Yale sociologist studies the niche market of cosmetic surgery for the young

A young woman looking at herself in the mirror, pouting
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In Yale medical sociologist Alka Menon’s work, she draws on her research in the United States and Malaysia to take a transnational look at cosmetic surgery.

What Menon found is that in addition to enhancing the looks that a patient already has, cosmetic surgeons craft entirely new looks for young people.

These new looks, says Menon, are oftentimes influenced by what young people see in the media. “They develop an idea of how they want to be perceived by the world and are seeking cosmetic surgery to create these looks and bring their body in alignment with a certain set of ideals.”

They are not necessarily trying to look like a previous version of themselves but something that never existed. That’s a difference,” adds Menon, who was recently appointed as an assistant professor in the Department of Sociology.

Alka Menon
Alka Menon

Menon’s work focuses on how cosmetic surgeons shape racial notions in their practice. She calls this shift in cosmetic surgery a “shaping of identification.” These patients, says Menon, have an aspiration that they want to realize about themselves.

Menon chose the United States and Malaysia because they are both multiethnic and multicultural societies. Studying global cosmetic surgery in these two countries, says Menon, presented a “terrific opportunity to look at multiculturalism and its effects on peoples’ thinking about beauty.”

In addition to conducting interviews with over 60 cosmetic surgeons in the United States and Malaysia, Menon sat in on initial consultations between surgeons and patients, observed cosmetic surgeries, attended international meetings where plastic surgeons gathered, and read research articles written by plastic surgeons for plastic surgeons. She also shadowed two surgeons in separate Malaysian clinics for about a month each.

Through this extensive research Menon discovered that global cosmetic surgery is transnationally networked, and that many doctors train and do fellowships in multiple countries. “Because insurance does not cover these procedures and is therefore not a hindrance to where a procedure is performed, patients might travel to another country for the services of a particular cosmetic surgeon whose work they admire,” says Menon.

These cosmetic surgeons are resisting universalism of their practice and instead are finding market niches to focus on in their practice,” notes Menon. One strategy that she found is that surgeons are trying to appeal to patients on the basis of their expertise on race. “They do this not with race as a biological or genetic entity but as very much a social experience. It is entirely superficial. The cosmetic surgeons expect that it will matter because of different cultural icons within a specific group. There are also different beliefs about what is beautiful in different groups with respect to what particular features you want to highlight and what parts of the body are seen as areas you might want to intervene upon.”

What types of procedures are these young people doing? Menon says that in Malaysia, which has positioned itself as a medical tourist hub, there is a trend towards changing eyes, noses, and even the overall shape of the face. And Korean plastic surgeons, says Menon, “have really pushed the envelope for what is possible to do to a body, period. They do bone shaving, jaw contouring, and more dramatic kinds of interventions. They are also more willing to experiment with different kinds of silicone implants in the face to have a very pronounced nose or eyes.”

Cosmetic surgeons act as gatekeepers to those seeking to dramatically change their appearance, explains Menon, and have to consider what is an acceptable motivation for plastic surgery and what is not for young patients. “Cosmetic surgeons have limits because people’s bodies have limits,” says Menon, “and a patient can be disfigured if those limits are exceeded.” Menon also took a look at the circumstances under which a cosmetic surgeon would deny a request to a patient for a certain procedure. “There is a fine balance between their responsibility as physicians — to do no harm — and their desire to stay practicing.”

Another area of interest for Menon is the influence that negative online reviews have on diminishing physician authority in cosmetic surgery. She analyzed the substance and perception of online physician reviews — which are qualitative and quantitative assessments of physicians written and shared by patients — in the case of cosmetic surgery in the United States. “Like other cash-pay medical specialties, cosmetic surgery is elective and paid for largely out of pocket, with patients having latitude in their choice of surgeon,” says Menon. “Surgeons report changing how they practice to establish and maintain their reputation.”

The Yale sociologist says that cosmetic surgery — and her research into it — is a shifting target. “Cosmetic surgeons have to figure out what’s trending every year and must identify the niches. I’ve captured it at one moment in time.”

For Menon, what she is most enjoying about her new role at Yale is the “great intellectual environment” that she has found in the Department of Sociology. “This department is really strong in thinking about global and transnational approaches to sociology — which is unusual and valuable.”

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Bess Connolly: elizabeth.connolly@yale.edu, 203-432-1324