cosmetic and reconstructive surgery and gender roles

The categorization of some surgeries as “cosmetic” or “reconstructive” serves to reinforce the gender binary.  The labels of cosmetic and reconstructive are placed upon surgeries in order to identify which ones are deemed necessary by society. According to the OED cosmetic refers to things that “affect appearance only… intended merely to improve appearances”, where reconstruction implies a return to what once was, or a return to nature. New kinds of surgeries, and new techniques for pre-existing procedures are always emerging, and the classification of these new procedures as cosmetic or reconstructive changes not only the gendering of surgeries but also the way society sees gender in general.

Cosmetic surgery is something that is associated with mostly with women in society in the US. It is associated with women because most kinds of cosmetic surgeries are done more often on women. Being concerned with appearance apart from mere functionality is a feminine trait, so these women who elect to have surgery are acting just as much within their gender roles as women who put on makeup everyday. A main difference in the categorization of surgeries that aren’t to improve physical functioning is that cosmetic surgeries are described as “reshaping of normal structures of the body in order to improve the patient’s appearance and self-esteem”.  Since reconstructive surgeries are “generally performed to improve function” they lack the sort of gender implications about women being more invested in their appearance that cosmetic surgery holds.

Sex Reassignment Surgery fits into both the categories of cosmetic surgery and reconstructive surgery in some ways. Like those who seek cosmetic surgery, people who want SRS are forced to justify it. People who seek cosmetic surgery are forced to explain wanting it, saying that they think it will make their self-esteem better, or will make them look more normal. Those seeking SRS are often made to tell a specific “transsexual” story, where they are forced to totally reject all other possible gender variations other than the one that matches the sex to which they wish to be reassigned. “… the candidates for surgery were evaluated on the basis of their performance in the gender of choice.” (Stone) Candidates for SRS know that doctors won’t want to perform surgery on them if they don’t want to conform totally to the gender to which they are being reassigned, so they are forced to give up the possible complexities of their gender identities in exchange for the surgery, and being re-fitted back into the gender binary. For those people who don’t choose to conform to this expectation, finding a surgeon willing to do SRS can be hard. “My desire couldn’t be for SRS because I wasn’t a transsexual, so it must be for cosmetic surgery, something normal people get.” (Spade) “Fixing” the problem of Gender Identity Dysphoria by placing the transsexual back into the gender binary, by reconstructing their sex to match their gender, is reconstructive because it is restoring this person to the natural gender binary. But, for those who would still not have their gender match their sex if they had SRS, there is no return to natural, or normal, so it would be considered a cosmetic surgery, even though the reasons for wanting the surgery might be the same. This has some practical implications, namely that insurance will sometimes pay for SRS as a “reconstructive” surgery, but won’t pay for an elective surgery.

Hymenoplasty is clearly a gendered procedure, since it can only be performed on female-bodied people, and there is no male equivalent, since there is no physical way to mark men losing their virginities. The procedure behind the hymenoplasty is presumably the same for any patient, but is the circumstances behind the procedures that make them different from one another. Some women may have never chosen to lose their virginity and break their hymen, some women might have been assaulted, or might have been in some accident that causes their hymen to break. For these women, choosing to have a hymenoplasty would just be choosing to have their bodies restored to a natural state, something that could be considered a reconstructive decision. There are also women who choose to have hymenoplasties done as a sort of gift to their husbands (nytimes) , a procedure which most people would perceive to be a cosmetic one. More complicated examples exist, like women who did choose to have intercourse and lose their virginity, but who would be in great danger if they were to not have their physical virginity restored. No matter whether a hymenoplasty is reconstructive or cosmetic, it is still reinforcing gender roles. The concept of reconstructive hymenoplasty is returning the hymen to its “natural” form, as though the standard of the ideal of female virginity is somehow a natural one. Cosmetic hymenoplasty confirms that women’s “natural” desire is to appeal to men, regardless of the cost, inconvenience, and pain that the woman goes through as a result of the procedure.

Not only do certain surgeries have gender connotations, but even their labels of cosmetic or reconstructive have an impact on them. Cosmetic procedures are feminized by the idea that is “natural” for women to be concerned about their appearances, whereas men should be more concerned with function. Cosmetic and reconstructive surgeries also allow people to express their gender identities in ways that wouldn’t be possible without these technologies, but the very existence of these procedures means that they are a whole new set of expectations for gender identity that there wouldn’t be otherwise. Since it is possible to reconstruct your virginity, or have cosmetic surgery to look more ideal, or have SRS to fit in a “normal” way into the gender binary, people are also pushed into filling these roles that surgical technology has made possible for them.