Original subtitles

[woman 1] There is definitely a look that is very on trend

and you see it anytime you open SnapChat or Instagram.

-[woman 2] The Coca-Cola body. -[man 1] Shaped like a guitar.

[woman 3] I think a lot of people think the Instagram body is hourglass.

And I think it's actually more of the spoon shape.

[narrator] And that body is often paired with a certain kind of face.

[man 2] Big lips, the fox eyes.

[woman 1] A slim little nose.

[woman 4] I guess like Kylie Jenner and like that kind of group.

[woman 5] I definitely think the Instagram look is not real.

[narrator] It depends what you mean by real.

It's true, some of those faces may have been altered with preset filters

or using apps like Facetune,

where you can make minute tweaks to your photo,

resizing, smoothing, shifting the very structure of your face.

There are all of these slight tweaks that we've been able to see on ourselves.

And more and more people with the access to pursue them

are starting to adopt that face for themselves in real life.

[narrator] The number of cosmetic procedures

has nearly doubled in the last decade.

They've gotten safer, cheaper, and more sophisticated.

And the patients receiving them have gotten younger and more diverse.

It feels like we're moving toward a future

where our appearances are fundamentally changeable.

So, is that a bad thing?

And, is plastic surgery changing the way we see ourselves?

You will be an entirely different man by the time the healing is complete.

[man] A fountain of youth at the end of a relatively painless syringe.

[woman] But there's no guarantee it will all end in smiles.

I think they need to expect a little bit of pain.

Well, it's a matter of looking the best you can for as long as you can.

It makes no difference what I'm feeling. My face never changes!

[laughter]

[Cattrall] The things we do to look good exist on a spectrum.

On one end, you have things like taking a shower,

wearing makeup, dyeing your hair.

That's long been considered good.

Enhancing your natural beauty.

As soon as you start looking at the language of beauty,

beauty talk is moral talk.

It's just got morality all over it.

So, "You deserve it. You're worth it."

"Don't let yourself go. You shouldn't have let yourself go."

Anytime you get shame, blame, praise, reward,

then you've got a moral claim going on.

[Cattrall] Then, on the other end of the spectrum,

things are riskier, more painful, more permanent.

And people make moral judgments about that too.

Take The Swan, a 2004 reality show that whipped America into a frenzy.

The show knew it was pushing boundaries, calling itself…

The most unusual competition ever devised.

[Cattrall] A team of surgeons,

plus a cosmetic dentist, therapist, trainer, and life coach,

crafted self-described ugly ducklings into swans,

and then pitted them against each other in a final beauty pageant.

Viewers loved it.

Millions tuned in every week.

But reviewers, they reacted with near-universal horror.

They called it ghastly, ridiculous, hurtful, and repellent.

It even made it onto CNN Primetime.

You don't make them ugly. And you don't even make them mediocre.

I mean, you dress 'em up, and, you know, you give them breasts.

Unfortunately, some people reacted negatively to the show.

[Cattrall] Cindy was a contestant on Season 1.

[Ingle] I'll start from the top.

So I had an eyebrow lift.

I had cheek implants. I had some fat removed under my eyes.

I had buccal fat removal, chin reduction, and a mini face-lift.

Breast augmentation. Then I had a tummy tuck.

And light liposuction on my inner thighs.

I started giving plastic surgery more thought

after my second child.

My body had went through such a physical change.

After I finished nursing my son, my breasts were just really misshapen.

No matter how much exercise or crunches, sit-ups I would do,

I was not losing my baby belly.

[Cattrall] But they were a young family

and couldn't spare the money for cosmetic surgery.

So when The Swan had a casting call commercial on the radio,

at that point, I knew that I needed to at least try.

-[Cattrall] And she has no regrets. -I'm very happy with the results.

That freaked me out. I had a teeny, tiny waist.

I'd never really had a waist before.

Love my nose. Love my nose.

I was really happy that day. It's kind of cool.

[Cattrall] After that season came out,

half a million women applied to be on the next one.

More people than live in the entire country of Iceland

were willing to go on television to get plastic surgery.

In the early 2000s, our idea of extreme was changing.

But this whole spectrum had actually been shifting gradually

for almost a hundred years.

[loud gunfire]

World War I was like nothing humanity had ever seen before.

Modern weaponry, tanks, machine guns, poison gas killed millions,

reduced cities to rubble,

and left in their wake a generation of injured soldiers,

many of them with faces disfigured by shrapnel and bullets.

Surgeons had never seen injuries like these before.

So to fix them, they had to get creative.

Crafting noses out of cartilage borrowed from ribs,

reforming shattered jaws with bits of leg bone,

and filling in hollowed cheeks with patients' own fat and tissue.

Surgeons spent years working on the same patients,

striving to make them look like themselves again.

And if they couldn't do that with flesh alone,

they hired actual artists to craft prosthetic masks.

Their work wasn't just about function.

It was about form.

One of those World War I surgeons

is now sometimes known as the father of aesthetic surgery.

As Joseph wrote,

"Someone who simply wants a normal appearance,

wishes to be inconspicuous,

should not suffer the odium of vanity."

He didn't just treat the wounded.

Joseph was Jewish, and so were many of his patients,

who wanted him to erase the markers of their ethnicity,

allowing them to be inconspicuous

in a society that was hostile towards them.

He helped put plastic surgery on the spectrum

as something you could do for aesthetics alone.

In the mid '20s,

half of America was going to the movies every week

and lots of budding stars were having their faces shuffled

and reassembled for the screen,

because those faces were their stock-in-trade.

Comedian Fanny Brice famously got a new nose,

and heartthrob Rudolph Valentino had his ears reshaped.

In 1924, a newspaper even launched

what may have been the first plastic surgery contest.

A search for the homeliest girl in New York,

so they could turn her misfortune

into a fortune.

A woman named Jacqueline Naagel won, and it worked.

She scored a movie contract and moved to California.

And in the decades since,

plastic surgery has only gotten cheaper, safer, and more accessible.

There are more providers. There are more types of providers.

Different price points.

It's become like other services, so you can find it across a range.

What is the difference between routine and extreme?

Is it about the time taken?

Is it about whether you can do it at home or it requires an expert to do it for you?

Is it about how risky and painful it is?

Usually, all we mean is what we would do ourselves, or would like to do.

[Cattrall] Is a push-up bra extreme?

How about braces or laser hair removal?

Cutting off a mole? Freezing off your fat? Fillers? Botox?

[Widdows] It wasn't very long ago when Botox was viewed

as this crazy thing that mad celebrities were doing,

injecting poison into their faces.

Oh, it's changed tremendously.

I think, before my time,

as a plastic surgeon, there was a lot of stigma.

But in general, now what I see is there's less guilt feeling,

there's less secrecy.

[woman] Prior to having children, I had a shape.

In my twenties, I had a nice shape.

When I…

I did show the doctor my wish pic,

but it was me younger.

I started to notice changes.

My eyes started to look a little bit more heavy, a little bit more tired,

and I didn't feel that way, I didn't feel tired.

I felt great, but I looked tired, and it bothered me.

I had gynecomastia as a child.

Uh, and then, when I got older,

I sort of just had a double mastectomy,

which is removal of breast tissue and fat tissue.

I believe that if you look good,

everything is gonna come smoother in your life.

I just always noticed women who would walk by,

and I was always like, "That woman's so beautiful."

It was always large-breasted women.

[Cattrall] Everyone's spectrum is different.

It depends on who you are and the culture you come from.

[Widdows] There are places where cosmetic surgery is just routine,

a rite of passage.

[Cattrall] Like South Korea, where one in three women in their twenties

have gotten work done.

And there's a special name

for surgeries undertaken just to improve your job prospects.

Or in Brazil.

[Widdows] There's a narrative about the right to beauty

and there's a whole thing about how the mistress, no more than the maid,

should have that right.

[Cattrall] And, in part, that's thanks to this man, Ivo Pitanguy,

a world-renowned surgeon to the rich and famous.

A lucrative business.

He bought his own private island.

But he also operated on the destitute for free,

earning him the nickname "The pope of plastic surgery,"

and the status of a national hero.

Here he is at Carnival in 1999,

surrounded by a sea of dancers

atop his very own elaborate float.

Pitanguy was a pioneer.

He developed techniques for tummy tucks that hid scarring below the bikini line,

championed less invasive mini face-lifts,

and developed the Brazilian butt lift.

The BBL is a procedure where fat is sucked from elsewhere in your body,

usually the thigh or belly,

and injected into your butt.

Back in the '80s, Playboy Brazil published a cover story

that called butts a national passion.

And decades before that,

Brazil's contestant in the 1954 Miss Universe Pageant, Martha Rocha,

had more curves than the average woman on that stage.

[announcer 1] Miss Brazil is a stunning stepper

as the contest narrows down to the finalists.

[Cattrall] She lost.

[announcer 2] And it's Miss USA.

[Cattrall] Because the judges said her hips were too big.

I remember when white women were scared to have fat asses.

Like I remember that being part of history.

Of Sir Mix-A-Lot's infamous song.

♪ I like big butts and I cannot lie ♪

The skit at the beginning, it captures that perfectly.

Oh, my God. Becky, look at her butt.

And what really helped to mainstream that was Kim Kardashian.

And the rest of her sisters, one by one, kind of slowly following suit.

[Cattrall] And the BBL became the fastest-growing procedure by far.

Brazil's passion for big butts has gone global.

But if you read Playboy for the articles,

you'd have found a much darker story.

A sociologist claimed the curvy beauty ideal

could be traced back to enslaved African women

who bore the children of their white slave owners,

resulting in eugenic aesthetic experiments that avoided Africanoid exaggerations.

In other words,

a Black woman's butt

on a body that otherwise looked white.

The obsession with big butts is definitely appropriative,

and it makes it so that now Black women who do not have that body type

are somehow seen as, like, less Black,

or less attractive as Black women.

Wish me luck.

I would see my boyfriend scrolling through social media sometimes

and the type of girls that he would like their pictures,

it didn't reflect what I looked like or what my body type looked like.

And I just felt like, "Here's a lane for me to get it done.

Why not fix something that I don't like?"

I just finished my surgery, guys.

[nurse] A little pain, sure. Without pain…

You know, what is beauty?

What is beauty without pain?

[Cattrall] And then there's the Instagram face,

which is basically a mash-up of features borrowed from different ethnicities.

Those slanted fox eyes and big, pillowy lips

have been mocked in racist caricatures for centuries,

and people now pay for them,

getting their temples pulled back with little dissolvable threads,

and their lips plumped with a few syringes of filler.

With more people being able to pursue

this body type that has been heavily influenced by tech

and by social media and by entertainment,

the expectation on what you should look like,

because we now know what you can look like based on the possibilities,

is getting smaller and smaller.

That window is getting more narrow.

What is normal is becoming narrower and is converging.

And that's new. We've never had that before.

So, for instance, body hair.

If you go back a little bit in the West, you find it's much more of a social norm.

[Cattrall] Some people removed their body hair. Some didn't.

Iconic beauty Sophia Loren often chose not to.

But then hairlessness became the standard.

We've normalized a hairless body, and we've done that globally.

We forget it's beautification, it's artifice.

[Cattrall] It's a feedback loop.

We make choices to bend to the beauty ideal

and that helps reinforce it,

moving the target of perfection even further out of reach.

[Kat] Growing up, I was kind of obsessed with the Victoria's Secret Angels.

Like, "Wow, look at these women."

It was like, "Va-va-voom," and I just wanted to look like that.

So I do struggle with wondering, if Victoria's Secret never existed,

if I had never seen those runway shows,

would I still have been boob obsessed?

Would I have wanted a breast augmentation?

[Cattrall] Our beauty ideal is now shaped by plastic surgery,

which means it's harder to achieve without it.

Things that were once extreme have become routine.

And at some point,

things that are routine can start to feel required.

But it's like anything else. If everybody dyes their hair

and you just have white hair at a certain age, are you an outlier?

Yes.

[Cattrall] And pretty much everyone would say

dyeing your hair is less extreme than surgery.

Especially something like the BBL.

There's a risk of injecting fat in the wrong place,

releasing it into your bloodstream, where it can stick together,

blocking arteries in your brain or lungs,

leading to infection, stroke, or death.

There's something strange going on there,

as we take practices that are deeply harmful and risky

and yet see them as benefiting ourselves.

It is constraining, but it does also provide some joy.

[Cattrall] Researchers have tried to measure the benefits of plastic surgery

and results have been mixed.

But one roundup of some of the best studies

found that, overall, it does seem to improve quality of life.

How much though, depends on the surgery.

Plastic surgery allows some people

to maybe exist in the world a little bit easier.

For some folks,

plastic surgery is a way to affirm their gender identity.

[woman] I had my brow bone shaven down. I had a brow lift.

I had a nose job, and I also had my chin done.

Surgery helps you feminize and helps you become the woman you want to be, but it's…

It's so much more than that.

The more passable I am as a cisgendered woman,

the more safe it is to walk down the street

or to just live a normal life.

We need to stop thinking about self-worth and self-value

and self-confidence as these arbitrary ideals.

I often say that I'm not in the business of making people look better.

I'm in the business of making people feel better.

I'm more open to putting myself out there. I'm more open to meeting new people.

I've made more friends, I think.

And that comes from me just feeling better about myself.

Just feeling stronger.

It really is freeing, because I know that,

every day, it's only gonna get better

and I'm just gonna become a thousand times more confident than I ever have been.

It just made me more confident in every aspect of my life.

Individually, I think it could be oppressive or empowering.

Collectively,

as something we think it's a good idea for human beings to generally do,

ideally we need to live in a world

where we don't need to cut up our bodies to be our best selves.

In regards to my daughter,

I-- I even struggled with telling her where I was going today,

because I didn't even know how to explain it to her

without telling her,

"Yeah. My boobs are fake. I had a breast augmentation."

How do I even explain that to her?

And I don't wanna plant the seed of,

"You need big boobs to be pretty,"

because then that's just gonna be in her mind,

like, "When I get older, if my boobs aren't as big as mommy's,

then I need to change that."

I mean if we could get old boobs, saggy boobs, breastfeeding boobs

and just have them on every bus stop,

we'd quite soon stop thinking of normal boobs

as these completely pert, round things.

There needs to be less conversations

about the good or the bad of plastic surgery itself,

and more dialogue about what it means to be a person in a marginalized body

and why desirability is even so important to that experience in the first place.

[closing theme music playing]