetic surgery. All the doctors in mystudy agreed that their role as docto r is to provide the be st technical skills possib lefor whatever service their patients dem and, not to question the m otivation of theirpatients. Her goal, Dr . Jone s said, is "like that of a psychiatrist in that I try tomake patients feel better about them selves." Sh e feels that surgeons have an ad-vantage over psychiatrists in treating cosmetic surgery patients because "we . . .help someone to change the way they look . . . psychiatrists are alwa ys trying tofigure out why a person wants to do what they want to do." By changing the

patients' bodies the way they would like them, she feels she provides them withan immediate and concre te solution to their feelings of inadequa cy.

Dr. Jones an d the other doctors say that they only turn patients away whe npatients expect results that are technically impossible, given such factors as thethickness of the patient's skin and the bone structure. "1 turn very few patientsaway ," said Dr. Kho o. And "Dr. Kwan" notes

I saw a young girl [a while back] whose eyes were beautiful but she wanted acrease. . . . She was gorgeous! Wonderful! But somehow she didn' t see i t that

way. But you know, I 'm not going to tell a patient every standard I have ofwhat's beautiful. If they want certain things and it 's doa ble, and if i t is consistentwith a reasonable look in the en d, then I don't stop them . I don't really discuss

it with them .

Like the other doctors in my study, Dr. Kwan sees himself primarily as a tech-nician whose main role is to correct his patient's features in a way that he thinkswould best contribute to the patient's satisfa ction . It does not bother him that h emust expose an individual, whom he already sees as pretty and not in need ofsurgery, to an operation that is at least an hour lon g, entails the adm inistering of



- -

local anesthesia with sedation, and involves the following risks: "bleeding,""hematoma, " "hemorrhage, " formation of a "gaping wou nd," "discolora-

tion," scarring, and "asymm etry in lid folds" (Sayoc 1 974: 162-166). He findsno need to try to change his patients' mind s. Likew ise, Dr. Sm ith said of AsianAmerican women who used to c om e to him to receive really large double eyelids:"I respect their ethnic backgrou nd. I don 't want to change them drastica lly." Yethe would not refuse them the surge ry "as long as it was som ething I can accom-plish. Provided I make them aware of what the appearance might be with thechanges. "

Though most of my Asian American wom an informants who underwent cos-metic surgery recovered fully within six months to a year, w ith only a few m inorscars from their surgery, they nonetheless affirmed that the psychologically trau-

matic aspect of the operation was something their doctors did not stress duringconsultation. E lena said of her do uble-eye lid surgery: "I thought it was a simpleprocedure. He [the doctor] should have know n better. It took at least an hour anda half. . . . And no matter how minor the surgery was, I bruised! I was swo llen."Likewise, Annie could remem ber well her fear during nose su rgery. Unde r localanesthesia, she said that sh e was able to witness and hear som e of the procedures.

I closed my eyes. I didn't want to look. I didn't want to see like the knives oranything. I could hear the snapping of scissors and I was aware when they wereputting that thing [implant] up my nose. I was kind of grossed out.

By focusing on technique and subordinating huma n emo tions and motivations totechnical end s, medicine is capable of normalizing Asian A merican w om en 's de-cision to undergo cosmetic surgery .

Mutual Reinforcement: M edicine and the Consumer-Oriented Society

The m edical system bolsters and benefits from the larger consumer-orientedsociety by perpetuating the idea that beauty is central to women's sense of selfand also by promoting a beauty standard for Asian Am erican women that requiresthe alteration of features specific to Asian American racial identity. All of the

doctors in my study stated that a "practical" benefit for Asian American wom enundergoing surgery to create or enlarg e their eyelid folds is that they can put ey emakeup on more a ppropr iately. Dr. G ee said that after double-eyelid surgery it is"easier" for Asian American women to put makeup on because "they now havetwo instead of just one plane on which to apply makeup ." Dr . Jones agreed thatafter eyelid surgery Asian American wom en "can do more dram atic things witheye ma keup." Th e doctors imply that Asian American w omen can not usually puton makeup adequately, and thus, they have not been able to look as beautiful asthey can be with makeup. By promoting the idea that a beautiful woman is onewho can put makeup on adeq uately, they further the idea that a wom an's identity

should be closely connected with her body and, particularly, with the represen-tational problems of the self. By reinforcing the makeup industry, they buttressthe cosmetic surgery industry of which they are a part. A double-eyelid surgerycosts patients $1,000 to $3,000.

Th e medical system also bolsters and benefits from the larger consum er so-ciety by appealing to the values of American individualism and by individualizing



the social problems of racial in equality. Dr. Smith remark ed that so many A sian

American women are now opting for cosmetic surgery procedures largely becau se

of their newly gained rights as women and as racial minorities:

Asians are more affluent than they were 15 years ago. They are more knowl-edgeable and Americanized, and their wom en are more liberated. I think in thepast many Asian wom en were like Arab wom en. Th e men had their foot on top

of them. Now Asian wom en do pretty much what they want to do. So if theywant to do a surgery, they d o it.

Such comments by doctors encourage Asian American women to believe thatundergoing cosmetic surgery is merely a way of beautifying them selves and thatit signifies their ability to exercise individual freed om .

Ignoring the fact that the Asian American wom en's decision to unde rgo cos-metic surgery has anything to do with the larger society's racial prejudice, thedoctors state that their Asian American women patients come to cosmetic sur-geons to mold their own standards of beauty. T he doctors point out that the spe-

cific width and shape the wom en w ant their crea ses to be or the specific sh ape ofnose bridges they want are a matter of personal style and individual choices. Dr.Smith explains:

We would like to individualize every procedure. Ther e is no standard nose we

stamp on everybody so that each patient's need is addressed individually. Mygoal is to make that indiv idual very happy and very satisfied.

Dr. Kw an also rema rked, "I think people recognize what's beautiful in their ownway ." In fact, the doctors point out that both they and their Asian Am erican pa-tients are increasingly getting more sophisticated about what the patients want.As evidenc e, they point to the fact that as early as a decade a go, do ctors used toprovide very wide creases to every Asian American patient who cam e for doubleeyelids, not knowing that not every Asian wanted to look exactly Ca ucasian. Th e

doctors point out that today many Asian American cosmetic surgery patients ex-plicitly request that their noses a nd eyelids not be mad e to loo k too Ca ucasian.

Recent plastic surgery literature echoes these doctors' observ ations. A 1991

press release from the American Academ y of Cosm etic Surgery quotes a promi-nent member as saying, "The procedures they [mino rities, including AsianAmericans] seek are not so much to look 'western' but to refine their features toattain facial harm ony." Th e double-eyelid surgery , he say s, is to give Asian eyes"a more open appearanc e," not a Western look. Likewise, McCurdy points outin his book that double-eyelid procedures should vary in accordan ce with w hetheror not the patient actually requests a Western eyelid.

In patients who desire a small "double eyelid ," the incision is placed 6-7 m m

above the ciliary margin; in those patients desiring a m edium-sized lid, the in-cision is placed 8m m above the ciliary m argin; in patients who requ est western-ization of the eyelid, the incision is placed 9-10mm abov e the ciliary margin.[McCurdy 1990:81

Fifty percent of all Asians in the world do have a natural crease on theireyelids, and thus it can be argued that those Asians who un dergo surgery for dou -ble eyelids are aiming fo r Asian looks, that they are not necessarily conform ingto a Western standa rd. Yet, by focusing on tech nique, that is, by focusing on how



many millimeters above the eyes their Asian American patients want their fold tobe or how long across the eyelid they want their fold to be draw n, the doctors d o

not fully recognize that the trend in Asian American cosmetic surgery is still to-ward larger eyes and a more prominent nose. They ignore the fact that the veryvaluation attached to eyes with "a more open appearance" may be a conse quenc eof society's racial prejudice. If the types of cosm etic surgery Asian A me rican s optfor are truly individual choices, on e would expect to see a number of Asians w hoadmire and desire eyes without a crease or a nose without a bridge . Yet the doctorscan refer to no cases involving Asian Americans who wanted to get rid of theircreases or who wanted to flatten their noses. M oreove r, there are num erous cases

of Asian A mericans, such as many Southeast Asians, who already have a naturaleyelid crease but feel the need to widen it even mo re for a less puffy ap pea ran ce.'

Clearly, there is a pattern in the requests of Asian American cosmetic surgerypatients.

In saying that their Asian American women patients are merely exercisingtheir freedom to choose a persona l style or look, the doctors promote the idea thathuman beings h ave an infinite variety of needs that technology can endlessly ful-fill, an idea at the heart of today's U .S . capitalism. As Susan B ordo explains, theUnited States has increasingly becom e a "plastic" cultu re, characterized by a"disdain for material limits, and intoxication with freed om , cha nge , and self-de-termination'' (Bordo 1990:654).Sh e points out that many consu mer products thatcould be considered derogatory to women and racial minorities are thought by the

vast majority of Americans to be only some in an array of consumer choices towhich every individual has a right. Sh e explains:

Any different self would do, it is implied. Closely connected to this is the con-struction of all cosmetic changes as the same : perms for w hite wom en, corn rows

on Bo Derek, tanning, makeup, changing hair styles, blue contacts for blackwomen. [Bordo 1990:659]

Conclusion

Cosmetic surgery on Asian American women for nose bridges and double

eyelids is very much influenced by gen der and racial ideolog ies. My research hasshown that by the conscious or unconscious manipulation of gender and racialstereotypes, the American medical system, along with the larger consumer-ori-ented society of which it is a pa rt, influences Asian A merican wom en to alter theirfeatures through surgery. With the authority of scientific rationality and techno-logical efficiency, m edicine is effectively able to maintain a gend er ideology thatvalidates women's monetary and time investment in beauty even if this meansmaking their bodies vulnerable to harmful and risky procedures such as plasticsurgery. M edicine is also ab le to perpetuate a racial ideology that states that Asianfeatures signify "dullness," "passivity," and "lack of emotions" in the Asian

person. The medicalization of racial features, which reinforces and normalizesAsian American women's feelings of inadequacy, as well as their decision toundergo cosmetic surgery, helps to bolster the consumer-oriented society ofwhich medicine is a part and from which medicine benefits.

Given the authority with which fields of "expert" kno wledge such as bio-medicine have com e to define com mon sense reality today, racism and sexism no



l o n g e r n e e d t o r e l y p r i m a r i ly o n p h y s i c a l c o e r c i o n t o l e g a l a u t h o r it y . R a c i a l s t e -

r e o ty p e s in f lu e nc e A s i a n A m e r i c a n w o m e n t o s e e k c o s m e t i c s u r g e r y . Y e t ,

t h r o ug h i t s h i g h l y s p e c ia l iz e d a n d v a l i d a ti n g f o r m s o f d i s c o u r s e a n d p r a c ti c e s,m e d i c i n e , a l o n g w i t h a c u l tu r e b a s e d o n e n d l e s s s e l f- f a sh i o n in g , i s a b l e t o m o t i-

v a t e w o m e n t o v i e w t h e i r f e e li n g s o f i n a d e q u a c y as i n d i v i d u a l l y m o t i v a t e d , aso p p o s e d t o s o c i a ll y i n d u c e d , p h e n o m e n a , t h e re b y e f f e c ti v e ly c o n v i n c i n g t h e m t o

p a r ti c ip a t e i n t h e p r o d u c t i o n a n d r e p r o d u c t i o n o f t h e l a r g e r s t r u c tu r a l in e q u a l i t i e s

t h a t c on t i nu e t o o p p r e s s t h e m .

Acknow~ledgrnenrs.I would like to thank Nancy Scheper-Hughes, Aihwa Ong, andCecilia de M ello for their help, insight, and inspiration from the inception of this research

project.This research was funded by the Edward H . Heller Endowm ent and a President's Un-dergraduate Fellowship, Un iversity of California, Berkeley.

Correspondence may be addressed to the author at 2226 Durant Avenue # 30 2, Berke-ley, CA 94704.

'In a 198 9 study of 8 0 men and wom en, men reported m any m ore positive thoughtsabout their bodies than did women (Goleman 199 1).

According to the American Society of Plastic Su rgeo ns, 87% of all cosmetic surgerypatients in 1990 were wom en. In m y stud y, in one of the two doctors' offices from whichI received statistical data on A sian American patients, 65% of Asian A merican cosm etic

surgery patients in 1990 were wo men ; in the other , 62 % .*At the first doctor's office, the doctor's assistant examine d every file fro m 19 90 . In

all, 121 cosmetic procedures were performed, 8 1 on white patients, 20 on A sian American

patients. Closely following national data, the most common procedure among white pa-tients was liposuction (58% of all cosmetic surgeries performed on white patients).

Th e second doctor allowed me to survey his patient files. I exam ined the 199 0 filesfor all patients with last names beginning with the letters A through L . Of these files, allthe cosmetic patients were Asian American. Thus, I do not have data on white patients

from this office.It is important to note that at the first doctor's office, where data on white cosmetic

surgery patients were available, the patients were older on average than the Asian Ameri-

can cosmetic surgery patients at the sa me clinic. Of the A sian Am erican patients, 65%' werein the age range of 19 to 34 years, com pared with only 14 .8% of whites. Only 20%' ofAsian American cosm etic surgery patients were in the ag e group of 35 to 64 years, how-ever, compared with 8 0.2 % of white cosmetic patients. All the other doctors in my study

confirmed a similar trend in their practices. They stated that this trend results from thetendency of w hites to seek cosm etic procedures to remo ve fat and sag ging skin that resultsfrom aging, in contrast to Asian Americans, who usually are not concerned with "cor-

recting" signs of aging.

'The shape s of eyes an d noses of A sians are not me ant in this article to be interpretedas categories that define an objective category of peop le called Asians. Categ ories of racialgroups are arbitrarily defined by society. Lik ewise, the physical traits by which pe ople arerecognized as belonging to a racial group have been determined to be arbitrary (see Molnar1983).

Also, I use the term "Asian American" to collectively nam e the women in this studywho have undergone or are thinking ab out undergoing cosm etic surgery. Although I realizetheir ethnic diversity, people of Asian ancestry in the United States share similar experi-ences in that they are subject to many of the sam e racial stereotypes (see Takak i 1 98 9).

"Cosmetic surgery for doub le eyelids, nasal-tip refinement, and n ose bridges is notlimited to Asians in the United States. Asians in East and Southeast Asia have requested



such surgeries since the early 1950s, when U .S . military forces began long-term occupa-tions of such countries as Korea and the Philippines. (See Harahap 1982; Millard 1964;

Sayoc 1954; and Kristof 1991 .)I do not mean to imply, however, that the situation within which Asian women de-

velop a perspective on the value and meaning of their facial features is identical in Asia

and the United States, where Asian wom en belong to a minority gro up. Th e situation in

Asia would require further studies. My ob servatio ns are limited to the United States.

'Dr. Smith informed m e that numerous Vietnamese, Th ai, and Indonesian women

come to him to widen their eyelid creases. I w as allowed to s ee their before-and-after sur-

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Documents

Medicalization of Racial Features