Download REPRESENTATIONS OF COSMETIC SURGERY IN

REPRESENTATIONS OF COSMETIC SURGERY
IN WOMEN’S MAGAZINES
A thesis submitted to
Kent State University in partial fulfillment
of the requirements for the degree of Master of Arts
by
Christina M. Touarti
August, 2007
Thesis written by
Christina M. Touarti
B.A., Kent State University, 2005
M.A., Kent State University, 2007
Approved by
________________________________________, Advisor
Dr. Elaine Hall
________________________________________, Chair, Department of Sociology
Dr. Richard Serpe
________________________________________, Associate Dean, College of Arts and
Dr. John Stalvey
Sciences
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TABLE OF CONTENTS
INTRODUCTION………………………………………………………………………...1
Supporting Literature...…………………………………………………………....3
Methods…………………………………………………………………………...6
LITERATURE REVIEW…………………………………………………………………9
Schemas………………………………………………………………………….10
Framing Theory………………………………………………………………….13
The Medicalization of Women’s Beauty………………………………...17
Surgery as Therapy………………………………………………………21
The Autonomous Voice………………………………………………….23
Perfection as Normalcy…………………………………………………..25
METHODS………………………………………………………………………………31
Sample……………………………………………………………………………32
Selecting Magazines……………………………………………………..32
Selecting Articles………………………………………………………...34
Final Sample………………..…………………………………………....36
Operational Definitions of Variables…………………………………………….38
Characteristics of the Articles……………………………………………38
Content of the Articles…………………………….……………………..42
Framing of the Articles…………………………………………………..47
Hypotheses……………………………………………………………………….54
Type of Magazine………………………………………………………..55
Race of Audience………………………………………………………...55
Rationales………………………………………………………………...56
Analysis…………………………………………………………………………..58
FINDINGS……………………………………………………………………………….61
Characteristics of the Articles……………………………………………………62
Time of Publication………………………………………………………62
Location of Article……………………………………………………….67
Length of Article…………………………………………………………72
Authors’ Information…………………………………………………….73
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Content of the Articles…………………………………………………………...80
Type of Procedure………………………………………………………..80
Specific Procedures Mentioned………………………………………….83
Mentions of Age………………………………………………………....90
Visual Images……………………………………………………………93
Representation of Cosmetic Surgery…………………………………108
Framing of the Articles…………………………………………………………113
Medicalization of Women’s Beauty……………………………………113
Surgery as Therapy……………………………………………………..123
The Autonomous Voice………………………………………………...132
Perfection as Normalcy…………………………………………………140
Hypotheses……………………………………………………………………...152
CONCLUSION…………………………………………………………………………158
Significant Findings…………………………………………………………….158
Limitations……………………………………………………………………...171
Contributions and Further Research……………………………………………175
APPENDIX A: BIBLIOGRAHPY OF SAMPLE……………………………………...178
BBIBLIOGRAPHY ……………………………………………………………………182
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LIST OF TABLES
Table 3.1: Type of Magazine and Title of Magazine
Table 3.2: Operational Definitions of Indicators for Medicalization of Women’s Beauty
Table 3.3: Operational Definitions of Indicators for Surgery as Therapy
Table 3.4: Operational Definitions of Indicators for the Autonomous Voice
Table 3.5: Operational Definitions of Indicators for Perfection as Normalcy
Table 4.1: Year and Season of Publication by Type of Magazine
Table 4.2: Location of Article by Type of Magazine
Table 4.3: Average Page Length by Type of Magazine
Table 4.4: Author’s Gender, Education, Profession, and Expertise by Type of Magazine
Table 4.5: Type of Procedures by Type of Magazine
Table 4.6: Specific Procedures Mentioned by Type of Magazine
Table 4.7: Mentions of Age by Type of Magazine
Table 4.8: Characteristics of Visual Images by Type of Magazine
Table 4.9: Surgically Focused Visual Images by Type of Magazine
Table 4.10: Representation of Cosmetic Surgery by Type of Magazine
Table 4.11: Medicalization of Women’s Beauty Frame by Type of Magazine
Table 4.12: Surgery as Therapy Frame by Type of Magazines
Table 4.13: The Autonomous Voice Frame by Type of Magazine
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Table 4.14: Perfection as Normalcy by Type of Magazine
Table 4.15: Summation Statistics of Frames by Type of Magazine
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CHAPTER 1
INTRODUCTION
In modern society, women face a barrage of media images promoting ideal
feminine beauty and various routes to achieve this beauty through the purchase of
products and services, including cosmetic surgery. Cosmetic surgery is increasingly
becoming one of the consumerist routes women are turning to in order to achieve cultural
standards of beauty. With increased technology, surgery is becoming an option for any
beauty ailment and as the options are increasing, so are the number of patients. The
increased use of cosmetic surgery in the Untied States is alarming. In 2005, an estimated
10.2 million cosmetic surgeries were performed, an 11% increase from the previous year
and an increase of 266% since 1992 (American Society of Plastic Surgeons 2006). Even
more surprising is the jump in the number of minimally invasive cosmetic procedures,
which has increased by 3158% since 1992 (American Society of Plastic Surgeons 2006).
More women are risking their health and finances for the sake of a more attractive
appearance, making the study of influences on women a very important research
endeavor.
In American society, most people are surrounded by numerous media outlets
daily. Television, movies, and magazines not only perpetuate the idealized standards of
beauty, which influence women’s body-image, but they also provide solutions to body1
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image problems. Articles that feature images of models that embody American standards
of beauty discuss the latest makeup, exercise routines, and cosmetic procedures that will
fix any and every beauty problem. Furthermore, representations of cosmetic surgery are
becoming more prevalent and openly discussed in the media. Reality television shows
are showing the process of cosmetic surgery through the patient’s eyes as well as the
doctor’s perspective. Meanwhile, fictional shows are glamorizing the use of cosmetic
surgery. In magazines, celebrities are questioned about their appearances and discuss
how they maintain an appealing physique, whether through exercise or liposuction. As
cosmetic surgery is discussed more openly in the media that women are exposed to, it is
likely that women are thinking about the use of surgery and whether it is a sensible option
for them. Therefore, it has become necessary to study the messages in the media which
may be an influence on women’s decisions to get cosmetic surgery.
Most studies that focus on cosmetic surgery have examined the topic through
interviews with patients and surgeons (Dull and West 1991, Gagné and McGaughey
2002, Gimlin 2000). While the information gained from these studies is valuable in
grounding my research, the focus of these studies tends to be how women feel after
having surgery. The thoughts and emotional well-being of women after surgery does not
provide an objective understanding of why women choose to get cosmetic surgery in the
first place. I am interested in understanding what comes before cosmetic surgery, or what
influences women to get cosmetic surgery. A relationship between the media and the
power of its influence has been shown in numerous studies and I believe the media may
also be influential in terms of proposing cosmetic surgery as a solution to appearance
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problems. While a relationship between media representations of cosmetic surgery and
women’s decisions to get cosmetic surgery may exist, it is impossible to understand this
relationship without first understanding the messages about cosmetic surgery in the
media. Therefore, my research objective is to develop an accurate depiction of the ideas
about cosmetic surgery to which women are exposed. More specifically, I aim to
evaluate the messages about cosmetic surgery, which women are exposed to in various
women’s magazines.
SUPPORTING LITERATURE
Messages from the media can be received and internalized on many levels. The
more abstract level, for the purposes of this study, involves the use of non-conscious
schemas. Schemas are cognitive structures that help individuals simplify information
into an organized system of cultural beliefs and cues. Although we are largely unaware
of the formation of schemas, they organize our experiences which are then referenced
each time we encounter a similar situation. Schemas based on prior experiences and
knowledge are reinforced through congruent information presented in present and future
situations. Some schemas are so taken-for-granted that we never question the use of
them. For example, the belief that women should be concerned with their appearance is
so commonly accepted most women do not question their efforts to get their hair dyed,
shop for stylish clothes, and put on mascara. However, more specific reasons to justify or
encourage the use of cosmetic surgery do not operate on the level of schemas. Instead,
the use of frames is more appropriate to study these messages.
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Framing theory involves the messages in the media that attempt to persuade an
audience to accept a situation as legitimate. Frames organize cultural meanings so they
make sense to the public and people then can use these frames to construct their own
meanings. Frames work like interpretive schemas in this sense, relying on the activation
of previous knowledge and experiences to help convince readers that a perspective is
true. For example, a frame may rely on the activation of a schema that cosmetic surgery
can improve one’s appearance to then persuade readers that cosmetic surgery can also be
therapeutic. However, depending on the complexity of a topic, multiple frames may be
used to convey the intended message. For this reason I developed four frames which I
expect will be used in women’s magazines when discussing cosmetic surgery. The four
frames are the medicalization of women’s beauty, surgery as therapy, the autonomous
voice, and perfection as normalcy.
The medicalization of women’s beauty refers to viewing the body and appearance
in medical and pathological terms. While this process has been applied to other natural
processes, such as reproduction and sexuality, the medicalization of women’s beauty
applies a medical lens to one’s natural appearance. This process involves viewing the
body in parts instead of the whole of the body, making it easier to see displeasing parts of
the body – breast, nose, stomach – as diseased, flawed, or genetically inferior. This
process occurs within the medical community as well as with individual women.
Therefore this frame will be examined in many contexts as any member of society can
contribute to the process of medicalization.
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Presenting cosmetic surgery not only as a medical process but also as a
psychological treatment is the core of my second frame of surgery as therapy. This frame
is based of the individualistic ideology in society, which justifies any means to improve
one’s self-esteem, including risking one’s health for a more attractive appearance.
Through this perspective, the body is a commodity that women can continuously
transform for the purpose of “feeling good” about herself. Because cosmetic surgery is
justified as a means of self-help, the stigma of vanity associated with surgery is
diminished. Hearing the testimony of a woman whose breast augmentation gave her the
confidence she always wanted may be especially meaningful to women who have a poor
body-image. The frame of surgery as therapy may be a significant framing technique
when discussing cosmetic surgery.
The autonomous voice frame portrays cosmetic surgery as a form of action and
control. With this understanding, women choose to get cosmetic surgery separate from
cultural influences and decide to take action against their displeasing appearances. The
feeling of autonomy through the process of cosmetic surgery begins with the selfdiagnosis of a problem and continues with the decision that professional treatment is
needed. Women are proud of their decision to get cosmetic surgery and are often
portrayed as brave and courageous for undergoing surgery. The sense of individualism
continues by tailoring the surgery, or other beauty enhancement procedures, to the needs
of each woman. Women feel empowered by the process of cosmetic surgery because
they have personalized the surgery. The procedure is chosen by the individual and she
determines how the surgery will transform her appearance.
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The frame of perfection as normalcy is based on the increasing standards of
beauty in American society. As standards of beauty increase, what was once considered
beautiful becomes normal and what was once normal becomes ugly. This occurrence that
encourages women to believe that their appearance is not acceptable and must be
improved to fit in with a limited ideal of beauty is referred to as the pathological
inversion of the norm. Cosmetic surgery connects with this frame because it allows
anyone to reach this limited beauty. In turn, the normative use of cosmetic surgery
increases the standards of beauty, creating a cycle between the interaction of standards of
beauty and the use of cosmetic surgery. The role of the media is significant in both
perpetuating a limited idealized beauty and in proposing cosmetic surgery a viable
option. Therefore, this frame is important to include in my analysis.
METHODS
In order to understand the messages in the media concerning cosmetic surgery, I
have chosen to do a content analysis of women’s magazines. In this content analysis, the
prevalence of articles about cosmetic surgery is examined as are the characteristics of
these articles across a variety of women’s magazines. I am selecting seven different
women’s magazines from which to draw my sample, which are categorized into four
magazine types. The first magazine type is traditional women’s magazines, or magazines
that focus on a broad range of women’s issues and topics. Redbook and Ladies Home
Journal are classified as this magazine type.
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Vogue and Glamour are classified as fashion and beauty magazines, the second
magazine type used in this study. These magazines discuss women’s issues to a lesser
degree than fashion and beauty items.
The third magazine type, target audience magazines, includes magazines that
address the same issues as other women’s magazines but for minority audiences. Latina
and Essence are selected for this magazine type.
Finally, the last magazine type includes a new magazine called Skin Deep. This
magazine focuses on anti-aging technology in general and cosmetic surgery more
specifically. Because this magazine is new to the women’s magazines market, I placed
this magazine in a separate surgical magazine category.
I am using these seven magazines to collect my sample of articles that focus on
cosmetic surgery. This sample allows me to compare the frequency of articles about
cosmetic surgery across magazine types as well as to use a coding scheme to analyze the
characteristics of these articles.
The coding scheme examines the general characteristics of the articles, including
time of publication, placement of articles, and author’s information, as well as the content
of the articles, focusing on the type of procedures, mention of specific procedures,
reference to age, use of visual images, and overall representation of cosmetic surgery.
These variables establish the context from which framing techniques are used. To
measure the use of my frames in articles about cosmetic surgery, I developed specific
indicators for each frame that embody the main components of the frames. I do have
specific expectations for the use of framing according to magazine types, which are
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expressed through six hypotheses. The findings examine the variables in terms of the
overall sample as well as comparing across magazines types and are reported through
percentages and summation statistics.
My research objective is to describe the messages concerning cosmetic surgery in
women’s magazines, specifically in terms of the use of frames. I developed four frames
based on the sociological literature about cosmetic surgery to study in the media. In the
next chapter, I detail the literature which grounds my use of framing theory and the
development of my four frames of the medicalization of women’s beauty, surgery as
therapy, the autonomous voice, and perfection as normalcy. In the third chapter, I specify
the variables developed to analyze the characteristics, content, and framing of articles.
Operational definitions and the coding scheme are explained as well as my expectations
for findings, which are expressed as six hypotheses. My method of analysis is discussed
as well. The fourth chapter reports the findings from my analysis. I report these findings
in the order of characteristics, content, and framing of variables. I end this chapter with a
discussion of the findings in relation to my hypotheses. Finally, my fifth chapter
discusses the significant findings in terms of framing and the possible implications of
these findings on women. The findings from this study are then applied to future
directions for research in this area of study.
CHAPTER 2
LITERATURE REVIEW
Before examining the possible link between cultural messages about cosmetic
surgery and women’s decisions to receive cosmetic surgery, we must understand what
messages exist and why they may be an important factor in women’s decisions.
Messages may be received and internalized at many levels of cognition. This chapter
will discuss how schemas and frames are two of these levels. When examining schemas,
the literature illustrates how individuals can internalize cultural cues and beliefs in nonconscious ways. This non-conscious internalization can guide our behavior, but new
arguments can also change our beliefs as well. Framing theory expands on the ways in
which readers may be influenced by the media to accept certain situations as legitimate
through the frames used to present information. Both schemas and frames are important
in understanding how the media can impact individuals. Finally, I review the literature
surrounding cosmetic surgery, looking for reoccurring themes. These themes are used to
develop the four frames I expect to find in media representations of cosmetic surgery.
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SCHEMAS
We have many ways of organizing information to make interactions easier to
understand. One such way is the use of cognitive schemas. Schemas are socially
constructed, cognitive structures that organize our perception and knowledge (Blair-Loy
2001). Sewell (1992) views schemas as principles of action and habits that form during
interaction and remain with individuals, although we are largely unaware of their
formation and use. Schemas are formed using prior knowledge and experiences, and
they are maintained through their activation during social situations (Fiske and Taylor
1991). We develop basic schemas to script interaction, such as how customers and
waiters are expected to interact. These schemas are then referenced each time we are in a
restaurant and reinforced when the interaction fits into the schema.
Being able to predict and control our situations through the non-conscious use of
schemas not only brings us comfort during social interaction, but also reproduces social
structures. As Sewell (1992) notes, schemas, or “rules” of structure, shape the manner in
which resources are valued and used. The distribution, use, and understanding of
resources, in turn, reinforce the schemas that support them, leaving the schemas intact
and unchanged for future use.
Schemas are cognitive structures that represent one’s organized knowledge on all
levels of abstraction (Ridley, Chih, and Olivera 2000). Schemas range in types of
knowledge that they order from the highly abstract, such as ideologies and individual
beliefs, to more concrete ideas, such as simple understandings of particular social settings
like a restaurant or school. When schemas consist of broad ideas, they are
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“generalizable” and transferable to many situations (Sewell 1992). In other words,
schemas are used frequently and in a variety of settings. For example, one’s schema
surrounding the belief that an individual is composed of the body and the soul can be
referenced in religious or romantic situations.
Schemas also impact how we experience and understand new situations. One
such way is that we remember details and information better when they fit with our
schemas (Fiske and Taylor 1991). As we recognize information that is consistent with
our schemas, we tend to overlook information that contradicts them. In this sense,
schemas have a priming effect for certain types of information, meaning that the prior
knowledge contained in our schemas heightens the awareness of schema-relevant
information. Brown and Dittmar (2005) noted such a priming effect when studying the
impact of images of thin models upon weight-related anxiety, using appearance schema
as a mediator. They exposed women, at different levels of attention, to magazine
advertisements featuring thin models. After this exposure, they measured schema
activation and weight-related anxiety using word-stem completion tasks and the Physical
Appearance State and Trait Scale. Appearance schema, the cognitive structure that
organizes appearance-related information that is relevant to the self, was found to have
been activated in over 80% of the women, resulting in weight-related anxiety. In this
instance, the appearance schema made women more aware of the models than the actual
products being advertised, in a sense priming women to notice appearances.
Cultural schemas are particular types of schemas that provide a socially
constructed framework for not only understanding society, but also for constraining and
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enabling action (Blair-Loy 2001). Blair-Loy (2001) emphasizes that cultural schemas go
beyond cognitive structures and affect the choices and actions individuals make. Sewell
(1992) also notes that the unique characteristics stored is one’s schemas, such as race,
gender, wealth, occupation, education, or others that describe one’s social position, shape
one’s knowledge and experience, and, in turn, one’s development of schemas. Ridley,
Chih, and Olivera (2000) assert that these personalized schemas often blend one’s own
cultural beliefs with those of the dominant culture, resulting in unique “cultural selfschemata” for each person. The consequences of activating unique “cultural selfschemata,” aside from the tendency to remember best information that supports our
schemas, can include large misunderstandings, hasty assumptions, and stereotyping.
Ridley, Chih, and Olivera (2000) illustrate the consequences of incongruent schemas
specifically in the medical community, where mutual understanding between patients and
doctors is especially important for proper treatment and healthcare. For instance, the
cultural schema of an immigrant from Latin America may be so incongruent with the
dominant American schema that a medical professional may believe that immigrant to be
mentally retarded if the difference in schemas is not considered.
As mentioned previously, schemas are built from prior knowledge, including
abstract levels of knowledge, such as beliefs and ideology. Such forms of knowledge are
so abstract and so widely accepted that we are often unaware of the use and activation of
schemas (Fiske and Taylor 1991). Black and Sharma’s (2001) observations and
interviews with workers in the beauty therapy industry exemplify the non-conscious use
of schemas. While many informants discussed the various purposes beauty therapy
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serves, not one questioned the need for the beauty therapy industry in general. This
reflects how beauty therapy has become so widespread and habituated that one does not
even question the significance of it.
Schemas are activated not only through interaction, but through language, written
and oral, and visual images. Schemas involve cultural beliefs and therefore can be
activated through many cultural vehicles, including the media. In the media, schemas are
likely to be found to convey messages that actors can understand without effort (Gamson
et al 1992). Gamson and colleagues (1992) refer to these messages as “naturalized
meaning.” Schemas, or naturalized meaning, serve as the background from which the
rest of the story or argument emerges. For example, the idea that cosmetic surgery is
used to improve appearance is a common assumption that does not need further
explanation. Unlike non-conscious schemas, the more specific reasons individuals use to
justify cosmetic surgery require further explanation and examination. Arguments
endorsing cosmetic surgery in the media attempt to persuade some women that this
surgery is a legitimate activity in general and an appropriate action for them in particular.
Persuasive media representations about cosmetic surgery are appropriately examined
using framing theory.
FRAMING THEORY
Framing theory is about the messages and ideas in the media that interpret a
problem or action, attempting to persuade the audience to accept the interpretation as
accurate and true. Frames organize information so that they make sense to the general
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public. In the process, frames bridge the gap between structural or cultural meanings and
the meanings individuals construct for themselves (Gamson 1992). A frame provides a
definition or interpretation of a situation that supports the larger cultural ideas, which
then guides the actions and ideas of individuals. In this sense, Snow and Benford
understand frames to be “interpretive schemata” (1992).
While both schemas and frames rely on ideology, frames are more interpretive
because they are not taken for granted as schemas often are. Frames allow for individual
agency; even though frames incorporate structural meanings, the individual plays a role
in developing and interpreting their meaning (Gamson 1992). The process of framing
contains a dynamic quality as meanings are continually challenged and changed. To
resonate with the individual while supporting the larger cultural schemas, the meanings
of frames are continuously adjusted, revised, and transformed.
Frames serve multiple purposes. While simplifying information for mass
consumption, frames also allow the audience to be persuaded by a specific interpretation
or idea about an activity. Snow and Benford identified diagnostic and prognostic frames
as two common types of framing (1992, 2000). Diagnostic frames identify a problem and
attribute the cause to someone or something. This type of frame places blame on whom
or what is responsible for a situation without proposing a possible solution. Problem
solving is left for prognostic frames, which provide a solution or strategy, whether
permanent or temporary, for the situation.
Diagnostic and prognostic framing strategies are commonly found in the study of
social movements; however, these two types of frames can easily be applied to the focus
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on women’s beauty in the media. For example, an article may use a diagnostic frame by
discussing the unattractive qualities of wrinkles and discoloration on skin as caused by
old age, genetics, or sun damage. But the same article continues with a prognostic frame
to suggest the use of the latest creams, powders, and even surgical procedures to resolve
the problem of undesirable skin.
The effectiveness of frames is difficult to measure or anticipate. Snow and
Benford have identified a few criteria that comprise the credibility of a frame, and thus
the likelihood that a reader would internalize that frame (1992, 2000). These criteria are
empirical credibility, legitimacy of proponents, and frame consistency. The idea of
empirical credibility refers to whether real events support the frame. This support comes
from facts and data that coincide with the message included through the frame. The
legitimacy of proponents is important because the status or expertise of the person stating
the frame affects whether the audience perceives the message as legitimate. Frame
consistency also affects how the audience interprets a frame. If the claims made within a
frame contradict the actions of the group making them, the audience is less likely to
accept the frame as legitimate. Even though these three criteria are important, all three
can be subjectively created and manipulated, making it difficult to judge their true
credibility.
Benford and Snow’s (2002) three criteria of frame credibility affect how well a
frame resonates with an individual, which is important to the internalization of the frame.
According to the theoretical understanding of resonance, a frame must resonate with a
reader’s life and ideology for it to be effective. Furthermore, the personal background of
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the individual is a factor in the resonance and internalization of frames. As Gamson and
his colleagues point out, each reader approaches the frame with beliefs and ideology
based on his/her race, gender, and socioeconomic status, which affect how well a
particular frame will resonate with him/her (1992). In other words, the reader has agency
in the process of framing. A reader interprets a frame as he/she understands it, but the
reader’s understanding can be complicated by interaction and discussion with others. As
Scheff explains, through discussion or debate, an individual can change the meanings and
messages of frames (2005). Benford and Snow discuss this process as “counter framing,”
which occurs at several levels including the individual level (2000). However, the
likelihood that the meaning will change at the individual level depends on the type of
media. The print media excludes discussion and a reader is only going to be exposed to
another frame if he/she reads another article. Other forms of the media, such as
television, are often group activities which provide more opportunities for individuals to
change the meaning of frames. Thus, an individual is less likely to change the meaning
of frames if exposed to them in a solitary experience, like in the print media.
Because it relies on resonating with previously held beliefs and ideologies,
framing does not work solely through the introduction of new knowledge. Instead
frames rely on priming effects and the activation of previous knowledge. Nelson, Oxley,
and Clawson (1997) tested framing effects on 116 undergraduates by presenting the
students with one of two arguments about welfare. In this two-part experiment, student’s
familiarity with welfare policy issues were assessed through a questionnaire the first day,
and approximately five days later framing effects were tested through an open ended
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questionnaire about attitudes towards welfare. Nelson and his colleagues found framing
effects were stronger among those who were already familiar with the content of the
frame than those who were unfamiliar with the frame’s content. Given the increasing
amount of media attention on cosmetic surgery through television shows, advertisements,
and magazines, it is logical to assume that females have enough knowledge of cosmetic
surgery for the frames surrounding them to have an effect.
Frames convey the context of an issue or activity for mass consumption. Issues
can be very complicated, and one frame may not easily sum up the context surrounding
issues. Thus multiple frames can refer to a single situation or topic (Scheff 2005). For
this reason, I have selected multiple frames to help understand how cosmetic surgery is
framed in the media. I drew upon sociological literature involving the development of
cosmetic surgery, the process of surgery, the perceptions of patients and surgeons, as well
as representations of surgery in the media for reoccurring themes that I develop into four
frames. My four frames are the medicalization of women’s beauty, the use of surgery as
therapy, the autonomous voice, and perfection as normalcy.
Medicalization of Women’s Beauty
The process of medicalization is a sociocultural occurrence in which individuals
use medical terms to define a problem, medical language to describe a problem, a
medical frame to understand a problem, or medical intervention as treatment of a problem
(Conrad 1992). Natural life processes, as Conrad (1992) calls them, often become
medical problems. Well known examples of the medicalization process include sexuality
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and reproduction. Birth control, though ineffective, used to be handled through home
remedies passed from one woman to another (Riessman 2003). With the increase in
technology and science, birth control now is handled through the medical profession.
Riessman (2003) further supports Conrad’s work, noting that childbirth, abortion, and
menopause are other aspects of women’s reproduction that have moved away from
women’s control and under the supervision of medical professionals. Also, many deviant
behaviors have undergone the process of medicalization. Conrad (1992) notes that
madness, alcoholism, eating disorders, hyperactivity, and learning disabilities are all
deviant behaviors that have become medical concerns.
The risks of cosmetic surgery are performed for the sake of a more attractive
appearance; this makes cosmetic surgery unique in the medicalization process (Sullivan
1993). Cosmetic procedures are often discussed in parallel with reconstructive surgery
under the term plastic surgery (Gillespie 1996). Discussing these two types of surgeries
under the same term blurs the difference between them, which is real and significant.
The purposes of reconstructive surgery are to restore normality and function, or to correct
disfigurements and deformities from birth or accident (Gillespie 1996, Davis 1999).
However, cosmetic surgery is performed only for aesthetic improvement, not to treat
physical ailments. Cosmetic surgery then contradicts medicine’s social mandate to
improve health and physical functioning as it only improves appearance (Sullivan 1993).
Gilman (1999) notes that aesthetic surgery was developed to treat stigma from disease,
battle, accidents, and race. The use of surgery for the removal of signs of race reflects the
aesthetic purpose of cosmetic surgery that risks a patient’s health without improving it.
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Sullivan(1993) notes that surgeons benefit from diagnosing beauty as a medical
condition. Patients of cosmetic surgery are healthy individuals which decreases their
chances of complications and the length of their recovery time. The quick recovery time
and lack of complications may make surgery a more accessible option because so much
aesthetic improvement is gained so easily. This healthy status may be part of the reason
so many patients return for further procedures.
The process of medicalization includes the power of the medical community, but
also requires the involvement of other groups from society. Conrad (1992) notes that the
involvement and expansion of the medical community is not always intentional in this
process, nor does the medical community gain social control over a problem through
medicalization. The process of medicalization occurs in many ways, from conceptual
thought to interactional experiences. Individuals must also see their problems as medical
conditions, which can occur through self-diagnosis and without the involvement of a
medical professional. Thus, the medicalization of appearance can be measured through
many facets of society including how women view their bodies.
The scholarly research on cosmetic surgery indicates that women tend to see their
bodies in medical and pathological terms. Gimlin (2000) conducted 20 qualitative
interviews with female patients of a cosmetic surgeon and found that many women
blamed genetics for the troubles they experienced with their bodies and described their
bodies as “flawed.” Describing their bodies in terms of flaws and genetics is an
indication that only professional and medical treatment could help. Gillespie (1996) and
Gagné and McGaughey (2002) note that women seek medical intervention in part
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because they are encouraged to view their bodies through a medical lens and in terms of
illness. Dull and West’s (1991) study elaborates on the reductionism involved in the
medicalization process. Through conducting several interviews with cosmetic surgeons
and patients, they found both parties view aspects of the body as diseased or deformed
because they tend to reduce the body to parts. By participating in this type of
reductionism, women distance the self from the flawed part of the body making it easier
to undergo cosmetic surgery.
Research shows that the medical lens is employed throughout the beauty industry.
In their analysis of cosmetic advertisements in women’s magazines and interviews with
cosmetic demonstrators and female consumers, Darden and Worden (1994) found
scientific language and medical appeals are often used to sell products. They also found
that cosmetic products are often associated with achieving a natural beauty, which tells
female consumers it is natural to need professional help to improve their looks. Black
and Sharma (2001) observed and interviewed workers in the beauty therapy industry and
found a similar medical appeal. Some spas and salons evoke a clinical appearance to
appear more professional, describing their services as “treatments” and focusing on
therapeutic aspects. Women are encouraged to view basic beauty services as a matter of
medical intervention through the presentation of beauty therapy as an extension of the
medical profession.
Research indicates the medicalization of women’s beauty is occurring on the
interactional level as evidenced by women’s statements, and the organizational level
through the use of medical appeals in ads. Therefore, I will use the concept of the
21
medicalization of women’s beauty as a frame in my research.
Surgery as Therapy
The idea of cosmetic surgery as therapy incorporates the ideology of
individualism and the need for self-esteem to justify the use of cosmetic surgery.
Psychology is an important instrument for medical professionals and patients, which
validates cosmetic surgery as a means of improving mental health (Fraser 2003). Fraser’s
(2003) analysis of medical texts discussing cosmetic surgery describes the body as an
enterprise in psychology, constantly changing for the purpose of creating happiness.
Gimlin (2000) mirrors this thought when describing the body as a commodity that
individuals constantly modify and upgrade according to their needs.
According to this understanding of the body as a commodity, you can transform
your body until it becomes what you want it to be as a means of “self-help.” This process
is evident when women justify cosmetic surgery as “doing it for one selves” thereby
casting surgery as therapeutic. Gagné and McGaughey (2002) interviewed fifteen
women who had undergone cosmetic surgery and found that they often alluded to the
importance of the alignment of an individual’s self with his/her body. When the body
does not represent the self, the options are to change the body or change the self-image.
Most women who do not participate in forms of beauty enhancement are seen as deviant
or rebelling against standards of feminine beauty. As a result, these women typically
receive negative sanctions from others. For many women, it is difficult to maintain a
positive self-image if they are receiving these negative sanctions (Gillespie 1996).
22
Given the conflicting circumstances surrounding feminine appearance, some
women find cosmetic surgery to be a satisfying solution because it relieves the stress
from being seen as deviant. Cosmetic surgery allows the body and self to align without
cultural disapproval while also relieving stress.
Women tend to be aware of the strong cultural link between the self and
appearance. Even in the daily use of cosmetics, women describe make-up as a way to
show pride in themselves (Darden and Worden 1994). Gimlin (2000) found that because
women are aware of the importance of appearance to feel emotionally satisfied, they tend
to believe surgery is necessary to align their outer selves with their true or inner selves.
Seeking self worth and “feeling good” about oneself is a valid cause in American culture,
which justifies cosmetic surgery as therapeutic if women are seeking a procedure “for
themselves” and not to please others or cultural standards (Dull and West 1991, Gimlin
2000).
Surgeons encourage the beliefs that surgery is therapeutic through their selection
of clients. Dull and West (1991) found surgeons prefer clients who are seeking cosmetic
surgery for themselves. Through doctor-patient interaction, surgeons justify seeking
cosmetic surgery as means to alleviate emotional stress and gain self-esteem for the
patient.
Cosmetic surgery is also therapeutic when women seek surgery as a reward.
Through a content analysis of articles in magazines, Brooks’ (2004) research reveals that
women often describe surgery as a treat or a form of self-indulgence. Black and Sharma
(2001) found similar results in the beauty therapy industry. Beauty therapy has become a
23
leisurely activity for some women who use it as a form of pampering or rewarding
oneself for hard work, long hours, or recent achievements. Cosmetic surgery is
therapeutic for its ability to transform the body as well as reward it. In other words,
women can express themselves more accurately through cosmetic surgery (Brooks 2004).
The need for expression and “feeling good” about oneself is valid in Western culture. I
will use the frame of surgery as therapy in my research because of this interesting
justification for cosmetic surgery.
The Autonomous Voice
The decision to get cosmetic surgery is often portrayed as one of action through
which women exercise control over their lives. I use the term the “autonomous voice” to
refer to this feeling of agency portrayed in the media and felt by women. Brooks (2004)
found cosmetic surgery is presented in the media through a “rhetoric of choice” in which
women choose to do something about their appearance or do nothing. Women are then
commended for their courageous decision to have surgery. These women are portrayed
as courageous, not only for fighting against signs of ageing, but also for admitting to their
use of surgery.
Rebellion and individualism are other qualities associated with patients of
cosmetic surgery. These associations are also found throughout the beauty industry.
Advertisements for cosmetic products often portray women actively fighting against bad
skin or signs of aging (Darden and Worden 1994). Darden and Worden (1994)
emphasize this “active voice” attached to what women accomplish with makeup that
24
“protects,” “conceals,” and “covers.” Black and Sharma’s (2001) study of the beauty
therapy industry shows the purpose of beauty has shifted away from merely attracting a
man. The beauty industry now presents products and treatments as a means of selfdiscovery and individualism. The beauty therapy industry promotes tailoring massproduced products and routine services to the individual needs of each female client,
enhancing the sense of individualism for the client.
Women often perceive the process of cosmetic surgery as an individual choice
unaffected by cultural ideals, giving the feeling of control and autonomy. This feeling of
individualism occurs because the process of diagnosis begins with the women. As Fraser
(2003) observed when analyzing medical texts discussing cosmetic surgery, women
decide a medical problem exists and propose the treatment. Women are responsible for
researching the procedure independently from consultations with surgeons. Furthermore,
they are expected to research their surgeon as well. This responsibility gives a “buyer
beware” message to women that encourages them to act independently, and almost
dispassionately, when deciding to undergo cosmetic surgery. Through the process of
self-diagnosis and research, women get an increased feeling of choice and responsibility.
The sense of individualism gained through the process allows them to perceive their
decision to be unaffected by the influence of cultural norms.
Gillespie (1996) also notes how cosmetic surgery can be empowering at the
individual level. Through surgery, individuals can achieve higher status and social power
by creating a more attractive appearance, overcoming barriers related to the norms of
beauty. The decision to have surgery is rationalized through the frame of the autonomous
25
voice because it allows women to take control of their lives.
The autonomous voice sometimes may be constructed as a false pretense.
Women believe their decisions are made independently when in reality cultural standards
of beauty influence their need for a more appealing appearance, creating a contradiction
between what women believe and what they do (Gillespie 1996). Gillespie (1996) refers
to this contradiction as a “paradox of choice” because women believe their choice is an
individual decision, but the choice itself is a result of cultural norms. Furthermore,
women come to surgeons as clients requesting work, but in the end the surgeons decide
what work will be done and what changes to make (Fraser 2003, Dull and West 1991).
Surgeons often suggest additional work, too. Discussing this contradiction, Gimlin
(2000) notes that the autonomy women feel exists is limited by a larger system of cultural
subordination.
Whether women are autonomous or merely perceive themselves to be
autonomous actors, the autonomous voice is an important frame surrounding cosmetic
surgery and will be used in my analysis.
Perfection as Normalcy
Ideal beauty consists of a limited ideal of perfection and the more limited this
ideal beauty becomes, the more likely it is that women will seek perfection to feel
normal. Brooks (2004) discusses the change in beauty to this narrow vision of perfection
as the “pathological inversion of the norm.” The pathological inversion of the norm
refers to the idea that because several ways to enhance appearance exist, a “normal”
26
appearance has become displeasing and a “beautiful” or “perfect” appearance has become
normal and expected. This idea is linked to cosmetic surgery because surgery allows
anyone to meet these standards of beauty (Gillespie 1996). If you are not born with a
beautiful face, you are expected to use make-up to cover up blemishes and surgery to
permanently fix flaws. In other words, so many ways to achieve beauty exist that
appearance is no longer left to chance. Therefore, the expectation of perfection is more
prevalent because it can easily be achieved.
As standards of beauty increasingly demand perfection and the use of surgery
increases, the variety that should exist among women’s beauty disappears and ideal
beauty becomes more limited. As mentioned before, cosmetic surgery is often used to
remove signs of race (Gilman 1999). Typically, women who have racial features
surgically removed tend to alter them to blend in with the dominant group and their ideal
of beauty, limiting the physical differences between two or more racial groups. Jones
(2004) also notes that surgery has blurred the lines between generations and different
ages by extending a youthful look to all ages. Jones refers to this extension of a youthful
appearance as a “stretched middle age” in which no one knows what a woman should
look like at the age of 30, 40, or 50.
As more women turn to cosmetic surgery to erase signs of aging and race, a very
limited ideal of beauty is created. This limited ideal encourages women to seek cosmetic
surgery, which in turn increases standards of beauty. The cycle created by the interaction
of standards of beauty with cosmetic surgery creates unrealistic expectations of beauty,
which most women would require surgery to fulfill.
27
Cosmetic surgery is unique to the beauty industry because instead of masking an
unattractive appearance with clothes or makeup, cosmetic surgery can transform the body
permanently. Interestingly, this technology is being used so women can feel normal. In
studies involving patients of cosmetic surgery, women have consistently described
getting surgery to fit in and feel normal (Dull and West 1991, Gimlin 2000). This
provides evidence for the “pathological inversion of the norm” because women feel
normal only if they have achieved this narrow version of perfection. Brooks’ (2004)
study shows that to many women cosmetic surgery is a form of body maintenance, even a
healthy alternative to exercise. This sort of comparison puts cosmetic surgery on the
same level as other routine forms of appearance enhancement, such as haircuts, clothing,
and makeup. Comparing cosmetic surgery to routine forms of appearance maintenance
may be part of the reason so many women think of surgery so casually, as though surgery
is a common need for any woman. In Gagné and McGaughey’s (2002) interviews with
fifteen female patients of cosmetic surgery, each one said cosmetic surgery is a natural
choice every woman would use if she could.
The beauty industry in general promotes the idea that women are incomplete
without cosmetic products and services. Women tend to believe that their natural
appearance is unacceptable and cosmetic assistance (products, services, surgery) is
needed to feel whole. Darden and Worden’s (1994) study reflects this logic as one
woman described her makeup as a uniform, something required to fit in, matching her
beauty to that of others. But the use of makeup does not make her feel exceptionally
beautiful, only average. Black and Sharma (2001) found clients in the beauty therapy
28
industry used services to regulate their bodies realizing they could never achieve
idealized beauty. Yet these studies provide evidence for the “pathological inversion of
the norm” because the vision of beauty has risen to such demanding standards that
women need to go to such measures and maintenance to feel acceptably beautiful, not
exceptionally beautiful. Cosmetic surgery is unique in the beauty industry because it
advertises the ability to achieve high standards of beauty in a fairly permanent fashion.
The normalization of high standards of beauty occurs in many ways. The media
plays a large role in the process of exposing women to idealized beauty because it
visually presents women who meet these expectations. Women do not have to think
about what “skinny” is because they see models who exemplify this ideal in magazines,
television, and movies. Mazur’s (1986) study of beauty trends in the U.S. notes standards
of beauty are developed and normalized through the exposure of bodies in the media.
The increased exposure of women’s bodies through the media allows for the comparison
and development of “perfect” bodies. At the same time exposure to these perfect bodies
increases the likelihood that women will internalize norms of idealized beauty, which
may be part of the reason some women seek cosmetic surgery to feel normal.
Interestingly, women are encouraged by surgeons to use magazines as sources for their
desired looks, yet these magazines will inevitably feature models that embody idealized
beauty (Fraser 2003). At the same time that women are encouraged to reference perfect
pictures for their desires, they are encouraged to keep reasonable expectations about what
cosmetic surgery can achieve for them. It seems unlikely that most women are able to
maintain realistic expectations under these circumstances. Given the interaction of the
29
media with women’s expectations of beauty, it is important that I include the frame of
perfection as normalcy in my analysis of women’s magazines.
The four frames I developed from the literature are often used by real patients and
medical professionals to describe the experience of cosmetic surgery. Since actual
patients and surgeons, not fictional or hypothetical characters, use these frames, I except
to find them in my analysis of women’s magazines. My research objective is to observe
how frequently the media uses these frames and in what ways these frames are used to
support or oppose cosmetic surgery. Because few research studies have focused on
representations of cosmetic surgery in the media, I am only analyzing these four frames
that I was able to gleam from the literature.
It is likely these four frames can persuade some women to think positively about
the process of cosmetic surgery or encourage them to get cosmetic surgery. To assess the
messages women may be exposed to, I will also analyze the presentation of these frames
in relation to other various variables, such as type of procedures mentioned, reference to
age, and use of visual images. As previously discussed, the effectiveness of frames
depends on the credibility with which they are established, including the creditability of
the person making the claims, as well as how well the frames resonate with readers.
Therefore my research will account for features of credibility through analysis of
information about the authors of articles. Through my research I intend to provide a
rudimentary, yet crucial, description of what women are exposed to daily through the
media. Understanding what frames are used in the media, and in what ways, will allow
30
further research to explore how the media may influence women’s decisions to get
cosmetic surgery.
CHAPTER 3
METHODS
My research objective is to analyze how cosmetic surgery is framed in women’s
magazines to better understand women’s exposure to messages in the media. To
accomplish this objective, I chose to do a content analysis of women’s magazines. I
decided to analyze women’s magazines for two reasons. First of all, in the print media,
frames can be directly observed and coded. Secondly, I needed to choose a media source
in which my topic of interest is likely to occur. Women’s magazines, I felt, are more
likely to reference cosmetic surgery than other sources of print media. Using writings
found in women’s magazines, I was able to code the basic content of the articles, such as
procedures mentioned and authority of the author as well as the four frames I developed
from the sociological literature about cosmetic surgery.
Below I go over the steps I took to develop my research. First, I discuss how I
determined my sample. This discussion includes the selection of magazines as well as
articles. Next, I discuss my coding scheme for the articles selected. I detail the
operational definitions of general characteristics variables, content variables, and
indicators for my four frames. After detailing my coding scheme, I discuss what I expect
to find based on my research through hypotheses. Finally, I discuss the method of
31
32
analysis that I use to develop a description of the topic of cosmetic surgery in women’s
magazines and to find support for my hypotheses.
SAMPLE
I drew my sample from seven different magazines, covering the years 2004 and
2005, for a total of 70 articles about cosmetic surgery.
Selecting Magazines
I selected the magazines for article analysis to provide coverage of a variety of
female audiences as well as allowing for the comparison of magazines across different
types. I developed a system of categorization for different types of magazines after
examining circulation rates, publisher’s statements, and reference materials. Also, when
considering the magazines for my sample, I purposively selected magazines that I
expected to include articles about cosmetic surgery among articles about other women’s
issues. Therefore, within the system of categorization I chose magazines that seem more
likely to discuss this topic in articles.
I will examine four different types of magazines. The first three types are drawn
from Doner’s categorization of “who’s who” in women’s magazines (1993). In her
article, women’s magazines are divided into traditional services, fashion and beauty, and
specialty titles. I have included all three of these types of magazines in my sample as
traditional women’s, fashion and beauty, and target audience magazines. While Doner
33
(1993) has placed ethnic-focused magazines under the category of specialty titles, I have
renamed this type as target audience because these magazines cover the same issues as
other women’s magazines, but for specific racial audiences. My last type of magazines
includes a magazine that focuses on image-enhancing technology, such as cosmetic
surgery. Therefore I will refer to this type of magazine as surgical.
After creating the four types of magazines to analyze, I selected magazines to
include in each type. For traditional women’s magazines, I have selected Redbook and
Ladies Home Journal. Both magazines have a high circulation rate (about 2.5 and 4
million respectively (SRDS 2006)) and will be categorized as traditional women’s
magazines for my research because the articles in these magazines tend to cover a broad
range of women’s issues and topics. For fashion and beauty, I have selected two
magazines. They are Glamour and Vogue, which tend to focus primarily on fashion,
beauty, and style, while discussing women’s issues to a lesser degree. For the target
audience magazines, I have selected Essence and Latina. The last type of magazine was
derived from a newly published magazine that focuses on image-enhancing education in
general, Skin Deep. This magazine, published by Meducation, Inc., is unique to the
magazine market because it is devoted to all things cosmetic, specifically cosmetic
surgery. Also, the magazine uses Board Certified surgeons to write the majority of the
articles in the magazine to educate readers of the process of cosmetic surgery. Because
Skin Deep is different from most women’s magazines, it is the only one which falls into
the surgical type.
34
Women’s magazines often target specific racial audiences. Therefore, magazines
will be sub-categorized by the race of the intended audience. Essence and Latina
represent some of the media specifically targeted to minority women. Essence is targeted
towards African American women and Latina is targeted towards Hispanic women.
While the other magazines do not specifically target Caucasian women, they do focus on
a Caucasian lifestyle and will be categorized as such.
Initially, I thought the variety of magazines being sampled would cover a range of
age and allow me to compare sub-categorize the magazine sample for age comparisons.
Using Magazines for Libraries (2005), the target audience of most these magazines were
listed according to high school readers, general adult, academic adult, and special adults.
While these categorizations can be meaningful, the categorization of the magazines from
my sample would provide for a skewed sample of articles, which would not allow for
appropriate comparisons. Therefore, I will not compare my sample according the age of
audience.
My sample of magazines includes Redbook, Ladies Home Journal, Essence,
Latina, Glamour, Vogue, and Skin Deep. The variety of these magazines should provide
interesting comparisons across type of magazine as well as race of audience.
Selecting Articles
For the purposes of my study, I selected any writings that discussed cosmetic
surgery excluding commercial advertisements. Thus, not all of the writings I included in
my sample are articles in the traditional sense. I also included columns and
35
question/answer sections as well as letters from the readers and editor’s notes. I included
any writing that discussed cosmetic surgery because the context of cosmetic surgery may
affect the frames presented to readers. For example, a letter from a reader may be much
shorter than a feature article, but the letter may convey a clearer frame of acceptance than
the article, which has three pages to use several frames and can convey multiple
messages. While I refer to each separate writing in my data as an article, it is important
to note that for this study, the term “article” is much broader than it is in typical use.
Prior to selecting and coding articles that discussed cosmetic surgery, I developed
a description of cosmetic surgery that served the purposes of my research. For my
purposes, cosmetic surgery includes invasive procedures, which require a scalpel, and so
called “noninvasive” procedures that typically involve injecting dermal fillers or
chemicals underneath the skin. I chose to include noninvasive procedures because they
can have serious health risks and are often used in conjunction with invasive surgical
procedures. I did not include procedures that involve laser treatment or laser therapy as
well as other procedures which involve treating the surface of the skin. I did not include
these procedures because it is unclear which procedures that use chemical, medical
equipment, or lasers are invasive to the skin and/or require medical professionals to
administer them. Because of the lack of clarity, I chose not to include any of these
procedures in my sample.
Furthermore, the articles I selected focus on cosmetic surgery as opposed to
reconstructive surgery. As previously mentioned, reconstructive surgery involves
treating deformities, injuries, or physical ailments while cosmetic surgery is used for
36
aesthetic purposes. Sometimes the context under which a procedure is performed affects
whether the surgery is considered cosmetic or reconstructive. For example, breast
reduction surgery can be performed to relieve back pain and stress, but it can also be
performed on patients who do not experience pain but prefer a smaller breast size. In the
latter case, the surgery is cosmetic in nature and thus is included in my sample. This
difference is most clear in my selection of articles from the surgical magazine. Some
articles focused on procedures that deal with sensation and physical feeling, such as the
“toe-tuck.” In this procedure, aesthetic appearance changes but the goal is to create a
more comfortable feeling in the foot for women who wear fashionable shoes. In other
words, the aesthetic change is secondary to the physical functioning or sensation of the
body. Articles that include surgeries of this manner were not included because they are
typically performed for other physical purposes besides appearance.
I had to omit three articles from my sample due to repetition. In the 2005 issue of
Skin Deep, three of the articles are repeated from the 2004 issue. While the titles and
visual images are changed, the text is still the same and thus was not included in the final
sample. However, the difference in presentation through the two years is significant and
will be discussed in more detail later.
Final Sample
I drew my sample from seven different magazines from the years 2004 and 2005.
I selected the articles for analysis by looking through each publication in the two years
37
and reading page by page for writings that discuss cosmetic surgery. After reading
through each magazine, I have a total of 70 articles included in my sample.
Table 3.1 shows the total number of articles for each magazine title and magazine
type. Fifty-one percent of my sample was found in fashion magazines, with half found in
Glamour and the other half found in Vogue. Twenty-nine percent of my sample came
from the surgical magazine Skin Deep. Eleven percent of the articles came from the
target audience magazines, with seven percent found in Essence and four percent found
in Latina. The traditional women’s magazines accounted for nine percent of the sample,
all of which came from Redbook. Ladies Homes Journal did not have any articles that
discuss cosmetic surgery.
Table 3.1: Type of Magazine and Title of Magazine, 2004-2005 (n=70 articles)
Type/Title of Magazine
Traditional
- Redbook
- Ladies Home Journal
Target Audience
- Essence
- Latina
Fashion
- Glamour
- Vogue
Surgical
- Skin Deep
Total
N
6
6
-8
5
3
36
18
18
20
20
70
*Percentages may not add up to 100 due to rounding.
%
9
9
-11
7
4
51
26
26
29
29
100
38
OPERATIONAL DEFINTIONS OF VARAIABLES
After collecting my sample, I coded the articles for characteristics of the articles
as well as content and framing. I developed variables which examine the characteristics
and content of the articles, as is often done in content analyses, to contextualize the topic
of cosmetic surgery. These variables provide an overview of the various vehicles used to
present the four frames I developed which may be used in articles about cosmetic
surgery. The characteristic features of the articles include time of publication, location of
article, page length, and author’s information. The content driven variables are type of
procedures, specific procedures mentioned, age mentioned, accompanying visual images,
and representation of cosmetic surgery. Finally, framing is coded according to the four
frames I developed from the literature about cosmetic surgery. The framing variables
examine specific messages that may be linked to the topic of cosmetic surgery. All of
these variables are discussed in detail below.
Characteristics of the Articles
Time of publication. Time of publication is measured through two variables. The
first is the year of publication. In terms of year, each article was collected from 2004 or
2005 and was coded accordingly. The second variable is month of publication. Month of
publication was coded according to the twelve months of the calendar year. While I was
able to code the year of publication for all of the magazines, I was not able to code for
month of publication for articles from Skin Deep. Skin Deep is a yearly publication
39
unlike the other magazines which are all monthly publications. Therefore I was not able
to code the month for this one magazine. The total number of articles included for the
variable of month is 50.
The variable of month was then collapsed into season of publication. I formed
four categories for season: Winter, spring, summer, and fall. Winter is made up of the
months December, January, and February. Spring consists of the months of March,
April, and May. June, July, and August are placed under summer. Fall is made up of the
months of September, October, and November. Since month of publication was not
coded for Skin Deep, neither was season of publication. The total number of articles
coded for season is 50.
Location of article. Location of the article is measured using two different
variables. The first variable is section. This variable codes the section of the magazine in
which the article is written. For instance, most women’s magazines have a health and
beauty section. An article which discusses cosmetic surgery may use different frames
depending on whether the focus is on health issues or beauty fixes. Typically, I was able
to use the table of contents to determine the section of the article. Occasionally the
section was not clear in the table of contents and was determined by surrounding articles,
the focus of the article, and if it appeared on the cover. The articles coded as features
tended to appear more than once in the table of contents and also appeared on the cover.
The six categories for section are beauty, health, men’s opinion, feature, readers’ letters,
and editor’s notes.
40
The location of the article is also measured by determining the page location of
the article in the magazine. Originally, I recorded the page number the article begins on
and the total number of pages in the magazine. These two variables were changed into a
new variable by dividing the starting page of the article by the total number of pages in
the magazine. The page location in the magazine reports where the article begins in
terms of percent through the magazine. This variable was then changed into a categorical
variable with four different categorizations: first quarter of the magazine, second quarter,
third quarter, and the fourth quarter of the magazine.
Location of the article is coded for all of the magazines except Skin Deep. Since
Skin Deep focuses on anti-aging technology throughout the magazine, the table of
contents does not list the articles according to section. Furthermore, since cosmetic
surgery is mentioned consistently throughout the magazine, it is not significant to
calculate where these articles tend to be located. Therefore, only 50 articles were coded
for section and page location.
Length of article. Length of the article is measured using one variable. Since all
of the magazines have relatively similar size pages, the length of article was measured in
terms of page length. The total length was observed from the start of the article to the
end, including visual images. By this I mean if one page consisted of only visual
illustrations while one and half consisted of text, the page length recorded was two and
half. Recorded page length ranges from as long as eight pages to as small as one thirtysecond of a page.
41
Author’s information. Author’s information is coded with four variables. First,
the author’s gender was coded, either male or female, if the gender could be determined.
I was able to code gender for 60 authors. The second variable is author’s degree. This
variable coded the highest level of the author’s education referenced if mentioned at all. I
was able to code education for 20 authors, which falls into one of three categories. These
categories are masters, doctorate, and medical degree (MD/RN). The third variable is
author’s work. This variable specifies the author’s profession and was collected
originally as a string variable. After collecting this variable from all of the applicable
articles, the list of professions was collapsed into four categories: writer, medical
professional, superintendent, and beauty director. Twenty-nine authors were coded
according to their profession. These first three variables rely on information that may or
may not be given in the article. Therefore each of these variables has a different number
of articles with the information provided.
The last variable coding author’s information is whether the author is presented as
an expert or not (author is an expert). This variable is determined in part by looking at
the topic of discussion in comparison to the author’s profession as well as how the author
presents the material. Typically, authors who are medical professionals or who have
conducted their own research on the topic are coded as an expert. While many authors
reference medical professionals, expertise on the topic is not necessarily established and
in most cases the author is merely being informed from one source. Therefore, authors
42
whose professions are not related to the topic are not considered experts for this study.
All 70 articles were coded for this variable.
Content of the Articles
Mentions of cosmetic procedures. Cosmetic procedures are observed through two
different variables. The first is type of procedures. Type of procedures refers to whether
the article discussed surgical procedures, non-surgical procedures, or both. As mentioned
when I defined cosmetic surgery for this study, invasive surgical procedures are included
in the study as well as so called “noninvasive” procedures. It is important to know which
type of procedures articles are discussing because the health risks, recovery time, and
aesthetic changes for the patient vary depending on the type of surgery discussed, and the
frames may vary as well. Also, if both surgical and non-surgical procedures are
discussed, the message may differ yet again. All 70 articles were coded for this variable
and only one did not directly discuss either type of procedures. This article was a letter
from a reader and was included in the sample because it was a response to an article
about cosmetic surgery in the previous issue. This one article was coded as neither
surgical nor non-surgical.
Cosmetic procedures were also coded as specific procedures mentioned. For this
variable I recorded each cosmetic procedure mentioned in an article without duplicates.
When I say without duplicates, I mean that if liposuction was mentioned four times
throughout the article, it was only recorded once. After recording this information for all
of the articles, I examined the different specific procedures mentioned and cleaned the
43
data into more inclusive classifications according to the type of procedure as well as the
location of the procedure on the body or purpose of the procedure. I grouped the surgical
procedures into the seven categories of facial work, breast work, lower body work,
liposuction, implants, upper arm surgery, and excisional lifting. Non-surgical procedures
were divided into only two categories: dermal filler injections and spider vein/cellulite
treatments. Most of these categories include sub-categories that are more specific in
terms of procedures mentioned.
After the specific procedures were reclassified, the number of mentions remained
the same. For example, if an article mentioned breast implants, breast lift, and breast
augmentation, three mentions are recorded for that article. However, after collapsing
surgeries into the specified categories, the article now has three mentions of breast
augmentation. Thus one article may mention several procedures that, under the new
classification, are coded for the same area of the body. The total number of specific
procedures mentioned for all seven magazines is 184.
Mentions of age. I coded for mentions of age similarly to how I coded for
specific procedures mentioned. Originally, I recorded each reference made to age in
relation to receiving cosmetic procedures or being aware of needing surgery presently or
in the future. This reference could be made in terms of the author’s age, the age of a
patient or person in particular, or age in general. Similar to how I coded cosmetic
procedures, I did not record the same age twice for the same article. However, I did
record specific ages (29, 35) and categorical ages (teens, twenties). Therefore, if one
44
article mentions the twenties twice and the age of 29 specifically, I recorded two
mentions of age for the article, twenties and 29. After recording all the mentions of age
for all articles, I categorized mentions into significant groupings. The following
categories are the final five categories used in my analysis: teens, twenties, thirties,
forties, and fifty and above. Most of these categories are broken into subcategories,
giving a more detailed description of how age is mentioned in my sample. A total of 91
mentions are included in my data.
Visual Images. I coded all visual images that accompanied the text of the articles
included in my sample. Visual images, for the purposes of this study, include any
photographs of people or objects as well as illustrations, drawings, or diagrams. Initially
I recorded the visual images as string variables. For each visual image, I wrote a brief
description that summarized the content of the image. After describing all the visual
images, I was able to assess the significant differences between the visual images. Once I
established the significant differences, I developed a coding scheme that established the
characteristics of the visual images. I coded each visual image for people present as well
as the characteristics of the people, and for objects present, including the function of the
object. Finally, I coded the surgical significance of the visual images. A total of 206
visual images were coded for 70 articles.
I coded for the presence of people through multiple variables. First I coded if the
visual image features people through a simple yes or no variable. Then I coded how
many people were featured in the article, with the categories ranging from one person to
45
six or more. Then I coded for the presence of a primary person through another simple
yes or no variable. A primary person was determined if one person was the focus of the
visual image or stood out from the other people in the visual image. If there was a
primary person featured in the visual image, I then coded the characteristics of this
person (characteristics of people). These characteristics include gender (male or female),
authenticity (model, celebrity, author, or ordinary person), and part of the body shown.
Out of the 206 visual images, 160 featured people and 156 featured a primary person.
I also coded for the presence of objects using two variables. The first variable
(features object) codes for the presence of an object or objects through a simple yes or no
dichotomy. If an object is featured in a visual image, I then coded more specifically the
characteristics of the objects. Most of the objects fell into one of two categories: medical
objects, which consist of medical equipment, medical supplies, and medical diagrams, or
body focused object, including exercise/weight focused equipment and cosmetic
products. A few objects did not fit any of these descriptions and were placed in an
“other” category due to the small numbers of these objects. Many of these objects were
sub-categorized as “fake” people. The category of “fake” people means that the image or
imitation of people is established through objects, such as dolls.
Finally, I coded for any surgically focused visual images. Again, I began with a
simple yes or no variable to code any surgical significance. If the visual image is related
to cosmetic surgery, I further coded for six specific surgical relations: before-and-after
pictures, after-surgery results, intraoperative illustration, medical supplies and equipment,
medical diagram, or surgery diagrammed on the body. An intraoperative illustration is a
46
photograph of the surgery as it is taking place. For the purposes of this study, an
intraoperative image includes staged photographs that mimic real photographs of surgery
as well as photographs of real surgeries. If a visual image diagrams the surgery on the
body, the visual image either has actual lines drawn of the body indicating where the
surgeon will cut or inject the skin or comments and lines are drawn over a photograph to
illustrate what parts of the body should be surgically altered. It is important to note that
one visual image may be surgically linked in more than one way. For example, in a
before-and-after image, the before photograph may show the body with the surgery
diagrammed on the body. In this case, the visual image is surgically significant in two
ways.
Representation of cosmetic surgery. For each article, I coded the overall
representation of cosmetic surgery in the text according to four categories. Articles were
coded as in support, cautionary, both supportive and advisory, or neither supportive or
advisory. Articles that are in support of cosmetic surgery present surgery in a positive
light. They highlight the benefits of surgery. Cautionary articles tend to expose the
dangers and negative side of cosmetic surgery, warning the reader against surgery.
Articles which are coded as both tend to caution the reader while also highlighting the
positive aspects of cosmetic surgery. In the case of neither, these articles tend to provide
unbiased information and do not advise against or for cosmetic surgery. All 70 articles
were included for this variable.
47
Framing of the Articles
As mentioned before, I developed four frames about cosmetic surgery. They are
the medicalization of women’s beauty, surgery as therapy, the autonomous voice, and
perfection as normalcy. For each frame, I created indicators which represent the
components of the frame. These indicators were coded using two different forms of
measurement. First, each indicator was coded for presence. Reading through each
article, I coded if the indicator is present or not present through a yes or no dichotomy. It
is important to note that many of the indicators depend not only on the words used but the
context in which they are used. Therefore, the presence of an indicator is determined by
the surrounding sentences, not just the precise wording of the indicator. After coding for
the presence of each indicator, I recorded how often the indicator occurred in the article.
This coding shows the frequency of these qualitative variables. All 70 articles were
coded for these variables. Below I discuss more specifically the indicators used for each
of the four frames.
Medicalization of women’s beauty. The medicalization of women’s beauty is a
frame I developed from the literature that explains cosmetic surgery as a medical process
and refers to an individual’s appearance in medical terms. I developed eight indicators
that summarize the medicalization frame, all of which are described in Table 3.2. The
first indicator (flaws) is describing appearance in terms of flaws or defects, indicating that
appearance is defective and needs correction. The second indicator (genetics) is
referencing biology, DNA, or genes when discussing appearance. The use of genetics
48
indicates that appearance is the result of biological processes that cannot be altered
without medical help. The third indicator (illness) is seeing appearance as an illness and
variations of the term, “illness.” Describing appearance as diseased, disfigured, or ill
indicates a medical condition, which requires medical treatment. The fourth indicator
(professional help) is the idea that professional or expert medical help is needed to fix or
enhance appearance. The fifth indicator (healthy alternative) is emphasizing cosmetic
surgery as a healthy alternative to other forms of appearance enhancement. Using
liposuction to remove the little fat that has not disappeared due to exercise is an example
because it refers to cosmetic surgery as an alternative to healthy habits. The sixth
indicator (achieving the impossible) is claiming cosmetic surgery can achieve the
impossible or achieve what otherwise could not be done. Referring to the results of
cosmetic surgery as magic or a miracle is included in this indicator. The seventh
indicator (medical environment) consists of describing the medical environment or
clinical facilities in detail. The final indicator (scientific language) for this frame is using
scientific or medical language. Emphasizing the scientific or medical processes involved
in cosmetic surgery means viewing the body in terms of a medical being and not in terms
of a whole, emotionally complex person. This concept is key to the medicalization
frame.
49
Table 3.2: Operational definitions of Indicators for Medicalization of Women’s Beauty
Medicalization of Women’s Beauty
1. Flaws
Describing appearance with flaws, irregularities, or
defects
2. Genetics
Referencing biology, DNA, or genes when discussing
appearance
3. Illness
Indicates that appearance is a medical condition by
describing it as diseased, disfigured, or ill
4. Needing Professional Expressing the need for a medical professional or
Help
expert to fix or enhance appearance
5. Healthy Alternative
Describing cosmetic surgery as an alternative to other
forms of appearance enhancement while emphasizing
the safety of the surgery
6. Achieving the
Describing surgery as achieve something impossible or
Impossible
could never have been achieved otherwise; mentioning
the results of surgery as a miracle or magic.
7. Medical Environment Describing the environment of medical offices or
clinical facilities
8. Scientific and Medical Using language that parallels science or emphasizes the
Language
chemical processes; using medical language and
describing processes in medical terms (not common
language)
Surgery as therapy. The surgery as therapy frame emphasizes viewing the body
and appearance as part of the emotional and mental well-being of the individual. I
developed six indicators that encompass the main concepts of this frame, all of which are
described in Table 3.3. The first indicator (self-esteem) refers to the ways in which
cosmetic surgery can affect an individual’s self-esteem, self-image, and confidence. This
reference can be to the state of esteem prior to or after receiving cosmetic surgery. The
second indicator (self-expression) is the self-expression gained through the process of
cosmetic surgery. This expression includes paralleling cosmetic surgery to therapy or
50
psychology. The third indicator (alignment to the true self) specifies the ability of
surgery to align the outer self to the true self. This reference can also include matching
the outside to the inside or other phrases that involve changing appearance to match the
individual’s personality. The fourth indicator (deserving) is referring to cosmetic surgery
as something one deserves as a reward or treat, including emphasizing the luxury or
leisure in getting surgery as a form of pampering. The fifth indicator (because you are
worth it) is using the “because you are worth it” rationale to justify cosmetic surgery.
This rationale indicates that you have earned the surgery and value yourself enough to get
it. The last indicator (for me) of this frame emphasizes getting cosmetic surgery for
oneself and no one else, implying the decision is for personal needs and not others’
expectations.
Table 3.3: Operational Definitions of Indicators for Surgery as Therapy
Surgery as Therapy
1. Self-esteem
2. Self-expression
3. Alignment to the
True Self
4. Deserving
5. Because you are
Worth It
6. For Me
Referring to the ways in which cosmetic surgery affects
self-esteem, self-image, and confidence
Mentioning how surgery allows the individual to express
his/herself, either therapeutically and psychologically
Referring to matching the outside to the inside, or the
true self to the outer self, due to cosmetic surgery
Discusses cosmetic surgery as a luxury or leisurely
activity used to pamper, treat, or reward those who
deserve or have earned it
Using the “because you are worth it” rationale to justify
cosmetic surgery
Discussing the use of surgery as for personal benefits, or
for oneself, and not to please others’ expectations
51
The autonomous voice. The autonomous voice is a frame which emphasizes the
individuality and action involved in changing one’s appearance, especially doing so with
cosmetic surgery. To cover the main concepts of this frame, I developed six indicators
discussed here and described in Table 3.4. The first indicator (individualized) is the sense
of individualism throughout the process of cosmetic surgery. This sense of individualism
includes emphasizing the patient’s involvement in researching the surgeon and the
procedure as well as tailoring surgery to the personal needs of the patient. The process
then becomes a rationalized choice on the part of the patient. The second indicator
(autonomy) is the autonomy used to decide to get cosmetic surgery. This “autonomy” is
discussed as an individual decision made by the patient without the influence of others’
opinions. The third indicator (active voice) is the active voice, which emphasizes control,
power, or action in terms of appearance through pro-active language. The fourth
indicator (rebellious tone) also conveys action, but does so with a rebellious tone. In this
case, language includes fighting aging, winning the war, saving your beauty, or other
phrases that convey more dramatic action taken against or for appearance. The fifth
indicator (emotional strength) describes the emotional strength involved in getting
cosmetic surgery. This indicator includes the courage to decide to get cosmetic surgery
and the pride in the decision and results. The last indicator (empowering) is the
empowering feeling gained from cosmetic surgery, including a feeling of liberation.
52
Table 3.4: Operational Definitions of Indicators for the Autonomous Voice
The Autonomous Voice
1. Individualized
Describes the research involved on the part of the patient;
refers to the choice to get cosmetic surgery as rational or
logical; describes the surgery a tailoring to individual
needs
2. Autonomy
Describes coming to the decision to get cosmetic surgery
by oneself; using the “by me, for me” rationale when
explaining the decision to get surgery
3. Active Voice
Terming the surgery in pro-active language that
emphasizes control, power, or action
4. Rebellious Tone
Describes the actions take towards appearance as
rebellious; fighting aging; winning the war; saving your
beauty
5. Emotional
Describes the courage throughout the process of cosmetic
Strength
surgery and the pride involved with the decision/results
6. Empowering
Referring to the liberating and empowering emotional
effects of cosmetic surgery
Perfection as normalcy. The frame of perfection as normalcy refers to the
increase in standards of beauty to the point where what was once considered beautiful is
now normal and many women use cosmetic surgery to achieve these “normal”
expectations. As shown in Table 3.5, I developed seven indicators to measure this frame.
The first indicator (to be normal) is the use of surgery to appear normal or to fit in. This
reference conveys the use of surgery to achieve an ordinary appearance, which indicates
the demanding standards of beauty. The second indicator (maintenance) is referring to
surgery as a form of maintenance similar to exercise, makeup, and other forms of
appearance enhancement. The use of surgery to maintain appearance includes the idea
that appearance needs to be regulated through regimens which include cosmetic surgery.
53
The third indicator (reasonable expectations) involves the reasonable, moderate, or
realistic expectations patients are expected to have in terms of the results of cosmetic
surgery. These realistic expectations relate to this frame because women are seeking
surgery with the expectation of looking normal and not extraordinary. Similarly, the
fourth indicator (not to be beautiful) is the use of cosmetic surgery with the understanding
that after the surgery the patient will not be beautiful. Again, this indicator shows that to
some women surgery is needed to appear normal, which indicates that idealized standards
of beauty have become normal. The fifth indicator (natural) parallels cosmetic surgery to
nature. This reference is done by describing cosmetic surgery as a natural choice or
emphasizing the natural appearance or results achieved through cosmetic surgery. The
sixth indicator (normative) is the normative use of cosmetic surgery expressed through
referencing the larger population. Phrases such as “everyone would” or “who wouldn’t”
indicate this idea by stating that surgery is so common everyone should or would chose to
get it. The seventh indicator (perfection) is the use of perfection or idealized standards
when discussing appearance. Discussing the body in terms of perfection or imperfection
implies that societal expectations include perfection and that perfection is achievable.
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Table 3.5: Operational Definitions of Indicators for Perfection as Normalcy
Perfection as Normalcy
1. To Be Normal
2. Maintenance
3. Reasonable
Expectations
4. Not To Be
Beautiful
5. Natural
6. Normative
7. Perfection
Refers to using cosmetic surgery to appear normal, fit in,
or look ordinary
Mentions cosmetic surgery as means to maintain or
regulate appearance; part of a regimen
Describes or emphasizes having moderate, reasonable, or
realistic expectation towards to result of cosmetic surgery
Describes the purpose of cosmetic surgery as not to be
beautiful
Describes cosmetic surgery as a natural choice or
emphasizes the natural appearance/results of cosmetic
surgery; parallels surgical processes to nature
Refers to the normative use of cosmetic surgery by
emphasizing that everyone should/would if they could
Refers to achieving, or attempting to achieve, perfection
or ideals; discussing the body in terms of imperfection or
perfection
HYPOTHESES
While my research objective is to describe what representations of cosmetic
surgery exist in the media, I was able to develop some hypotheses about what I expect to
find. I developed two types of hypotheses based on either magazine type or race of
audience. These hypotheses estimate the relationship according to the number of articles
I expect to find as well as which frames I expect to be most prevalent. I used publisher’s
statements, reference materials, and the literature from which I developed the four frames
to create my hypotheses. This information allowed me to estimate the focus of each
magazine and which frames are likely to align with the goals of each magazine type.
55
Type of Magazine
1. Fashion and beauty magazines are more likely to feature articles about cosmetic
surgery than traditional women’s magazines.
2. Articles from fashion and beauty magazines are more likely to use the frames of
medicalization of women’s beauty and perfection as normalcy than articles from
traditional women’s magazines.
3. Articles from traditional women’s magazines are more likely to use the frames of
surgery as therapy and the autonomous voice than articles from fashion and beauty
magazines.
4. While all four frames will be present in the surgical magazine, the frame of
medicalization of women’s beauty is more likely to occur than the other three frames.
Race of Audience
5. The target audience magazines are less likely to feature articles about cosmetic
surgery than the magazines that target European American audiences.
6. Articles in the target audience magazines are more likely to use the frame of
perfection as normalcy than articles in magazines that target European American
audiences.
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Rationales
As mentioned above, I developed hypotheses after being informed of the intent of
each magazine through publisher’s statements and comparing these statements with the
literature about cosmetic surgery. The first and fifth hypotheses address the likelihood
that magazine types will feature articles about cosmetic surgery. As my first hypothesis
states, I believe that fashion and beauty magazines are more likely to feature articles
about cosmetic surgery than traditional women’s magazines because a large portion of
these magazines address issues of beauty and appearance. Traditional women’s
magazines approach their audience as decision makers for a household and, therefore,
traditional women’s magazines cover more topics than fashion and beauty magazines and
have less room to dedicate to issues of appearance. My fifth hypothesis, that target
audience magazines are less likely to feature articles about cosmetic surgery than
magazines which target European American audiences, is drawn from the publisher’s
statements that state that minority culture is embraced in target audience magazines.
Because cosmetic surgery can be seen as an attempt to diminish racial features or an
absence of pride for one’s heritage, I believe target audience magazines will not feature
the topic of cosmetic surgery as frequently as other magazine types.
My second and third hypotheses state the expected relationship between the use of
frames in articles from traditional women’s and fashion and beauty magazines. I expect
articles in the fashion and beauty magazines to use the frames of the medicalization of
women’s beauty and perfection as normalcy more frequently than articles in traditional
women’s magazines. Meanwhile, I believe that articles in the traditional women’s
57
magazines are more likely to use the frames of surgery as therapy and the autonomous
voice than articles in fashion and beauty magazines. My rationale for these hypotheses is
that traditional women’s magazines address women as individuals with a variety of
responsibilities to themselves, family, and careers. Therefore, the emotional appeals of
cosmetic surgery as an empowering action or a therapeutic release of stress may appeal
more to this audience. In other words, the audience of traditional women’s magazines
needs to find a voice and appeals of individualism may be more persuasive to these
women. Fashion and beauty magazines address trends and popular looks, and, therefore,
the frame of perfection as normalcy may add to the need to meet the expectations of
appearance in society. The content of fashion and beauty magazines tend to address
issues of societal standards, and therefore, these magazines may be more likely to use
appeals to fulfill these standards. Because fashion and beauty magazines address women
primarily as consumers for themselves (not households), specifically beauty enhancement
products, the medicalization frame can help make an informed decision on the latest
products and treatments.
My fourth hypothesis, that the frame of the medicalization of women’s beauty
will be the most frequently used frame in articles from the surgical magazine, is drawn
from the publisher’s statement of Skin Deep. The publishers discuss the use of medical
professionals as authors of articles and the desire to inform readers of the latest
technologies involving cosmetic surgery. Therefore, it seems the objectives of the
magazine are well suited for the medicalization frame.
58
Finally, my sixth hypothesis states that articles in target audience magazines to
use the frame of perfection as normalcy more frequently than articles in magazines that
target European American women. I hypothesize this pattern because minority women
may be vulnerable to the idea that they do not fit the expectations of appearance in
society. Because cosmetic surgery can be seen as an issue of race, the appeal of just
wanting to be normal may be a convincing argument for women who are farthest from
traditional European American beauty. Therefore, the frame of perfection as normalcy
may be very persuasive because it tries to convince women that surgery can help them
meet these expectations.
ANALYSES
To describe how women’s magazines represent cosmetic surgery, I used
descriptive statistics to compare variables across magazine types. I did not use other
statistics (such as standard deviations or t-tests) for a couple significant reasons. First,
the purpose of my study is to describe the how frequent the topic of cosmetic surgery is
in women’s magazines and how the topic is presented. Therefore, inferential statistics
are unnecessary for the purpose of this study. Second, the small size of my sample leaves
little room for advanced analysis. Comparing variables across magazine types and the
categorization of a variable often isolated one article. Circumstances such as these leave
little room for meaningful analysis beyond basic descriptive statistics.
Most of my analysis includes frequency distributions and percentages. Following
convention in standard content analysis, I use the ten percentage points benchmark to
59
determine meaningful differences when comparing across magazine types (Hall 2000).
Occasionally means are used when appropriate. It is important to note that throughout
my findings the unit of analysis changes and thus the total sample changes depending on
the variable. Variables are analyzed according to the articles and the content of the
articles. When discussing the content of the articles, these variables often shift focus to
the number of mentions, such as procedures mentioned, age mentioned, and mention of
indicators.
When comparing variables across different types of magazines, it is typically very
simple to see the patterns to relationship. However, when comparing frames to determine
possible support for my hypothesis, it is important to note that three types of comparisons
are made to see the relationship between magazine type and the use of frames. The first
involves a total record of frame indicators present. This analysis may mean, for example,
that seven out of eight of the indicators for the medicalization of women’s beauty were
present in the article.
The second method of analysis for comparing the use of frames examines the
number of mentions of a particular indicator, or the frequency of an indicator in an
article. In other words, how often an indicator, such as illness, is used in an article. In
contrast to the first measure which captures which indicators are used, the second
measure captures the prevalence of the indicator that are used. Therefore, an article may
use the illness indicator from the medicalization frame, but this second measure may
show that the indicator occurred several times in one article. Both the presence and
60
frequency of the indicators are important when analyzing the appearance of my four
frames in articles surrounding cosmetic surgery.
The final method of analysis uses summation statistics of the frames to compare
across magazine types. These statistics consist of the mean number of mentions of a
frame per article and the number of mentions of a frame per article in terms of range.
My sample for this research study is drawn from seven magazines which are
categorized into four magazine types: traditional women’s, fashion and beauty, target
audience, and surgical. Of these four magazine types, 70 articles were collected which
focus of the topic of cosmetic surgery. These articles are coded for characteristics of the
articles as well as more content specific variables. Most importantly, the four frames of
the medicalization of women’s beauty, surgery as therapy, the autonomous voice, and
perfection as normalcy were coded for presence of indicators and the number of mentions
of indicators. This method of coding provides the presence of frames as well as which
indicators were emphasized in articles. In the next chapter, I report the findings of these
variables for both the overall sample and in comparison across magazines types. Similar
to this chapter, I first report the more general variables, including characteristics and
content, which set up the context in which frames are used. Second, I analyze the
findings in regards to the four frames I developed, looking at which frames are most
prevalent in the overall sample, across magazine types, and within each magazine type.
Finally, I discuss the findings in relation to my six hypotheses and conclude whether they
are supported through this analysis.
CHAPTER 4
FINDINGS
The findings from my research describe what women may be exposed to in the
media regarding cosmetic surgery. This description includes the frequency with which
the topic of cosmetic surgery occurs as well as the context in which it occurs. Therefore
my findings begin with the broader picture in terms of how much exposure exists and
narrows to the more content-focused messages within these articles. First, I examine the
general characteristics of the articles, including the variables of time of publication,
location of article, length of article, and author’s information. These variables describe
the general picture of how often and where women may find articles about cosmetic
surgery. After describing this information, I look more closely at the content of the
articles. Content related variables include type of surgical procedure, specific surgical
procedures mentioned, age mentioned, visual images, and the overall representation of
cosmetic surgery in the article. These variables provide the context from which my four
frames will be analyzed. The general characteristics and content variables (shown in
Tables 4.1 through 4.9) are analyzed to contextualize the use of frames concerning
cosmetic surgery. Finally, I analyze the frequency of my four frames of medicalization
of women’s beauty, surgery as therapy, the autonomous voice, and perfection as
normalcy, to determine how prevalent they are and in what contexts they are most
61
62
prevalent. The analysis of frames examines more closely the messages that accompany
the topic of cosmetic surgery.
CHARACTERISTICS OF THE ARTICLES
The variables that describe the general characteristics of the articles include time
of publication, location of article, length of article, and author’s information. Time of
publication is described through two variables: year of publication and season of
publication. Both year and season are shown in Table 4.1. Overall, 70 articles about
cosmetic surgery were collected from 146 magazines. The frequency of articles about
cosmetic surgery in this sample of women’s magazines is fairly low, averaging to less
than one article an issue. While the topic of cosmetic surgery is not discussed
consistently across issues of women’s magazines, the frequency does vary depending on
the type of women’s magazines and messages surrounding cosmetic surgery are still
worthy of study.
Time of Publication
Looking at the frequency distribution across the two years, articles featuring
cosmetic surgery are evenly distributed across 2004 and 2005. Fifty-seven percent of my
sample was published in 2004 and 43% was published in 2005. These proportions
indicate that overall articles about cosmetic surgery only occurred slightly more in the
year 2004 in this sample. Therefore, when looking at distribution across magazine types,
63
analyzing the total number of articles for both years will suffice. The total distribution of
publication of articles will be used to examine my first and fifth hypotheses, which
examine which magazine types are most likely to feature articles about cosmetic surgery.
My first hypotheses is that fashion and beauty magazines are more likely to feature
articles about cosmetic surgery than traditional women’s magazines while my fifth
hypothesis is that target audience magazines are less likely to feature articles about
cosmetic surgery than the magazines that target European American audiences.
The publication of articles discussing cosmetic surgery is unevenly distributed
across magazine types. Table 4.1 shows the final distribution of articles from both years
according to magazine type. The fashion and beauty magazines had the largest portion of
articles about cosmetic surgery accounting for half of the total sample. The surgical
magazine also accounted for a large portion of the sample at 29% of articles about
cosmetic surgery. The traditional women’s and target audience magazines featured fewer
articles about cosmetic surgery at 9% and 11% of articles respectively.
These proportions support my first and fifth hypotheses. My first hypothesis was
that fashion and beauty magazines are more likely to feature articles about cosmetic
surgery than traditional women’s magazines. Fifty-one percent of my sample came from
fashion and beauty magazines and only 9% came from traditional women’s magazines.
Therefore my first hypothesis is supported. The distribution of articles across magazine
types supports my fifth hypothesis as well. My fifth hypothesis was that target audience
magazines are less likely to feature articles about cosmetic surgery than the magazines
that target European American audiences. Target audience magazines were less likely to
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Table 4.1: Year and Season of Publication by Type of Magazine, 2004-2005 (n=70
articles)
Type of Magazine
Year and
Season of
Publication
Traditional
n
%
2004
3
8
50
-
--1
2
Winter
Spring
Summer
Fall
2005
-
Winter
Spring
Summer
Fall
Total
3
1
1
1
-6
Fashion &
Beauty
n
%
n
%
n
%
5
21
11
28
55
40
102*
57
13
63
1
4
--10
50
3
8
53
58
4
8
4
5
10
38
1
2
--9
100
Surgical** Total
Target
Audience
n
%
15
----50
42
2
3
3
6
11
101*
36
9
5
12
5
7
30
45
----51
100
20
30
100
43
4
7
4
6
29
100
70
100
100
*Percentages may not add to 100 due to rounding.
**The Surgical Magazine, Skin Deep, is a yearly magazine and therefore was only coded
by year and not season as well.
65
feature articles than surgical and fashion and beauty magazines. While the proportions
between the number of articles found in traditional women’s magazines and the number
found in target audience magazines were very similar, the traditional women’s magazines
were the only women’s magazine that targeted European American women which
featured a similar number of articles as the magazines that target minority women. These
findings indicate that women who read target audience magazines are less likely to be
exposed to the topic of cosmetic surgery than women who read magazines targeting
European American women.
Women’s magazines that feature articles discussing cosmetic surgery with a
greater frequency are the fashion and beauty magazines and the surgical magazine. It
seems logical that the surgical magazine, Skin Deep, would include many articles about
cosmetic surgery because one of the focuses of the magazine is surgery. However, a shift
in the content of the Skin Deep magazine occurred from the 2004 issue to the 2005 issue.
The 2005 issue featured more articles that were unrelated to the cosmetic surgery.
Articles which focused on makeup, exercise, and other topics found in more general
women’s magazines were featured; including articles such as these shows a shift away
from a surgical magazine towards a more general women’s magazine that discusses
cosmetic surgery frequently. Furthermore, it is interesting that almost twice as many
articles about cosmetic surgery were found in fashion and beauty magazines compared to
the surgical magazine. Clearly, cosmetic surgery is assumed to be a relevant topic for the
readers of fashion and beauty magazines. Traditional women’s and target audience
magazines were less likely to feature articles about cosmetic surgery. Perhaps for readers
66
of traditional women’s and target audience magazines, cosmetic surgery is not a relevant
topic.
I also recorded time of publication through season in which the articles appeared.
As Table 4.1 shows, I collapsed the twelve month calendar year into the four seasons of
winter, spring, summer, and fall. The surgical magazine was not analyzed for this
variable since it is a yearly publication. Overall, articles about cosmetic surgery were
distributed fairly evenly across seasons. The spring season of 2004 had the largest
portion of articles at 24% of the 50 articles included for the variable of season. Between
the two years, the spring season accounted for 38% of articles about cosmetic surgery.
The other three seasons were fairly similar ranging from 18% of articles to 26% of
articles. Table 4.1 also shows the season of publication across magazine types, which
revealed noteworthy findings. The fashion and beauty magazines featured multiple
articles about cosmetic surgery per season each year. This finding is important because it
shows that in this type of women’s magazine, articles about cosmetic surgery occur fairly
consistently across issues and women who subscribe to these magazines are likely to be
exposed to this topic frequently. In the traditional women’s and target audience
magazines, articles about cosmetic surgery did not occur in every season of either year.
This finding indicates that cosmetic surgery is not as frequent of a topic in these
magazines compared to the fashion and beauty magazines. Overall readers of fashion
and beauty magazines are more likely to be exposed to the topic of cosmetic surgery than
readers of traditional women’s and target audience magazines.
67
Location of Article
I also analyzed articles featuring cosmetic surgery based on the location of the
article. The location of articles was recorded through two variables: section and page
location. The surgical magazine, Skin Deep, was not included for these variables because
the magazine does not have sections in the table of contents and features articles about
cosmetic surgery throughout the whole magazine. Overall, as Table 4.2 shows, articles
about cosmetic surgery occurred most often in the beauty section of a magazine with 38%
of the total sample of 50 articles in this section. Articles were also found frequently as
readers’ letters making up 26% of the total sample. However, all of the readers’ letters
were found in fashion and beauty magazines, indicating that fashion and beauty
magazines are the only type that includes feedback about cosmetic surgery from the
readers in their published issues. The use of reader’s letters shows an inclusion of readers
in the topic of cosmetic surgery, not just informing them of a writer’s claims.
Interestingly, articles about cosmetic surgery were infrequently found in the health
section of magazines. Only 10% of articles from the total sample were found in the
health section of the magazines. This finding indicates that many of these articles may
not approach the topic of cosmetic surgery with concern for the health risks or possible
dangers of surgery.
When looking more closely at the distribution of section across magazine types,
different patterns emerge. In target audience magazines, the greatest portion of articles
was in the beauty section. Seventy-five percent of the articles from this magazine type
were found in this section. This percentage is much higher than in the other two
68
Table 4.2: Location of Article by Type of Magazine, 2004-2005 (n=50 articles)**
Type of Magazine
Location of
Article
Traditional
Target
Audience
n
%
Fashion &
Beauty
n
%
Total
n
%
n
%
3
16
50
6
32
75
10
53
28
19
101*
38
Readers’
Letters
--
--
--
--
13
100
36
13
100
26
Feature
3
33
50
--
--
6
67
17
9
100
18
Health
--
--
2
40
25
3
60
8
5
100
10
Men’s
Opinions
--
--
--
--
2
100
6
2
100
4
Editor’s
Notes
--
--
--
--
2
100
6
2
100
4
Total
6
12
100
8
16
100
36
71
101*
50
100
100
B. Page Location in Magazine
1st Quarter
1
7
17
5
33
63
9
60
25
15
100
30
2nd Quarter
2
15
33
1
8
13
9
77
28
12
100
26
3rd Quarter
2
18
33
2
18
25
7
64
19
11
100
22
4th Quarter
1
9
17
--
--
10
91
28
11
100
22
Total
6
12
100
8
16
101*
35
72
100
50
100
100
A. Section
Beauty
*Percentages may not add to 100 due to rounding.
**Skin Deep was not included for these two variables because the magazine does not
divide articles into sections and has articles about cosmetic surgery throughout the
magazine. Therefore, the total number of articles included in this table is 50.
69
magazine types. Of the articles found in fashion and beauty magazines, only 28% of
articles were featured in the beauty section while half of the sample from traditional
women’s magazines was found in the beauty section. Interestingly, articles about
cosmetic surgery in traditional women’s magazines were just as likely to be discussed in
the beauty section of the magazine as to be discussed in a special feature article. Target
audience magazines never drew special attention to the topic of cosmetic surgery through
presenting an article as a feature article, and less than one-fourth of the sample from
fashion and beauty magazines were feature articles. However, articles in target audience
magazines did draw attention to the health risks of cosmetic surgery with one-fourth of
articles in the health section of the magazine. The health section was not frequently used
for the placement of articles about cosmetic surgery in fashion and beauty magazines (8%
of articles) or traditional women’s magazines (no articles).
Articles from fashion and beauty magazines had the most variety of article
location in terms of the section of the magazine. Though the articles tended to cluster in
the beauty and readers’ letters sections (28% and 36% of articles respectively), this
magazine type was the only one to discuss the topic of cosmetic surgery in readers’
letters, men’s opinions, and editor’s notes. This variety indicates a range of contexts in
which cosmetic surgery may be discussed. The contexts of the articles in fashion and
beauty magazines spanned beauty, health, and feature articles, as well as the opinions of
certain audiences. The inclusion of men’s opinions informs the readers what some men
might think if they choose to get cosmetic surgery, an issue which may be of interest to
some women. Furthermore, the inclusion of readers’ letters allows for feedback from the
70
audience of the magazine. Including the opinions of various groups of people reflects a
broader reality of what people think about the use of cosmetic surgery.
Articles from traditional women’s and target audience magazines lacked this
variety of contexts. Articles in traditional women’s magazines were limited to the
contexts of the beauty section and feature articles. The emphasis on the topic of cosmetic
surgery as feature articles indicates the topic of cosmetic surgery is not common to this
magazine type and when discussed requires more attention. Articles in target audience
magazines were limited to the contexts of the beauty and health section. I find the
contexts used for articles in target audience magazines especially noteworthy because
these magazines are geared towards minority women and the emphasis of cosmetic
surgery to achieve beauty can affect the pride of racial features while linking cosmetic
surgery with health can point out the dangerous extremes beauty can reach.
The location of articles in magazines is also meaningful when looking at the page
location of articles according to quarters of the magazine. Looking at the distribution of
articles according to quarters of the magazine can be important because, in print media,
readership is highest for articles in the front and decreases as the page number increases
(McCombs and Mauro 1977). This finding implies that women are more like to read
articles in the first two quarters of the magazine than the last two quarters. Overall,
according to Table 4.2, articles discussing cosmetic surgery occur fairly evenly across
quarters of the magazine, ranging from 22% to 30% of articles in each quarter. However,
looking across magazine types, certain patterns emerge. Articles in target audience
magazines were likely to be featured in the first quarter of the magazine. About two-
71
thirds of the articles from target audience magazines were in the first quarter compared to
one-fourth of articles or less in fashion and beauty and traditional women’s magazines.
A considerable amount of articles from traditional women’s and fashion and beauty
magazines were in the second quarter (33% and 28% of articles respectively) compared
to the 13% of articles from target audience magazines. In the third quarter of the
magazine, a substantial portion of articles (33 to 25% of articles) were found from
traditional women’s and target audience magazines compared to the 19% of articles from
fashion and beauty magazines. Finally, no articles from target audience magazines were
featured in the fourth quarter of the magazine while 17% of articles from traditional
women’s magazines and 28% of articles from fashion and beauty magazines were in the
last quarter of the magazine. Overall, articles about cosmetic surgery in target audience
magazines were clustered in the first quarter of the magazine while articles from
traditional women’s magazines were clustered in the second and third quarters.
Interestingly, articles in fashion and beauty magazines were distributed fairly evenly
throughout the magazine, which indicates that articles in fashion and beauty magazines
do not use page location to emphasize the topic of cosmetic surgery. The opposite occurs
in articles from target audience magazines, in which articles were featured most often
towards the front of the magazine. The topic of cosmetic surgery is emphasized in
articles from target audience magazines by placing the articles where readers are most
likely to look.
72
Length of Article
Emphasis on the topic of cosmetic surgery is also described through the length of
the articles. The average page length of the articles reveals how much attention, in terms
of volume, is given to the topic of cosmetic surgery. The mean distribution of page
length by magazine type is as follows:
Table 4.3: Average Page Length by Type of Magazine, 2004-2005 (n=90 articles)
Type of Magazine
Fashion &
Beauty
mean s.d.
Surgical
Total
mean s.d.
Target
Audience
Mean s.d.
mean s.d.
mean
s.d.*
1.76
2.62
1.63
4.30
2.52
2.30
Traditional
Average
Length
of
Article
1.87
2.58
1.79
2.23
* s.d. stands for standard deviation.
Overall, articles in the surgical magazine tended to be longer, with a mean of 4.3 pages,
than articles in traditional women’s, target audience, and fashion and beauty magazines.
This longer length is not surprising because one of the focal topics of the magazine Skin
Deep is cosmetic surgery and, therefore, seems likely that articles in this magazine would
discuss cosmetic surgery to greater lengths than articles in the other types of magazines.
Articles in target audience magazines tend to be longer than articles in traditional
women’s and fashion and beauty magazines by about one page. The mean for the articles
in target audience magazines (2.62 pages) indicates that, compared to articles in
traditional women’s and fashion and beauty magazines, these articles discuss cosmetic
73
surgery to a greater extent. This finding, combined with the finding that articles about
cosmetic surgery in target audience magazines are placed towards the front of the
magazine, shows that when target audience magazines feature articles about cosmetic
surgery a greater emphasis is placed on the topic compared to traditional women’s and
fashion and beauty magazines.
Authors’ Information
Looking at the information surrounding the authors of articles about cosmetic
surgery can also reveal important findings of credibility. As Table 4.3 shows, I looked at
four aspects of author’s information: gender, education, profession, and expertise. Each
of the variables may impact the credibility of frames for different reasons. In terms of
gender, the majority of authors (73%) were female for the whole sample. The gender of
the author is noteworthy because articles about cosmetic surgery, especially in women’s
magazines, are targeted towards women and female authors may be able to relate to
female audiences more effectively than male authors. I suspect that the female status
may be more persuasive than the male status because female authors can relate to the
pressure to meet standards of feminine beauty and the experience of cosmetic surgery
typical of female patients. The commonality between female author and female reader
make frames more persuasive than claims made by male authors.
The distribution of author’s gender across types of magazines reveals that the only
magazine type with a majority of male authors was the surgical magazine. Seventy
percent of the authors of articles in the surgical magazine were male even though the
74
Table 4.4: Author’s Gender, Education, Profession, and Expertise by Type of Magazine,
2004-2005 (n=72 authors and coauthors)**
Type of Magazine
Author’s
Information
Traditional Target
Audience
n
%
n
%
(n=6)
A. Author’s
Gender
6
- Female
- Male
6
-1
- MD/RN
- PHD
1
--
-
Medical
Writer
Superintendent
Beauty
Director
(n=9)
7
5
2
--1
28
--
--
-2
--(n=6)
%
(n=21)
n
%
(n=72)
20 33
60
6
14
44
19
15
16 80
20
14
2
18
2
(n=21)
28
16 55
29
14
1
1
--
23
7
1
1
4
4
--(n=36)
(n=20)
102*
100
73
27
(n=72)
(n=36)
8
(n=8)
n
(n=21)
3
-7
Surgical Total
(n=36)
3
(n=9)
2
47
26
2
--10
(n=36)
(n=9)
(n=6)
3
12
7
-(n=6)
B. Author’s
Education
C. Author’s
Profession
10
Fashion
& Beauty
n
%
100
100
90
10
(n=72)
100
100
70
24
3
3
(n=70)
D. Author(s) is
an Expert
6
9
100
8
11
100
36
51
100
20 29
100
70
100
100
- Yes
3
13
50
1
4
13
5
22
14
14 61
70
23
100
33
- No
3
6
50
7
15
88
31
66
86
6
47
100
67
13
30
*Percentages may not add to 100 due to rounding.
**There were 70 articles, two of which had a coauthor, totaling 72 authors. However,
these variables were coded based on provided information and some articles did not
include much information on the author. The total for the variables are: gender (n=60),
education (n=20), profession (n=29), and expert (n=70).
75
audience of these articles is most likely female. The prevalence of male authors in the
surgical magazine is very different from the other magazine types. Articles in traditional
women’s and target audience magazines featured only female authors. In articles from
fashion and beauty magazines, the majority of authors were female as well at 93% of
authors. The use of male authors in the surgical magazine may mean that authors are not
trying to appeal to readers through gender status. However, articles in traditional
women’s, target audience, and fashion and beauty magazines may be counting on the
female authors to appeal to female readers through commonalities. Looking at gender
alone, the findings indicate that the authors of articles in traditional women’s, target
audience, and fashion and beauty magazines may relate more to women and be more
persuasive to female audiences than the articles in surgical magazines.
Author’s education, if revealed, can be a way of establishing the credibility of
claims made in an article. Of the 72 authors for the total sample of articles, education
was mentioned for 28% of authors. In terms of education, articles in the surgical
magazine revealed the level of education of authors more frequently than articles in other
magazine types. For 21 authors in the surgical magazine, 76% of authors revealed their
education. For the other magazine types, author’s education was mentioned for less than
20% of authors. Looking at the level of education mentioned, overall medical degrees
(MD or RN) were most prevalent for the whole sample. When mentioned, 90% of
authors had medical degrees and only two authors (10%) had a PhD as their highest level
of education achieved. The two PhD degrees were from articles in the surgical magazine,
and interestingly one of the PhDs was medically related (the author’s profession was a
76
clinical psychologist). The only non-medical degree occurred in an article written by a
patient of cosmetic surgery. The majority of medical degrees referenced indicate that
when education is mentioned, it is likely to establish credibility on the topic of cosmetic
surgery. Furthermore, articles in target audience magazines never indicated the education
of any author and, therefore, articles about cosmetic surgery in this magazine type may
tend to have less credibility compared to articles featured in traditional women’s, fashion
and beauty, and surgical magazines.
The profession of the author can effect the presentation of material and
information in an article, but can also contribute to the credibility of the article. Forty
percent of authors revealed their profession out of 72 authors. Overall, as Table 4.3
shows, medical professions were most frequently mentioned. For the total sample, 70%
of identified professions were medically associated. The use of medical professionals
can create more credibility for the claims in the article because the profession can create a
knowledgeable status of the author for the readers. The opinions of a plastic surgeon
seem more reliable than those of the editor of a magazine. However, articles that are
written by medical professionals can also become advertisements for a specific surgeon
or surgical facility. Although I did not systematically coded for this information, reading
through many of the articles written by medical professionals I found that these authors
often mention their ability to perform a procedure successfully and not the ability of
surgeons in general. Articles in which an author writes “I pioneered and have perfected
the endoscopic suspension facelift” (Skin Deep 2005: p. 118) exemplify this idea. Some
articles even go as far to point out the mistakes of other surgeons: “Some plastic surgeons
77
incorrectly expose the fat cells to the air … Other surgeons sieve the fat cells … Here in
San Paulo, we centrifuge the fat cells” (Skin Deep 2004: p. 16-17). Professional writers
were also a substantial portion of professions mentioned at 24% of author’s professions.
Writers may take a different approach to persuading women to consider cosmetic surgery
than a medical professional might. Medical professionals can use their expertise of
surgery while writers can use the perspective of a patient if writing about their own
experiences with surgery. The approach of a writer may be more relevant to readers who
are considering becoming patients. The approaches of medical professionals and writers
may affect readers differently.
Looking at the profession of authors according to magazine type, different
patterns emerge. The surgical magazine had the largest portion of listed author’s
profession, with identifiable professions for 16 authors out of 21 authors. Eighty-eight
percent of these authors had medically associated professions. Author’s profession was
only identified for half of the authors of articles from traditional women’s magazines.
However, articles in traditional women’s magazines tended to include medical
professionals when mentioning an author’s profession with 66% of authors having a
medically related profession. Articles in fashion and beauty magazines, surprisingly, did
not include the profession of authors often, with only eight identifiable professions for 36
authors. However, when mentioned, an author’s profession was just as likely to be
medically related as to be writing related. This finding may indicate a mixture of
methods of persuasion for articles in this magazine type. Articles in target audience
magazines, which only identified author’s profession for 22% of authors, only referenced
78
professional writers. Articles in target audience magazines, therefore, are the only
articles that never use medical professionals as authors, which may indicate a lack of
credibility to readers.
The most important variable in determining the credibility of the author is
whether the author is presented as an expert. This variable is coded from the perspective
of the reader and whether he/she would believe the author is an expert on the topic the
article discusses. Expertise was determined by looking at the topic of discussion in
comparison to the author’s profession as well as how the author presents the material.
For example, presenting cosmetic surgery through research findings or scientific
processes conveys an expertise and informed knowledge while writing about personal
experiences does not imply this expertise. Though expertise can include non-medical
research, it is slanted towards the expression of medical knowledge because cosmetic
surgery is a medical procedure. This variable was coded for all 70 articles. Overall, only
one-third of authors were presented as experts for the total sample. Looking across
magazine types, articles from the surgical magazine had the largest portion of authors
who were presented as experts. Seventy percent of the authors in the surgical magazine
indicated enough credibility to be viewed as experts. This portion is considerably high,
especially compared to articles in fashion and beauty and target audience magazines
whose expert authors ranged from 13% to 14% of authors. Articles in traditional
women’s magazines presented authors as experts just as often as they did not present
authors as experts. Overall, articles in traditional women’s magazine and the surgical
magazine both tended to establish the credibility of authors as experts. Therefore, readers
79
may find articles in these two magazine types more persuasive than articles in target
audience and fashion and beauty magazines.
The results of the variables discussed above cover the general characteristics of
the articles that reveal the importance and credibility of the topic of cosmetic surgery in
articles from my sample. In summary, the fashion and beauty and surgical magazines
tended to feature articles about cosmetic surgery more often than other magazine types.
This finding lends support to my hypothesis (#1) that fashion and beauty magazines are
more likely to feature articles about cosmetic surgery than traditional women’s
magazines. However, distribution of articles across magazine types does not fully
support my hypothesis (#5) that target audience magazines are less likely to feature
articles about cosmetics surgery than magazines targeted at European American
audiences. Furthermore, articles in the surgical magazine frequently provided
information about the authors of articles. The largest portions of identifiable gender,
education, and profession were of authors from the surgical magazine. While traditional
women’s and target audience magazines did not feature as many articles as the surgical
and fashion and beauty magazines, a greater emphasis was placed on articles about
cosmetic surgery in these magazine types compared to surgical and fashion and beauty
magazines through presentation. Articles in traditional women’s magazines were most
likely to be presented as feature articles, and articles in target audience magazines were
most likely to be placed in the front of the magazine. Finally, articles featured in the
80
surgical magazine were more likely to establish the credibility of authors compared to
traditional women’s, target audience, and fashion and beauty magazines.
CONTENT OF THE ARTICLES
To establish the context of the articles about cosmetic surgery, I developed six
variables that focused on the content of the articles. These variables include type of
procedure, specific procedures mentioned, mention of age, visual images, characteristics
of visual images, and overall representation of cosmetic surgery.
Type of Procedure
Type of procedures refers to the mention of surgical or non-surgical procedures,
or both types of procedures. Surgical procedures refer to invasive cosmetic surgery, such
as breast augmentation or a nose job, while non-surgical procedures refer to minimally
invasive cosmetic work, like botox and dermal filler injections. Table 4.4 shows that
overall articles tended to discuss surgical procedures more than non-surgical procedures
or both types of procedures. Forty-three percent of articles discussed only surgical
procedures. Articles that discussed non-surgical procedures and articles that discussed
both surgical and non-surgical procedures were equally represented at 27% and 29% of
articles respectively. Only one article did not mention any type of procedure directly and
was coded as neither surgical nor non-surgical.
81
Table 4.5: Type of Procedures by Type of Magazine, 2004-2005 (n=70 articles)
Type of Magazine
Type of
Procedures
Traditional Target
Audience
n
%
n
%
--1
3
-13
Fashion
& Beauty
n
%
16
53
44
Surgical
Total
n
14
%
43
65
n
30
%
99*
43
Non-surgical**
6
32
100
3
16
38
8
42
22
2
11
10
19
101*
27
Both Surgical
&
Non-surgical
Neither***
--
---
4
20
50
11
55
31
6
25
25
21
100
29
--
---
--
---
1
100
3
--
---
1
100
1
Total
6
9
100
8
11
36
101*
51
100
20
29
10
0
70
100
100
Surgical
*Percentages may not add to 100 due to rounding.
**By non–surgical procedure, I mean “minimally invasive” procedures which typically
involve injections as opposed to incisions.
***Because I included letters from the readers in my data set, there was one letter which
was in response to an article about cosmetic surgery, but did not specifically discuss
surgery.
When looking across types of magazines, the surgical magazine had the largest
portion of articles that discussed invasive surgical procedures. Sixty-five percent of the
articles from Skin Deep mentioned only surgical procedures. A considerable portion of
articles in fashion and beauty magazines also discussed surgical procedures. Forty-four
percent of articles, nearly half the sample, mentioned only surgical procedures. The
discussion of more invasive procedures indicates more dramatic changes in appearance as
well as health consequences. Articles which mention surgical procedures may be taking
82
more extreme positions for or against surgery. A small portion of articles from target
audience magazines discussed surgical procedures (13% of articles) and articles in
traditional women’s magazines never discussed surgical procedures.
Articles in traditional women’s magazines only discussed non-surgical, or
minimally invasive, procedures. Non-surgical procedures do not create as overwhelming
or permanent a change as surgical procedures. These small changes can often be
discussed in a casual tone compared to more invasive procedures, which can send the
message to readers that cosmetic surgery is not a serious health risk. Substantial portions
of articles in target audience and fashion and beauty magazines discussed non-surgical
procedures at 38% and 22% of articles respectively. However, just 10% of articles in the
surgical magazine addressed only non-surgical procedures. This percentage seems low
since the magazine is targeted at cosmetic technology and non-surgical procedures are
becoming more commonplace.
Half of the articles in target audience magazines discussed both surgical and nonsurgical procedures in the same article. Mentioning both types of procedures may
indicate a greater variety in terms of cosmetic surgery coverage. This added coverage
seems fitting since target audience magazines tend to be longer in page length compared
to articles in traditional women’s and fashion and beauty magazines. While articles in
traditional women’s magazines never discussed both types of procedures, a considerable
portion of articles in the surgical magazine (25% of articles) and fashion and beauty
magazines (31% of articles) did. Articles in fashion and beauty magazines also showed a
fairly diverse distribution across the types of procedures. The recurrent discussion of
83
surgical, non-surgical, and both surgical and non-surgical procedures in articles also
indicates diverse coverage of the topic of cosmetic surgery and a variety of contexts.
Specific Procedures Mentioned
An extension of the type of procedures is the variable of specific procedures
mentioned. This variable codes every time a unique procedure was mentioned in an
article, with a total of 184 mentions of specific procedures for the entire sample of 70
articles. Table 4.5 shows the mentions of specific procedures grouped according to
surgical and non-surgical procedures as well as area of the body or purpose of the
specific procedures. Overall, 124 specific procedures were of surgical procedures,
accounting for 67% of specific procedures mentioned. Within the surgical procedures,
40% of procedures involved facial work. Facelifts, eye jobs, and nose jobs occurred most
often in the category of facial work. Breast work, lower body work, and liposuction
occurred in similar portions. Twenty-two percent of specific surgical procedures
mentioned involved breast work, typically focusing on breast augmentation as opposed to
breast reduction. Lower body work accounted for 18% of the sample of surgical
procedures mentioned, mostly focusing on tummy tucks and buttock augmentation.
Liposuction occurred in 15% of the mentions of surgical procedures. Interestingly,
excisional lifting (the removal of slackened skin which usually accompanies liposuction)
was only mentioned once in one article from Skin Deep. This single mention of
excisional lifting may indicate that articles in the surgical magazine discussed cosmetic
84
surgery more thoroughly than the other types of magazines, or at least in the case of
liposuction.
The mention of implants without relation to a certain area of the body accounted
for only four percent of the surgical procedures mentioned. Furthermore, upper arm
surgery and excisional lifting were each only mentioned once. These low proportions
make them insignificant in comparison to other types of procedures. However, it is
important to note that these three types of surgical procedures were only mentioned in
articles from fashion and beauty magazines or the surgical magazine. This finding
indicates that there is more diversity when discussing cosmetic surgery in articles from
these magazine types.
Looking across magazine types, the mention of facial work occurred similarly in
articles from fashion and beauty, target audience, and surgical magazines. Forty-four
percent of surgical procedures mentioned in articles from fashion and beauty magazines
were of facial work, while in articles from target audience and surgical magazines facial
work accounted for 40% and 38% of surgical procedures respectively. Facial work was
the most frequent type of surgical procedure mentioned for the three of these magazine
types. The frequent mention of facial work indicates an awareness of the appearance of
the face over other parts of the body.
Breast work and lower body work occurred similarly within magazines types.
Breast work was mentioned in similar proportions in articles from target audience and
surgical magazines at 20% and 15% of surgical mentions respectively. Mentions from
target audience magazines were fairly similar with breast work accounting for 29% of
85
Table 4.6: Specific Procedures Mentioned by Type of Magazine, 2004-2005 (n=184
specific procedures)
Type of Magazine
Specific Procedures
Traditional
Target
Audience
Fashion
& Beauty
Surgical
Total
n
%
n
%
n
%
n
%
n
%
A. Surgical (n=124)
Facial Work
--
---
11
22
44
21
42
40
18
36
38
50
100
40
- Facelift
- Eye Job
- Nose Job
- Eyelid Crease
- Lip Augmentation
- Chin Work
- Necklift
Breast
---------
- Augmentation
- Reduction
Lower Body
----
- Tummy Tuck
- Buttock
Augmentation
- Lower Body Lift
- Thigh Lift
Liposuction
---
4
3
2
1
5
3
11
7
----
--2
1
1
9
1
1
7
2
2
18
Implants
--
- Silicone Implants
- Implants(general)
- Saline Implants
Upper Arm Surgery
-----
---
---
-----
---
-4
4
-1
2
-5
3
2
7
------
19
20
32
28
11
8
---
---
9
6
6
----15
13
2
5
1
-1
-1
56
29
23
10
50
17
20
2
100
2
7
4
2
3
1
-1
7
6
1
10
4
3
-1
--
26
15
45
21
39
15
80
9
---
16
14
12
3
2
2
1
27
22
5
22
5
3
1
1
1
101
22
*
100
18
100
15
100
4
100
1
86
Table 4.6 continued: Specific Procedures Mentioned by Type of Magazine, 2004-2005
(n=184 specific procedures)
Type of Magazine
Specific Procedures
Target
Audience
Fashion
&Beauty
Surgical
Total
n
%
n
%
n
%
n
%
--
---
--
---
1
100
2
1
100
1
---
25
20
100
52
42
47 38
100
124
100
101
*
17
73
2
4
18
31
5
46
99*
77
Traditional
n
%
A. Surgical Procedures (n= 124)
Exicisional Lifting ---Total
--
B. Nonsurgical (n=60)
Dermal Filler
8
Injections
- Botox
- Restylane
- Dermal Fillers
(general)
- Fat Injections
- Collagen
- Silicone
- Sculptra
- Cortisone
- Dysport
Spider Vein and
Cellulite Treatment
- Mesotherapy
- Sclerotherapy
- Ambulatory
Phebectomy
- Stringcision
- Closure/Ablatio
n
Total
100
67
94
11
100
3
2
1
1
-1
10
6
5
1
---
15
8
7
-1
-1
--3
------9
3
2
2
1
1
1
2
2
1
1
-----
5
4
3
2
1
1
14
21
27
64
82
14
6
---
1
2
--
2
3
2
2
---
----
5
5
2
---
1
1
---
---
1
1
11
18
100
11
18
100
*Percentages may not add to 100 due to rounding.
33
55
100
5
8
100
60
99*
23
100
100
87
surgical mentions. Articles from target audience and surgical magazines were similar
again when mentioning lower body work. Twenty-eight percent of the surgical
procedures mentioned from target audience magazines involved lower body work while
21% of the surgical procedures from the surgical magazine focused on this area of the
body. Articles from fashion and beauty magazines mentioned lower body work less
frequently at ten percent of surgical procedures mentioned. The proportions indicate that
articles in fashion and beauty magazines tend to mention procedures which affect the
upper part of the body compared to articles in the target audience and surgical magazine.
This finding is further supported by the inclusion of upper arm surgery in an article from
a fashion and beauty magazine. This procedure was not mentioned in any other
magazine type including the surgical magazine. Finally, articles from traditional
women’s magazines did not mention any surgical procedures, which is consistent with
the findings from the variable of type of procedures.
Of the 184 specific procedures mentioned, 33% of mentions were of non-surgical
procedures. The majority of non-surgical procedures mentioned involved dermal filler
injections with 77% of non-surgical mentions being of specific dermal fillers or the use of
them in general. Of the various types of dermal fillers listed, the mention of botox was
most frequent. Spider vein and cellulite treatments accounted for 23% of mentions of
non-surgical procedures. The mention of mesotherapy and sclerotherapy occurred most
often, both of which involve injecting chemical solutions into the skin or veins. The
purposes of non-surgical procedures create smaller changes than surgical procedures.
However, the categories of dermal fillers and spider vein/cellulite treatment have a lot of
88
variety in terms of specific techniques or products, perhaps due to the limited use of such
procedures.
Looking across magazine types, articles from fashion and beauty magazines and
the surgical magazine focused mostly on dermal fillers as opposed to spider vein and
cellulite treatment. Articles from the surgical magazine only mentioned dermal fillers
and 94% of non-surgical mentions from fashion and beauty magazines involved dermal
fillers. Furthermore, articles from fashion and beauty magazines had the most variety of
dermal fillers mentions. A large portion of non-surgical mentions from traditional
women’s magazines also mentioned dermal fillers frequently at 73% of non-surgical
mentions. Articles from target audience magazines mentioned dermal fillers less
frequently with only 18% of non-surgical mentions involving this category. Instead,
articles from target audience magazines mentioned spider vein and cellulite treatment
more frequently at 82% of non-surgical mentions. In articles from traditional women’s
magazines, such treatments were mentioned less frequently at only 27% of non-surgical
mentions. However, articles from fashion and beauty magazines and the surgical
magazine mentioned these treatments least often at 6% of non-surgical mentions or less.
In general, articles from traditional women’s magazines did not have much
variety in the specific procedures mentioned and all were non-surgical procedures as
well. These types of procedures involve smaller changes and fewer risks than more
invasive surgical procedures. This finding indicates that traditional women’s magazines
may mention cosmetic surgery as small fixes for common problems, such as frown lines
or spider veins, instead of major overhauls for permanent aesthetic changes.
89
Furthermore, it is interesting that articles in this magazine type focus so much on the use
of dermal fillers, which typically are used to create facial changes, but never mention
more dramatic procedures that affect the face, such as facelifts. This finding further
supports the message that cosmetic surgery is used for small fixes.
Articles from fashion and beauty, target audience, and surgical magazines
mentioned a variety of specific procedures and therefore sent a different message from
articles in traditional women’s magazines. Articles in target audience magazines
mentioned facial work and spider vein/cellulite treatment most frequently, showing a
balance between surgical and non-surgical procedures. Mentioning both types of
procedures, especially in the same article, indicates a more comprehensive coverage of
cosmetic surgery. This balance contrasts articles in the surgical magazine which focused
more on invasive surgical procedures, such as facial work, lower body work, liposuction,
and breast work. Non-surgical procedures were mentioned only five times compared to
47 mentions of surgical procedures. It seems fitting that the surgical magazine would not
mention smaller procedures and instead focus on the more invasive surgical procedures
because the magazine Skin Deep emphasizes the technology of cosmetic surgery.
Articles from fashion and beauty magazines mentioned dermal fillers, facial work, and
breast work most frequent. Furthermore, articles in fashion and beauty magazines had
the greatest variety of specific procedures mentioned, including both surgical and nonsurgical procedures. The only specific procedure not mentioned in this magazine type
was excisional lifting. This variety indicates a diverse coverage of the topic of cosmetic
surgery.
90
Mentions of Age
The reference to age in articles about cosmetic surgery was also examined
according to number of mentions. Similar to specific procedures mentioned, each unique
mention of age was recorded for every article for a total of 91 mentions of age for 70
articles. Table 4.6 shows how these mentions of age were broken into significant
groupings with sub-groupings detailing more specific breakdowns. Overall, the age
grouping of thirties, twenties, and fifty and above occurred most often. The age range of
the thirties accounted for 30% of the total mentions, most of which came from the subgrouping of 30 to 35 years of age. The twenties, which occurred in 29% of the mentions
of age, was evenly dispersed within the sub-groupings. Twenty-two percent of the
mentions of age were of the fifty and above range, in which the ages of 50-54 were most
prevalent. The age ranges of teens and the forties were fairly low in comparison to the
other grouping, ranging from 7% to 13% of mentions of age.
The reference to age was often similar across magazine types. For the thirties,
articles from fashion and beauty magazines and the surgical magazine had very similar
proportions at 29% and 33% of mentions respectively. The number of mentions in target
audience magazines was distantly similar at 20% of references to age. What is very
noteworthy is that these exact same proportions occur for the twenties as well. The only
magazine type that differs between the twenties and thirties is the traditional women’s
magazines, which had only one article than had only one mention of age, which was in
the thirties age range. The similarities between articles in the other three magazine types
91
Table 4.7: Mentions of Age by Type of Magazine, 2004-2005 (n=91)
Type of Magazine
Age
Mentioned
Traditional
n
%
Teens
--
Twenties
--
-----
- 20s
- 20-25
- 26-29
Thirties
---1
- 30s
- 30-35
- 36-39
Forties
-1
---
- 40s
- 40-43
Fifty and
above
- 50s
- 50-54
- 55 and
above
Total
------1
4
100
---
---
Target
Audience
n
%
Fashion &
Beauty
N
%
Surgical
Total
n
%
n
%
--
5
1
17
4
31
33
6
100
7
101*
29
2
1
1
-2
1
1
-3
1
2
3
1
2
--
--8
20
7
20
25
30
15
30
16
9
4
3
16
4
8
4
5
3
2
14
83
9
62
29
59
29
42
9
70
25
1
9
4
1
10
11
56
100
100
*Percentages may not add to 100 due to rounding.
8
-3
5
8
1
3
4
4
-4
3
30
33
33
17
15
13
1
-2
62
101*
24
26
10
8
8
27
6
13
8
12
4
8
20
100
30
100
13
100
22
3
11
6
26
100
91
100
101*
92
indicates that the two age groupings are equally represented and the age of 25 is just as
likely to appear as the age of 35 in articles from target audience, fashion and beauty, and
surgical magazines.
The age range of fifty and above was similar for age mentions from target
audience magazines and fashion and beauty magazines, at 30% and 25% of mentions
respectively. Mentions in the surgical magazine were much lower in this grouping at
only 13% of mentions of age. Age mentions for the grouping of the forties was low for
mentions from the surgical magazine as well as fashion and beauty magazines. Only
17% of the mentions from the surgical magazine were of the forties and only 9% of
mentions for the fashion and beauty magazines were. Mentions of age in articles from
target audience magazines have a substantial portion in this age range at 30% of
mentions. The mention of teenage years was low across all magazine types, ranging from
no mentions to 9% of mentions.
The distribution of age within types of magazines is noteworthy because some
magazines seem to target younger audiences when discussing cosmetic surgery. When
referencing age, articles in fashion and beauty and surgical magazines tended to mention
the ages of the twenties and thirties. In articles from fashion and beauty magazines,
approximately 60% of the age mentions were of the twenties and thirties. This
proportion is similar in articles from the surgical magazine at two-thirds of the mentions
of age. Furthermore, articles in the fashion and beauty and surgical magazines were the
only magazine types to reference the teenage years when discussing cosmetic surgery.
Portraying women of young ages using cosmetic surgery may encourage readers,
93
regardless of their age, that they too should use cosmetic surgery. Articles in the target
audience magazines relay a different message by tending to mention older ages. In this
magazine type, 60% of the mentions of age occur in the forties and fifty and above.
These mentions of older age make it seem normative to get cosmetic surgery past a
certain age. Lastly, the lack of mentions of age in articles from traditional women’s
magazines is important because it indicates that readers are not typically given an age
reference to when surgery is appropriate. Instead the readers may be left to draw their
own conclusions about the relevancy of age to cosmetic surgery.
Visual Images
The use of visual images to accompany text can change or aid the message of an
article. For the 70 articles included in my sample, a total of 206 visual images were
coded for an average of three visual images per article. Each visual image was coded for
the presence of people and the presence of objects. Table 4.7 shows the number of visual
images that include people and objects, as well as the characteristics of the people and
objects featured. Of the 206 visual images, 78% featured one person or more while only
31% of visual images featured objects (shown in panels A and C of Table 4.7). This
pattern holds across magazine types as well. The visual images of all magazine types
featured people more than objects. The pattern for the visual images for target audience
magazines and the surgical magazine were most skewed with about 87% of images
featuring people and around one-fourth featuring objects. Traditional women’s
94
Table 4.8: Characteristics of Visual Images by Type of Magazine, 2004-2005 (n=206
visual images)
Type of Magazine
Characteristics
of Visual
Images
Traditional Target
Audience
n
%
n
%
(n=20)
(n=23)
Fashion
& Beauty
N
%
(n=53)
Surgical
Total
n %
(n=110)
n
A. Visual Images Featuring People (n=206 visual images)**
- Features
11
7
20 13
36 23
93 58
55
87
68
85
People
B. Characteristics of Primary People*** (n=156 visual images)
Gender
(n=11)
(n=20)
(n=31)
(n=86)
- Female
11
19
29
60
- Male
--
1
2
26
Authenticity
- Model
1
(n=20)
15
(n=33)
23
(n=92)
28
- Ordinary
Person
- Author
9
5
--
49
1
--
3
15
- Celebrity
--
--
7
--
Part of Body
- Face
3
4
(n=33)
13
(n=92)
54
- Lower Body 8
3
5
21
- Upper Body
2
7
16
11
8
1
(n=11)
(n=11)
--
- Whole Body -/Silhouette
(n=20)
%
(n=206)
160
101*
78
(n=148)****
119 100
80
100
29
20
(n=156)
100
67
43
100
63
40
100
19
12
100
7
5
(n=156)
100
74
47
100
37
23
100
25
16
100
20
13
95
Table 4.8 continued: Characteristics of Visual Images by Type of Magazine, 2004-2005
(n=206 visual images)
Type of Magazine
Characteristics
of Visual
Images
Traditional Target
Audience
n
%
n
%
(n=20)
(n=23)
C. Visual Images Featuring Objects
Fashion
& Beauty
n
%
(n=53)
Surgical
Total
n %
(n=110)
n
%
(n=206)
- Features
9
14
6
10
24
45
26
Objects
D. Characteristics of Objects (n=63 visual images)
38
45
24 38
22
63
100
31
Medical
Objects
- Equipment
4
21
33
38
100
60
4
4
8
21 55
88
3
- Diagrams
--
--
--
15
15
- Supplies
--
1
--
3
4
Body Focused
Objects
- Cosmetic
Products
- Weight/
Exercise
Equipment
Other Objects
5
- Other
Objects
- “Fake”
People
Total
--
--
6
1
7
--
--
3
2
5
11
44
39
56
5
1
13
83
8
17
8
7
54
29
--
---
19
13
3
1
4
--
8
2
--
3
--
5
--
9
---
--
---
9
75
38
3
25
13
12
101*
21
100
19
14
6
10
24
38 24 38
63 100
100
100
100
101*
100
*Percentages may not add to 100 due to rounding.
**Each visual image was coded separately for the presence of people and objects.
Therefore an image may have both people and objects present.
***The characteristics of people were included only for visual images which featured a
primary person. 156 of the 160 visual images of people featured a primary person.
****Gender could not be determined for eight of the visual images. Therefore only 147
visual images are included for the gender variable.
96
magazines had a more diverse distribution of images of people and objects with 55% of
images showing people and 45% of images showing objects.
The use of visual images is connected to the topic of cosmetic surgery for many
reasons. One of these reasons mentioned in a previous chapter is that patients often look
through magazines in order to show surgeons their desired appearance (Fraser 2003). If
an individual can relate to the images of people in magazines, he or she may be more
likely to perceive surgery as a viable option. Of 160 visual images which featured
people, 156 (98%) of visual images featured a primary person. A primary person, for the
purpose of this study, was defined as a person who was the focus of the visual image or
stood out from the others in the image. If a primary person was present, the
characteristics of the person were coded for gender, authenticity, and part of the body, all
which can have an impact on the perception of surgery for readers.
My sample of magazines target female audiences and not surprisingly, the
majority of people portrayed in these visual images were female. Eighty percent of the
primary people coded for gender were female. Across magazine types, the visual images
from traditional women’s, target audience, and fashion and beauty magazines were
skewed on this variable with males featured in 0 to 6% of visual images. Articles in the
surgical magazine were the only articles that featured a considerable proportion of men in
visual images with 30% of primary people being male in this magazine type. The
portrayal of male figures is interesting because female readers are not likely to use these
images as comparisons for what cosmetic surgery can do for them or what they would
like surgery to accomplish for them. However, the majority of images of primary people
97
in articles from this magazine type are female. Therefore female readers can compare
themselves to the majority of visual images of people in articles from every magazine
type.
The authenticity of the people featured in visual images is also important to the
ability of readers to relate to the person featured. Authenticity refers to whether the
primary person is a model, celebrity, author of the article, or an ordinary person such as a
patient or doctor. Overall, visual images of primary people most often featured models
and ordinary people with 43% and 40% of visual images featuring such people. Visual
images in target audience and fashion and beauty magazines featured similarly large
portions of models as primary people. Seventy-five percent of the primary people
featured in target audience magazines were of models and 70% of the primary people in
fashion and beauty magazines were of models. A substantial portion of primary people
(30%) were models in the surgical magazine as well. However, visual images in
traditional women’s magazines featured only one image of a model, which accounted for
nine percent of visual images of primary people. Visual images in traditional women’s
magazines featured a high portion of ordinary people in their sample of primary people.
Eighty-two percent of the primary people were of ordinary people in this magazine type.
This percentage is a large portion even compared to visual images in the surgical
magazine, in which 53% of the primary people were ordinary people. Therefore, the
development of unrealistic expectations may be less likely to occur in articles from the
surgical and traditional women’s magazines as they tended to feature ordinary people and
real results in visual images when discussing cosmetic surgery compared to the articles in
98
target audience and fashion and beauty magazines that tended to feature idealized beauty
through models.
The use of visual images of the author of articles also has findings worthy of note.
As I mentioned before, when articles use authors with medical degrees the articles can
begin to read as advertisements for the author’s practice. The use of an author’s picture
may have the same effect, establishing credibility for that surgeon in particular and not
the surgical field in general. The surgical magazine featured a modest portion of images
of the author of the article at 16% of primary people featured. In both traditional
women’s and fashion and beauty magazines the portion was similarly low at 9% of their
visual images of primary people. Interestingly, visual images in target audience
magazines were never of an author. This finding fits in with previous findings that show
articles in target audience magazines are less likely to establish the credibility of the
author through author’s information.
The visual images that featured a primary person were also coded according to
part of the body featured. Overall, the majority of these images focused on the face of
the individual. Forty-seven percent of the images of primary people featured the face.
Featuring the face is interesting because it is often considered the most expressive and
emotional part of the body, which can connect to the emotions of the readers.
Interestingly, featuring the whole body or a silhouette of the body occurred infrequently
at 13% of primary people, similar to the portion of images that featured the upper body.
The image of the whole body or silhouettes also sends a unique message to
readers. First, showing the whole body represents the entirety of the individual and
99
makes it more difficult to reduce the body into parts, which is part of the medicalization
process. Second, silhouettes do not detail the image of the body as accurately as other
visual images might. Silhouettes are less likely to embody idealized beauty and,
therefore, may be less likely to evoke idealized beauty in readers.
In terms of magazine types, visual images from all four magazine types had a
substantial portion that focused on the face of the individual. Visual images from the
surgical magazine had the largest portion at 59% of primary people. The target audience
and traditional women’s magazines had the lowest portions ranging from 20% to 27% of
primary people. Traditional women’s magazines had a large portion of visual images that
focused on the lower body of the primary person. Seventy-three percent of the images of
primary people in this magazine type focused on this body part, which seems to
contradict the emphasis on dermal filler injections discussed earlier, as these are
generally used for facial work. The portions for the images featuring the lower body
from the other three magazines were more modest, ranging from 15% to 23% of primary
people. These three magazine types had similar portions for images that focused on the
upper body, ranging from 10% to 21% of primary people, while articles from traditional
women’s magazines had no visual images that focused on the upper body. Articles from
traditional women’s magazines also had no visual images which showed the whole body
or the silhouette of the body and the portion of such images from articles in the surgical
magazine were very low as well. However, the majority of visual images (55% of
primary people) in target audience magazines featured the whole body or the silhouette of
the body. This portion was lower for fashion and beauty magazine at only 24% of
100
primary people. This finding indicates that while visual images in both target audience
and fashion and beauty magazines tended to feature models, the visual images of primary
people in target audience magazines may be less likely to evoke idealized beauty than the
images in fashion and beauty magazines because these images feature the whole body or
a silhouette.
Out of the 206 visual images coded for this study, 31% featured objects. Overall,
the most frequently featured objects were of medical objects. Sixty percent of the visual
images of objects featured medical objects, of which the most frequent were medical
equipment and diagrams. Medical equipment accounted for 30% of the objects in visual
images and medical diagrams accounted for another 24% of the objects. Interestingly,
medical supplies appeared infrequently accounting for only 6% of the objects from visual
images. Body focused objects, which raise the awareness of appearance, accounted for
21% of visual images of objects. Cosmetic products occurred slightly more frequently at
13% of visual images of objects while exercise and weight focused equipment accounted
for 8% of visual images of objects. Nineteen percent of visual images of objects were in
the other category, consisting of objects that were not able to be meaningfully grouped.
Across magazine types, the medically related objects appeared in visual images
from all four magazine types. The consistent presence of medical objects implies, at least
visually, that the articles support the frame of medicalization of women’s beauty. This
frame encourages women to view their appearance under a medical lens. Therefore, the
representation of medical objects may be used to gather support for or against my
hypothesis (#2) that articles in fashion and beauty magazines are more likely to use the
101
frame of medicalization of women’s beauty than traditional women’s magazines. Large
portions of visual images of objects in the target audience and surgical magazines were of
medical objects at 83% and 88% of visual objects respectively. In articles from target
audience magazines, medical equipment was featured most often while medical diagrams
were featured most often in articles from the surgical magazine. Articles from the
surgical magazine also featured a variety of medically related objects, including
equipment, supplies, and diagrams. In fact, medical diagrams were only featured in
visual images from the surgical magazine. Substantial portions of objects were of
medical objects in traditional women’s and fashion and beauty magazines, ranging from
33% to 44% of objects in visual images. For both of these magazine types, the only
medical objects featured were of medical equipment. The use of only one form of
medical objects limits the representation of the medicalization of women’s beauty frame
in articles from traditional women’s and fashion and beauty magazines.
Looking at the three ways in which visual objects are medically related indicates
that articles in target audience magazines and the surgical magazine are more likely to
visually indicate the frame of the medicalization of women’s beauty than articles in
traditional women’s and fashion and beauty magazines. Furthermore, the surgical
magazine visually represented the frame of medicalization in a variety of ways. The
proportions of medical objects across magazine types do not support my second
hypothesis that fashion and beauty magazines are more likely to use the frame of
medicalization of women’s beauty than traditional women’s magazines. Visually,
fashion and beauty magazines are about just as likely to indicate this frame as traditional
102
women’s magazines with only a ten percent difference between the two magazine types.
These two magazine types only visually represent the medicalization frame through
medical equipment, limiting the variety of visual images that may indicate this frame for
readers.
The use of body focused visual objects is important in raising the awareness of
female readers to their own appearance. The image of exercise and weight focused
equipment can remind women of the need to regulate their body, which is one of the
indicators of the frame of perfection as normalcy. The frame of perfection as normalcy
focuses on the rising standards of beauty in society that raises the awareness of
appearance in many women. The image of cosmetic products can have a similar effect as
it reminds women of the need to use makeup to alter their appearance. Darden (1994)
referenced the use of makeup as a uniform, something mandatory of all women, which
can also indicate the frame of perfection as normalcy. Therefore, the use of body focused
visual objects can lend support for or against two of my hypotheses that focus on the
prevalence of the frame of perfection as normalcy. Articles from traditional women’s
magazines featured the largest portion of body focused objects at 56% of visual objects.
Articles from target audience and fashion and beauty magazines featured distantly similar
portions with body focused objects accounting for 17% and 29% of objects in visual
images. However, visual images from fashion and beauty magazines showed more
variety in body focused objects, including both cosmetic products and exercise/weight
focused equipment. Interestingly, articles from the surgical magazine did not feature any
103
body focused objects and, therefore, did not visually represent the frame of perfection as
normalcy.
Overall, the presence of visual images does not visually support my hypothesis
(#6) that target audience magazines are more likely to use the frame of perfection as
normalcy than the European American magazines. Visually, the proportion of images in
target audience magazines that indicate this frame is low with only one visual image of
body focused equipment. While this in one more that images from the surgical magazine,
the proportion of body focused objects is higher in both traditional women’s and fashion
and beauty magazines. Furthermore, these findings do not visually support my
hypothesis (#2) that fashion and beauty magazines are more likely to use the frame of
perfection as normalcy than traditional women’s magazines. More visual images from
traditional women’s magazines (55% of objects) indicated this frame than visual images
from fashion and beauty magazines (30% of objects).
While some visual images may indicate specific frames, I coded for specific
surgical associations to show the total number of visual images that are directly
associated with cosmetic surgery. Table 4.8 shows the portions of images that are
surgically associated as well as the various surgical links. Only 39% (81 visual images)
of the 206 visual images that accompanied articles about cosmetic surgery were
surgically linked. The use of surgically linked visual images varies according to
magazine type. In articles from the surgical magazine, visual images were just as likely
to be surgically related as to not be surgically related. Visual images in traditional
women’s and fashion and beauty magazines had similar portions of surgically related
104
images, ranging from 23% to 25% of images. A substantial portion of images in target
audience magazines also were surgically related at 39% of visual images. Overall,
articles in the surgical magazine emphasized the topic of cosmetic surgery visually
through surgically linked visual images most often. However, the emphasis of the topic
of cosmetic surgery through visual images occurred considerably in each magazine type.
I identified six different surgical associations and each surgical link was coded for
presence in each surgically focused visual image. Therefore, one visual may have
multiple surgical associations. The most frequent surgical association overall was before
and after pictures, which show images of a patient before and after cosmetic surgery.
Forty-two percent of the surgically focused visual images were before and after pictures.
The other five surgical associations occurred in less than one-fourth of the visual images.
The presence of medical equipment and supplies related to cosmetic surgery occurred in
22% of the surgically focused visual images. The surgical associations of diagramming
the surgery on the body, intraoperative visual images, and medical diagrams occurred in
similar portions, ranging from 12% to 15% of surgically linked images. After surgery
images or results occurred in only 9% of the surgically associated visual images.
Looking across magazine types, large portions of before and after photos were
found in surgically focused visual images of traditional women’s, target audience, and
surgical magazines. The largest portion was in target audience magazines at 56% of
surgically focused images. The use of before and after images is important to the readers
because it can illustrate what they should expect if they choose to get cosmetic surgery.
The presence of before and after images was similar in articles from traditional women’s
105
Table 4.9: Surgically Focused Visual Images by Type of Magazine, 2004-2005 (n=81
visual images)**
Type of Magazine
Surgically
Focused
Visual Images
Traditional
n
%
Target
Audience
n
%
Fashion
& Beauty
N
%
Surgical
Total
n
n
%
81
(n=206)
101*
39
%
A. Surgically Focused Visual Images (n=206 visual images)
(n=20)
(n=23)
(n=53)
(n=110)
- Yes
5
7
9
11
12 15
55 68
25
39
23
50
B. Characteristics of Surgically Focused Visual Images (n=81 visual images)
(n=5)
(n=9)
(n=12)
(n=55)
(n=81)
Surgical Associations Involving the Body
- Before &
2
5
After
Pictures
- Diagrams --Surgery
on the
Body
- Intra-2
operative
Visuals
- After
1
-Surgery
Visuals
Surgical Associations Involving Objects
- Medical
2
4
Equipmen
t&
Supplies
--- Medical
Diagrams
1
26
34
100
42
3
9
12
100
15
1
8
11
100
14
2
4
7
100
9
6
6
18
100
22
--
10
10
100
12
*Percentages may not add to 100 due to rounding.
**Every visual image was coded separately for the various surgical associations.
Therefore some images may have multiple surgical associations.
106
and surgical magazines, ranging from 40% to 47% of surgically linked images. Articles
in fashion and beauty magazines did not feature many before and after images, with only
8% of the sample featuring such images. After surgery results can have a similar effect
as the before and after pictures. However, after surgery images were less prevalent
overall, occurring infrequently in the surgical magazine and not present in the target
audience magazines. Traditional women’s and fashion and beauty magazines had similar
portions of after surgery results, ranging from 17% to 20% of surgically linked images.
Articles in fashion and beauty magazines were the only articles that featured more after
surgery results than before and after images.
The surgical associations of diagramming surgery on the body and intraoperative
images can also make the readers more conscious of their own appearance and how
surgery can alter it. Diagramming surgery on the body occurred only in surgically
focused visual images from fashion and beauty magazines and the surgical magazine.
This surgical association occurred in similar portions for both magazine types, ranging
from 16% to 25% of surgically linked images. Intraoperative images, or photographs
during surgical procedures, were not present in articles from traditional women’s
magazines. In articles from the other three magazine types, the proportions of
intraoperative images ranged from 8% to 22% of surgically linked images. Articles in
target audience magazines had the largest portion (22% of surgically linked images) and
articles in fashion and beauty had the lowest (8% of surgically linked images).
It is important to note that the intraoperative images in target audience and
fashion and beauty magazines were staged using models. Furthermore, when
107
diagramming surgery on the body, images in fashion and beauty magazines diagrammed
surgery on models and celebrities, not real patients. The use of models and celebrities
contrasts with the use of ordinary patients and doctors in images from the surgical
magazine. The use of images of models can send an unrealistic message to readers.
While discussing the use, need, or technology involved in cosmetic surgery, women are
being exposed to models who exemplify idealized beauty. As a result, women may
develop unrealistic expectations of what surgery can do for them. The use of celebrities
may have a similar effect, though the use of celebrities in visual images only appeared in
articles from the fashion and beauty magazines.
The opposite effect may be achieved through the use of visual images of ordinary
people. Showing visual images of real patients can give readers more realistic
expectations of what cosmetic surgery can do for them. Although the surgical magazine
had modest portions of surgically focused images which diagramed surgery on the body
(16% of surgically focused images) and intraoperative images (14% of surgically focused
images), these images attempted to show the reality of cosmetic surgery. The attempt at
realism is also shown through the use of multiple surgical associations in one visual
image. For example, some intraoperative images showed the surgery diagrammed on the
body as the doctor was using medical supplies to operate. This combination of surgical
associations emphasizes the process of cosmetic surgery. The visual realism is further
supported by the findings that only images from the surgical magazine included medical
diagrams when discussing surgery. The surgical magazine may be the only magazine
type that is achieving the realism of surgery through visual images. The same can not be
108
said for the surgically focused visual images of the other magazine types, which portray
the idea of cosmetic surgery in a more artificial way.
However, the attempt at realism changed from the first issue (2004) to the second
issue (2005) of Skin Deep. Although not shown in tables, the visual images from the
2005 issue featured fewer people and of the primary people featured, the proportions of
models and ordinary people featured were very similar (35% and 40% of primary people
respectively). This contrasts the proportions of models and ordinary people in articles
from the 2004 issue (30% and 56% of primary people respectively). Furthermore,
articles in the 2004 issue featured surgically focused visual images of before and after
images, after surgery results, and intraoperative images while articles in the 2005 issue
did not feature any such surgically focused visual images. It seems the reality of
cosmetic surgery was only visually attempted in the first issue of Skin Deep and not the
second issue, which attempts to visually appear more like a general women’s magazine.
Representation of cosmetic surgery
When coding for the details of the content of articles, I also coded for the overall
representation of cosmetic surgery in each article. Articles were coded as either in
support, cautionary, both supportive and cautionary, or neither supportive nor cautionary.
The supportive representation of cosmetic surgery presents the use of cosmetic surgery in
a positive light while a cautionary representation discusses the dangers or cosmetic
surgery, warning readers. Articles which were both supportive and cautionary discussed
the benefits of surgery as well as the risks. Articles which were neither supportive nor
109
cautionary did not advise for or against cosmetic surgery. Table 4.9 shows the
distribution of this variable. Overall, articles most frequently represented cosmetic
surgery in a supportive way. Thirty-nine percent of the sample of articles was in support
of cosmetic surgery. Representing cosmetic surgery as cautionary or both supportive and
cautionary occurred in similar portions at 20% and 27% respectively. A modest portion
of articles (14% of articles) represented cosmetic surgery in neither a supportive nor
cautionary way. These neutral articles are most interesting because they inform the
readers without trying to persuade them, letting the readers decide.
Table 4.10: Representation of Cosmetic Surgery by Type of Magazine, 2004-2005
(n=70)
Type of Magazine
Representation
of Cosmetic
Surgery
Total
Traditional
Target
Audience
n
%
2
7
25
Fashion
& Beauty
n
%
15 56
42
n
--
%
---
Both:
Supportive &
Cautionary
Cautionary
3
16
50
3
16
38
7
--
---
1
7
13
Neither:
Supportive nor
Cautionary
Total
3
30
50
2
6
9
100
8
In Support
Surgical
n
10
%
37
50
n
27
%
100
39
37
19
6
32
30
19
101*
27
10
71
28
3
21
15
14
99*
20
20
25
4
40
11
1
10
5
10
100
14
11
101*
36
51
100
20
29
100
70
100
100
*Percentages may not add to 100 due to rounding.
110
The way cosmetic surgery is represented varies across magazine types. Similarly
large portions of articles from fashion and beauty magazines and the surgical magazine
represented cosmetic surgery supportively. Half the articles in the surgical magazine
were in support of surgery and 42% of the articles in fashion and beauty magazines were
as well. In target audience magazines, one-fourth of articles portrayed surgery
supportively. However, articles in traditional women’s magazines did not portray
cosmetic surgery supportively, nor did these articles portray surgery cautiously. In
traditional women’s magazines, half of the articles represented surgery both supportively
and cautiously. This portion was the largest across the four magazine types. Articles in
target audience magazines and the surgical magazine were similar again with 30% to
38% of articles representing both sides of cosmetic surgery. Only 19% of articles from
fashion and beauty magazines represented both sides of surgery, the lowest portion of
articles for this representation. However, articles from fashion and beauty magazines had
the highest portion of cautionary representations at 28% of articles. Proportions from
articles in target audience and the surgical magazines were similar again at 13% and 15%
of articles respectively. Articles from target audience magazines and the surgical
magazine did differ when representing surgery neutrally. Articles in the surgical
magazine were very low at 5% of articles as were the fashion and beauty magazines at
11% of articles. However, one-forth of the articles in target audience magazines
presented cosmetic surgery as neither supportive nor cautionary. Articles from traditional
women’s magazines were even higher proportionally, with half of the articles
representing surgery neutrally.
111
To summarize the tables covering the content of articles about cosmetic surgery,
articles in the surgical magazine were most often in support of cosmetic surgery and least
often represented cosmetic surgery without support or caution. In terms of visual images
(Table 4.7 and 4.8), articles in the surgical magazine frequently had surgically focused
visual images and these images tended to use real patients or doctors, achieving a sense
of realism in the depiction of cosmetic surgery. Articles in the surgical magazines were
similar to the content of articles in target audience magazines for certain variables. In
terms of visual images (Table 4.7), articles from both magazine types tended to visually
indicate the frame of the medicalization of women’s beauty. Furthermore, when looking
at specific procedures mentioned (Table 4.5), articles from both magazine types tended to
mention similar surgical procedures, including similar proportions of facial, breast, lower
body, and liposuction procedures. These magazine types differ in the mention of nonsurgical procedures. Articles from target audience magazines were more likely to
mention spider vein and cellulite treatments while articles from the surgical magazines
never mentioned such treatments and only mentioned dermal fillers when referencing
non-surgical procedures.
Articles in fashion and beauty magazines were most likely to cautiously represent
cosmetic surgery. However, articles in fashion and beauty magazines tended to have
diverse representations of cosmetic surgery (Table 4.9). The pattern of diversity and
variety occurred in other variables as well, such as type of surgical procedures and
mentions of specific surgical procedures (Tables 4.4 and 4.5). The variety in distribution
112
shows that articles in fashion and beauty magazines discuss cosmetic surgery in multiple
contexts. The diversity of ideas surrounding cosmetic surgery in fashion and beauty
magazines differs greatly from articles in traditional women’s magazines. These articles
tended to be very uniform, always focusing on non-surgical procedures such as dermal
fillers and spider vein/cellulite treatment without reference to age or a specific
representation of cosmetic surgery and representing either both sides to cosmetic surgery
or neither (Tables 4.5, 4.6, and 4.9). This simplicity provides readers with the chance to
decide for themselves how they feel about cosmetic surgery and when it should be used.
Finally, the findings from the visual images (Table 4.7) do not visually support
any of my hypotheses surrounding the representation of frames. Visual images of
medical objects indicate the frame of the medicalization of women’s beauty, while the
visual images of body focused objects indicate the frame of perfection and normalcy.
After examining visual images, articles in fashion and beauty magazines were not more
likely to represent the frame of medicalization of women’s beauty through visual images
compared to articles in traditional women’s magazines (hypothesis #2). Nor were these
articles more likely to visually indicate the frame of perfection as normalcy compared to
traditional women’s magazines. In fact, articles in traditional women’s magazines were
more likely to visually indicate the frame of perfection as normalcy than articles in
fashion and beauty magazines. Furthermore, the use of body focused objects in articles
from target audience magazines does not support the idea that these articles are more
likely to use the frame of perfection as normalcy compared to magazines that target
113
European American audiences (hypothesis #6). However, the use of visual images to
represent specific frames is a small portion of the overall representation of frames.
The textual analysis of frames that follows provides a more developed
understanding of the representation of frames in articles about cosmetic surgery.
FRAMING OF THE ARTICLES
Medicalization of Women’s Beauty
The frame of the medicalization of women’s beauty explains cosmetic surgery as
a medical process and refers to an individual’s appearance in medical terms. I developed
eight indicators (flaws, genetics, illness, professional help, healthy alternative, achieving
the impossible, medical environment, and scientific language) to summarize the main
points of this frame. Table 4.10 shows the frequency of these eight indicators according
to presence in articles and number of mentions. Of these eight indicators, scientific
language, language that parallels scientific and medical processes, occurred most
frequently overall with 50% of all articles using this indicator. Describing appearance in
terms of genetics and illness occurred in 19% of articles and referencing surgery as a
healthy alternative to other forms of beauty enhancement occurred in 17% of articles.
The indicator of flaws, describing the body as flawed or irregular, was present in 16% of
articles and achieving the impossible, describing an appearance that cannot be achieved
without cosmetic surgery, was present in 14% of articles. Expressing the need for
professional help and describing a medical environment were present in very few articles,
114
Table 4.11: Medicalization of Women’s Beauty Frame by Type of Magazine, 20042005 (N=70 articles)
Type of Magazine
Medicalization
of Women’s
Beauty Frame
Traditional
n
%
A. Coverage
(n=6)
by Articles
Scientific Language
4
11
67
Genetics
---Illness
1
8
17
Healthy Alternative
---Flaws
1
9
17
Achieving the Impossible
---Medical Environment
---Professional Help
1
17
17
Target
Audience
n
%
Fashion
& Beauty
n
%
Surgical
Total
n
n
(n=8)
(n=36)
(n=20)
(N=70)
%
%
5
14
63
11
31
31
15
43
75
35
100
50
1
8
13
8
62
22
4
31
20
13
100
19
3
23
38
2
15
6
7
54
35
13
100
19
1
8
13
6
50
17
5
42
25
12
100
17
--
---
6
55
17
4
36
20
11
100
16
1
10
13
6
60
17
3
30
15
10
100
14
--
---
5
83
14
1
17
5
6
100
9
2
33
25
3
50
8
--
---
6
100
9
115
Table 4.11 continued: Medicalization of Women’s Beauty Frame by Type of Magazine,
2004-2005 (N=70 articles)
Type of Magazine
Medicalization
of Women’s
Beauty
Traditional
n
%
Target
Audience
n
%
Fashion
& Beauty
n
%
Surgical
Total
n
n
%
%
B. Coverage
by Mentions
Scientific
Language
5
20
33
83
141 100
55
Genetics
--
2
13
4
19
100
7
Illness
1
5
2
22
30
100
12
Healthy
Alternative
--
1
9
5
15
100
6
Flaws
1
--
14
7
22
100
9
Achieving the
Impossible
--
1
10
3
14
100
5
Medical
Environment
--
--
8
1
9
100
4
Professional
Help
1
2
3
--
6
100
2
Total
8
125 49
100
256 100
100
3
100
31
12
100
92
36
100
*The totals for presence of indicators are for the same 70 articles each time. Thus the
totals may contain some repetition as multiple indicators may be present in the same
article.
116
each at only 9% of the total sample. Looking at the number of mentions, indicators
followed a similar order of frequency though slightly more skewed than when looking at
presence. The indicator of scientific language accounted for 55% of mentions while the
other indicators accounted for 12% of mentions or less. A total of 256 mentions of these
indicators occurred for the total sample of 70 articles. Therefore, articles about cosmetic
surgery averaged 3.66 mentions of the medicalization of women’s beauty frame an
article.
Looking at indicators across magazine types, the most frequently used indicator
for articles in all four magazine types was scientific language. The surgical magazine has
the largest portion of articles using this indicator at 75% of articles. An example of
scientific or medical language is discussing different body types as “gynoid” and
“android” as one article in Skin Deep (2004: p. 17) did. Typically, women’s magazines
refer to different body shapes as “pear” or “apple” to illustrate carrying excess weight on
the lower or middle of the body. Replacing these commonly used phrases with more
precise medical terms encourages the medical lens. Another example is referring to
“facial wasting” (Vogue 2004, August: p. 160) as the process by which the face ages.
The proportion of articles in the surgical magazine which use the indicator of scientific
language is similar to that of traditional women’s magazines (67%) and slightly higher
than that of target audience magazines (63%). However, fashion and beauty magazines
had a much lower proportion of articles compared to the other magazine types with the
indicator of scientific language present in only 31% of articles. This finding is
meaningful since I hypothesized that articles in fashion and beauty magazines would be
117
more likely to feature the frame of medicalization of women’s beauty than articles in
traditional women’s magazines. Looking at this one indicator, which was so common for
articles in other magazine types, my hypothesis is not supported.
The indicators of genetics and illness occurred with the same frequency in the
total sample. However, the presence of these indicators varies according to magazine
type. Indicating illness, disease, or disfigurement in reference to appearance occurred
most often in articles from the surgical magazine and target audience magazines, ranging
from 35% to 38% of articles. Articles in Skin Deep (2004: p. 47, 50) often used phrases
such as “cosmetic contour deformity” and “aesthetic deformity” when discussing a
displeasing appearance due to aging. One article in Essence (2005, January: p. 34) stated
“if you are plagued by cellulite in your thighs and derriere, you may be an ideal candidate
for stringcision,” associating cellulite with disease and proposing a medical treatment.
Articles in traditional women’s magazines referenced the illness indicator in 17% of
articles, but the lowest proportion was in fashion and beauty magazines at 6% of articles.
The indicator of genetics occurred more consistently across magazine types. In articles
from target audience, surgical, and fashion and beauty magazines, the presence of this
indicator ranged from 13% to 22% of articles. This indicator is exemplified by phrases
such as “my big chest was an undeniable part of my genetic inheritance” (Vogue 2004,
April: p. 144) which portrays a lack of ability to change your appearance on your own.
This indicator can encourage readers to purchase any product, including surgery, if it
“promises to save me from – or at least slow down – my genetic fate” (Vogue 2004,
March: p. 438). While the indicator of genetics was consistently present throughout
118
articles in these three magazine types, it did not occur once in articles from the traditional
women’s magazines.
The indicators of healthy alternative, flaws, and achieving the impossible
occurred moderately throughout the total sample of articles, ranging from 14% to 17% of
articles. Across magazine types, these indicators varied little as well. Articles from
traditional women’s magazines did not feature the indicators of healthy alternative and
achieving the impossible. The indicator of healthy alternative looks at cosmetic surgery
as a safe option of beauty enhancement similar to exercise. This indicator was present in
13% of articles in target audience magazines and a similar portion, 17% to be exact, of
articles from fashion and beauty magazines featured the indicator. The portion of articles
from the surgical magazine was distantly similar with one-fourth of articles referencing
this indicator. Interestingly, these exact proportions occurred for the indicator of
achieving the impossible except for articles from the surgical magazine. This indicator
describes the results of surgery as impossible through other means, comparing surgery to
magic or miracles. Only 15% of articles from the surgical magazine discussed using
cosmetic surgery to achieve results that were not possible without surgery. Furthermore,
articles in traditional women’s, fashion and beauty, and surgical magazines referenced
the indicator of flaws, appearance irregularities and defects, in similar proportions,
ranging from 17% to 20% of articles. However, not one article from target audience
magazines used this indicator.
The need to change appearance through professional help was present in only
nine percent of the total sample. Yet in certain magazine types, this indicator occurred
119
frequently. Professional help was used in 25% of the articles from target audience
magazines and 17% of articles from traditional women’s magazines. However this
indicator was present in only eight percent of articles from fashion and beauty magazines
and absent from articles in the surgical magazine. The absence of this indicator in the
surgical magazine is intriguing because the articles for this magazine are mostly written
by medical professionals, yet they never explicitly encourage readers that a medical
solution is needed for their aesthetic problems. The description of a medical
environment, which also occurred in nine percent of articles in the total sample, was
present in few articles across magazine types as well. Articles in traditional women’s and
target audience magazines did not use this indicator, and it was only present in five
percent of the articles in the surgical magazine. However, in fashion and beauty
magazines, the medical environment indicator occurred in 14% of articles. Looking
within magazine types, all indicators were present through articles from fashion and
beauty magazines while only four indicators were present in articles from traditional
women’s magazines. This finding may indicate that fashion and beauty magazines are
more likely to reference the frame of medicalization than traditional women’s magazines,
which supports my hypothesis.
While the presence of indicators within articles allows for comparison of
individual indicators, the number of mentions of indicators provides the emphasis of
specific indicators and the medicalization of women’s beauty frame as a whole. While as
a whole the number of mentions followed a similar ordering as the presence of indicators
would predict, a few noteworthy findings are shown when looking across magazine
120
types. The indicator of scientific language accounted for the most number of mentions in
every magazine type, ranging from 63% to 66% of mentions in articles from traditional
women’s, target audience, and surgical magazines. In articles from fashion and beauty
magazines, 36% of mentions were of the scientific language indicator. Interestingly,
these proportions indicate multiple mentions of scientific language per article. Articles
of the surgical magazine averaged 5.5 mentions an article, having 83 mentions when the
indicator was present in only 15 articles. Articles in the target audience and fashion and
beauty magazines also had multiple mentions, with a mean of four and three mentions per
article respectively. Clearly, this indicator in emphasized when present. The use of
scientific language was not emphasized in articles from traditional women’s magazines,
in which the indicator was mentioned five times for four articles for a mean of 1.25
mentions an article.
Articles from traditional women’s magazines were the only articles that did not
emphasize indicators through multiple mentions an article. However, articles in fashion
and beauty magazine did emphasize certain indicators, indicating that articles in fashion
and beauty magazine may be more likely to reference the frame of medicalization than
articles in traditional women’s magazines. Articles in fashion and beauty magazines
emphasized the indicator of flaws, which accounted for 15% of mentions from this
magazine type. The indicator was only present in six articles, but was mentioned 14
times, averaging to a men of 2.33 mentions an article. This indicator was also
emphasized in articles from the surgical magazine, with almost two mentions an article.
The indicator of achieving the impossible was also emphasized in articles from fashion
121
and beauty magazines with almost two mentions an article. The indicator of illness was
emphasized in articles from target audience magazines and the surgical magazine.
Eighteen percent of mentions from the surgical magazine referenced illness, yet this
indicator was mentioned 22 times for being present in only seven articles. These
numbers give a mean of three mentions an article, indicating emphasis of the illness
indicator. Articles from target audience magazines also emphasized the indicator,
averaging almost two mentions an article. Though present, the other indicators of the
medicalization of women’s beauty frame were not emphasized through multiple
mentions.
In summary, the frame of the medicalization of women’s beauty occurred most
frequently in the articles from the surgical magazine compared to the other magazine
types. As Table 4.14 shows, the surgical magazine had the highest mean of 6.25
mentions an article and also the largest range of 0-27 mentions. The mean for the total
sample of articles was only 3.66 mentions an article, almost half the mean for article from
the surgical magazine. The repeated use of this framing is interesting because of the
subtlety involved in the medicalized view. For example, scientific language, which was
very prevalent in this magazine type, can persuade readers of a medicalized frame while
seeming to inform readers of the process of cosmetic surgery. For example, one article
described one of the considerations for breast augmentation to be “the plane of implant
placement: underneath the breast tissue (subglandular) or underneath the pectoralis major
muscle (submuscular or subpectoral)” (Skin Deep 2005: p. 67). Many readers may
believe that breast augmentation is always discussed by referencing the plane of implant.
122
Therefore, readers may believe they are being informed about the process of cosmetic
surgery instead of being persuaded to view their breast in terms of medical parts without
relation to the whole body. The message may appear to be of medical information about
the process of cosmetic surgery, indicating the subtlety of this frame.
Articles in target audience magazines and fashion and beauty magazines were
similar in their average representation of the frame of medicalization of women’s beauty.
For articles from target audience magazines the mean was 3.88 mentions an article with a
range of 0-13 mentions. For article from fashion and beauty magazines, the mean is
slightly smaller at 2.56 mentions an article but with a slightly larger range of 0-15
mentions. However, the two magazine types varied in the inclusion of certain indicators,
particularly the indicators of flaws, medical environment, and illness. In target audience
magazines, describing appearance in terms of illness occurred in 38% of articles. This
indicator is especially meaningful for readers of target audience magazines because of the
message it can send to women. The message that one’s body or appearance is diseased
can be especially influential to minority women who may already feel inferior to
European American standards of beauty. Articles in fashion and beauty magazines
represented all the indicators of the medicalization of frame, including the indicators of
flaws and medical environment which were not present in articles from target audience
magazines. The variety of indicators used sends a more complicated message to readers.
The mentions of medicalization in articles from this magazine type sends the message to
readers that their appearance is flawed and genetically inferior, but cosmetic surgery is a
healthy alternative to other forms of beauty enhancement and can achieve a beautiful
123
appearance like no other treatment can. The use of many medical appeals at the same
time may resonate more with readers than repeating the same indicator frequently.
Articles in traditional women’s magazines were least likely to support the
medicalization frame with a mean of only 1.33 mentions an article and a small range of
zero to three mentions. The minimal presence and mention of indicators implies that the
medicalization frame in not supported in traditional women’s magazines. This minimal
representation supports my second hypothesis that fashion and beauty magazines were
more likely to mention the medicalization of women’s beauty compared to traditional
women’s magazines. On average, articles from fashion and beauty magazines mention
the frame of medicalization of women’s beauty 2.56 times an article. This mean is nearly
double the mean for articles from traditional women’s magazines. Furthermore, the
range of mentions from articles in fashion and beauty magazines is greater than the range
from articles from traditional women’s magazines, indicating that articles in fashion and
beauty magazines tend to have multiple mentions compared to articles from traditional
women’s magazines.
Surgery as Therapy
The surgery as therapy frame involves viewing the body as part of the emotional
well-being of an individual and cosmetic surgery as a way of improving both the body
and the emotional well-being of an individual. I developed six indicators (self-esteem,
self-expression, alignment to true self, deserving, because you are worth it, and for me) to
encompass the major points of this frame. Table 4.11 shows the distribution of these
124
indicators according to presence in articles and number of mentions. Overall, the most
frequent indicator was that of self-esteem, or the referencing how cosmetic surgery can
affect self-esteem, self-image, and confidence. This indicator occurred in 20% of the
total 70 articles. Self-expression, the use of surgery to therapeutically or psychologically
express oneself, occurred in 14% of articles as well. The other four indicators each
occurred in less than 5% of articles in the total sample. The presence of indicators is
infrequent, and looking at the indicators measured through mentions further supports a
low occurrence of this frame. A total of 60 mentions of the frame occurred for the entire
sample of 70 articles. Most of these mentions, 83% of mentions to be exact, were of the
self-esteem and self-expression indicators. However, the indicator of self-esteem was
twice as likely to be mentioned compared to the self-expression indicator. The difference
between the two indicators increased when switching focus from presence to number of
mentions. The number of mentions of the other four indicators was still low, ranging
from 2% to 7% of mentions. The low occurrence of mentions averages to less than one
mention an article (.86 mentions an article in Table 4.14), reflecting an infrequent
presence of the surgery as therapy frame in articles about cosmetic surgery.
Examining the indicators across magazine types, none of the indicators for this
frame were present in articles from traditional women’s magazines. However, in the
articles from the three other types, indicators from this frame were present to varying
degrees. This initial finding does not support my hypothesis that articles in traditional
women’s magazines are more likely to feature the frame of surgery as therapy than
articles in fashion and beauty magazines. The indicator of self-esteem occurred most
125
Table 4.12: Surgery as Therapy Frame by Type of Magazines, 2004-2005 (N=70)
Type of Magazine
Surgery as
Therapy Frame
Traditional
n
A. Coverage
by Article
Self-esteem
%
(n=6)
Target
Audience
n
%
Fashion
& Beauty
n
%
Surgical
Total
n
n
(n=8)
(n=36)
(n=20)
(N=70)
%
%
---
3
21
38
6
43
17
5
36
25
14
100
20
--Alignment to the True Self
---For Me
---Deserving
---Because You are Worth It
----
3
30
38
6
60
17
1
10
5
10
100
14
--
---
2
67
6
1
33
5
3
100
4
--
---
1
33
3
2
67
10
3
100
4
--
---
2
100
6
--
---
2
100
3
--
---
1
100
3
--
---
1
100
1
-Self-expression
--
126
Table 4.12 continued: Surgery as Therapy Frame by Type of Magazines, 2004-2005
(N=70)
Type of Magazine
Surgery as
Therapy Frame
Target
Audience
n
%
Fashion
& Beauty
n
%
Surgical
Total
n
n
%
B. Coverage by
Mentions
Self-esteem
--
6
17
10
33
100
55
Self-expression --
5
6
6
17
Alignment to
the True Self
--
--
2
2
4
100
28
100
7
For Me
--
--
1
2
3
100
5
Deserving
--
--
2
--
2
100
3
Because You
are Worth It
--
--
1
--
1
100
2
Total
--
60
100
100
Traditional
n
%
---
11
18
100
29
48
100
20
%
33
100
127
often in articles from target audience magazines. Thirty-eight percent of articles from
this magazine type used this indicator. Phrases which discuss how “rhinoplasty, tummy
tucks, liposuction and eye lifts can provide a psychological boost and restore youthful
confidence” (Essence 2004, March: p.42) exemplify this indicator. The importance of
confidence is discussed more dramatically in phrases such as “for the woman what has
always despised her lips, collagen feels like confidence” (Glamour 2004, January: p.
138). Referring to self-esteem occurred in moderate proportion in articles from fashion
and beauty magazines and the surgical magazine as well. This indicator was present in
one-fourth of the articles in the surgical magazine and in 17% of articles from fashion
and beauty magazines.
The presence of the indicator of self-expression occurred in the same proportion
of articles as the self-esteem indicator for articles from target audience and fashion and
beauty magazines (38% and 17% of articles). For articles in both of these magazine
types, the indicator of self-esteem was just as likely to be present as the self-expression
indicator. The use of surgery to create some balance between your physical appearance
and your mental conception of yourself can be very persuasive. One article in Glamour
(2004, January: p. 136) questioned the popularity of cosmetic surgery, stating “maybe
there’s something to all those ads for plastic surgery, the ones that pitch their product as a
vehicle of self-expression, even self-love.” Even referring to the use of dermal fillers as
“therapies” emphasizes the expression of the self and detracts from the fact that it is a
medical procedure (Vogue 2005, February: p. 216; Vogue 2004, August: p. 161). The use
of the self-expression indicator occurred most often in articles from target audience
128
magazines. Articles in the surgical magazine rarely referenced self-expression with this
indicator occurring in only 5% of the articles. When comparing self-expression to selfesteem, self-esteem occurred much more frequently in one-fourth of articles. This
comparison is interesting because in articles from the other magazine types, the selfexpression indicator occurred just as often as the self-esteem indicator.
The indicators of alignment to true self, for me, deserving, and because you are
worth it were present in few articles across magazine types. None of these indicators
were present in articles from target audience and traditional women’s magazines. The
indicator of for me, the mention of surgery for personal benefit and not to meet societal
standards, occurred in articles from both fashion and beauty magazines and the surgical
magazine. However, the proportions were low at 10% of articles or less. The indicator
of alignment to true self, the use of surgery to create an appearance which fits the inner
self, was also present in these two magazine types, but was still infrequent at less than
10% of articles. Furthermore, the only articles to use the indicator of deserving,
emphasizing the luxury in surgery, and the rationale because you are worth it were from
fashion and beauty magazines. Again, the portion of articles referencing these indicators
was low and present in only one or two articles. Though these four indicators were
infrequently present, when used they can convey powerful messages. For example, one
woman wrote about her decisions to get breast reduction saying that after surgery “they
[her breasts] were … the breasts I had always imagined I had, only to be rudely
enlightened when I saw myself in the mirror” (Vogue 2004, April: p. 167). Many readers
may be able to relate to this statement and the feeling that surgery can give them the
129
appearance they wish they had. Even brief comments such as “I think all women deserve
good skin” (Vogue 2005, August: p. 253) can remind readers that they to deserve to look
as good as they wish.
Looking at the number of mentions of indicators allows for a better understanding
of which indicators were emphasized in writings about cosmetic surgery. Across
magazine types, the proportions of mentions of the indicators followed a similar order to
the proportions of the presence of indicators. For articles in target audience, fashion and
beauty, and surgical magazines, mention of the self-esteem indicator occurred most
frequently, ranging from 50% to 59% of mentions. Also, the mention of self-esteem was
emphasized in articles from all three magazine types through multiple mentions. Only
six articles from fashion and beauty magazines used this indicator yet it was mentioned
17 times, averaging almost three mentions an article. Furthermore, articles from target
audience and surgical magazines averaged two mentions of self-esteem in articles in
which the indicator was present. Therefore, the indicator of self-esteem not only accounts
for a large portion of mentions but it is also emphasized when present.
In articles from target audience magazines, the mention of self-esteem was almost
just as likely to occur as mention of self-expression (55% and 45% of mentions
respectively). The mention of self-expression was less likely to occur in articles from
fashion and beauty magazines and the surgical magazine, ranging from 21% to 30% of
mentions. It is noteworthy that 30% of the mentions from the surgical magazine were of
the self-expression indicator because it was present in only one article. This indicator
was clearly emphasized in this article with six mentions of the same indicator.
130
Mention of the other four indicators from this frame did not occur in articles from
the target audience magazines. The indicators of alignment to true self and for me were
mentioned in the surgical magazine. However, these mentions were fairly low at 10% of
mentions each. All four indicators of alignment to true self, for me, deserving, and
because you are worth it were mentioned in articles from fashion and beauty magazines.
These mentions were also low, ranging from 3% to 7% of mentions. However, it is
noteworthy that articles from fashion and beauty magazines mentioned all six of the
indicators of the frame of surgery as therapy. The variety of types of indicators shows an
inclusion of different ways of framing the same idea, which may reach a wider range of
readers. Also, this variety is in direct contrast to the articles from traditional women’s
magazines which did not mention any of the indicators, showing a lack of support for my
hypothesis that articles from traditional women’s magazines are more likely to feature
this frame than articles in fashion and beauty magazines.
In summary, the statistics from Table 4.14 indicate that articles from target
audience magazines were most likely to indicate the frame of surgery as therapy.
Articles from the target audience magazines averaged 1.38 mentions an article with a
range of zero to four mentions. However, the indicators of self-esteem and selfexpression were the only indicators that occurred throughout articles from this magazine
type. Following close behind, the surgical magazine had a mean of one mention an
article with a slightly higher range of zero to five. The reference to the frame of surgery
as therapy, again, is indicated mostly through the reference of the two specific indicators
of self-esteem and self-expression. The description of cosmetic surgery as therapeutic is
131
meaningful in the surgical context, especially because many of the authors of articles in
Skin Deep are medical professionals. To appeal to readers through medical or
psychological reasoning would seem a logical writing tactic. However, many of the
indicators of this frame were not mentioned frequently throughout articles from this
magazine type.
Articles in traditional women’s magazines were least likely to indicate the frame
of surgery as therapy because none of the indicators were present or mentioned
throughout the sample of articles. Articles in fashion and beauty magazines,
interestingly, had the largest variety of indicators and range (0 to11 mentions) of the
magazine types but also had the lowest average (.81 mentions an article) of the three
magazine types which featured the frame at all. These statistics shows that while the
frame was not indicated often, when indicated it was done so in variety of ways. These
findings also counteract part of my third hypothesis that articles from traditional women’s
magazines are more likely to use the frame of surgery as therapy than articles in fashion
and beauty magazines. Instead, the opposite is true; articles in traditional women’s
magazines were less likely, rather than more likely, to use the surgery as therapy frame
compared to articles in fashion and beauty magazines. However it is important to note
that overall, this frame was not very prevalent in any magazine type, averaging less than
one mention for the entire sample.
132
The Autonomous Voice
I developed six indicators to measure the frame of the autonomous voice, a frame
that emphasizes the individuality of the patients in the process of creating a beautiful
appearance through cosmetic surgery. Of these six indicators (individualized, autonomy,
active voice, rebellious tone, emotional strength, and empowering), the two most frequent
indicators were individualized and active voice at 36% of articles each. The
individualized indicator stresses the patient’s role is deciding to get surgery and how
surgery is tailored to individual needs while the active voice indicator is portrayed
through pro-active languages that convey power, control, and action. As Table 4.12
shows, a moderate portion of articles featured the indicator of rebellious tone, which
portrays appearance as a battle, at 17% of articles. The other three indicators, referring to
the emotional strength, empowering emotions, and feeling of autonomy involved in the
process of cosmetic surgery, occurred infrequently in less than 10% of articles. Looking
at the number of mentions of indicators shows similar results. The individualized
indicator accounted for 41% of mentions and the active voice indicator accounted for
31% of mentions. Thirteen percent of mentions were of the indicator of rebellious tone.
The other three indicators accounted for 7% of mentions or less. One-hundred and
thirteen mentions occurred for 70 articles, averaging to slightly more than one and half
mentions an article.
When examining the presence of indicators across magazine types, a large
portion, 65% to be exact, of articles in the surgical magazine used the individualized
indicator. The individualized indicator emphasizes the individual’s personal involvement
133
Table 4.13: The Autonomous Voice Frame by Type of Magazine, 2004-2005 (N=70)
Type of Magazine
The
Autonomous
Voice Frame
Traditional
n
A. Coverage
by Article
Individualized
%
(n=6)
Target
Fashion
Surgical
Audience & Beauty
n
%
n
%
n
%
Total
(n=8)
(n=36)
(n=20)
(N=70)
n
%
--
---
3
12
38
9
36
25
13
52
65
25
100
36
--
---
5
20
63
10
40
28
10
40
50
25
100
36
--
---
4
33
50
6
50
17
2
17
10
12
100
17
---
1
17
13
4
67
11
1
17
5
6
100
9
--
---
--
---
3
75
8
1
25
5
4
100
6
--
---
2
67
25
1
33
3
--
---
3
100
4
Active Voice
Rebellious Tone
Emotional Strength
-Empowering
Autonomy
134
Table 4.13 continued: The Autonomous Voice Frame by Type of Magazine, 2004-2005
(N=70)
Type of Magazine
The
Autonomous
Voice Frame
Traditional
n
%
Target
Fashion
Audience & Beauty
n %
n
%
Surgical
Total
n
n
%
%
B. Coverage
by Mentions
Individualized
--
8
14
24
46
100
41
Active Voice
--
6
17
12
35
100
31
Rebellious
Tone
--
6
7
2
15
100
13
Emotional
Strength
--
1
5
2
8
100
7
Empowering
--
--
5
1
6
100
5
Autonomy
--
2
1
--
3
100
3
Total
--
23 20
100
49
---
43
100
41
36
100
113 100
100
135
in cosmetic surgery through statements such “patients can pick and choose from a
smorgasbord of rejuvenations – fat injections, Botox” (Vogue 2005, February: p. 216).
After all, one doctor reminds readers “it’s your face, your body and your life” and
therefore your decision (Glamour 2004, October: p. 131). Substantial portions of articles
in target audience (38% of articles) and fashion and beauty magazines (25% of articles)
referenced the individualized indicator as well, while articles from traditional women’s
magazines did not reference this indicator or any other indicator from this frame. The
frame’s absence in articles from traditional women’s magazines shows a lack of support
for my hypothesis that articles from traditional women’s magazines are more likely to
feature the frame of the autonomous voice than articles in fashion and beauty magazines.
For the indicator of active voice, target audience magazines and the surgical
magazine had similarly high portions of articles which used this indicator. Sixty-three
percent of articles in the target audience magazines included the active voice and half of
the articles in the surgical magazines did too. Over one-fourth of the articles in fashion
and beauty magazines used the active voice indicator. Active voice is exemplified in
statements that discuss taking actions against appearance or an attitude that expresses
“why don’t you do something about those thighs” (Glamour 2004, May: p. 218.
Emphasis in the original article). The idea that women who have had cosmetic surgery
are “eager to display the way they’ve taken control of their bodies” (Glamour 2004,
January: p.136) uses pro-active language that can make the reader want to take action as
well.
136
The indicator of rebellious tone occurred in half of the articles in target audience
magazines. This portion was considerably large compared to fashion and beauty
magazines and the surgical magazine in which the presence of this indicator occurred in
17% to 10% of articles. The rebellious tone is a step past active voice, portraying one’s
relationship with appearance as a battle. Discussing treatments that “fight cellulite,”
“combat them [skin problems],” and using “nonsurgical treatments [dermal fillers] to
help you win the war on wrinkles” (Essence 2005, January: p. 34, 31; Essence 2004,
January: p. 33) display this rebellious tone. While the presence of the indicators of
emotional strength and empowering were similarly low across magazine types, mentions
of these indicators can be very powerful. The emotional strength indicator emphasizes
the courage and pride involved in surgery while the empowering indicator focuses on the
feeling of liberation and power gained from surgery. Claming that “aesthetic surgery is
now a badge proudly worn” (Vogue 2004, June: p. 180) and that “for the women racked
with anxiety over her thighs, liposuction can feel like liberation” (Glamour 2004,
January: p. 138) can resonate with some readers. However, emotional strength was
present in articles in target audience, fashion and beauty, and surgical magazines while
empowering was only present in fashion and beauty magazines and the surgical
magazine. The indicator of autonomy, coming to the decision to get cosmetic surgery
without the influence of others, was only present in articles from target audience and
fashion and beauty magazines. Interestingly, this indicator was low for the total sample
and the sample from fashion and beauty magazines, but was present in 25% percent of
articles from target audience magazines.
137
Across indicators, articles from target audience magazines tended to have large
portions that referenced the indicators. Overall, articles from target audience, fashion and
beauty magazines, and the surgical magazines all had a variety of indicators present.
However, it is surprising that the more direct indicators of autonomy and empowering,
which do not subtly express the idea of the autonomous voice, were not present
frequently throughout the sample. The autonomous voice seemed to appear in more
subtle ways in this sense. Articles from traditional women’s magazines did not represent
this frame at all. This finding does not support the part of my third hypothesis that states
articles in traditional women’s magazines are more likely to use the frame of the
autonomous voice than articles in fashion and beauty magazines.
Examining the number of mentions for the frame of the autonomous voice reflects
a similar breakdown. The individualized indicator accounted for 59% of the mentions
from articles in the surgical magazines and 35% of mentions from articles in target
audience magazines. These portions are significant because they indicate multiple
mentions of this indicator in articles. In target audience magazines, three articles used the
individualized indicator and it was mentioned a total of eight times for these three articles
for a mean of 2.67 mentions an article. The number of mentions for articles in the
surgical magazine is almost double the number of articles the indicator is present in as
well. This situation is similar to the number of mentions of active voice in articles from
fashion and beauty magazines. Though articles from target audience, surgical, and
fashion and beauty magazines were proportionally similar (ranging from 26% to 35% of
mentions), the number of mentions from fashion and beauty magazines was 17 for only 9
138
articles for a mean of 1.89 mentions an article. Again, these numbers indicate the
occurrence of multiple mentions of the active voice indicator in the same article.
The number of mentions of other indicators was fairly low except for the indicator
of rebellious tone. While this indicator accounted for only 14% of mentions in fashion
and beauty magazines and 5% of mentions from the surgical magazine, one-fourth of the
mentions from the target audience magazines referenced the rebellious tone indicator.
The indicators of emotional strength, empowering, and autonomy were fairly low in the
magazine types which they were mentioned in, ranging from 10% of mentions and lower.
However, it is noteworthy that the number of mentions from articles in fashion and
beauty magazines had the most consistent distribution of mentions. This distribution
shows a variety of indicators and conveys a more complex message of the autonomous
voice. Articles in this magazine type conveyed a varied message of this frame while
articles in traditional women’s magazines did not mention this frame at all. Again, these
findings counteract my hypothesis. In fact, these findings support the opposite; articles in
traditional women’s magazine are less likely, rather than more likely, to use the frame of
the autonomous voice than articles in fashion and beauty magazines.
In summary, articles in the target audience magazines were most likely to indicate
the frame of the autonomous voice. As illustrated in Table 4.14, articles from target
audience magazines averaged 2.88 mentions an article with a range of zero to seven
mentions. However, it is important to caution that this finding may not be specific to the
topic of cosmetic surgery in target audience magazines. The use of the autonomous voice
may be present throughout articles from target audience magazines in general because
139
empowering messages are often used when targeting minority women. Comparing the
use of the autonomous voice in other magazine types, articles in the surgical magazine
had a mean of 2.05 with the same range of zero to seven mentions. The use of this frame
in the surgical magazine is interesting because the articles are often written by
professionals who emphasize their role and skill in the process of surgery. Emphasizing
the role of the patient’s decision and desires seems to contradict the importance of the
surgeon. Furthermore, articles from both target audience magazines and the surgical
magazine seemed to use a couple of indicators frequently instead of using of variety of
indicators. The lack of variety may indicate missed opportunities for the articles to
resonate with readers.
Articles in the traditional women’s magazine were least likely to feature this
frame. This finding was surprising because I had anticipated this frame as being likely to
resonate with readers of traditional women’s magazines and it was not mentioned once in
any articles from this magazine type. However, articles from fashion and beauty
magazines did feature indicators of the frame of the autonomous voice fairly frequently,
counteracting my hypothesis (#3) that articles in traditional women’s magazines are more
likely to use the frame of the autonomous voice than articles from fashion and beauty
magazines. Articles from fashion and beauty magazines averaged 1.36 mentions an
article with a range of zero to six mentions. Clearly, articles in fashion and beauty
magazines were more likely to use the frame of the autonomous voice than articles in
traditional women’s magazines, showing an absence of support for my original
hypothesis. However, it is important to note that articles from fashion and beauty
140
magazines used a variety of indicators. This variety shows that when the frame was
referenced, it occurred in a variety of appeals to the readers. In other words, these
articles may be more likely to affect readers because readers are given a variety of ideas
with a greater likelihood that one will resonate with them.
Perfection as Normalcy
The frame of perfection as normalcy emphasizes the demanding standards of
beauty in today’s society to the point that what was once normal is now ugly and what
was once beautiful is now expected of everyone. I developed seven indicators (to be
normal, maintenance, reasonable expectations, not to beautiful, natural, normative, and
perfection) to illustrate this frame, all of which are displayed according to presence in
articles and number of mentions in Table 4.13. Overall, the indicators of perfection,
natural, and maintenance occurred most frequently ranging from one-fourth to one-third
of articles from the total sample. The indicator of perfection refers to attempting to
achieve idealized beauty or discussing the body in terms of imperfections and perfection.
The natural indicator emphasizes the surgery as a natural process which achieves naturallooking results while the maintenance indicator includes the need to regulate and
maintain appearance through cosmetic surgery. Having reasonable expectations about
cosmetic surgery and reference to normative use of surgery in society occurred less
frequently at 13% and 10% of articles respectively. However the indicators of to be
normal, using surgery to fit in, and not to be beautiful, getting cosmetic surgery without
the expectation of being beautiful, were insignificantly low occurring in less than 4% of
141
Table 4.14: Perfection as Normalcy by Type of Magazine, 2004-2005 (N=70)
Type of Magazine
Perfection as
Normalcy
Frame
A. Coverage
by Articles
Perfection
Traditional
n
%
(n=6)
Target
Audience
n
%
Fashion
& Beauty
n
%
Surgical
Total
n
n
(n=8)
(n=36)
(n=20)
(N=70)
%
%
--
---
1
4
13
19
83
53
3
13
15
23
100
33
1
5
17
2
10
25
10
50
28
7
35
35
20
100
29
6
17
Reasonable Expectations
---Normative
---To Be Normal
---Not to be Beautiful
----
5
28
63
10
56
28
2
11
10
18
100
26
2
22
25
3
33
8
4
44
20
9
100
13
1
14
13
4
57
11
2
29
10
7
100
10
--
---
2
100
6
--
---
2
100
3
--
---
1
100
3
--
---
1
100
1
Natural
Maintenance
1
142
Table 4.14 continued: Perfection as Normalcy by Type of Magazine, 2004-2005 (N=70)
Type of Magazine
Perfection as
Normalcy
Frame
Target
Audience
n
%
Fashion
& Beauty
n
%
Surgical
Total
n
n
%
B. Coverage by Mentions
Perfection
--
1
47
5
53
100
39
Natural
1
2
12
15
30
100
22
Maintenance
1
6
24
2
33
100
24
Reasonable
Expectations
--
2
4
4
10
100
7
Normative
--
1
4
2
7
100
5
To Be
Normal
--
--
2
--
2
100
1
Not to be
Beautiful
--
--
1
--
1
100
.01
Total
2
Traditional
n
%
1
100
12
9
100
94
69
100
28
%
21
100
136 100
100
143
articles each. Looking at the number of mentions of indicators, a similar breakdown
occurs though slightly more skewed. Perfection is mentioned most frequently accounting
for 39% of mentions in the total sample while the maintenance and natural indicators
accounted for 24% and 22% of mentions respectively. The other four indicators were
mentioned very sparsely ranging from 7% to less than 1% of mentions. For the 70
articles, a total of 136 mentions of the frame of perfection as normalcy occurred. This
total number of mentions averaged to 1.94 mentions an article.
Looking across magazine types, the indicator of perfection was present in over
half of the articles from fashion and beauty magazines. Referencing this indicator can be
of women trying to achieve perfection, including statements such as “the promise of an
as-perfect-as-I-can-be body has inspired me” (Vogue 2004, March: p. 598) and hunting
down the “name of the surgeon who’s mastering a method for perfect arms” (Vogue
2005, August: 171. Emphasis in the original article). However, this indicator was also
used when discussing the negative side of cosmetic surgery, in which “you swap one
imperfection for another … imperfectly shaped breasts for ones with scars” (Glamour
2004, January: p. 154). The perfection indicator occurred in similar proportions in
articles from target audience and surgical magazines at 13% and 15% of articles
respectively. Reference to perfection did not occur in any of the articles from traditional
women’s magazines.
The indicator of natural occurred in substantial portions across articles from
target audience, fashion and beauty, and surgical magazines ranging from 25% to 35% of
articles. Using cosmetic surgery to achieve a natural appearance seems a bit illogical, but
144
is often mentioned. One article commented that when using cosmetic surgery “we don’t
strive for unnatural perfection anymore” and instead “people are going back to a more
natural look” when getting surgery (Vogue 2005, February: p. 218). One women
described how having rhinoplasty helped her change from “‘having my dad’s big, round,
masculine nose’” to a nose the “‘looks more natural to me’” (Latina 2005, April: p. 111).
Interestingly, this indicator was present in an article from traditional women’s magazines.
While it was present in only one article, it is the first indication of any frame except the
medicalization of women’s beauty in articles from this magazine type.
The indicator of maintenance occurred in 63% of articles from the target audience
magazines and over one-fourth of articles from the fashion and beauty magazines.
Referring to cosmetic surgery as a form of maintenance implies surgery is “crossing over
from [a form of] frivolous indulgences to required grooming” (Glamour 2004, January: p.
154). As one women wrote after receiving dermal filler injections, “maintenance, I called
it. All part of staving off a major overhaul sometime down the road” (Vogue 2004,
March: p. 598). The maintenance indicator also occurred in one article from the
traditional women’s magazines for a percentage of 17% of articles. This proportion was
similar to the 10% of articles from the surgical magazine which referenced the
maintenance indicator.
The indicators of reasonable expectations and normative were not present in
articles from traditional women’s magazines. However, these indicators were modestly
present in the other magazine types. The reference to reasonable expectations occurred
similarly in articles from target audience magazines and the surgical magazine at 25%
145
and 20% of articles respectively. This indicator specifies the need for patients to be
realistic about what surgery can do for them. As one woman commented, “I’m not going
to have the arms of a 20-year-old. I’m realistic” (Vogue 2005, August: p. 171). However,
for as important as this indicator is in not raising patients’ expectation, its presence was
low for articles from fashion and beauty magazines. The indicator of normative, which
expresses the common use of cosmetic surgery in society, was generally low across
magazine types as well. The portion of articles featuring this indicator ranged from 10%
to 13% of articles in target audience, fashion and beauty, and surgical magazine. The
indicators of normal and not to be beautiful occurred only in articles from fashion and
beauty magazines, and occurred infrequently at 6% and 3% of articles.
Similar to the other frames, articles from fashion and beauty magazines showed
the most variety of indicators for the frame of perfection as normalcy. This variety
indicates support for the part of my second hypothesis that states fashion and beauty
magazines are more likely to use the frame of perfection as normalcy than traditional
women’s magazines. While articles from target audience magazines do not have the
same variety of indicators as in fashion and beauty magazines, five out of the seven
indicators are present in articles from this magazine type. The same indicators present in
articles from target audience magazines were used in the surgical magazine. Looking at
the presence of indicators, my sixth hypothesis that target audience magazines are more
likely to use the frame of perfection as normalcy than European American magazines is
not supported.
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The breakdown of number of mentions across magazine types showed similar
patterns. The indicator of perfection was most prevalent overall, but across magazine
types this indicator accounted for half the number of mentions from fashion and beauty
magazines. Significantly, this indicator was present in only 19 articles but was
mentioned 47 times. These nineteen articles averaged 2.5 mentions of perfection an
article. This finding shows that the indicator of perfection is emphasized when it is
present in articles from fashion and beauty magazines. Articles from the surgical
magazine had fewer mentions of the perfection indicator which accounted for only 18%
of the mentions from these articles. However, the number of mentions of perfection
averaged 1.7 mentions an article for the three articles the indicator was present in. Again,
this indicates some added emphasis of this indicator.
The indicators of maintenance and natural were also frequently present in articles
about cosmetic surgery. Looking at the distribution of number of mentions supports this
frequency. Fifty percent of mentions in articles from target audience magazines
referenced the maintenance indicator. This percentage was the same from articles from
traditional women’s magazines; however, this mention was one of only two mentions of
the frame of perfection as normalcy. Twenty-six percent of the mentions from articles in
fashion and beauty magazines also used the maintenance indicator. Similar to the
number of mentions of perfection, articles in this magazine type mentioned the indicator
of maintenance multiple times. For the ten articles the indicator was present in, 24
mentions of maintenance occurred. These numbers again average to close to 2.5
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mentions an article, showing that the idea that one’s appearance needs to be maintained is
emphasized in these articles.
The emphasis of a particular indicator through mentions occurred in articles from
the surgical magazine as well. For the indicator of natural, 54% of mentions from these
articles were of this indicator. Furthermore, for the seven articles the indicator was
present in, these articles averaged 2.14 mentions of the natural indicator. In articles from
the surgical magazine this indicator was emphasized. In comparison, the mentions of the
natural indicator in articles from traditional women’s magazines did not emphasize the
indicator with only one mention for the article it was present in. The indicator of
reasonable expectations accounted for modest portions of mentions from articles in target
audience magazines and the surgical magazine (17% and 14% respectively). The other
indicators of normative, normal, and not to be beautiful occurred in few mentions across
magazine types ranging from 8% to 1% of mentions in articles.
In summary, articles from fashion and beauty magazines were most likely to use
the frame of perfection as normalcy. On average, articles from fashion and beauty
magazines contained 2.61 mentions an article (Table 4.14). These articles also had the
greatest range (0 to 12 mentions) compared to articles in the other magazine types.
Articles from traditional women’s magazines were least likely to feature this frame with a
mean of .33 mentions an article and a range of only zero to one mention. This finding
confirms the portion of my second hypothesis which states that articles from fashion and
beauty magazines are more likely to feature the frame of perfection as normalcy than
articles in traditional women’s’ magazines. However, it is interesting that this frame was
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absent in all articles from traditional women’s magazines. I had expected traditional
women’s magazines to focus more on the individual and emotional appeals found in the
frames of surgery as therapy and the autonomous voice. These frames emphasize the
emotional and mental strength gained from surgery, whereas the frame of perfection as
normalcy emphasizes conforming to societal standards. I find it surprising that
magazines which target all aspects of women’s lives -- family, career, home, and love -would use articles with such appeals as those of the need to maintain your body or use
surgery to appear natural.
Articles from target audience magazines were almost just as likely to feature this
frame as article in the surgical magazine. Target audience magazines averaged 1.50
mentions an article (with a range of zero to four mentions) while the surgical magazine
averaged 1.40 mentions (with a range of zero to six mentions). Comparing the frequency
of the frame of perfection of normalcy in target audience magazines to magazines which
target European American audiences does not support my sixth hypothesis. While
articles from traditional women’s magazines were less likely to feature the frame than
articles from target audience magazines, articles in the surgical magazine were just as
likely to feature the frame, and articles in the fashion and beauty magazines were more
likely to mention this frame. In general, articles from target audience magazines are not
more likely to use the frame of perfection as normalcy than articles in magazines for
European American audiences. However, the use of the frame of perfection as normalcy
in articles from target audience magazine can be especially powerful for readers. These
readers, minority women, may already feel insecure about their non-European American
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appearance, and reading articles which emphasize the need to regulate the body to appear
natural or normal may resonate particularly well with women in this situation.
Frames by Magazine Types. Looking at the use of frames within magazine types,
I begin by examining the use of frames in traditional women’s magazines. Unlike
articles in the other magazine types, articles from traditional women’s magazines used
only two of the four frames I developed. Of the two frames, the frame of the
medicalization of women’s beauty occurred most frequently in articles from traditional
women’s magazines. The mean number of mentions of this frame was 1.33 mentions an
article, compared to the .33 mentions an article for the frame of perfection as normalcy
(Table 4.14). The frame of perfection as normalcy occurred sparsely compared to the
frame of medicalization of women’s beauty in articles from traditional women’s
magazines. The frames of surgery as therapy and the autonomous voice were absent
from articles in traditional women’s magazines. Overall, the articles from this magazine
type did not use these four frames as frequently as the other magazine types did.
Within articles from target audience magazines, the frame of medicalization of
women’s beauty occurred most frequently with a mean of 3.88 mentions an article (Table
4.14). This mean was even higher than the mean for the total sample (3.66 mentions an
article). The frame of the autonomous voice also occurred prevalently in articles from
target audience magazines as well. References to this frame averaged 2.88 mentions an
article. Finally, the frames of perfection as normalcy and surgery as therapy were
referenced similarly throughout articles in this magazine type. The frame of perfection as
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Table 4.15: Summation Statistics of Frames by Type of Magazine, 2004-2005
Type of Magazine
Summation
Statistics
Fashion
& Beauty
Surgical Total
0-15
2.56
3.36
0-27
6.25
6.18
0-27
3.66
4.61
0-4
1.38
1.69
0-11
.81
2.81
0-5
1.00
1.81
0-11
.86
1.87
0-7
2.88
2.42
0-6
1.36
1.85
0-7
2.05
1.61
0-7
1.61
1.88
0-4
1.50
1.31
0-12
2.61
3.16
0-6
1.40
1.64
0-12
1.94
2.56
Traditional
Target
Audience
A. Medicalization of Women’s Beauty
(n=256 mentions)
- Range
0-3
0-13
- Mean
1.33
3.88
- Standard
1.37
4.23
Deviation
B. Surgery as Therapy
(n=60)
- Range
0
- Mean
0
- Standard
0
Deviation
C. Autonomous Voice
(n=113)
- Range
0
- Mean
0
- Standard
0
Deviation
D. Perfection as Normalcy
(n=136)
- Range
0-1
- Mean
.33
- Standard
.52
Deviation
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normalcy was mentioned on average 1.50 mentions an article while the autonomous
voice frame had a mean of 1.38 mentions and article. Throughout articles in target
audience magazines, framing was used fairly frequently when discussing cosmetic
surgery with a variety of frames referenced.
Articles in fashion and beauty magazines referenced the frame of perfection as
normalcy most often with a mean of 2.61 mentions an article (Table 4.14). However, this
mean was very similar to the mean of medicalization of women’s beauty at 2.56 mentions
an article. These two frames also had a large range of mentions. For perfection as
normalcy, the range was zero to 12 mentions and the range was zero to 15 mentions for
the medicalization frame. Furthermore, the frame of the autonomous voice occurred
moderately at 1.36 mentions an article. The frame of surgery as therapy was least likely
to occur in articles from fashion and beauty magazines. With a mean of .81 references to
surgery as therapy, this frame occurred modestly in these articles. Overall, articles from
fashion and beauty magazines used a variety of frames and indictors throughout
discussions of cosmetic surgery.
In the surgical magazine, the frame of the medicalization of women’s beauty
occurred most often in articles compared to the other frames. The frame of
medicalization was referenced an average of 6.25 mentions an article (Table 4.14). The
mean was the highest mean for any frame in any magazine type. Furthermore, the mean
of this frame in the surgical magazine is almost double the mean of this frame for the
entire sample of articles (3.66 mentions an article). This mean supports my hypothesis
(#4) that the frame of the medicalization of women’s beauty is more likely to occur than
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the other three frames in articles from the surgical magazine. The frame of
medicalization of women’s beauty also had very large range of mentions (0-27)
indicating how prevalent this frame was within articles from the surgical magazine.
However, the other frames still occurred frequently through the articles from the surgical
magazine. The frame of the autonomous voice averaged 2.05 mentions an article,
showing frequent representation of this frame. The frames of perfection as normalcy and
surgery as therapy occurred less frequently with means of 1.40 and 1.0 mention an article
respectively. While these three frames occurred moderately through articles from this
magazine type, the frequency of these frames further supports my hypothesis that the
frame of medicalization of women’s beauty is more likely to be present than other frames
in articles from the surgical magazine.
HYPOTHESES
Most of my findings were exploratory and I had not expected certain patterns to
emerge. However, I did have expectations in terms of the number of articles featured and
reference to my four frames. I developed six hypotheses that expressed these
expectations according to magazine types. The first and fifth hypotheses involved which
magazines were more likely to feature articles about cosmetic surgery. My first
hypothesis, that fashion and beauty magazines are more likely to feature articles about
cosmetic surgery than traditional women’s magazines, was supported with 36 articles in
fashion and beauty magazines compared to only six articles from traditional women’s
magazines (Table 4.1). My fifth hypothesis, that target audience magazines are less
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likely to feature articles about cosmetic surgery than magazines which target European
American audiences, found support as well. While target audience magazines were less
likely to feature articles than fashion and beauty magazines and the surgical magazine,
the number of articles from traditional women’s magazines was fairly comparable to the
number of articles from target audience magazines. While the traditional women’s
magazines published six articles about cosmetic surgery between the years 2004 and
2005, target audience magazine published eight articles (Table 4.1). However, when
comparing the number articles from target audience magazines to those targeting
European American audiences in general, a reader is less likely to find an article about
cosmetic surgery in the target audience magazines, supporting my fifth hypothesis.
Four of my hypotheses focused on the content of articles, specifying the
relationship between the use of frames and magazines types. My second hypothesis was
that articles in fashion and beauty magazines were more likely to use the frame of the
medicalization of women’s beauty and perfection as normalcy than traditional women’s
magazines. The findings from the textual indicators of these frames (Table 4.14) strongly
support both aspects of this hypothesis. The mean number of mentions of the
medicalization of women’s beauty frame in articles from fashion and beauty magazines
was almost double the mean for articles from traditional women’s magazines.
Furthermore, articles in fashion and beauty magazines used all of the indicators from this
frame while articles in traditional women’s magazines only used three (Table 4.10).
Looking at the frame of perfection as normalcy, the mean number of mentions in articles
from fashion and beauty magazines was almost eight times higher than the mean from
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articles in traditional women’s magazines. Again, articles in fashion and beauty
magazines had more variety in the use of indicators than articles in traditional women’s
magazines (Table 4.13). In terms of text, both parts of my hypothesis are supported. In
contrast to textual indicators of the frames, visual images from articles in fashion and
beauty magazines are just as likely to indicate the frame of the medicalization of
women’s beauty through the use of visual images of medical objects as articles in
traditional women’s magazines (Table 4.7). Furthermore, articles in fashion and beauty
magazines were less likely, rather than more likely, to visually indicate the frame of
perfection as normalcy through the use of body focused objects than articles in traditional
women’s magazines. Therefore, the visual representations of frames differ from the
textual representations.
My third hypothesis focuses on the frames of surgery as therapy and the
autonomous voice, hypothesizing that these frames are more likely to be used in articles
from traditional women’s magazines than fashion and beauty magazines. However,
neither of the two frames or their indicators were present in articles from traditional
women’s magazines. This finding was surprising and counteracts what I had expected to
find. The frames of surgery as therapy occurred modestly in fashion and beauty
magazines and the autonomous voice frame was prevalent in these articles (Table 4.14).
Therefore, my third hypothesis is not supported and articles in traditional women’s
magazines are less likely, rather than more likely, to use the frames of surgery as therapy
and the autonomous voice than articles in fashion and beauty magazines.
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My fourth hypothesis pertains to the use of frames within articles from the
surgical magazine. I expected the frame of the medicalization of women’s beauty to be
the most prevalent frame in articles from this magazine type. The statistics from Table
4.14 support this hypothesis. The mean number of mentions of the medicalization frame
was 6.25 mentions an article which is three times the mean of the autonomous voice
frame, and four and half times the mean for the perfection as normalcy frame.
Furthermore, the mean for the medicalization frame is about six times higher than the
mean for the surgery as therapy frame. Therefore, the textual findings support my
hypothesis, showing that the medicalization of women’s beauty frame is the most
prevalent frame in the surgical magazine. The use of visual images also indicated the
frame of the medicalization of women’s beauty more often that the frame of perfection as
normalcy. While the articles from this magazine type used visual images which feature
medical equipment, supplies, and diagrams, none of the visual images featured cosmetic
products or exercise/weight focused equipment. Therefore, my hypothesis is supported
through textual analysis and examining visual images.
My sixth, and final, hypothesis analyzed in the findings is that articles in target
audience magazines are more likely to use the frame of perfection as normalcy than
articles in magazines which target European American audiences. Looking at the textual
indication of the frame of perfection as normalcy, my hypothesis is not supported. The
mean number of mentions of this frame in articles from target audience magazines was
greater than the mean for articles from traditional women’s magazines (1.50 and .33
mentions an article respectively as shown in Table 4.14). However, this mean was very
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similar to the mean of articles from the surgical magazine (1.40 mentions an article),
indicating that articles from target audience magazines and the surgical magazine
mention this frame with similar frequency. Furthermore, articles from fashion and beauty
magazines featured the frame more often than articles in target audience magazines (2.61
and 1.50 mentions an article respectively). Textually, support was not found for my
hypothesis because target audience magazines are more likely to the feature the frame of
perfection as normalcy only when compared to articles from traditional women’s
magazines. Visually, the images accompanying the test of articles about cosmetic
surgery do not support my hypothesis. Articles from target audience magazines featured
only one visual image of a body focused object (Table 4.7). Furthermore, articles in
target audience magazines were less likely to feature body focused visual images than
articles from traditional women’s and fashion and beauty magazines. Therefore, no
support exists, both textually and visually, for the hypothesis that articles in target
audience magazines are more likely to use the frame of perfection as normalcy than
magazines that target European American audiences.
Overall, some of my hypotheses were supported while some of the findings did
not fulfill some of my anticipated outcomes. However, some noteworthy findings are the
infrequent presence of articles about cosmetic surgery in traditional women’s magazines
and the infrequent use of my four frames in these articles. These surprising findings
indicate readers of traditional women’s magazines may not be influenced on the topic of
cosmetic surgery due to a lack of exposure of ideas. However, the analysis of articles
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from target audience, fashion and beauty, and surgical magazines supports the finding of
diverse representations of cosmetic surgery. Readers of target audience, fashion and
beauty, and surgical magazines are exposed to a variety of ideas about cosmetic surgery.
In the next chapter, I examine the implications of these findings. First, I look at the
significance of these findings for future representations of cosmetic surgery in the media
and the effect they may have on women. Then I examine the limitations of this study and
possible areas of improvement in future studies. Finally, I discuss how my research may
be used to further research in the area of cosmetic surgery.
CHAPTER 5
CONCLUSION
My research objective was to observe how cosmetic surgery is framed in order to
better understand the messages to which women are exposed to in the media. My study
resulted in some interesting conclusions about the inclusion of the topic of cosmetic
surgery in certain magazine types. However, this study could be improved through a
variety of ways and redirected to further research in the area of cosmetic surgery. In this
chapter I first summarize the significant findings from this research, pointing out the
unique qualities of representations of cosmetic surgery in the various magazine types. I
specify the importance of the findings involving the framing of cosmetic surgery for
women today. Then I discuss some of the limitations of the coding scheme I used and
how the scheme could be improved. Finally, I discuss the contributions this study has
made to the literature on cosmetic surgery and how the findings can be used to further
research in this area of study.
SIGNIFICANT FINDINGS
In terms of framing, I developed the four frames of medicalization of women’s
beauty, surgery as therapy, autonomous voice, and perfection as normalcy from the
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159
sociological literature surrounding cosmetic surgery. This literature often referenced
interviews with women who had cosmetic surgery, reflecting the ideas of those closest to
the process of surgery. Because women who have had surgery are expressing the ideas
which my frames are composed of, I expected all four frames and their indicators to be
prevalent in articles from women’s magazines. Furthermore, when a complex topic is
being discussed, multiple frames are often used together to express the topic fully.
Therefore, I expected to find all four frames present throughout articles, indicating the
use of multiple frames to influence readers. Looking at the findings according to the use
of frames, some findings met my expectations while others findings were unanticipated.
The frame of the medicalization of women’s beauty was the most prevalent frame
within magazine types and for the total sample. As I had anticipated, this frame was
more prevalent in articles from fashion and beauty magazines than articles from
traditional women’s magazines (hypothesis #2). Also, the frame of medicalization was
the most prevalent frame within articles from the surgical magazine (hypothesis #4).
However, the prevalence of this frame in articles about cosmetic surgery is interesting for
the message sent to readers. The process of medicalization involves the participation of
individuals in many processes, from conceptual thought to interactional situations
(Conrad 1992). Therefore, the process on medicalization includes but is not limited to
the medical community because individuals must also view their body through a medical
lens for the medicalization of women’s beauty to occur. The findings support this
occurrence because many of the writers were not medical professionals yet they included
the medicalization frame in their writings. Some of the articles were written by women
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who had undergone cosmetic surgery, and use of this frame in these articles further
reflects that some women are viewing their bodies in medical terms. Finally, the
exposure of readers to the ideas of this frame further encourages the public to adopt a
view of medicalization. The frame of the medicalization of women’s beauty was the
most prevalent frame within all magazine types and it is possible that women are more
likely to adopt this frame than the other three frames I developed. Therefore, the frame
of the medicalization of women’s beauty may be most influential in encouraging women
to get cosmetic surgery.
Another interesting side to the use of the medicalization of women’s beauty frame
is the visual representation of the frame in articles. This visual representation can be
achieved through featuring medical objects or visual images with surgical associations.
Across magazine types, articles from the surgical magazine most often featured such
visual images. Furthermore, visual images that revealed the instruments used for
procedures, the actual incisions made during surgery, and the results of real patients show
readers the realistic side to cosmetic surgery as well as encourage the medicalization
frame. The use of visual images that represent this frame is significant because readers
can be exposed to the messages of the images while merely flipping through the
magazine. However, these images were mostly included in the 2004 issue of Skin Deep.
The visual aspects of articles shifted focus from the 2004 issue to the 2005 issue. In the
2005 issue of Skin Deep, fewer surgically focused visual images were featured, a larger
portion of visual images featured models, and a lower portion featured ordinary people
compared to the previous year. After this premiere issue in 2004, it seems the magazine
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is attempting to visually appear like more general women’s magazines. Some of the
unique qualities of these articles may not be found if the years of 2005 and 2006 were
sampled. Therefore, it is likely that few women are exposed to and influenced by visual
images that represent the frame of the medicalization of women’s beauty.
The process of medicalization can often take the control away from the individual
by turning the process into a medical condition. Similar to the medicalization of
reproduction and sexuality, the medicalization of women’s beauty takes the natural
process of an aging appearance and turns it into a medical problem with a medical
solution. Birth control used to be handled through home remedies passed from one
woman to another and today woman go to medical professionals to learn about birth
control (Reissman 2003). Similarly, women used to makes creams to clear up skin and
today they seek the help of dermatologists who prescribe treatments. In the process of
medicalization, women lose control over their appearance. Images in the media provide
women with norms of beauty and medical professionals tell them how to achieve these
norms. However, the medicalization of women’s beauty is unique because it can risk the
health of individuals for the sake of a more attractive appearance.
The risk involved with cosmetic surgery was not discussed as frequently as I had
expected and when mentioned, the risks were often counteracted by emphasizing the
importance of choosing a certified surgeon. Therefore, the frame of medicalization was
frequently present yet the negative aspects to medical treatment were infrequently
discussed, indicating that women may be more likely to adopt a medical view because
they are not exposed to the negative outcomes of cosmetic surgery.
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The frame of surgery as therapy did not occur as frequently as I had expected it
would. This frame focuses more on emotional appeals to justify or encourage the use of
cosmetic surgery. I was surprised that these emotional appeals were not used more
frequently because emotions may resonate more with readers than medical language or
cultural standards. One possible explanation for the minimal presence of this frame is
that it makes sense most often when an individual is talking about her experience with
cosmetic surgery. Therefore, articles that are not written from a first-person perspective
in dealing with cosmetic surgery may not find these appeals as logical as the indicators
from the medicalization of women’s beauty and perfection as normalcy frames. Another
explanation is that the indicators for this frame were primarily prognostic, or provide a
suggested solution for a problem (Snow and Benford 1992). In this case, the problem is
poor mental image and the indicators of this frame provide a solution through using
cosmetic surgery as a form of self-expression or a means to align the true self to the outer
self. The use of prognostic frames may not be as necessary as diagnostic frames, which
establish a problem and a cause of the problem, because it may be more difficult to
convince a reader of a problem than a solution. The frame of the medicalization of
women’s beauty is mostly diagnostic, attributing unappealing appearances to flaws,
genetics, and illness. This diagnostic frame was also the most prevalent across magazine
types while the prognostic frame of surgery as therapy was the least prevalent frame for
the sample. This finding lends support to the idea that prognostic frames may be less
prevalent than diagnostic frames.
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Looking across magazine types, the frame of surgery as therapy was not present
in articles from traditional women’s magazines while this frame was present in articles
from fashion and beauty magazines. This finding disconfirms my hypothesis (#3) that
this frame is more likely to be used in articles from traditional women’s magazines than
fashion and beauty magazines. However, the frame of surgery as therapy was most
prevalent in articles from target audience magazines. The ideas surrounding this frame
are very powerful. The idea that the body is an enterprise or commodity that can be
constantly upgraded to improve one’s self-esteem exemplifies this frame (Fraser 2003,
Gilmin 2000). This idea was expressed through specific indicators as well as the mention
of the financial availability of surgery. Articles which referenced the decreasing prices in
surgery and discussed the financial commitment of cosmetic surgery illustrate the body as
something you own, not something you are. This language encourages the idea that your
appearance is just something you change to improve how you feel towards yourself,
liking buying a new car. Although this message is powerful, it was not as prevalent as
the other frames and, therefore, women are less likely to adopt this view of cosmetic
surgery.
Making the decision to get cosmetic surgery can be portrayed as a positive effort
to restore the mental well-being of a woman who is unhappy with her appearance.
However, this message can be taken one step further to the point where refusing cosmetic
surgery or other cosmetic technologies can be dangerous for one’s mental well-being.
Brooks (2004) found that sometimes the use of surgery is portrayed as a preventive
measure for one’s health. This message is justified, for example, by explaining the stress
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of losing weight through exercise and diet may be damaging to one’s self-esteem if the
weight is never lost. Meanwhile, liposuction can easily remove the obsession over
weight loss and relieve stress. While I did not find this specific framing technique in my
sample, it is possible that, in a society that justifies any measure to make someone feel
better, such appeals may become more prevalent as cosmetic surgery becomes a more
common practice among women. Furthermore, the appeal of using surgery to prevent
unhealthy mental obsession may be persuasive to women who would otherwise turn to
eating disorders to achieve a slender figure.
While the frame of the autonomous voice occurred moderately throughout the
whole sample, the presence of this frame varied greatly across magazines types. This
frame was not present in articles from traditional women’s magazines while it was
mentioned fairly often in articles from fashion and beauty magazines. This finding
counteracts my hypothesis (#3) that articles in traditional women’s magazines are more
likely to feature the frame of the autonomous voice than articles in fashion and beauty
magazines. Furthermore, articles from target audience magazines featured this frame
most frequently compared to the other magazine types. The interesting aspect of this
frame is that it can convince readers that they have a “rhetoric of choice,” in which they
can accept the fate of an aging appearance or do something about it (Brooks 2004). This
choice was often affirmed by women in articles who decided “to do something” about
their dissatisfaction with their appearance. However, the sense of individual choice when
getting cosmetic surgery is expressed while the cultural influence on these decisions is
rarely addressed by women in these articles. It seems that in women’s magazines,
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women do not admit to what influenced them to get cosmetic surgery, but do admit to
feeling the choice was made autonomously. Therefore, women reading magazines are
only exposed to the autonomous feeling in articles and not the feeling that society is
influencing their decisions.
Along with this sense of autonomy and individualism comes an assumed
responsibility on the part of the patient. Some articles about cosmetic surgery discussed
the need for involvement on the part of the patient. This involvement ranged from
ensuring the surgeon is board certified to contacting former patients to see if they were
happy with the results of that surgeon. Patients were also encouraged to research desired
procedures on their own, learning as much about the process of cosmetic surgery as
possible. The decision to get cosmetic surgery then becomes an informed decision which
creates a “buyer beware” warning (Fraser 2003). As Fraser (2003) points out, the
emphasis on being an informed patient means that patients are aware of the risks and
possible results of surgery. Therefore, if the procedure has unexpected side effects or the
patient is not satisfied with the results, it becomes the patient’s problem because she
chose to get the surgery knowing the risks. The informed, individualized process of
cosmetic surgery can be a detriment to women whose surgeries are not successful. This
message can also be detrimental if women have internalized cosmetic surgery as an
individual process and then blame themselves for the negative consequences of the
surgery.
The frame of perfection as normalcy occurred moderately throughout the total
sample of articles, but was referenced most frequently in articles from the fashion and
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beauty magazines. This finding supports my expectation that articles in fashion and
beauty magazines are more likely to use the frame of perfection as normalcy compared to
articles from traditional women’s magazines (hypothesis #2). However, the use of this
frame is most intriguing in articles from target audience magazines. The frame of
perfection as normalcy examines the increasing standards of beauty, which may affect
women of minorities differently because they do not fit the traditional standards of
European American beauty. The idea that one’s appearance is not acceptable as is and
must be improved to reach acceptable standards can be especially meaningful for
minority women who already feel insecure about their ethnic appearance. This frame
occurred moderately across articles in target audience magazines, reflecting that minority
women who read these magazines are being exposed to the idea that cosmetic surgery can
be used to meet societal standards. However, the use of this frame did not provide
support for my hypothesis (#6) that articles in target audience magazines are more likely
to feature the frame of perfection as normalcy than magazines that target European
American audiences. While articles from target audience magazines were more likely to
mention this frame than articles from traditional women’s and surgical magazines, they
were less likely, rather than more likely, to mention this frame than articles from fashion
and beauty magazines.
Similar to the frame of the medicalization of women’s beauty, the frame of
perfection as normalcy can be represented visually. The use of cosmetic products and
equipment used for exercise and weight loss can remind readers of the need to regulate
the body, which is part of the perfection as normalcy frame. Interestingly, articles from
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traditional women’s magazines most often featured such body focused visual images.
However, the frame of perfection as normalcy can also be reinforced or contradicted
through the presentation of models who embody idealized beauty or real patients who
show the realistic results of surgery. The use of models can reinforce this frame because
they show readers that high standards of beauty are achievable and in the process
encourage women to strive to achieve these standards. Using this understanding, articles
in target audience and fashion and beauty magazines visually supported the frame of
perfection as normalcy because they featured a large portion of visual images that
focused on models. Readers of these articles are exposed to images of women who
exceed the increasing standards of beauty while reading about the increasing technology
of cosmetic surgery. This combination of images and messages can be very influential
because the images make it difficult for women to maintain reasonable expectations
while the writing proposes cosmetic surgery as a solution to their desires. Furthermore,
the use of these visual images illustrates the role of the media in perpetuating standards of
beauty that most women do not meet.
While I was expecting to find all of my frames and indicators present in the
articles sampled, articles from traditional women’s magazines were the only articles that
did not use a variety of framing. As mentioned above, articles in traditional women’s
magazines did not feature the frames of surgery as therapy and the autonomous voice.
Furthermore, the frame of perfection as normalcy was mentioned sparsely in these
articles while the frame of the medicalization of women’s beauty was mentioned
moderately. The minimal use of framing in articles from traditional women’s magazines,
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combined with the lack specific representation favoring or discouraging cosmetic surgery
in these articles, lets the readers decide from themselves how they feel towards cosmetic
surgery. These articles are not trying to persuade the readers one way or the other, but
are trying to inform readers of the option of cosmetic surgery. These articles are unique
in comparison to articles in the other magazine types because when readers of traditional
women’s magazines are exposed to the topic of cosmetic surgery, they may be less likely
to be affected by the content of the articles. In other words, articles in this magazine type
may not influence women’s thoughts on cosmetic surgery.
In articles from target audience, fashion and beauty, and surgical magazines, all
four frames were present to varying degrees. The result of these various representations
and the variety of indicators is that the same message is not sent repeatedly through
articles. Readers of these magazines are exposed to a variety of ideas concerning
cosmetic surgery. The combination of frames can lead to different representations of
cosmetic surgery that can persuade readers, through different appeals, to get or decide
against cosmetic surgery. This variety appears most often in articles from fashion and
beauty magazines, in which all indicators from all four frames were present. Subscribers
of this magazine type are not exposed to same ideas about cosmetic surgery and instead
are exposed to a variety of articles that span support for cosmetic surgery to caution
against it.
While I expected to find a variety of ideas about cosmetic surgery, I was not
expecting to find articles that expressed the same concerns about cosmetic surgery as the
articles from the sociological literature. A few articles from the fashion and beauty
169
magazines spoke very clearly about some of issues sociologists spoke of in my literature
review. For example, one article titled “Why Pretty isn’t Pretty Enough Anymore”
(Glamour 2004, January) spoke very clearly of the high standards of beauty in today’s
society that icons such as Audrey Hepburn and Marilyn Munroe do not embody. This
article allowed plastic surgeons to critique the appearance of these two women and how
cosmetic surgery would have benefited both women. By critiquing women who were
once idealized, this article described the pathological inversion of the norm of which
Brooks (2004) wrote. The pathological inversion of the norm involves an increase in the
expectations of appearance to the point that what was once beautiful is now normal and
what was normal is now displeasing. Stressing the pathological inversion of the norm
through the criticism of icons was followed by a discussion about the extreme measures
women go through to achieve beauty and the negative consequences of these extremes
include cosmetic surgery. Some of these consequences included the implications for the
next generation of women if their mothers’ use cosmetic surgery to maintain their youth.
This discussion is similar to Jones’ (2004) article that addressed concern for generational
issues as well. Addressing the cultural concerns regarding cosmetic surgery and
standards of beauty may have the opposite effect of discussing these issues in more subtle
manners. Women who read articles such as this one may be empowered to stand up
against standards of beauty, not flock to the closest surgeon.
I find it very interesting that some articles were raising issues of cultural concerns
and not merely individual issues with cosmetic surgery. This awareness written into
articles reflects a desire to inform readers of larger issues and not merely persuading or
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dissuading women to get cosmetic surgery. The inclusion of articles that have the same
concerns about cosmetics surgery as the sociological literature shows that the writers
seem to be minimally aware of the cultural impact of cosmetic surgery on society and
readers are being exposed to these ideas. However, cosmetic surgery is only one
component to a complicated social issue. The discussion of cultural concerns may impact
the way women think about weight loss, cosmetic products, cosmetic surgery, and the
increasing demands of idealized feminine beauty.
Finally, while the topic of cosmetic surgery did not occur frequently in my sample
of women’s magazines, the four frames surrounding cosmetic surgery may be applied to
other women’s topics and the beauty industry in general. Therefore, though women are
not exposed to the idea of cosmetic surgery frequently, they may be exposed to these four
frames frequently. The medicalization of women’s beauty can be applied to weight loss
through diets which focus on changing the metabolic rate of the body and cosmetic
products that promise to stimulate collagen production. Black and Sharma’s (2001) study
emphasized how the use of medical appeals can be attractive to clients for a variety of
body focused products and services in the beauty therapy industry. The other three
frames are also transferable to the larger beauty industry. The idea that enhancing
appearance is therapeutic, the basis for the surgery as therapy frame, can be applied to
strict exercise routines, trendy clothes, and expensive makeup. Furthermore, Darden and
Worden (1994) explained how the beauty industry encourages women to use mass
produced products to express their individuality, similar to the individuality expressed in
the autonomous voice frame. The frame of perfection as normalcy raises an awareness to
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idealized beauty that can occur when discussing cosmetic surgery, applying lipstick, or
trying on a pair of jeans. The beauty industry utilizes these frames in various media
outlets. Women then are exposed to these framing techniques more consistently than
they are exposed to these ideas surrounding cosmetic surgery. Therefore, the study of
these frames is significant not only for the effect they may have on the decision to get
cosmetic surgery, but also for the effect they may have on women’s decisions concerning
appearance in general.
LIMITATIONS
While my research has yielded interesting results in the area of cosmetic surgery,
my study was limited in a few ways. Using Doner’s (1993) magazine types was helpful,
but I am not convinced that singling out Skin Deep into a separate magazine type was
appropriate. As I mentioned before, the magazine shifted in appearance and content from
the year 2004 to the year 2005. This shift made the magazine appear more like the
average women’s magazines instead of a surgically focused magazine. Furthermore, I
did not have another surgical magazine to compare against Skin Deep. Finally, the
circulation of this magazine is not as popular as the other women’s magazines sampled.
Therefore, because not as many women are exposed to the messages in Skin Deep,
studying the messages in this magazine may not be very meaningful when focusing on
what messages may influence women to get cosmetic surgery.
Sampling all “articles” that discussed cosmetic surgery may have been too broad
for the purposes of this study. I included any writings that specifically addressed the
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topic of cosmetic surgery as “articles” for my sample. The inclusion of question and
answer segments was not very meaningful as these articles tended to be brief and did not
go into much depth about cosmetic surgery. Furthermore, the inclusion of readers’ letters
was interesting because they often expressed direct opinions of real women, but they
were very brief and may have skewed some of my variables for the fashion and beauty
magazines. For example, readers’ letters tend to be very brief, only a few lines, and may
have lowered the average page length of articles considerably in fashion and beauty
magazines (the only magazine type which included the topic of cosmetic surgery in
reader’s letters). In future research, the inclusion of only full length articles may be more
helpful, especially because many readers do not read certain sections, such as readers’
letters.
Furthermore, articles which only dedicated a portion of the article to cosmetic
surgery were included. This inclusion may have inflated the page length variable and
overemphasized the discussion of cosmetic surgery. For example, only if only one page
of a three page article discusses cosmetic surgery, the recorded page length was three
pages. The inaccuracy of this variable also overestimates the frequency of the topic of
cosmetic surgery in general. While 70 articles were collected from my sample, some of
these articles did not discuss cosmetic surgery as the primary issue. Again, this limitation
reiterates the need to include only full length articles which are solely focused on
cosmetic surgery in future research.
While I think most of my variables were successful in obtaining meaningful
results, the coding for authors’ information may need some improvement. Aside from
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articles in the surgical magazine, most articles did not include information about the
author of the article. Therefore, the findings from the variables that coded author’s
information were not as revealing as I had hoped they would be. Instead of coding only
for author’s information, coding for author’s references may have been helpful too.
While most of the authors of articles in fashion and beauty and target audience magazines
were not medical professionals, the authors often referenced interviews or information
from medical professionals. This referencing can establish credibility to the readers.
Therefore, it may have been better to code for references along with author’s information.
The variable of expertise could also be improved by specifying the intent of the
variable. As coded, expertise is slanted towards the author being a medical professional
or having medical knowledge. However, expertise from experience may be persuasive as
well. Developing two variables, one for medical expertise and one for personal expertise,
may be valuable in future research to specify which type of expertise is used most
frequently and may resonate best with female audiences.
Because I developed the four frames that I used to analyze the content of the
articles, this study was the first application of these frames and the indicators were not as
refined as they could be. First, the medicalization of women’s beauty frame was most
frequent, but developing operational indicators was also easiest for this frame. For this
reason I had eight indicators, the most of any of the four frames, and these indicators
tended to be more inclusive than other indicators. For example, the indicator of scientific
language includes a variety of information or phrases that pertain to a diverse number of
situations. In contrast, the indicator of not to be beautiful from the perfection as
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normalcy frame includes a specific idea that patients do not expect surgery to make them
exceptionally beautiful, which is only expressed in a few phrases. Therefore, the
frequency of the medicalization of women’s beauty frame may be due to the
operationalization of the indicators. For future research, indicators need to be developed
that are more comparable measures in terms of number of indicators and context of
indicators.
Second, some of the indicators from the frames are very similar to each other and
may have been better if measured as one indicator instead of two. For example, the
indicators of to be normal and normative from the perfection as normalcy frame are very
similar. To be normal includes the use of surgery to fit in while normative includes the
common use of cosmetic surgery in society. Both of these indicators occurred fairly
infrequently. However, if measured as one indicator the findings would be more
meaningful. Occurrences such as these further support the need to refine the
measurement of my frames.
Finally, some of the indicators may have been too specific and broadening the
ideas may have helped the analysis of the frames. For example, the indicator of
maintenance from the frame of perfection as normalcy looked at the need to maintain
appearance and regulate the body. I tried to stay close to my definition as I coded, but as
I was reading I noticed other phrases that may have applied which I did not include.
Articles often referenced using cosmetic surgery as a tune-up that is needed every so
often. Unfortunately, my study was the first to use these measures and in sticking to the
definitions of the indicators, I did not coded for new themes or phrases that may have
175
indicated my frames. Therefore, when refining the coding system I developed, it is
important to acknowledge that other measures of the frames need to be explored as the
sociological literature was not always accurate in anticipating what ideas were in articles
about cosmetic surgery from women’s magazines.
CONTRIBUTIONS AND FURTHER RESEACH
My research contributes to the literature surrounding cosmetic surgery by
examining the messages about cosmetic surgery in print media targeted at women. Most
of the sociological literature examines the topic of cosmetic surgery through interviews of
individuals who have gotten cosmetic surgery. These studies are analyzing how women
feel towards cosmetic surgery after having received surgery. My content analysis
explores the messages in the media that may influence women to get surgery or may
discourage women from getting surgery. These findings provide a step towards
understanding what may be one of the reasons the number of women getting cosmetic
surgery is continuously increasing in the United States.
Furthermore, few research studies have investigated the representations of
cosmetic surgery using systemic indicators to discover messages in the media. A great
deal of the research discussing cosmetic surgery has been more exploratory and
qualitative than this study. My research puts the exploratory research to use by creating
specific frames to discover the prevalence of specific ideas surrounding cosmetic surgery.
I systematically coded for specific indicators according to presence in articles and
frequency of mentions within articles. Instead of general impressions, my coding scheme
176
shows specific frequencies for which indicators and frames as a whole occur. While a
few other studies have explored how cosmetic surgery is framed in women’s magazines,
they have studied fewer frames and ideas about the use of cosmetic surgery. My research
has taken the ideas previously used for studying frames and combined them into one
study. This study gives a broader view of frames used to discuss cosmetic surgery.
Despite the limitations of my study, this research provides an important stepping
stone to further research because it can link interviews with real patients to some of ideas
that may encourage women to get cosmetic surgery. This study can be taken in two
directions to further research. Another more refined content analysis should be
undertaken using a larger sample. After using the measures of my frames in this study,
some knowledge has been gained in terms of what needs to be changed in order to create
a more refined system of measurement as well as what ideas are more prevalent and
should be focused on in future studies. After creating a more reliable system of
indicators and coding, a new content analysis using a larger sample would depict a more
expansive view of what women may be exposed to in the media. While applying this
coding system to a larger sample of magazine articles would be interesting, perhaps using
magazines that target men and the general public would be interesting, as would applying
the use of these frames to television shows about cosmetic surgery. Television shows
that focus on cosmetic surgery are increasing in numbers and popularity. These
television shows include reality shows that feature real patients and doctors, talk shows
that feature specials on this issue, and fictional stories involving the use of cosmetic
surgery. Television shows also reach audiences that vary in terms of age, race, and
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socioeconomic status. These shows may be influential on women’s decisions as much, if
not more so, than articles about cosmetic surgery. It would be intriguing to know if
television exposes women to the same ideas about cosmetic surgery as the print media.
While it is important to understand what women are exposed to in terms of
cosmetic surgery, it is also important to understand how messages and frames are
affecting women. Therefore, the findings from this research could be used to examine
which frames resonate best with women and how they may or may not change women’s
opinions of cosmetic surgery. Using this study, writing samples could be developed that
exemplify the frames and indicators studied. These writing samples could be used in an
experiment to test for any changes in appearance consciousness as well as thoughts
towards cosmetic surgery after exposure to specific frames. An experiment established
with this purpose would determine if the frames used when discussing cosmetic surgery
are effective and if these frames may be encouraging or discouraging women to get
cosmetic surgery. As idealized beauty is becoming more difficult to achieve, many
women are striving to attain this beauty through risky means. It is important to
understand what messages are convincing women to use such extreme forms of
appearance enhancement and from where these messages are coming. After these
questions are answered, change can be made to encourage women to accept their bodies
and beauty instead of risking their health and finances to meet cultural expectations.
APPENDIX A
BIBLIOGRAPHY OF SAMPLE
Ackerman, Boris, M.D. 2005. “Facial Rejuvenation Surgery: Achieving a Youthful
Natural Appearance.” Skin Deep, pp. 48-53.
Almonte, Yesenia. 2004. “You ask, Latina Answers.” Latina, April, pp. 46.
Anderson, Richard, M.D. 2005. “The Scarless Facelift.” Skin Deep, pp. 114-18.
Anonymous Mother. 2005. “Finding Me Again.” Skin Deep, pp. 45-46.
Barry, Helana, Ph.D. 2005. “The Pursuit of Perfection/Happiness.” Skin Deep, pp. 1417.
Baxter, Richard, M.D. 2005. “‘Plane’ Talk about Breast Augmentation.” Skin Deep, pp.
64-68.
Beard, Hilary and Pamela Edwards. 2005. “The Naked Truth.” Essence, January, pp.
30-31, 34, 36, 38, 30.
“Beauty & the Beast: When Bigger is Not Always Better.” 2005. Skin Deep, pp. 81.
Bennett, Krista. 2004. “Your Most Private Beauty Questions, Answered.” Redbook,
August, pp. 140-41.
“Breasts Be Gone: A Man’s Story.” 2005. Skin Deep, pp. 147.
Brown, Sarah.
2005. “Instant Gratification.” Vogue, October, pp. 286, 288, 290.
2004. “The Price of Perfection.” Vogue, March, pp. 435-36, 438.
Bucay, Vivian W., M.D. 2004. “Under the Skin.” Vogue, February, pp. 82.
Bucklan, Erinn. 2005. “The Naked Truth.” Latina, April, pp. 115.
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179
Bullock, Maggie. 2004. “The Full Face.” Vogue, August, pp. 160, 163.
Byrd, Veronica, asha bendele, and Diane Weathers. 2002. “Body Works.” Essence,
March, pp. 50.
Carp, Steven, M.D. 2005. “Tighten Your Tummy.” Skin Deep, pp. 22-27.
Chu, Ying. 2005. “Stretching the Limits.” Vogue, August, pp. 249-253.
Ciotto, Joseph R. 2004. “More Than Your Average Joe.” Skin Deep, pp. 34-35.
Dagen, Jamie. 2004. “Pretty or Plastic?” Glamour, March, pp. 44.
Day, Doris J., M.D.
2005. “Q & A: Ask the Skin Doc.” Redbook, May, pp. 78.
2005. “Ask Dr. Day.” Redbook, January, pp. 38.
2004. “Ask Dr. Day.” Redbook, October, pp. 40.
Deen, Christy. 2004. “Pretty or Plastic?” Glamour, March, pp. 44.
Dominus, Susan.
2004. “Our Love/Hate Affair with Our Bodies” Glamour, May, pp. 216-19, 274.
2004. “Why Pretty Isn’t Pretty Enough Anymore.” Glamour, January, pp. 13639, 154.
Drake, Laurie. 2005. “Smooth Operator.” Vogue, November, pp. 264, 268.
“Face Value.” 2005. Vogue, May, pp. 80 (first Reader’s letter).
“Face Value.” 2005. Vogue, May, pp. 80 (second Reader’s letter).
Fong, Kanani. 2005. “One for the Ages.” Vogue, November, pp. 114.
Giampapa, Vincent, M.D. 2004. “The 48 Hour Necklift.” Skin Deep, pp. 10-13.
Gregory, Deborah and Pamela K. Johnson. 2004. “Is Plastic Surgery Worth It?”
Essence, March, pp. 42.
Grimaldos, Karen. 2005. “What You Need to Know about Plastic Surgery.” Latina,
April, pp. 110-11, 115.
Gold, Sunny Sea. 2004. “My Mom, Her Breast Implants and Me.” Glamour, January,
pp. 139.
180
Hall, Jane. 2004. “A Woman in Full.” Vogue, April, pp. 144, 148, 167.
Hicks, Pearlman, M.D. 2004. “The Changing Face of Rhinoplasty: the State of
Rhinoplasty in the Non-Caucasian Nose.” Skin Deep, pp. 40-45.
Huszar, Stephanie. 2005. “What’s Gorgeous Now: Imperfect Looks.” Glamour,
October, pp. 242-47.
Jake. 2004. “Why Guys Say Real is Better.” Glamour, August, pp. 102.
Jones, Julia.
2005. “Call to Arms.” Vogue, August, pp. 167, 171.
2004. “Needle Nation.” Vogue, March, pp. 572, 598-99.
Kazanjian, Dodie. 2005. “Small Wonders.” Vogue, February, pp. 216-19.
Kim, Jeannie. 2004. “Will Your Man Notice You Makeover.” Redbook, October, pp.
162-65.
Kramer, Cheryl. 2005. “The Cellulite Solution?” Redbook, August, pp. 139-42.
Kure, Robert Katsuhiro, M.D. and Akhiro Minami, M.D. 2004. “The Americanization
of Asian Eyes.” Skin Deep, pp. 62-67.
Laing, Jennifer.
2004. “Nip & Tuck.” Essence, March, pp. 38-40.
2004. “Forever Young.” Essence, January, pp. 33-36, 40, 42, 44.
Lamont, Elizabeth. 2004. “Botox Backlash.” Vogue, May, pp. 211-12.
Leive, Cindi. 2005. “Perfect Schmerfect.” Glamour, October, pp. 52.
Levy, Ariel. 2004. “Shopping for Surgery.” Vogue, June, pp. 180, 182.
Lockwood, Ted, M.D. 2004. “Lower Body Overhaul.” Skin Deep, pp. 46-53.
Long, R. 2004. “Pretty or Plastic?” Glamour, March, pp. 44.
Lorenc, Z. Paul, M.D. 2004. “10 Plastic Surgery Secrets Every Woman Should Know.”
Glamour, October, pp. 124, 126, 128-29.
Manson, Joann E., M.D. 2005. “Your Doctor Is In.” Glamour, February, pp. 92.
Martello, Jeannette, M.D., J.D.
181
2005. “Not Better Than Botox.” Skin Deep, pp.54-60.
2004. “Lunchtime Lipo.” Skin Deep, pp. 6-9.
2004. “What Went Wrong.” Skin Deep, pp. 39.
McGreer, Louise. 2004. “New Dimensions.” Vogue, July, pp. 50.
Morales-Munoz, Eileen. 2004. “Your Beauty Views.” Glamour, December, pp. 32.
(Reader’s letter)
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Pound, Edwin III, M.D. 2004. “Belly Button Breast Aug.” Skin Deep, pp. 68-74.
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Robinson, Elisabeth. 2005. “Going Public.” Vogue, August, pp. 248-49.
Sarah. 2004. “This Could Happen to You.” Skin Deep, pp. 36-38.
Summers, Sandy, RN. 2004. “Editor’s Note.” Vogue, November, pp. 134.
“The Sex Appeal of Women with Real Bodies.” 2005. Glamour, March, pp. 244-47.
Toledo, Luiz, M.D. 2004. “Bigger Buttocks Today: The Brazilian Way,” Skin Deep, pp.
14-19.
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Vernon, Chris. 2004. “Real Men Love Real Women.” Glamour, October, pp. 40.
W., K. 2004. “Real Men Love Real Women.” Glamour, October, pp. 40, 44.
“What Will & Won’t Cure Your Jiggle.” 2005. Glamour, April, pp. 256-57
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