The Physical Examination in Cosmetic Surgery: Communication Strategies to Promote the Desirability of Surgery

Abstract

Cosmetic surgery is a controversial medical practice that is rapidly expanding in the United States. In 2004 alone, 9.2 million procedures were performed. From breast augmentation to tummy tuck, Americans are taking surgical/medical/health risks to alter their bodily appearance. Although many scholars have criticized the practice, few have looked closely at how plastic surgeons interact with prospective surgical candidates. This essay explores videotaped data of naturally occurring interactions between plastic surgeons and patients seeking to transform their physical appearance. Drawing on action-implicative discourse analysis (Tracy, 2005), the article describes plastic surgeons' embodied and discursive activities during a typical physical examination. The core analysis shows how the patient's body and its aesthetic features can be used by plastic surgeons as interpretive resources to promote the desirability of surgery. By touching excess tissue, pinching it, moving it, or applying tools and artifacts (e.g., tape measurer) on and around the body, plastic surgeons literally bring to life patients' bodily “flaws.” Through their multimodal performance, I argue, plastic surgeons mark the desirability of surgical transformation. As medicine meets consumerism, medical activities turn persuasive, incrementally constructing the patient's body as a territory of surgical need.

ACKNOWLEDGMENTS

This article is based on the author's doctoral dissertation, directed by Karen Tracy. Thanks to Teresa Thompson and three anonymous reviewers for their valuable feedback. I also deeply appreciate the following individuals for their support, advice, and help in moving this essay (or a version of it) forward: Karen Tracy, Curtis LeBaron, Lawrence Frey, Robert Craig, Lisa Keränen, Frederic Platt, Robert Agne, Alexander Lyon, and Robert Ulmer.

Notes

¹Cosmetic surgery is not the only example of this shift. As Sullivan (2001) explained, “Elective treatments for vision, snoring, infertility, impotency, and weight control are a few areas of medicine aggressively marketed by physicians” (p. 202). Similarly, physicians operating under managed care face somewhat different conditions in that medical cost is to be minimized.

²Plastic surgeons at BYC offer surgery for aesthetic purposes only; they do not operate on patients who seek reconstructive surgery or procedures that are covered by insurance programs.

³One participant requested to have her interactions audiotaped rather than videotaped, representing approximately 60 min of raw interaction.

⁴This research project received institutional review board approval. To protect participants' identities, including the medical crew, pseudonyms are used and digital frames presented in this essay have been digitally altered by (a) removing identifiable marks on participants' bodies, (b) blurring the face and body parts, and (c) altering colors, shades, and brightness of the physique.

⁵ Robinson (2003) proposed that acute visits in the primary care operate in four sequential activities, including (a) establishing a new medical problem as the reason for the encounter, (b) gathering additional information in the form of history-taking and the physical examination, (c) delivering the diagnosis to the patient, and (d) recommending a treatment.

⁶The patient does not immediately gaze at her own body. She originally maintains what Heath (1986) described as a “middle distance look” thereby evading mutual gaze. But, when the surgeon reaches for the excess tissue on her abdomen, she lowers her head and gazes at the area.

⁷As conversation analysts explained “A silence is a space in the talk where no discernable verbal sounds are being uttered. Silences, when they occur within a speaker's turn at talk and preceded by and followed by the same speaker's utterances, are called ‘pauses.’ When they occur in turn-transition spaces, they shall be referred to as ‘gaps’” (Psathas, 1990, p. 219).

⁸ Fitch (2003) used the term cultural persuadables to denote the ways in which “persuasion is fundamentally shaped by culture” (p. 100). I see her concept as being equally applicable to microcultures such as professional institutions.

⁹Pointing is a complex communicative act. As Goodwin (2003) explained:

A central locus for the act of pointing is a situation that contains at least two participants, one of whom is attempting to establish a particular space as shared focus for the organization of cognition and action. Within such a field, pointing is constituted as a meaningful act through the mutual contextualization of a range of semiotic resources including at least (a) a body visibly performing an act of pointing; (b) talk that both elaborates and is elaborated by the act of pointing; (c) the properties of space that is the target of the point; (d) the orientation of relevant participants toward both each other and the space that is the locus of the point, and (e) the larger activity within which the act of pointing is embedded.” (p. 219)

¹⁰His comment was made after watching a physical examination. It reflects his reaction and analysis of his own communicative performance.