Cosmetic surgery and allied procedures were less hard hit by the great global crash than many other businesses. Women saw their faces and bodies as assets needing investment to help them in a tough market

Laurie Essig said in spring 2007 that the United States was on the verge of a major crisis, during a conference call from Middlebury College, Vermont. Her level of economic expertise barely allows her to sort out her coffee break bill, but her area of sociological research – cosmetic surgery – perfectly positions her to observe “the subprime mortgage crisis of the body”.

People in the US pay for 85% of cosmetic procedures (surgery, laser and injections) by borrowing. There is no minimum downpayment, as is required in every other country except Mexico and Australia. This is the result of measures Ronald Reagan introduced after he became president in 1981: the authorisation of medical advertising and credit deregulation. The institutions that specialise in financing medical procedures – the largest is CareCredit, a subsidiary of General Electric – approve loans widely and easily. Interest rates can reach 28%, and double if a debtor misses a single monthly payment. Cosmetic surgery was once only available to the wealthy, but has become an enormous industry producing “a much more widespread standardisation of Americans’ faces and bodies”. A practitioner said it now attracts “everyone from hairdressers to Walmart executives’ wives”. Patients are 90% female and 80% white, and between 2000 and 2010, spent almost $12.5bn annually.

Sector growth, at 465% over the past decade, has kept up with the widening of the gap between the rich and poor. Essig believes that it is the result of an attempt to resolve the contradiction between grandiose dreams, intensified by media depictions of the way of life of a privileged class, and decreasing real incomes. It also fits with the neoliberal vision of a malleable subject, free from predetermined traits and expected to work continuously towards personal perfection. It is based on the conviction that responsibility for everything – problems as well as solutions, failure as well as success – lies with the individual, rather than society.

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