Body Image and Mass Media: the Example of the US Television Makeover Show

Imago Hominis (2007); 14(4): 352-357
Bernadette Wegenstein

“A woman is more authentic the more she looks like what she has dreamed for herself.”

The transvestite Agrado in the film Todo sobre mi madre (1999) by Pedro Almodóvar

Cosmetic Surgery

According to the American Society for Aesthetic Plastic Surgery, nearly 11.5 million cosmetic surgical and non-surgical procedures were performed in the United States in 2006. Since 1997 the overall number of procedures increased 446 percent.1 Demand for cosmetic surgery products has been growing roughly 11.2 percent yearly, reaching a market size of $2 billion by the end of 2007, driven mostly by new product approvals, favorable cultural and demographic trends, and improved technology.2 The sensational character of these statistics could be extended ad infinitum when reading the details published by the ASAPS.

We could highlight the fact that patients for cosmetic surgery procedures have gotten increasingly younger. Take, for instance, the fact that in 2006 16,477 rhinoplasties, 7,915 Botox injections, and 5,423 Hylaform/Restylane injections were performed in the U.S. on adolescents. Or, if we want to analyze the data in terms of gender dynamics, we might note that, while the most popular invasive procedure for women in 2006 was breast augmentation, followed by eyelid surgery and abdominoplasty, men – who had only 8% of the total 11.5 million procedures done – underwent mostly liposuction, eyelid surgery and rhinoplasty. The most popular non-invasive procedure for men and women in 2006 was Botox injections (3,181,592 procedures), and the most popular invasive procedure liposuction (403,684 procedures).

But what is really of interest in the context of the reality TV makeover phenomenon is what impact these shows (starting in 2002 with ABC’s Extreme Makeover, followed by FX’s Nip and Tuck in 2003, FOX’s The Swan in 2004, E! channel’s Dr. 90210 in 2004, and MTV’s I Want a Famous Face, also in 2004) have had on the overall consumption of cosmetic surgeries. The data speak volumes. In 2003 overall cosmetic procedures were at 8.3 million with an increase of 12% in surgical procedures and 22% in non-surgical procedures from the previous year. The year 2004, however, which is also the peak of the makeover show genre, features a 44% increase, totaling 11.9 million procedures with surgical procedures increased by 17% and non-surgical by 51 percent! ASAPS President Peter Fodor attributes this growth to media coverage, including the dramatic increase in surgery shows: “I believe at least some of this upward trend may be attributable to increased media coverage of plastic surgery in 2004…. People have had many more opportunities to see, first hand, what plastic surgery is like and what it can do for others. That can be a strong incentive for them to seek the same benefits by having cosmetic procedures themselves.”3

In 2005 and 2006 surgical and non-surgical procedures increased by only 1% (in 2005 non-surgical procedures declined even by 4% to 9.3 million), and have been stabilized at 11.5 million ever since. To give a practical example for this market movement: rhinoplasty increased for men from 38,989 procedures in 2004 to 45,945 in 2005, but decreased to 33,143 in 2006. In other words, the heyday has been reached. We are now facing the age of a normalized, slowly progressing growth in cosmetic procedures.

Reality Television

According to Nielsen Media Research 56% of all of American TV shows today are reality television programs. About 69% of TV shows worldwide (cable and broadcast) are accounted for by reality television.4 Within the spectrum of reality TV, there are documentary style shows, in which ordinary people are followed into their daily lives, as in Family Plots; docu-soaps starring celebrities, such as Britney Cam with Britney Spears; talent searches, in which ordinary people try to become celebrities, such as America’s Next Top Model; historical re-enactments such as Colonial House (PBS 2004), set in the American frontier of 1628; an increasing number of dating shows, such as For Love or Money; law enforcement/courtroom/military shows such as the British Commando VIP; reality game shows such as Big Brother and Survivor, which may include a military component as with Boot Camp, or a sport component as with The Ultimate Fighter; and, finally, lifestyle change shows such as The Monastery, and the booming sub-genre of self-improvement or makeover shows, such as I Want a Famous Face, Pimp my Ride, or Ten Years Younger, which can also feature game show characteristics, as with The Swan’s pageant. All of these subgenres have one thing in common: they incorporate to a greater or lesser degree the narrative strategy of “wish fulfillment.”

Looking at the economics behind reality television itself, cheap production costs are behind the format’s original boom. Reality TV was a response to the economic restructuring of U.S. and British television in the 1980s. The growth of cable, VCRs, the market dominanceof powerful networks like FOX, as well as the emergence of local independent stations led to a fragmentation of TV audiences. As a result, advertising revenues had to be spread among a larger pool of distributors and created pressure on broadcasters to cut per-program production costs. As Chad Raphael points out in his analysis of the political-economic forces behind the emergence of a genre that he calls “Reali-TV,” there is an “inseparability of the television industry’s economic needs and how this genre represents reality.”5 What Raphael emphasizes with the term "Reali-TV" is that the economic crisis of television could have been solved by merely expanding infotainment or other programming trends. Instead, crime-time television, tabloid TV, and on-scene shows, as well as documentaries, were adapted into a new format that claimed access to “reality,” to the “truth.”

The Swan: You Must Surrender!

FOX Network is the most prolific purveyor of reality television programs. One of its most eye catching and publicly debated reality dramas was The Swan (2004-2005). The show features three main characteristics: it is a self-improvement/makeover show, a game show, and at the same time a wish fulfillment show. The Swan was created and produced by Nely Galán, a Latina woman (originally Cuban) who lives – as she puts it – “a self-confident businesswoman’s life in Hollywood.6 In her invention of a reality television version of Anderson’s fairy tale the “ugly duckling,” the beauty pageant contestants undergo major surgery in addition to other non-invasive makeovers such as styling, dieting, work out, and therapy in order to be transformed into female beauty ideals. The producer herself watches over them as “life coach” over a three-month period, during which the women are away from their families and habitual lives in order to undergo the transformations – “internal” and “external” as the show explains – and to “pass” into a new life. In her role as life-coach Galán can be aggressively straightforward: “no more candy, ice-cream. Say good-bye to your old life and habits. Look into the future and into feeling good.”7 For a total of seven weeks in each episode a pair of two contestants compete against each other; the winner of the final competition – a tele-spectacle which was watched by more than 10 million Americans in the first season (May 24, 2004) – is crowned “the Swan” and walks away with $50.000 in addition to a new self: “On our show, you don’t walk away with nothing, you walk away with $250,000 worth of services from day one.”8 There is only one ultimate winner at the end of each season, whose wish for a better life and look has been fulfilled in addition to her being awarded the first prize. But what is this prize really for?

In my interview about her motivations behind the extremely successful show (300.000 applications to the second, and 500.000 applications to the third season) and her views on the need for makeover, I learned that the key for a “successful transformation,” i.e., the key for the successful casting of a contestant, is the extent to which the woman is willing to “surrender” to beauty culture. Rachel Love-Fraser and Elisa Stiles won the first and second seasons respectively because, apparently, they “gave in” the best. But who are these successfully-to-be-made-over women? What nearly all contestants who ever appeared on The Swan share is the fact that, despite being obsessively unhappy with a particular body feature, there is no “big problem” evident in their looks. The first season’s sixteen all white9 contestants certainly did not look “ugly” by any means: in a more than careful casting the women were tested for body dysmorphic disorder10 – which they were perhaps predisposed toward, but did not clinically suffer – and were ultimately chosen for being "normal" while at the same time being willing to “surrender” to something that would come “upon” them. While for the television spectators, as for the readers of the various beauty magazines and tabloid press where these women were featured, their need for makeover was strengthened by the fact that their before-photographs were taken in bad clothes and from bad angles, showing them with sad and at times desperate faces, nothing dramatic was actually wrong with them. What was not apparent, however, was how they felt about themselves, and what kind of fragile relationship they revealed toward their own body image. Rachel Love-Fraser, for instance, winner of the first season, wanted to leave everything behind and focus on “who she really was,” as she stated in a People Magazine interview.11 Galán reiterated in her interview with me that the best way to undergo a successful change is to let it happen. Let culture happen. It is certainly no longer far-fetched to read these made-over bodies as “twenty-first century neo-cyborgs”12 who are bearing the marks of techno-capital on their own flesh. After all, it is on their own skin and in their bodies that culture marks its desire for a better self, a better body, and a better life. These bodies, in other words, become the site of the argument itself.

Why Makeover and Why Not?

Galán’s goal, however, is not to change culture, but to get to the “truth” within these women’s psychic spheres. Only by matching outside to inside will we be able to fit in, to pass, is what she tells me over and over again in different words. Galán sees herself as a therapist, someone who knows more about the truth than do her patients themselves. Ultimately, she says she wants to help these women to be comfortable in their own skin: “If something bothers you,” she says, “why wait and suffer? Go fix it!”

While the motivations behind creating a reality television show may be to a certain extent predictable, it is worth looking into the body concept that reveals itself behind it. The idea is that by changing a body part, the entire body self/body image will change too, including the “inside,” which is the “place” where – according to Nely Galán, as well as to the show’s psychotherapist Dr. Lynn Ianni – a woman who wants to undergo a body transformation should start. But where or what is that place really, and what does it stand for?

In Better Than Well, bio-ethicist Carl Elliott trenchantly draws a connection between being put on psychopharmaca such as Prozac, taking anabolic steroids, or undergoing cosmetic surgery. All of these “strategies of the self” are ultimately in the service of looking “the way we were meant to look.”13 Elliott approaches the theme of enhancement technologies in search of the “true authentic self” both from a medical and bio-ethical angle, and from a cultural theoretical one. He looks at drugs like LSD and Paxil (a drug that prevents you from blushing in public); at literature such as Conundrum,14 a memoir of transition from man to woman; at the histories of cosmetics and cosmetic surgery; as well as at travel literature and the theme of passing into the “new self” en voyage. One of the most important readings he gives is that of the tale of the Wizard of Oz: “Here is a key to understanding the place of enhancement technologies in contemporary America. The Scarecrow, the Tin Man, and the Lion do not go to the Wizard because they want to be ‘enhanced.’ They go because they want to be themselves. In the Wizard of Oz, as in contemporary America, the search for the good life is an inward search for authenticity. As Dorothy says, ‘If I ever go looking for my heart’s desire again, I won’t look any further than my own backyard. If I don’t find it there, I never really lost it to begin with.’”15

Sander Gilman has demonstrated that the history of cosmetic surgery is deeply related to the history of psychoanalysis: “Curing the physically anomalous,” he writes, “is curing the psychologically unhappy.16 Or, to put it into more drastic language as Elizabeth Haiken does in her history of cosmetic surgery, “cosmetic surgery became ‘psychiatry with a scalpel.’17 While the domain of the physical is one that operates via the identification with one’s own body image (both the image du corps, i.e., how the subject perceives her body, and image de corps, i.e., the body as perceptive apparatus, in Herni Bergson’s distinction from Matière et mémoire. Essai sur la relation du corps à l’esprit, 1939) that is fed through the encounter with the other and the gaze, the psychological realm is inwardly directed, as Galán and the women I interviewed reveal: it is a private realm that presumably only they have access to. As Susan Bordo18 and Virginia Blum19 have shown in their approaches to studying women’s motivations for undergoing cosmetic surgery, most women state that they are doing it “for themselves.” Bordo argus that “’me’ is imagined as a pure and precious inner space, an ‘authentic’ and personal reference point untouched by external values and demands. A place where we live freely and won’t be pushed around.20 This utopian space is precisely what is at stake when Nely talks about “fixing your problem,” or Dorothy finds out that her home is really where she has always been to begin with, where she started to be a self, in Kansas. This authentically true self, however, is something that woman must find, must search for, maybe in a journey, or in some other rite de passage (i.e., three months away from her family, as for The Swan). Before she can find it, she must deserve it, like Rachel, who gave in enough to deserve not only the image but also an additional $50.000. But what happens when she finds it?

Psychologists usually say that it is doubtful that in the long run a new body image will actually cure a person’s soul. Nevertheless, there is evidence that women appear to be happier than before with an altered nose, a liposucted belly, or larger breasts. It is not the goal of these reflections to prove these women wrong, as this would require a long-term supervision of their states of mind. Rather, what interests me in a next step is to evaluate the cultural judgments behind makeovers. If the “true self” is one other layer of a mediated body, a layer, however, where the changing body image appears to come to rest, then how is that layer different from the one that stops one step before it, namely, where beauty is natural, in-born, and not to be modified?

From an ethical point of view these two positions – the one defending cosmetic surgery and the one attacking it – seem to operate similarly. Both assume that there is an ultimate layer that “represents” “true authentic being.” A being that is natural and that matches the inside to the outside or vice versa. The many girls we interviewed for the documentary did not have a problem with the medical procedures in makeover shows, but with the fact that you may not find your true self via this particular kind of procedure. The major concern (especially among young men) was that you may not deserve this beautiful new body, as you did not work hard enough for it, or do your crunches every day, or diet rigorously enough. As Elliott points out: “The commercial appeal of revealing the true self depends not only on the idea that you have a true self that can be revealed by a drug, but also that you will be happier and better off for revealing it. This may be a uniquely American idea.21 The American-dream-rhetoric inherent to such argumentation is indeed very strong. The ultimate message is that there is always a way to be even happier, truer, “selfer,” or somehow better off.

What both of these ideological positions have in common is that they believe in an interior place where a true self somehow lives. A religious move would be to say that it is a sacrosanct place, holy, and only God would be able to touch it. While girls who don’t favor cosmetic surgery may be invested in this latter opinion, it would be easy to see them shift to the other position, the one that still believes in that place, but that simply suggests enhancement technologies as a way to reach it. And cosmetic enhancement is getting less and less invasive, hence surgical, as we could see from our statistics.

If we look at the origins of the word cosmetic, we find that it goes back to the Greek kosmetikos – relating to adornment. At the same time the verb kosmein means to arrange and to adorn. So, “cosmetic” is, in other words, derived from “cosmos,” that which was there to begin with, but which was there precisely in order to be put into order. And the correlate to this, is that that special place of intimate self identity, like the cosmos itself, is already the result of an adornment. The origin, the center, is cosmetic all the way down. The cosmetic gaze, then, is the gaze on the body that believes in it as the cosmos, the original holy place, all the while being the operative force in its construction as endless adornment. In the format of the US reality television makeover show we see the cosmetic gaze in one of its most fervent applications within today’s popular culture, which is slowly but surely shaping the appearance of our diverse bodies into body images of conformist and stereotyped Westernized beauty.


Parts of this text will appear in the introduction to Bernadette Wegenstein (ed.), Reality Made Over: The Culture of Reality Makeover Shows; special issue of Configurations 14.1. and 14.2 (forthcoming 2008; The Johns Hopkins University Press).


  2. Kuczynski A., Beauty Junkies: Inside Our $15 Billion Obsession With Cosmetic Surgery, Doubleday, New York (2006), p. 152
  4. Another statistic to keep in mind: the average individual American watches television for roughly four hours a day, and the average American household watches over seven hours of television a day. According to one study, television accounts for nearly 40 percent of the average American’s free time; quoted in Elliott C., Better Than Well. American Medicine Meets the American Dream, W. W. Norton & Company, New York and London (2003), p. 84.
  5. Chad R., The Political Economic Origins of Reali-TV, in: Murray S., Ouellette L. (ed.), Reality TV. Remaking Television Culture, New York University Press, New York and London (2004), p. 119
    For coining the term “Reali-TV” Chad refers to an article by Siegel E., It’s Not Fiction. Or, It’s Not Reality. It’s Reali-TV, Boston Globe, 26 May 1991, A1.
  6. Interview for the documentary Made Over in America by Bernadette Wegenstein and Geoffrey Alan Rhodes;
  7. The Swan, The Complete Series, First Season (2004), DVD edition, gaLAnEntertainment 2006
  8. Interview for the documentary Made Over in America
  9. The second season featured two episodes with each one handicapped woman, as well as some ethnic diversity.
  10. Body Dysmorphic Disorder is a psychiatric disorder characterized by excessive preoccupation with some imagined defect in physical appearance, causing the subject significant distress or impairment in social, occupational, or other important areas of functioning. (DSM-IV, Diagnostic and Statistical Manual, Fourth Edition, quoted in Phillips K. R., The Broken Mirror. Understanding and Treating Body Dysmorphic Disorder, Oxford University Press, New York and Oxford (1996), p. 33.
  11. Green M., Lipton M. A., The Swan Controversy: Has TV plastic Surgery Gone Too Far?, cover story, People Magazine, June 7 2004, p. 61
  12. Term coined by Zylinska J., Of Swans and Ugly Ducklings: Bioethics between Humans, Animals and Machines, in: Wegenstein B. (ed.), Reality Made Over: The Culture of Reality Makeover Shows
  13. Elliott C., op.cit. 2
  14. Morris J., Conundrum, Harcourt Brace Jovanovich, New York (1974)
  15. Ibid., p. 173
  16. Gilman S., Creating Beauty to Cure the Soul, p. 7.
  17. Haiken E., Venus Envy. A History of Cosmetic Surgery, The Johns Hopkins University Press, Baltimore (1997); quoted in Elliott C., p. 121
  18. Bordo S., Unbearable Weight: Feminism, Western Culture, and the Body, University of California Press, Berkeley, CA (1993)
  19. Blum V., Flesh Wounds. The Culture of Cosmetic Surgery, University of California Press, Berkeley, CA (2003).
  20. Quoted in Elliott C., p. 113
  21. Quoted in Elliott C., p. 76

Anschrift der Autorin:

Associate Professor Bernadette Wegenstein
Media Study/The University at Buffalo
Visiting Associate Professor
German and Romance Languages and Literatures
The Johns Hopkins University
Gilman Hall 330, 3400 N. Charles Street
Baltimore, MD 21218, USA

Institut für Medizinische
Anthropologie und Bioethik
Unterstützt von: