Running head: PLASTIC UNWRAPPED 1

Plastic Unwrapped: Insights into the Plastic Surgery Industry and its Patients

Marian Cook

Spring Hill College

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Abstract

Humans have been modifying their bodies since antiquity. Advancements in technology and

medicine have only broadened the horizon, resulting in the billion-dollar industry that is plastic

surgery today. Plastic surgery consists of two branches: reconstructive and cosmetic. This paper

concerns cosmetic surgery and its patients. As the number of cosmetic surgery patients has risen,

so have certain perceptions and portrayals of this group. To address these misconceptions, a

documentary was created that focused on the stories of two cosmetic surgery patients: one who

had a breast reduction and one who had a breast augmentation. The effectiveness of the

documentary was then evaluated through the lens of Social Responsibility theory and through

analysis of qualitative data from a random sample of 22 respondents. The survey found that 91%

of respondents (20 out of 22) credited the documentary with giving them an enhanced

understanding of patients and their reasons to have cosmetic surgery.

Keywords: plastic surgery, cosmetic surgery, media, social media, advertising, teasing, mental

health, self-esteem
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Plastic surgery consists of “improving the function or appearance of parts of the body

through reconstructive or cosmetic medical procedures” (“Plastic Surgery,” n.d.). It is composed

of two branches: reconstructive and cosmetic (sometimes referred to as aesthetic). This paper

will focus on cosmetic surgery, which is done to improve or enhance one’s appearance. It

includes invasive and non-invasive (i.e., non-surgical) procedures. For example, invasive

procedures constitute breast enhancements (e.g., augmentations and reductions), facial

contouring (e.g., rhinoplasties), body contouring (e.g., liposuction, abdominoplasty), and facial

rejuvenation (e.g., facelifts). Non-invasive, or minimally-invasive procedures, include things like

Botox, dermal fillers, and chemical peels.

Plastic Surgery Through the Ages

Plastic surgery has been around for centuries. Before the advent of technology, plastic

surgery was simply body modification through non-surgical means. Consider the Padaung

women of Myanmar, who have been elongating their necks for centuries by wearing coils of

brass rings (National Geographic, 2013). They do so because long necks are “considered a sign

of great beauty and wealth that will attract a better husband” (Waddington, 2002, ¶ 2). However,

across the border in China, it was believed that foot binding attracted husbands and symbolized

wealth and beauty. This practice, which emerged in the 10th century with the royal court, only

went out of fashion until the early 20th century (Schiavenza, 2013). About 6,000 miles away in

West Africa, scarification has been commonplace for hundreds of years. It involves cutting and

scarring the skin to create intricate patterns that relay messages about “status within a

community, passage into adulthood or a connection to a spiritual group” (Brooks, 2014, ¶ 2).

Corsets have been another mode of body modification. In the 16th century, they emerged to

“improve the shape of the bust and not narrow the waist” (“Victorian Era Corsets:
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Undergarment,” n.d., ¶ 4). Their popularity exploded, though, in the Victorian Era with the

introduction of the sewing machine. While young girls wore them to correct their posture,

women wore them to narrow their waists and support their breasts. It was a symbol of wealth,

and by the 19th century “it was a fashion to have an hour-glass figure” (n.d., ¶ 9).

It was only until the late 19th century and the early 20th century that today’s definition of

plastic surgery emerged. In 1895, the first documented breast augmentation and reconstruction

took place in Germany (“History of Plastic Surgery,” n.d.). Then came an onslaught of facial

injuries with World War I due to innovations in weaponry. For his work with wounded soldiers,

Harold Gillies, a New Zealand surgeon, emerged as a pioneer of facial reconstructive surgery

and the father of modern plastic surgery (“The Birth of Plastic Surgery,” n.d.). The 1900s also

saw the rise of dangerous and strange experiments to enlarge the breasts. It began with paraffin

injections in the 1890s, then extended to materials like goat’s milk, ox cartilage, rubber, and

cooking oil (Thorpe, 2015). Then, after World War II, Japanese prostitutes began injecting their

breasts with liquid silicon and cobra venom (or olive oil) to cater to the preferences of American

soldiers (2015). Today, there are only two FDA-approved implants for breast enhancements:

saline implants and silicone gel-filled implants.

The Growing Popularity of Cosmetic Surgery

Since the early 2000s, plastic surgery has been booming, especially cosmetic surgery. Its

growth has been attributed to access, safety, advancements, affordability, attitudes—even the

media (“The Increase in Popularity,” 2008). For example, the dawn of the internet gave patients

quick and easy access to information about procedures, costs, and surgeons. Further, with

advancements in technology and medicine, cosmetic surgery became safer and cheaper (than it

was originally). Attitudes toward cosmetic surgery have also changed through the help of
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celebrities, advertisements, and social media. With it being popular among celebrities, “[patients]

feel better knowing that that close-to-perfection image on the television did not come naturally;

and perhaps, [they] too can benefit from cosmetic surgery” (2008, ¶ 6). A proliferation of

cosmetic surgery advertisements has helped too, along with social media’s fixation on beauty.

Cosmetic surgery in the United States.

This growth is evident in the numbers nationwide and globally. For instance, from 2000

to 2017, the number of breast augmentations in the United States increased by 41 percent

(American Society of Plastic Surgeons, 2017). Other cosmetic surgeries that rose include lip

augmentations (60%), buttock lifts (254%), upper arm lifts (5,235%), and tummy tucks (107%).

The top five cosmetic surgeries of 2017 were breast augmentations, liposuction, rhinoplasties,

eyelid surgery, and tummy tucks. In total, 16.9 million Americans spent $16.7 billion in cosmetic

procedures in 2017 alone. Of equal importance is the demographics of this group: 92% are

female, 73% are Caucasian (12.3 million), and 49% are 40 to 50 year olds (2017).

Internationally, the United States dominated as well. In 2016, it ranked first in having the most

cosmetic procedures (International Society of Aesthetic Plastic Surgery, 2016). It also ranked

first in surgical procedures, non-surgical procedures, other non-surgical, face rejuvenation,

injectables, and breast procedures (2016).

Cosmetic surgery in foreign countries.

Across the globe in South Korea, the plastic surgery industry is doing so well it has been

dubbed the world’s plastic surgery capital (Marx, 2015). Some estimate that in the capital of

Seoul alone, between one-fifth and one-third of women have gone under the knife (2015). In

Brazil, the surgery of choice is buttock augmentations and lifts—so much so that in 2016 there

were about 89,000 procedures (International Society of Aesthetic Plastic Surgery, 2016). To put
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it into perspective, the worldwide number of buttock augmentations and lifts in 2016 was

369,278—Brazil made up 24 percent of those (2016). As for Iran, it was named the rhinoplasty

capital of the world in 2013 (Wynarczyk, 2015). Nose jobs there are considered a rite of passage,

a demonstration of wealth (which attracts more suitors), and an act of defiance against restrictive

dress codes (Nayeri, 2014). Burgeoning as the Middle East’s “go-to area for cosmetic

treatments” is Dubai (“Beauty Therapy,” 2017, ¶ 2). Before the Syrian war, it was Lebanon who

boasted a thriving cosmetic tourism market, attracting medical tourists through its inexpensive

procedures. Nevertheless, domestic demand is booming, with more than 1.5 million cosmetic

procedures being done annually in a country of only 6 million (2017).

Perceptions of Patients

Despite its popularity, cosmetic surgery is still shrouded in shame, especially in the

United States. While Iranian and Lebanese patients wear their bandages proudly, few American

patients leave their home before they are fully healed. Most do not even discuss their procedures.

This stems from perceptions of cosmetic surgery patients. One study by the Pew Research Center

(2016) examined these perceptions. It found that most Americans (61%) believe people are too

quick to undergo cosmetic surgery and use them in non-important ways. In addition, 34% said

that cosmetic surgery is technology taken too far, and 26% said that cosmetic surgery has more

downsides than benefits. On the other hand, 54% believe it has equal benefits and downsides,

and 16% believe it has more benefits than downsides. The study also found that religiosity,

income, and education affect one’s perception of cosmetic surgery patients. For instance, 65% of

those who reported a “high” religious commitment believe people are too quick to undergo

cosmetic surgery. Further, 78% of Americans with an income of $75,000 or higher believe

cosmetic surgery is an appropriate use of technology, whereas only 49% of Americans with an
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income under $30,000 agree. As for education, 75% of Americans with a college or postgraduate

degree believe cosmetic surgery is an appropriate use of technology, compared with 49% of

Americans with a high school degree or less (2016).

Patient Portrayals in the Media

These perceptions are then exacerbated through patient portrayals on television. More

often than not, patients’ stories are relegated to superficial coverage like the television shows

Botched, The Swan, Extreme Makeover, Bridalplasty, etc. Not only do these shows gloss over

patients’ stories, they amuse and pander to the voyeuristic pleasures of audiences at the expense

of patients. Consider the popular E! show Botched about renowned plastic surgeons Paul Nassif

and Terry Dubrow fixing botched cosmetic surgeries. This series, with over 60 episodes,

chronicles the distress and dissatisfaction of patients with cosmetic surgeries gone wrong. From

infected implants to noses in danger of falling off, audiences are constantly deriving amusement

from the misfortunes of patients. With very few formal analyses (e.g., documentaries and

newscasts) of the industry and its patients, audiences are thus left with a surface-level and

stereotypical understanding of cosmetic surgery patients.

Rationale

Therefore, it is essential that more formal analyses of the industry and its patients be

conducted, especially ones that address misconceptions about its patients. Furthermore, the

cosmetic surgery industry is growing at a rapid pace, and it is projected to be worth USD $43.9

billion globally by 2025 (Grand View Research, 2017). Meaning, the number of cosmetic

surgery patients will increase, and so will the public’s interest in them and the industry.

Communicators must meet these demands. The preferred medium for addressing these issues and

meeting these demands is a documentary.

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Purpose

Consequently, the purpose of this project is to explore the effectiveness of a documentary

in addressing misconceptions about cosmetic surgery patients. It is meant to help non-patients

recognize the nuances of patients’ stories. To accomplish this, the documentary will examine in-

depth the lives of two patients: one who had a breast augmentation and one who had a breast

reduction—by keeping the number of patient subjects small, audiences can get to know the

patients deeply and personally. This analysis will include, but not be limited to, the patients’

reasons for choosing cosmetic surgery, and their sentiments about the results and non-patients’

perceptions about themselves. A secondary focus of the documentary will concern the industry’s

growth—is it driven by the media, society, beauty standards, a combination, or something else

entirely? The effectiveness of the documentary (and the reasons for choosing that medium) will

be explained through the lens of Social Responsibility theory.

It should be noted that this documentary does not seek to promote or condemn cosmetic

surgery, but simply present the facts and opinions of those from both sides of the argument. Its

first and foremost goal is to help audiences understand the nuances of cosmetic surgery patients.

The question of whether or not the industry is harmful ultimately lies with the audience

members. While it is easy to interpret the director’s aims at demystifying patients as a promotion

of the industry, it is in fact meant to encourage understanding and reduce rash judgments—as

should be the goal of any journalist.

Research Question

So, this project seeks to learn the following: Will this documentary be effective at helping

audiences understand cosmetic surgery patients—their stories, reasons, sentiments, and results?
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Literature Review

This documentary is not the first to delve into the cosmetic surgery industry, but it is one

of a few that have delved into the lives of American cosmetic surgery patients. Countless

research has been done on the motivating factors of cosmetic surgery patients, and the effects of

media messages and restrictive beauty ideals, but much of this is quantitative rather than

qualitative. Patients’ stories are then consigned to reality television shows like Botched and The

Swan, which focus more on the results than what led them there. For this documentary to be

effective and accurate, it will first have to examine previous research on the subject.

Reasons Patients Seek Cosmetic Surgery

In 2012, 204 British Columbians were surveyed to find out what motivates people to get

plastic surgery (Furnham & Levitas, 2012). The questions assessed their perceptions of plastic

surgery, their self-esteem, life satisfaction, self-rated physical attractiveness, religious

commitment, and media consumption. The authors found that “lower ratings of self-esteem and

life satisfaction, increased media exposure to cosmetic surgery via television shows, time spent

watching television and religiosity were all significant predictors of the likelihood of undergoing

cosmetic surgery” (2012, p. e48). Another study, similar to that of Furnham and Levitas, wanted

to know the same. However, instead of surveying people, the authors analyzed 48 studies on the

subject (Haas et al., 2008). Surprisingly, the results revealed that the most common motivating

factors include body dysmorphic disorder (BDD), body image, self-esteem, and teasing. The

researchers found that most people who have cosmetic surgery are satisfied with their results, but

of those who are not may have BDD, an extreme preoccupation with defects or imagined defects

on the skin, face, and nose that may be minor and unnoticeable to most. In other words, patients

with BDD are likely to have multiple procedures, and usually request rhinoplasties, liposuction,
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and breast augmentations. Cosmetic surgery can also exacerbate their condition and lead to

increased suicide attempts and violence towards the physician. In addition, the researchers found

that people who report having had or desiring cosmetic surgery experienced teasing in their

childhood or adolescence more than those who reported no desire to get cosmetic surgery (2008).

Unlike other studies about cosmetic surgery patients’ motivations, one chose to focus

solely on the role of teasing as a motivating factor. To assess this, the researchers surveyed 449

patients aged 18 to 70 undergoing cosmetic surgery in Australia (Jackson et al., 2012). They

defined teasing as “bullying or peer victimisation whereby the victims experience verbal taunts

regarding some aspects of their appearance, personality or behavior” (2012, p. 130). In their

study, the authors review previous research on teasing, one of which found that appearance-

related teasing was significantly related to depressive symptoms, anxiety, and fear of negative

evaluation. Of those surveyed, 42.8% reported that they had been teased or bullied about their

appearance. Furthermore, patients seeking rhinoplasties (61%) were the most likely to have been

teased. In second place was patients seeking breast reduction procedures (51%), and in third was

patients seeking breast augmentations (42%) (2012). This study, along with the others, suggests

that the factors motivating people to seek plastic surgery is more expansive than just low self-

esteem.

The Growth of the Industry and Its Players

Doctors, celebrities, toy manufactures, and the media all have something in common:

they have aided the cosmetic surgery industry. The authors of one article write, “People become

dissatisfied with their appearance when they perceive a discrepancy between their actual

appearance and an ideal, whether that ideal is that of a doctor, celebrity, or a toy manufacturer”

(Blair & Shalmon, 2005, p. 15). Examples include the physical antitheses between
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heroes/heroines and villains (consider Disney’s Little Mermaid); the homogenous appearance of

dolls like Bratz and Barbie (tall, blonde, thin, and white); and makeover-based reality shows like

Extreme Makeover, The Swan, and I Want a Famous Face that tote the physical, emotional, and

social benefits of cosmetic surgery. Of note are also the persuasive tactics of advertisements: a

focus on transformation to convince consumers their dissatisfaction can be alleviated with

products (2005). One study sought to quantify the impact of advertisements. Researchers in the

United Kingdom examined cosmetic surgery advertisements in the country; specifically, those

with discount incentives, risk information, and imagery (Ashikali et al., 2017). Two studies were

conducted. In the first, they created four advertisements with different conditions to examine the

impact of discount incentives versus risk information. And in the second, they examined the

impact of differing images (female models versus the clinic versus scalpels). The studies yielded

interesting results, but both ultimately showed that cosmetic surgery advertisements negatively

influence weight and appearance dissatisfaction, no matter the information or images provided.

As for the United States, promotional sales offers for cosmetic surgery in magazines increased

from 1985 to 2004, whereas risk information was present in less than 10% and did not differ over

time (2017).

To understand the data, the researchers analyzed it through Sociocultural theories, which

“consider the media as having one of the strongest influences on body image” (2017, p. 256).

They discuss Social Comparison theory, which states that people make downward or upward

comparisons of themselves to others, and Self-objectification theory, which states that the

pervasive sexualization of women in Western culture has led women to focus on the physical self

and self-objectify. Further, the authors discuss consumer culture’s prominent ideals (image and

affluent lifestyle) that are promoted through the media. The authors write, “[These unattainable
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standards create] discrepancies between people’s current appearance and financial status and the

media-prescribed ideals, which in turn can cause dissatisfaction, leading people to engage in a

range of maladaptive behaviors” (2017, p. 257).

In another study, 91 college students were asked to watch an episode of Extreme

Makeover, the popular 2002 ABC series where people were transformed through the help of

plastic surgeons, dieticians, dentists, dermatologists, stylists, and makeup artists (Markey &

Markey, 2012). The surveys, which collected qualitative and quantitative data, found that most

participants tended to view makeover-based reality TV shows as fairly positive. Most responses

focused on the physical and psychological benefits of cosmetic surgery; meaning, the

participants were receptive to the media’s message that women should take drastic measures to

conform to beauty standards. Further, the study found that its male participants were as

impressed as the women by the program’s message of the benefits of physical enhancements.

The authors write, “it is possible that men are internalizing female beauty ideals just as women

do…This may lead to disappointment among men and increased pressure among women to

succumb to drastic efforts to alter their physical appearance” (2012, p. 216). The authors also

found a correlation between female participants’ positive reactions to the program and their

interests in getting cosmetic surgery. This supports scholar Anne Balsmo’s claims, who in her

examination of cosmetic surgery as the “technological reproduction of the gendered body” found

that the cosmetic surgery industry targets men and women differently, but targets women

especially (1992, p. 225). She writes, “The female body comes to serve, in other words, as a

sight of inscription, a billboard for the dominant cultural meanings that the female body is to

have in postmodernity” (1992, p. 226). Balsmo also discusses how cosmetic surgery may be
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regarded as a “fashion surgery,” a method of oppression or empowerment, and the equivalent of

body modification procedures like tattoos and piercings (1992, p. 226).

Social Responsibility Theory

In 1956, Fred Siebert, Theodore Peterson, and Wilbur Schramm proposed their four

theories of the press: Authoritarian theory, Libertarian theory, Social Responsibility theory, and

Soviet Media theory. These theories are Normative theories; meaning, they are generalizations

about the ideal relationships between the media and the government and public. In their book,

Siebert et al. (1956) define the press as “all the media of mass communication” (p. 14). In the

United States, the relationship between the press and the government and public is best described

by the Social Responsibility theory—which is actually a modification of the Libertarian theory

(1956, p. 7). Essentially, Social Responsibility theory states that “freedom carries concomitant

obligations; and the press, which enjoys a privileged position under our government, is obliged

to be responsible to society for carrying out certain essential functions of mass communication in

contemporary society” (1956, p. 74). These essential functions include providing information

and discussion, enlightening the public so it can self-govern, being a government watchdog to

protect individual rights, servicing the economy through advertising, providing entertainment,

and being financially self-sufficient. In other words, the media must “inform, entertain, sell—but

chiefly to raise conflict to the plane of discussion” (1956, p. 7). This means bringing to light

issues and stories—like cosmetic surgery patients’—that go unheard. Further, the media must

adhere to social responsibility and professional ethics, but if they do not, the public must see that

they do.

Social Responsibility theory is relevant to this documentary because the film will

showcase patients’ stories, most of which are dismissed to entertaining television shows or
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quantitative data in studies. As a communicator, the director has an obligation to the public to

shine a light on a group that has been dismissed and misrepresented. Not only will the film

enlighten audiences, it will start a discussion through an analysis of the industry and the players

that aided its growth. Consequently, a partial focus of the film will be self-analysis, considering

the media’s role in the industry and in establishing narrow beauty standards.

Method

Participants

The intended audience of the documentary is non-patients, specifically those who may

have misconceptions about cosmetic surgery patients. Thus, the documentary focused on two

cosmetic surgery patients. These two patients are female, ethnically diverse, and have had

different procedures. One is Gina Ferro, a 21-year-old Cuban-American woman living in

Tuscaloosa, Alabama, who had a breast augmentation in 2016. The second patient is Sara

Walmsley, a 22-year-old Caucasian woman from Tuscaloosa who had a breast reduction in

August of 2018. These patients were chosen for five reasons. One, a small number of patient

subjects allows audiences to connect with and understand the patients more thoughtfully and

deeply. Two, women make up 92% of cosmetic surgery patients, and 73% are Caucasian

(American Society of Plastic Surgeons, 2017). Three, they are two out of a small number of

patients who are willing to candidly discuss their cosmetic surgery stories. Four, their surgeries

fall under breast enhancements, which are the most requested procedures in the United States

(International Society of Aesthetic Plastic Surgery, 2016). Five, their procedures juxtapose each

other.

The film also featured three academics, two plastic surgeons, and eight non-patients. The

academics and surgeons were included to present the facts of the subject, and the non-patients
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were included to present opinions from each side of the argument. Dr. Jessy Ohl, who teaches at

the University of Alabama, and Mrs. Genevieve Dardeau, who teaches at the University of South

Alabama, presented expertise from the communication arts field. Dr. Jamie Franco-Zamudio of

Spring Hill College presented psychological expertise. Dr. John Menard and Dr. Ross Bunch,

both board-certified, were the featured plastic surgeons. Both have clinics in Tuscaloosa, and

have over 20 years of experience in the field. Dr. John Menard is also Sara Walmsley’s surgeon.

The fourth and final group of subjects featured in the film included eight non-patients.

One of those non-patients was specifically sought out due to her relationship with one of the

patients. The non-patient’s name is Caitlin Shortall, and has been friends with Gina Ferro since

preschool. She discussed why it was important for her to support Gina’s decision to get a breast

augmentation. The other non-patients were randomly selected through conducting 5-minute

street interviews in downtown Mobile, Alabama. A total of 10 street interviews were conducted;

however, three were cut due to the similar nature of their responses and the time constraints of

the film—the director wanted to keep the documentary under 25 minutes to hold the audience’s

attention. Aside from footage of the subjects, the documentary also featured a clip from a

popular plastic surgery television show, cosmetic surgery advertisements, cosmetic surgery

diagrams, infographics, and establishing shots. The plastic surgery television show included was

MTV’s I Want a Famous Face. The featured cosmetic surgery advertisements were ones found

in the plastic surgeons’ offices, and around Tuscaloosa and Mobile. The documentary also

included screen grabs of celebrities’ Instagram pages. These celebrities (Kylie Jenner and

Kendall Jenner) were chosen for their popularity on Instagram and in the beauty industry. The

screen grabs were used as B-roll as Dardeau discussed how the media gives audiences ideations

and idealizations, and the detrimental effects of social media on one’s self-esteem. Lastly,
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establishing shots (meant to establish the setting of the film) consisted of popular spots around

Tuscaloosa and Mobile, and the surgeons’ offices.

Materials and Procedure

The following is a list of equipment needed to shoot the film:

• Nikon D3400 DSLR camera (2)

• 18-55mm lens

• 70-300mm lens

• DSLR camera battery (2)

• DSLR camera battery charger (2)

• Tripod (3)

• DSLR Steadicam/gimbal

• Vidpro XM-L wired lavalier microphone

• LR44 battery for the lavalier microphone (4)

• Professional shotgun condenser microphone

• Dynamic mic

• Ledgo LED Bi-Color 600 panel with stand

• Adorama 12” circular collapsible disc reflector, gold/white

• Extension cord

• Spring clamp

• Panasonic professional AG-HMC40 AVCHD camcorder

• Panasonic camera battery

• Panasonic camera battery charger

• XLR cable
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• 16 GB or 32 GB SD card (2)

Since the film is centered on helping non-patients understand cosmetic surgery patients,

its style was simple and straight-forward, while remaining engaging. Sit-down interviews were

conducted for all patients, professors, surgeons, and friends of the patients. In these interviews,

two DSLR cameras and a lavalier microphone were used. The cameras, supported on tripods,

were positioned at different angles, but in accordance with the 180-degree rule. One camera was

a medium shot of the subject, and another was a close-up of the subject. The white balance and

ISO varied by location, but all interviews were filmed in 1920x1080; 30p with a shutter speed of

1/60. Further, the ISO never exceed 800 because it creates film grain. The lavalier microphone

was hooked up to one of the cameras, and then clipped on at the top of the subject’s shirt. All

subjects signed a release form before the beginning of a recording (see Appendix A).

Furthermore, natural light was used unless the location lacked a natural light source. If

that was the case, an LED bi-color 600 panel was used. It was positioned in a way that created

flat lighting, with some contrast on the subject’s face. The director also avoided using two

different cameras (e.g., a Panasonic camcorder and a DSLR) in one interview because their video

quality is noticeably different, even when their settings (i.e., frame rate resolution, shutter speed,

white balance, etc.) are the same. For interviews, the DSLRs were best because the video quality

was bright and crisp. However, they only recorded in 20-minute or 10-minute segments,

depending on the amount of storage on the SD card. When shooting B-roll, fast-paced action, or

situations that required impromptu zooms, the Panasonic camcorder was used. The DSLRs

worked just as well, but they do not have automatic zoom. All fast-paced action was shot in

1920x1080; 60p or 1920x1080; 60i. For the non-patient street interviews, one DSLR camera was

used with a dynamic mic. Again, these interviews were shot in 1920x1080; 30p. As for B-roll,
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most of it consisted of the patients doing their day-to-day activities or spending time with

friends. The patients also shared photos from before and after their surgeries.

As to the interview questions, the patient ones focused on chronicling the patients’

cosmetic surgery stories (see Appendix B for the complete questions): What led up to their

decision? Were there family and friends supportive? Did they get the results they intended? How

has it changed their lives? Do they plan to have any more surgeries? The communication arts

professor questions focused on identifying the media’s impact on the plastic surgery industry and

its patients (see Appendix B): How does the media convince the public certain beauty standards

are ideal and should be modeled? For the psychology professor, the questions focused on

understanding the psyche of cosmetic surgery patients (see Appendix B): What motivates people

to get plastic surgery? Is there a correlation between certain mental health disorders and those

who get plastic surgery? The questions asked of the plastic surgeons were ones to understand the

facts of the industry (see Appendix B): Why do you think the plastic surgery industry is

booming? Why were the top five surgeries of 2017 so popular? What kinds of patients do you

typically see? The last group of interview subjects were the non-patients. The non-patients, from

the street interviews, were asked one question: What are your thoughts on cosmetic surgery and

people who undergo it?

In week 2 (see Appendix H for complete timeline), the director began and completed pre-

production; meaning, a script and shot list were created. The director watched documentaries like

Brand New You: Makeover Television and the American Dream and The Illusionists to get a

sense of documentaries about the beauty industry. And the director watches short documentaries

produced by Vox, Refinery29, and the New York Times to grasp the style and format of long-

form journalism. Finally, the director reached out to patients, professors, and surgeons to gauge
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their interest in the project. For the subjects based in Tuscaloosa, the director immediately

scheduled interview times and B-roll sessions with them. These meetings occurred during Labor

Day weekend and Fall Break. In week 3, the director scheduled interviews and B-roll sessions

with the remaining subjects or those based in Mobile.

In week 4, the director began production; meaning, sit-down interviews and B-roll

sessions were conducted. Weeks 4-7 were dedicated to filming the main subjects (the patients,

professors, and surgeons). For subjects based in Tuscaloosa, production began in week 2, during

Labor Day weekend. By week 7 (Fall Break), the director completed interviews and B-roll

sessions with all subjects based in Tuscaloosa. Weeks 8-9 were dedicated to filming the

secondary subjects (non-patients), acquiring footage of advertisements and MTV’s I Want a

Famous Face, creating statistical graphics, and finding background music for the film. An

episode from I Want a Famous Face was found through Vimeo. The director was able to use the

clip due to the Fair Use doctrine. The same applied for the director’s use of Sound & Color by

Alabama Shakes in the credits. However, for certainty, the director reached out to the music

publisher, Broadcast Music, Inc. (BMI), who granted the director permission since the song

would be used for higher educational purposes (see Appendix C). Other background music was

found through freemusicarchive.org or creativecommons.org, which offer music in the public

domain.

In week 6, the director booked Gautrelet Room for November 8 to screen the

documentary to a random sample. In week 9, the director conceptualized a flyer for the

documentary screening (see Appendix D), and began broadcasting it on social media and

Campus Update. The flyers were also hung in locations across campus. These promotional

methods were done to attract a large random sample. The director then reached out to local
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restaurants for free catering, and was successful in acquiring it from Tropical Smoothie (see

Appendix E). Meanwhile, in weeks 10-12, the director was in post-production; meaning, the

director was editing together the documentary.

The screening, which attracted 15 attendees, was the director’s data collection, and

allowed the director to gauge the effectiveness of the documentary, i.e., test her research

question. It began at noon, and before the director started playing the 23-minute documentary,

she gave a brief introduction, thanking them for attending and informing them that there would

be a survey at the end. The introduction was kept short so as not to taint the results of the survey.

The survey consisted of five open-ended questions: Now that you have seen the film, have your

views of cosmetic surgery patients changed and how so? What was your biggest take-away from

the film? What are the messages this film sends? What aspects of the film did you enjoy and

why? Do you have any suggestions for improvement? The last two were optional and do not

comprise the results section because they were formulated to help the director improve her video

skills.

Attendees had the option of completing the survey physically or electronically. Fourteen

chose to hand-write their responses. One chose to type it—the director chose SurveyMonkey as

the platform. To increase the pool of respondents, the director then promoted the documentary on

social media, asking those interested in watching it to message her. Those that messaged her

received a YouTube link to the documentary and a link to the online survey. The director gained

seven more respondents through this method.

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Results

In total, the director collected 22 responses: 15 through the screening and seven through

social media. Through a thematic analysis of the responses, the director found that a majority of

respondents gained new information and much of it pertained to the reasons patients seek

cosmetic surgery (see Appendix G).

Three of the five survey questions were analyzed for data collection. Reason being, the

last two were optional and more for helping the director improve her visual and storytelling

skills. Further, to extend the number of questions past five, considering they are all open-ended,

would have made the respondents less likely to answer all of them or more likely to rush through

them.

Question one asked respondents if their views of cosmetic surgery patients had changed

through watching the documentary. In analyzing the responses, the director found that all

respondents interpreted the question as whether or not the documentary had changed their

opinion of cosmetic surgery (i.e., against it or for it). So, the following themes emerged: a

change of perspective (C), a slight change of perspective (SC), and no change of perspective

(NC). However, whether the respondents are supportive or not of cosmetic surgery was

ignored—as noted before, the aim of the documentary is to augment non-patients’ knowledge of

patients. The director found that 18% of respondents had a change of perspective, 9% had a

slight change, and 73% had no change (see Appendix G, p. 88). Further, the director found that

73% of respondents noted gaining information that “confirmed” or “reaffirmed” their

perspective. Responses received a score of gained information (GI) if they mentioned

understanding patients’ reasons or having acquired data. For example, Respondent 10 wrote, “I
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was pretty much against cosmetic surgery when it’s not in a reconstructive way. The film

confirmed that.”

However, some responses were nuanced and vague and had to be classified with a certain

rationale. For instance, Respondent 12 wrote, “I think it is 100% up to the individual. However,

goals should be realistic.” This response was classified under gained information (GI) because

the last sentence hinted to aspects of the documentary (e.g., comments by Dr. Ross Bunch and a

clip of I Want a Famous Face). Respondent 14 wrote, “As a person who has always wanted

surgery, I think this shows that it is surgery. The markings on the girl make it clear.” This

response was classified under change of perspective (C) and gained information (GI) because the

respondent suggests that s/he is now hesitant to get cosmetic surgery due to learning the risks.

Question two asked respondents to comment their biggest take-away from the film. Four

major themes emerged from an analysis of the responses: patient reasons (PR), addictive

properties (AP), media messages (MM), and plastic surgeons (PS). The patient reasons (PR)

theme covers responses that mention gaining an understanding of patients’ motivations. The

addictive properties (AP) theme covers responses that mention the “high” or “addictive” qualities

of cosmetic surgery. The media messages (MM) theme covers responses that discuss the power

of media images. And the plastic surgeons (PS) theme covers responses that write favorably

about plastic surgeons and how they “want to help.” In analyzing the responses, the director

found that 73% of respondents noted patient reasons as their biggest take-away, 4% noted

addictive properties, 14% noted media messages, and 9% noted plastic surgeons (see Appendix

G, p. 89).

Some responses mentioned the right to choose (e.g., “get plastic surgery if it’s what you

want”) and how “judging only hurts.” These responses were classified under patient reasons (PR)
PLASTIC UNWRAPPED 23

because they showed a certain thought process. For example, Respondent 9 simply wrote, “That

people shouldn’t judge people for getting plastic surgery.” The response suggests that one cannot

shame a patient for their decision because patients’ motivations are unique. Respondent 3

expresses a similar sentiment, “My biggest take-away from the film is that no two statistics are

the same. Reasons for cosmetic surgery are numerous and should not be judged.”

The third and final question was as follows: What are the messages this film sends? In

analyzing the responses, the director found two themes similar to that of question two: patient

reasons (PR) and media messages (MM). The other themes that emerged were results of plastic

surgery (RPS) and growth of the plastic surgery industry (GPSI). The results of plastic surgery

(RPS) theme covers responses that discuss the “societal ramifications of plastic surgery” and

patient results (i.e., physical and emotional effects of cosmetic surgery). The growth of the

plastic surgery industry (GPSI) theme covers responses that discuss the future of the plastic

surgery industry (i.e., its growing client pool). The director, thus, found that 45% of respondents

noted patient reasons, 23% noted media messages, 27% noted results of plastic surgery, and 5%

noted growth of the industry (see Appendix G, p. 90).

A few responses focused on how those interested in having cosmetic surgery should

carefully consider their decision. For instance, Respondent 20 wrote, “This surgery should be

given careful consideration before deciding to have it. These girls did that, and were happy with

the outcome.” Likewise, Respondent 4 wrote, “Make a rational decision. Don’t do it on a whim

and be informed.” Both respondents were classified under the results of plastic surgery (RPS)

theme because they hint at the possibility of unsatisfactory physical and emotional results.

Meaning, a patient could have a botched surgery or a successful surgery that does not meet their

unrealistic expectations.
PLASTIC UNWRAPPED 24

In conclusion, the director found that 91% of respondents (20 out of 22) noted an

enhanced understanding of patients and their reasons to have cosmetic surgery. This figure is the

result of combining the number of responses with a patient reasons (PR) theme from questions

two and three.

Discussion

The cosmetic surgery industry is a billion-dollar business, nationally and globally.

Current projections estimate that it will only get bigger; meaning, so will its patient pool.

Currently, very few platforms exist where patients can tell their stories without being

sensationalized, ridiculed, shamed, or misrepresented. Oftentimes, they are written off as

insecure or vain by audiences who have only been exposed to patients through television shows

like Botched, The Swan, and I Want a Famous Face. Numerous studies have been done on

patients, some of which found that patients’ motivations can range from religiosity to a history of

teasing, but these have been quantitative more than qualitative.

As a communicator, the director has a social responsibility to share the stories of a group

that has been misrepresented and stigmatized. The director also has a responsibility to non-

patients and the general public, since many are curious about the industry and its patients. So, in

accordance with Social Responsibility theory, this documentary was needed to relay accurate

information about patients and start a discussion about an industry that holds a significant niche

in the United States economy. Documentary was the optimal medium to do this because of its

audio-visual nature. For instance, countless studies have found that audio-visual storytelling has

higher rates of transferability of knowledge than other forms of learning across all fields—for

example, nursing (Johnston et al., 2017).

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As previously mentioned, the aim of the documentary was to help non-patients gain a

better understanding of cosmetic surgery patients, not to promote cosmetic surgery. The results

demonstrate this. Seventy-three percent of respondents (16 out of 22) reported that their opinion

of cosmetic surgery had not changed. However, their opinion was strengthened through the

documentary’s delivery of information—73% reported gaining information that confirmed or

reinforced their opinion. So, the data demonstrates that the documentary allowed audiences to

form their own opinions about the cosmetic surgery industry. How information is interpreted

varies by the individual, but as a communicator, the director has a responsibility to present the

facts objectively and from all sides of the argument. Another noteworthy finding is that 91% of

respondents (20 out of 22) reported an enhanced understanding of cosmetic surgery patients’

stories. With that in mind, it can be deduced that this documentary was, in fact, effective at

helping audiences understand cosmetic surgery patients—their stories, reasons, sentiments, and

results.

The success of this documentary can be explained with assistance from Social

Responsibility theory. Social Responsibility theory first emerged when Siebert, Peterson, and

Schramm proposed four theories of the press. Originally, only three existed, but the theorists

modified this when they noticed the unique relationship of the press, government, and public in

the United States (Siebert et al., 1956, p. 77). For instance, “As the twentieth century opened,

publishers spoke more and more often of the duties which accompanied the privileged position

of the press under the constitution” (1956, p. 83). This rhetoric thus formed the basis of modern

journalism standards: truthfulness, objectiveness, and accuracy. These principles demonstrate a

responsibility to the public, who form opinions and make decisions based on the information

relayed by the press. Equally important is how the press portrays members of the public: “This
PLASTIC UNWRAPPED 26

requirement would have the press accurately portray the social groups, the Chinese and the

Negroes, for example, since persons tend to make decisions in terms of favorable or unfavorable

images and a false picture can subvert the accurate judgment” (1956, p. 91). But the press has

failed cosmetic surgery patients—as seen through sensationalist television shows, few qualitative

studies, and few media products with patients at the center telling their stories in-depth. So, the

reason this documentary was successful is because patients want to tell their stories and non-

patients want to hear them.

With that said, the documentary is not impeccable. It had limitations, which was noted by

Respondent 2 in response to question three: “It showed mostly the successful plastic surgeries,

and while it touched on the drastic things that can go wrong, I felt like it was slightly biased.

Overall, it gave an empowering message, which is good.” However, Respondent 10 wrote, “I

don’t think it was pro or against plastic surgery, but more informative which I liked because it

allowed for people to make their own opinions.” These responses not only indicate that

individuals interpret information differently, but that the lack of a regretful patient was a

limitation. Another limitation was the lack of a patient with a facial surgery—this was noted by

Respondents 2 and 7 in response to question five (see Appendix F, p. 65 and 70). The addition of

these types of patients might have increased the number of respondents who reported an

enhanced understanding of patient reasons and might have eliminated declarations of partiality.

Other limitations include the size of the random sample and the length of the documentary—

Respondent 15 in response to question five wrote, “The content is very broad and dense and I

feel as though a 23-minute runtime makes it really difficult to make a solid dive into each

relevant subject for the topic” (see Appendix F, p. 78). In conclusion, future documentaries on

the subject should consider the addition of these elements.

PLASTIC UNWRAPPED 27

Reflection

When I was in elementary school, my parents bought a camcorder for Christmas to start

filming my school events and gymnastics tournaments. But instead of being filmed, I preferred

filming. For those first few years, I did not touch it because I was afraid of breaking it. That

changed, however, when I was assigned a history project on King Henry VIII. The assignment

called for making a poster on the monarch, a slideshow, or a video—I chose video. So, my

parents and I staged a royal court right in the living room, with my father as Henry VIII and I as

the cinematographer, and recreated Henry’s petition to have his marriage to Catherine of Aragon

annulled. It felt very much like a History Channel production. After that, I started using the

camcorder to document my summers in Nicaragua (my home country) and to make short movies

with my friends—the first one being a zombie production. I would say that was my most

ambitious film: I was the director and lead actress (zombie #1). My best friend was zombie #2,

and we played the part by covering ourselves in baby powder, wearing dark makeup (taken from

my mother’s vanity—without her permission), and donning tattered overalls. But when we

moved to Tuscaloosa, Alabama, from Destin, Florida, I lost the camcorder and did not make

another video until junior year of high school. It was a short documentary on Truman Capote for

my creative writing class. It was all text and images, with some clips from Breakfast at Tiffany’s

and Capote, starring Philip Seymour Hoffman as the eccentric author. I put it all together on

CyberLink PowerDirector, a video editing program I did not know I had until I started exploring

the features of the new laptop my parents bought me that same year.

It would only be until sophomore year of college that I would actually pick up a video

camera again, and it was when I received my media kit for Intro to Media Production Lab. It was

in doing my feature video assignment, a profile on Douglas Dillon (SHC’s official “scrubs guy”),
PLASTIC UNWRAPPED 28

that I finally realized my affinity and passion for video. But by the time I realized this, I felt like

it was too late to change my major. So, I stayed with journalism because it felt like the safest

option: my mother has connections in the field from her time as a journalist, I had been honing

my writing skills for years, and I was scared I would not make it in the movie industry. It was

also around the time I was considering law school, so I thought I would find true happiness there.

It took two months of a strenuous writing internship in DC and a long conversation with

my supervisor for me to realize that I was setting myself up for failure and misery. I discussed

with her my plans to go to law school and she advised me to really think it through: Was it

something I wanted or was it something expected of me? Then we got on the topic of dream

jobs, and I mentioned wanting to be a big-time movie director like Spielberg, Coppola, or

Scorsese. That led her to suggest I make some videos for the magazine. So, I made three text-

driven micro videos based on three articles from the July issue, and I got more positive feedback

on them than I had for any of my articles. The executive team liked them so much they even

considered implementing a video department. That is when I started considering going to film

school. The internship was coming to an end and fall semester of senior year was approaching,

which meant I had to begin preparing for senior seminar. I knew I wanted to do something with

video, not only to build my visual portfolio, but also to prepare me for the rigor of film school;

however, I was unsure of how I would combine it with journalism. It was not until I watched The

Truth Behind Instagram-Famous Plastic Surgeons by Refinery29 that I realized I could do a

documentary on a subject I know all too well.

Aside from the stress of scheduling conflicts and deadlines, I loved every minute of it. It

never felt like a task, which I have often felt with writing. The whole process proved to me that

film school is the right option and I am finally headed in the right direction. For this being my
PLASTIC UNWRAPPED 29

first official film, I think I did a pretty good job. I am most proud of its creative and professional

elements. For example, I really like my intro and outro. I like the songs I used. I like my graphics

and use of color. I like my shots; however, some could be more interesting, less grainy, and less

wobbly. Furthermore, I like the range and number of academics I interviewed; it makes my

documentary feel even more official.

On the other hand, there are aspects I wish I would have done better and differently. For

example, I wish I could have featured a third patient, specifically one who had a rhinoplasty, but

I could not find such a patient. This was even mentioned by one of my respondents in response

to question five. While breast enhancements are controversial and apparent, facial cosmetic

surgeries (especially rhinoplasties) are even more so. The reason for this is because the first thing

you look at when you meet someone is their face. Countless research has been done on how we

judge someone by the appearance of their face. So, if you are attractive (meaning, you conform

to Western beauty ideals), you are more likely to be perceived as intelligent, trustworthy,

friendly, etc. This means you also receive more benefits, whether that be social or economic

(studies have found that attractive people get paid more, get more promotions, and are hired

sooner). So, to follow the story of someone who went from, say, a Roman nose to a button nose

would have been interesting and possibly yielded shocking results. I also wish I could have

featured a patient who regretted having cosmetic surgery, then I could have contrasted a story of

regret with two stories of satisfaction.

I also need to improve my audio skills. There was some background noise in Sara’s sit-

down interview and in the street interviews. There was also some white noise in the background

of my narration. Lastly, I wish I would have made my documentary longer, but I knew if I did, I

would run the risk of losing my audience’s attention. To make a long documentary, but one that
PLASTIC UNWRAPPED 30

is wholly engaging, requires a lot of experience as a documentary filmmaker, which I obviously

do not have. In conclusion, if I had to do it all again, I would focus on finding a patient who

regrets their surgery and a patient who had a rhinoplasty.

PLASTIC UNWRAPPED 31

References

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APPENDICES
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Appendix A
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Appendix B
Interview Questions

Patients:

1. What cosmetic procedures have you had?

2. When and how did you get the idea to have cosmetic surgery?

3. Did you feel pressured to get cosmetic surgery?

4. Were you ever hesitant or scared about the risks?

5. What were you hoping to achieve from the surgery?

6. Was your family supportive of your decision? Your friends?

7. How did you decide your new features? Were they modeled after someone you know

personally, someone famous, or a features you’ve always preferred?

8. How did you feel throughout the process—consultation, surgery, and post-operation?

9. After the surgery, did you immediately feel a drastic change in your life—emotionally,

physically, and/or socially?

10. Did/Do you ever feel stigmatized for your decision? How do you respond to critics?

11. Do you find it hard to tell others about your surgery?

12. How has the surgery changed your life and your future?

13. Would you encourage others to get cosmetic surgery?

14. Do you have any regrets?

15. Did you get the results you wanted?

16. Do you plan to have any more cosmetic surgeries? If so, why?
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Communication arts professors:

1. How does the media shape beauty standards?

2. How does the media convince the public certain beauty standards are ideal and should be

modeled?

3. How does the media affect one’s self-image?

4. What are the differences between the way the media targets women versus men?

5. Is the media capable of motivating people to get plastic surgery? If so, how does it do

this?

6. Are people who consume a lot of media more likely to get plastic surgery?

7. Is there anything else you would like to add?

Psychology professor:

1. What motivates people to get plastic surgery?

2. What roles do mental health, the media, religion, and culture play in the plastic surgery

industry and its patients?

3. Is there a correlation between certain mental health disorders (e.g., body dysmorphia) and

those who get plastic surgery?

4. What kind of people do you think are more prone to get plastic surgery and get addicted

to it?

5. Do you think patients are getting the results they intended? How are the results affecting

their mental health or self-image?

6. The majority of cosmetic surgeries are to achieve Western ideals of beauty. Why is that?

7. Is there anything else you’d like to add?

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Plastic surgeon:

1. What seems to be the primary motivations of your patients to get plastic surgery?

2. Why do you think the plastic surgery industry is booming?

3. The top five surgeries of 2017 were breast augmentations, liposuction, rhinoplasties,

eyelid surgery and tummy tucks. Why do you think these procedures are so popular?

4. What kind of people tend to get plastic surgery or become addicted to it?

5. How many patients do you see each year and what are the most popular surgeries

requested?

6. Do you find that patients’ cosmetic requests are realistic? What or who do they usually

model their new features after?

7. What are the risks of having cosmetic surgery and have you ever had a complication

during a surgery?

8. Is there anything else you would like to add?

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Appendix C
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Appendix D
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Appendix E
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Appendix F
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Appendix G
Questions
Questions Themes Key Phrases
Now that you have seen the
film, have your views of
cosmetic surgery patients
changed and how so?
Change (C) change, yes
Slight Change (SC) a little, maybe
No Change (NC) no change, not really, no
stories, understand, types of
people, why choose,
knowledge, patient
viewpoint, motives, media
influence, positive light,
confirmed, reaffirmed, role of
Gained Information (GI) shaming, realistic goals,
reduces stigma, patient
perspectives, age, addictive
nature (of plastic surgery),
psychological aspect,
enhanced view, information,
data, statistics, facts
What was your biggest take-
Gained Information
away from the film?
understand reasons, statistics,
numerous reasons, no
judgment, not all to enhance
looks, personal choice, race,
numbers, many reasons,
different situations, no shame,
Patient Reasons (PR) different motivations, new
perspective, do what want,
confidence factor, different
reasons, range of impetus to
pursue, finances,
demographics, psychological
aspect
hard to stop, short high, new
Addictive Properties (AP)
things to fix,
media powerful, media
Media Messages (MM) influential, media messages,
media impacts, social media
want to help, improve lives,
Plastic Surgeons (PS)
keep patients realistic, attend
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to clients, counsel clients,

advise clients
What are the messages this
Gained Information
film sends?
understand reasons, statistics,
numerous reasons, no
judgment, not all to enhance
looks, personal choice, race,
numbers, many reasons,
different situations, no shame,
different motivations, new
Patient Reasons (PR) perspective, do what want,
confidence factor, different
reasons, range of impetus to
pursue, finances,
demographics, psychological
aspect, knowledge,
informative, not all extreme
celebrity-lookalike wannabes
media powerful, media
influential, media messages,
Media Messages (MM)
media impacts, social media,
media impact, media images
things that can go wrong,
successful plastic surgeries,
change person’s view of
Results of Plastic Surgery themselves, be rational before
(RPS) undergo plastic surgery,
ramifications, legacy, careful
consideration, outcomes,
impact of cosmetic surgery
Growth of Plastic Surgery No shrinking client pool,
Industry (GPSI) growing industry
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Responses
Question One: Now that you have seen the film, have your views of cosmetic surgery patients changed and how so?
Slight No
Respondent Response Change
Change Change
Gained
Information
“I’ve always felt that plastic surgery is an individual’s decision. My supportive
1 view hasn’t changed. Rather, I feel even more supportive after hearing their x x
stories.”
“No. I know people from both sides of the argument. Two people very close to me
2 got breast implants and while one was liberated, the other, I felt like, looked better x
before. I would never tell her that, though.”
“My views on cosmetic surgery have become more open. I feel like I understand
3 why people choose cosmetic surgery, and the types of people that choose it x x
(everyday people, not just rich whites).”
“They have not really changed. I have never considered plastic surgery but have
4 x
known others who have. It has its pros and cons like most everything.”
“Views haven’t necessarily changed, but the film offered a lot of scientific
5 x x
knowledge of the issue and a chance to hear the viewpoint from the patient.”
“Not really, I’m really open minded about plastic surgery & I think that the
6 documentary does a good job at having different points of view about it, as well it x x
shows different motives to get a boob job.”
“More understanding in thought process and aftermath and more focused on the
7 person. The outside media influence into getting surgery is a big factor in making x x
them feel not confident.”
“Not really, I’ve generally been openminded and understanding about why people
8 x
have to or choose to have plastic surgery.”
“Yes my views have changed because now I see plastic surgery in a more positive
9 x x
light.”
“Not really, I was pretty much against cosmetic surgery when it’s not in a
10 x x
reconstructive way. The film confirmed that.”
“A little bit yes. I didn’t ever realize how shaming can come into play when
11 x x
considering plastic surgery. I also think it is up to the person.”
12 “I think it is 100% up to the individual. However, goals should be realistic.” x x
13 “Didn’t change, its a person’s choice as it is their body.” x
“As a person who has always wanted surgery I think this shows that it is surgery.
14 The markings on the girl with the reduction makes it clear. I also think in my mind x x
it reduces the stigma to emphasize choice.”
“My views on cosmetic surgery patients have not changed much as I am typically
15 not opposed to the choice of getting plastic surgery. The film gave me some x x
examples of patients and their perspectives that strengthened my views.”
“I don't think my view changed. Did confirm the relatively young age of some
16 x x
surgery candidates.”
“Not really. I believe if plastic surgery makes someone feel better about
themselves, they are entitled to it. I do believe that some augmentations are not
17 appealing to me personally. People have the right to get it done, and I have the x
right to think it is attractive/unattractive. But I would not criticize someone and i
would keep my thoughts to myself if I found it unappealing.”
“No. Before watching the film, I had the mindset that anyone can do whatever
18 they want if it makes them happy. Seeing the joy of the subjects in the film, only x x
confirmed my stance.”
“Maybe a little. The first time I had to think about this topic was when my best
friend was getting a nose job and I was very against it because of sadness of her
not accepting herself but then, after thinking about all the other ways we adjust
19 ourselves: piercings, bleaching our hair, etc, I didn’t feel like it was wrong. So in x x
this film I saw how wanting a plastic surgery could also be a bad thing, and how it
can be addictive and how the ‘high’ of feeling good after plastic surgery
eventually goes away and you might start doubting your decision.”
20 “No. I think it’s ok if that’s what you want. To each his own.” x
“They haven’t really changed. I still believe that cosmetic surgery is a personal
21 opinion and can be helpful improving someone’s self esteem whoever there’s a x x
deeper psychological aspect to that desire.”
“My views have not necessarily changed, but enhanced with more information
22 x x
and perspectives from different people”
Totals 4 2 16 16
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Question Two: What was your biggest take-away from the film?
Gained Information
Patient Addictive Media Plastic
Respondent Response
Reasons Properties Messages Surgeons
“Plastic surgery is more than what people see on reality TV. In reality,
1 majority of cases of plastic surgery occur due to reasons we may not all x
agree on but reasons we should be able to understand.”
“Once you start, it is hard to stop. You keep finding new things about
2 x
yourself to ‘fix’ in order to meet the mold society has set, which is sad.”
My biggest takeaway from the film is that no two statistics are the same.
3 x
Reasons for cosmetic surgery are numerous and should not be judged.”
“Your body, your choice. Don’t change for others. Also not all plastic
4 x
surgery is to enhance looks.”
“Media messages are very powerful and influential. We (advertisers) have
5 to be strategic in choosing what messages to show to audiences because x
they can impact lives significantly.”
“The number of people & race that get plastic surgery was impressive.
Also the fact that one of the patients actually says social media affected her
6 x
decision because a lot of people don’t accept it or are aware of social
media’s impact on them.”
“Let people do what they need to be comfortable with themselves. Judging
7 x
only hurts. Change media so there is no need of perfection.”
“My biggest takeaway is that plastic surgery is done for many reasons by
8 x
people in different situations and is not something to be ashamed about.”
9 “That people shouldn’t judge people for getting plastic surgery.” x
“There are different motivations behind plastic surgery & I think that can
10 x
change how we see & view it.”
“I feel like I have a new perspective on the surgery and more of the
11 x
reasons why people get them.”
12 “Get plastic surgery if it’s what you want.” x
“Plastic surgery seems very confidence driven, has its dangers but
13 x
confidence seems to outweigh this.”
“That plastic surgeons cannot give you the famous face. Some people do it
14 x
for several different reasons. It is a personal choice.”
“My biggest take-away from the film was that the plastic surgery industry
does not want to embrace the stereotype that they are there to completely
15 change a person. Rather, they want to help make some changes to improve x
their lives, but they will stop someone from getting a surgery if they feel
like it is absolutely unnecessary or dangerous.”
“The range of impetus to pursue. And that younger surgery candidates did
16 not seem to worry about who/ what funds their surgery as long as they x
were able to obtain it.”
“Plastic surgery is really not some crazy thing people do to be forever
17 young. It is often slight augmentation. It is troubling to see that 93% of x
surgeries involve women, though.”
“That cosmetic surgery can bring people true happiness, and we should be
18 careful about the comments we make to people regarding their x
appearance.”
“That people have different reasons for getting plastic surgery. In the
media it is usually made fun of I feel like, like the only plastic surgery that
19 x
exists is a nose job and a boob job. But some people, the ones that don’t
NEED it, still benefit from it greatly, like breast reduction.”
20 “It is definitely a personal choice; right for some, not right for all.” x
“That people who choose cosmetic surgery get improved self esteem
21 whoever that can be a short term feeling as more in depth psychological x
issues might be at play.”
“It was interesting to see that plastic surgeons not only attend to what their
22 clients want but also do counseling with their patients with regards to x
expectations and what’s possible/ advisable.”
Totals 16 1 3 2
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Question Three: What are the messages this film sends?

Growth of
Results of
Patient Media Plastic
Respondent Response Plastic
Reasons Messages Surgery
Surgery
Industry
“There are pros and cons to everything—plastic surgery included. I think
1 the film sends the message that people shouldn’t be so quick to judge x
because everyone has their reasons for undergoing surgery.”
“It showed mostly the successful plastic surgeries, and while it touched on
2 the drastic things that can go wrong, I felt like it was slightly biased. x
Overall, it gave an empowering message, which is good.”
“The film sends messages about body positivity and about how cosmetic
3 x
surgery can change a person’s view of themselves for the better.”
4 “Make a rational decision. Don’t do it on a whim and be informed.” x
“Plastic surgery is a choice, a personal choice that people can pay to alter
5 their appearance for personal reasons. It sends knowledge and positivity x
about the issue.”
“Reasons why people get plastic surgery; different perspectives on plastic
6 x
surgery; testimonials; facts about plastic surgery”
“No judgement. People choose plastic surgery because they want to feel
7 x
more confident and comfortable with themselves.”
“This film sends generally positive and understanding messages. Not
8 x
judgmental, just informative.”
“That plastic surgery isn’t some horrible thing that it is sometimes viewed
9 x
as and if it makes you feel better to get it, then you should.”
“I don’t think it was pro or against plastic surgery but more informative
10 x
which I liked because it allowed for people to make their own opinions.”
“Empowerment to women (or pointing out how social media warps our
11 x
idea of empowerment).”
12 “Media influences body image; such a controversial issue” x
13 “Overall it helps with confidence in a person, its very personal” x
“I believe the film sends is that plastic surgery is a choice, a personal
choice, However, it does emphasize that a lot of this is influenced by the
14 x
media and that this can cause the desire in people; not a black and white
issue.”
“The film sends the message that plastic surgery patients are not always the
extreme celebrity-lookalike wannabes as they are made out to be. Rather,
15 x
they are very normal and relatable people who just wish to make a slight
change to their body for the sake of their health and their peace of mind.”
“The cosmetic-side of this industry is not going away in foreseeable future.
16 Apparently that side is in no danger of encountering a shrinking client x
pool.”
“What are the societal ramifications of body alteration? What legacy are
17 we leaving behind and how do we inspire young children coming of age in x
such a society?”
“I think that we are supposed to be thinking about if the media has an
18 impact on the rise in plastic surgery, but based on the interviewees I don’t x
think they were that much influenced by that.”
“It just gives a variety points of view on the plastic surgery and how it can
19 be good and bad and necessary and not that necessary at all. Just gives me x
information about plastic surgery and the variety of outcomes.”
“This surgery should be given careful consideration before deciding to
20 x
have it. These girls did that, and were happy with the outcome.”
“I believe that film does a good job exploring the deeper impact cosmetic
21 surgery has on someone who chooses that path more so than just being x
fixated on the image superficially.”
“That there is a line between healthy needs and expectations of self image
22 x
and unhealthy expectations steered by images in media.”
Totals 10 5 6 1
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Appendix H