YESMAR OYARZUN  

Thank you for joining us. I want to start off with us setting the scene about how you got into this work. And so just a little bit of background about where you're from and where you grew up and what it was like. And if you have any tidbits about how that shaped you getting into the sociology of aesthetic surgery, I would be very interested in hearing anything about that as well.

 

ALKA MENON  

Yeah, so I grew up in College Station, Texas, actually. And as I get older, it's clearer and clearer to me how growing up in Texas has shaped my tastes and perspectives, especially now that I live in New England, which is really quite different culturally and of course, geographically and in terms of climate. And while Texas has changed enormously since the years that I was there, as a child, I still have family there and I'm regularly visiting with my list of things that I want to eat, like Tex Mex and barbecue. 

 

ALKA MENON  

So it's very close to my heart. I think there were certainly experiences I had, as the child of immigrants growing up in this community that made me interested in cultural difference and sort of paying attention to patterns of taste and preference in that way. But I did not know anything about aesthetic surgery at the time, I think goes a long way from having that kind of a perspective. But I certainly developed an almost sociological or anthropological eye for thinking about multiculturalism, based on the kind of background early experiences that I had.

 

YESMAR OYARZUN      

So how did you end up coming to the sociology of plastic surgery? And in the beginning, How was that received by the sort of people around you–sociologists, plastic surgeons, the kind of people who would be involved in either sociology or surgery.

 

ALKA MENON  

I did not enter grad school in sociology with any kind of awareness of plastic surgery, or even really of beauty ideals and aesthetics, as the topics being of interest to study. I was more interested or insofar as I have narrowed down my interests at that point, it was thinking about the relationship between race and medicine and kind of how society mediated the relationship between those things and how technology mediated that relationship. So I majored in biology as an undergraduate, but discovered this subfield of Science and Technology Studies, which had a more critical eye to the production of knowledge. And genetics and genomics were very much the focus of a lot of that new research coming out in STS at that time. And so I had found this really late in my undergraduate years and had sort of been thinking about it afterwards, when I was working in public health. How is it that these statistics are being produced about racial disparities? 

 

ALKA MENON  

In medicine, I worked in a tuberculosis clinic in Houston, actually, for the City of Houston Public Health Department in tuberculosis control, and there were funding sources that depended on different kinds of racial or ethnic communities. It was both a funding imperative to know what the racial disparities look like in this specific instance. And a kind of public health one, right? You want to know what the patterns actually were. But then figuring out how that worked on the ground? How do you decide what a refugee patient from Somalia, what race they are when, you know, they're confronted with a form with a bunch of categories they've never maybe encountered like Asian or Native American for the first time. That was a really interesting and ongoing practical challenge for people who are out there in the field delivering health care or doing contact investigations. 

 

I came into graduate school interested in that kind of translation process. How do you get you know, how are the statistics that reveal these trends on the broad level produced in the first place, and what are the consequences of choices in that structure? And so I was looking for a way to do this. I was interested in genetics and genomics, of course, were still something on my mind based on what I had encountered as an undergraduate and what was out there in the scholarship, in the talks that I was seeing. But I was taking a seminar on biomedicine and looking for case studies to write about for a seminar paper, and they came across an article in The New York Times about a phenomenon that the author called “ethnic plastic surgery.” And I'd never heard of this before, I hadn't thought a lot about plastic surgery, but it was very clear that this was different. It was a little bit more like my experience in Houston, with patients trying to navigate these categories and think about what they would mean for their own practical lives and a little bit less of the kind of top down genomics projects of scientists generating knowledge based on the US racial census categories. 

 

ALKA MENON  

And so I did a little more digging about some of the surgeons who were mentioned in that article, you know, I found websites where they would offer specific kinds of procedures that were tailored to different racial or ethnic groups, and some of them had written medical journal articles that would specify, you know, this is how you would create an ideal, let's say, African American nose. And so I ended up writing about those articles, those medical journal articles written by plastic surgeons about coming up with these ideal noses that have these kinds of racial types to them. And, you know, I wrote based on a sample from that seminar paper, mostly constrained by time, but I kept returning to this, it eventually became a master's thesis. 

 

And then I wanted to understand a broader picture of okay, this is what's out there in the medical journal article world. This is what's after textbooks and discourse. But what does this look like when you actually talk to surgeons, or observe them in practice, or go to a conference? And so while this was something that my advisors were very supportive of in graduate school, it was a strange way to take on race in medicine, right? Cosmetic surgery, which is what I was focusing on, was a subset of plastic and reconstructive surgery that was all about ideal appearances or looking better enhanced, not necessarily about fixing a functional deficit, or even a congenital abnormality at birth. And so it was very much about creating something for a person that had never existed for them before that person that we're creating an ideal. And, and so I think a lot of this sociological attention was a little skeptical initially of in the broader field of well, this is certainly a phenomenon that had had important gender ramifications. You know, most cosmetic surgery patients were women, about 90%. But it was sort of the sort of status quo at the time was very much this is something that white women are doing mostly or wealthy women are doing in the United States. And that's where it ends, this doesn't, this isn't really the place you would go to study race, unless it's about removal of markers of race or ethnicity, of stigma. And that's kind of where the scholarship had been in sociology through the 90s on this. And so it wasn't really seen as tackling some of the same issues that the research on race and genomics or race and genetics was doing, where there was a real concern about the potential biologization of race. 

 

ALKA MENON  

But I found that plastic surgeons themselves were pretty interested in thinking about what racial difference meant for them, or cultural difference meant for them, and, and how they needed to make adjustments to incorporate different kinds of social identities into their practice. And while race was certainly not front of mind, for most of the surgeons that I was contacting, it was one of several factors that was important to them. They were fully steeped in the social lives of their patients in a way that I thought made a lot of sense if you wanted to have this broader perspective on racial differences and racial health disparities in medicine, and approached from a fundamentally different angle with a firm route and consumerism, and a little bit less of a kind of scientific typology, logic, despite that being what I had initially found what had gotten me interested in this in the first place where those journal articles about noses that offered these very clear types. So that tension really became the animating one to explain and to describe, in my research going forward.

 

YESMAR OYARZUN      

Now, that's very cool, because those are the same kinds of things that I encounter as I approach dermatology, from a perspective that is not about vitiligo, or albinism are these kinds of interests that people have of people like turning from black to white or changing color or things rather than the sort of like ideal or pursuit of different kinds of ideals that are like racialized in the like tiny inner workings rather than in the sort of face value ways that we think about race? I'm supposing though, I want to pose this as a question that you started in the United states. 

 

So what was it like, sort of starting that project in the United States? And if we want to flow into how that differed from taking on these questions in Malaysia and the ways that the subject matter has to change and the people involved and the perception of the project as a whole changes, as well as sort of how people on the ground that you encounter in Malaysia in the US read the project and the stakes of the project?

 

ALKA MENON  

Yeah, that's a great question. So I think that when I started the project, I had read these medical journal articles initially as being a kind of American centered project. They were written in journals in English, many of those journals were housed in the United States. But what I came to realize after doing more research is that actually, these journal articles are subscribed to by plastic surgeons from all over the world. And really, what I was capturing with that medical journal article level was this expert discourse that was global in nature. To some degree, you know, there were authors, mostly from the United States, but a very high proportion, also from China, from South Korea, from Brazil, from Colombia, who were writing in, and that was a necessary backdrop to interpreting what the use of racial types was achieving. But it was a sort of scientific communication lingua franca almost. And so that actually in a way was its own kind of site. That was distinct from either what I found in the United States, or then subsequently in Malaysia. So I kind of quickly found once I started talking to surgeons, or observing them in the United States, that there was another way that practice looked pretty different. And that practice in the United States and practice in Malaysia had some similarities that were both different from this global level of export expert, idealized, standardized discourse. 

 

ALKA MENON  

I think, in the I kind of did this back and forth process, I had just started to do the fieldwork component to interviewing surgeons and observing them in the United States when I got a pilot Opportunity Grants to do research with the Social Science Research Council, which I was using to say like, is there some other site where I can see whether what's going on here is the story about us multiculturalism, where we're celebrating all the iterations of potential difference And, and kind of elaborating upon that in a US multicultural, specific way? Or is there something else potentially going on? Would we see this in another multicultural society, that's postcolonial that has a totally different set of histories and contemporary linkages between race or ethnicity in the body. And so this Social Science Research Council grant gave me the opportunity to pick between a couple of international field sites, one of which was Singapore, and the other was Malaysia. And I had gone into this thinking, Okay, it's probably going to be Singapore. And Singapore is a very unique place. It's a small city-state, but it's very wealthy and had a big medical tourist industry. And so I thought there would probably be some similarities between the US and Singapore, but that Singapore would be this, this kind of hub of operations that would allow me to, to sample something about the elite level of cosmetic surgery in Asia. 

 

ALKA MENON  

But when I actually arrived in Singapore and Malaysia, I found that there was a potentially really interesting story to be told about Malaysia, both in terms of the elements of thinking about a domestic population, you know, Malaysia is a bigger country, it's 30 million people. So there were certainly people who were living in Malaysia who wanted plastic surgery. In addition to these medical tourists, the medical tourist market was also a little less elite. And so you had a little more variety and who was showing up both in nationality terms, in terms of people from Australia and New Zealand, in racial terms, you have white patients, you have different kinds of Asian patients, but also in terms of religion, the sort of importance of different Asian religious traditions from Islam to Buddhism came into play. And very quickly, it reframed a lot of things that had been invisible to me, just looking at the US context, and it gave them boxes. And so while it was immediately apparent that this kind of everybody being different and celebrated in their own way, and this new ideal is creating a story that I initially saw or expected in the US was not going to be the story in Malaysia. A potentially more interesting story was emerging about in positions of transactional fluids and kind of comparisons across places, and that Malaysia was at a really interesting crossroads to examine that, and that neither the US nor Malaysia was really central to the field of cosmetic surgery from that a scientific cutting edge biomedical point of view, right? 

 

In the public imagination, at the point that I began to research, if you had asked people, “What's a country that you would associate with cosmetic surgery?,” it would have been something like South Korea, or Brazil, where these are, these are countries that are really popularized certain cultural looks, that were very obviously augmented by cosmetic surgery, and that the surgeons themselves had reputations internationally among plastic surgeons for pushing the envelope for what it was possible to do with the human body.

 

So the US and Malaysia were both places, which in some ways were more conservative in that regard, and also had these large populations of internal racial diversity that were woven up in the national myth of each society in really interesting ways. And so the juxtaposition of these things revealed something about both places, and about this global level of expert discourse.

 

YESMAR OYARZUN      

So I’d like for you to talk more about how you came to think about this relationship between beauty ideals, and the nations. But also, if you have a moment or a few moments where this kind of clicked for you where this turned on, and how does medicine fit into this? Obviously, through the creation of it through toxic surgery, but also, there are other ways that medicine sort of lurks in the background and creating the nation through race may lead to you to talk about sort of how that's occurred to you.

 

ALKA MENON  

So I think that if I had had on known from the outset, as a first year graduate student that I was interested in plastic surgery and beauty ideals, I would have, I would have arrived at this, this idea of thinking about the relationship between beauty ideals in the nation a lot sooner, because there's this really interesting body of scholarship on on exactly those issues with beauty pageants, right, which is a explicit site where bodies are ranked relative to one another, and that bodies, people debate whether or not a specific iteration of physical appearance can stand in for the nation and represent it. And then again, it's mostly women. But there's certainly racial dimensions to this as well. There's class dimensions to it that are very important, and sexualities is an important part of it. That was really nicely articulated in this scholarship. 

 

But when I was doing my field work, and thinking about cosmetic surgery, and race and medicine, I was coming much more from the standpoint of genetics and genomics. The research that was out there had really influenced me in shaping the kinds of questions I had, or the guesses or hypotheses I had about what I would find. And there at the time, there was this, this kind of surge of scholarship that was about Asia, right, Asian Biotech. There's an edited volume by Aihwa Ong and Nancy Chen that talked about different countries within Asia and how they position themselves relative to one another, with different kinds of technologies or medicines or even practices, including medical tourism. John de Moya had a book about nation building and medical systems in South Korea. And so these these the idea of training and expertise and scientific knowledge projects as being nation building enterprises, and that these genomics and genetics, databases, being a physical manifestation of you know, trying to take elements of the body to represent or standing in for the nation, but with DNA, right with sequences as being an important part of the story there. That's really more where I was coming from and thinking about medicine as being central. 

 

ALKA MENON  

And so when I got to Malaysia, one of the very first interviews I did with a plastic surgeon, these two totally different ways of thinking about the relationship between the body and nation or, you know, representing the nation crystallized for me in one moment. Because he said, you know, he was trying to situate for me what it was that was unique about Malaysia, or what beauty deals were sought after, for cosmetic surgery for people in Malaysia. And he said, “Malaysia is not a boob society, you know, the US bigger is better people have bigger cars, they bigger houses, they definitely have bigger boobs. But Malaysia, it's not like that at all. If anything, people asked to make their breasts smaller.” 

 

So this was like a really simple kind of overly stylized statement he made. And I'm paraphrasing, of course, what he said. But it was a sort of lightning bolt moment of he's characterizing all of Malaysia this way. He's not giving me the differences between racial or ethnic groups within Malaysia, which is what I had actually asked about in the question. And those, you know, I had gone to Malaysia thinking, “Okay, if this is a story of multiculturalism, akin to the US story, then you would expect a kind of one version of Beauty that's about Malaysian Indians, and another for Malaysian Chinese, a third for Malays, and the fourth for everyone else or for white medical tourists.” But that's not what he was drawing, he was sort of saying this is what all of those groups kind of have in common, that's maybe different. I think this was aimed very much at me as an American researcher might expect that plastic surgery is associated with bigger boobs. That's not what it is here, right? This is “You need to reframe what you're thinking about.” That these things were relational for him to, to some degree, there's differences within the country, but also differences in practicing in Malaysia from practicing in the US or from practicing in Thailand, or even South Korea and Malaysians were especially cognizant of this, you know, if they go to a plastic surgery conference, there's always somebody from another country, who's there, it's not they have some small meetings that are regional in nature that are just specific to the country, but they're much more plugged into this, at least regional or transnational network. And then they think about how to position what they have to offer patients relative to their international competitors or collaborators in a way that American surgeons in the US really didn't have to, in many cases, right, the US has maybe 6000 plastic surgeons, a subset of those are cosmetically focused. But that's an enormous amount of competition just domestically. 

 

ALKA MENON  

And so a lot of the, the way that they were thinking about this, when I would talk to them was about differences within the US because it was already such a big market in its own right. So it took going outside the US to help frame this broader potential conversation. And then I could go back and see where it appeared in what American surgeons said too. And once this kind of a few of these flashes of conversation had made this clear to me, you could see it in other ways you could see it on the conference stage, when a surgeon from Mexico who was presenting to an audience of mostly Asian surgeons in Japan would use certain kinds of categories. There would be these moments where the nation would just pop up a flag would be there, right? That these were used as not just shorthands. But there would be these even informal competitions, where it's like people would stand in for, you know, they do like a quiz bowl, where you stand in for your region of the world. And it was playful. 

 

But this was very much an animating part of the discourse that helped connect for me what was going on.There's this element of, of beauty ideals and representing the nation that way, there's this element of scientific expertise, and clinical skill and kind of craft. Both of these things are being built up in these kinds of ways. And they really converge in cosmetic surgery in a way that I don't think is unique to cosmetic surgery, but is really much easier to see. Everybody agrees there's a cultural component to cosmetic surgery, and that not all cosmetic surgery looks the same. People might debate how different cardiology looks from Malaysia to the United States, that there might be more similarity there. But the forces are still there, right? That there are these differences that will affect the craft of surgery, even for heart surgery across those two locations, too. So it's a kind of example where it's exaggerated because of the possibilities and the other cultural meanings of what's going on. But it makes apparent forces that I think are at work and other examples of medicine as well.

 

YESMAR OYARZUN      

I think that's such a beautiful example of a moment and I think that's why I also asked for a moment, because we see in him suggesting that America is a boob society and Malaysia is not a way of making Think Malaysia cohere as a nation. That's not what he's doing. He's differentiating, presumably, between, you know, the right kind of look for the right kind of person. But all of these looks kind of cohere in a, you know, “Malaysia is a more conservative country,” like the Malaysian people are more conservative as a nation, Americans are wild and out there, it's really interesting how like the nation comes to cohere, even though societies, both of which are thought to be diverse. And one of the words that has become sort of my nemesis in all of these things is diversity. Because diversity means so many things, and diversity, at least in the United States context where I work, is sort of like something that everyone wants to appeal to. Like “America is a diverse nation,” and you know, “DC is a diverse city,” and “New Orleans is a diverse city” and like the places that I go, like, these places are diverse, and that's important. And when we're asserting that we want to talk about the ways that these people are coming together, and they're all the same. And they're all like Americans, and you know, we should take care of them all the same. 

 

And in order to do that, at least dermatologists argue from a medical standpoint, rather than an aesthetic standpoint, in order to do that we have to attend to differences in certain kinds of ways. But diversity is also what makes America coherent. And so it's like, it's, I don't know what the question is about that. But it's just like, very interesting, a way that like diversity makes these two nations Malaysia in the US cohere even as, like, on the ground, the ideals become very ethnic, or, or, you know, become structured around difference rather than diversity as like a, I don't know, the ideal, right?

 

ALKA MENON  

And I mean, it offers a convenient toggling back and forth point, right, that you can kind of level up to diversity. So it's, it's boxing, all of that difference in one category, and just sort of gesturing to this shared importance without having to get specific. And so you can see that in both the US and Malaysia, how surgeons would strategically go back and forth between being more specific about racial difference versus just gesturing to the idea that this existed and it was important.

 

YESMAR OYARZUN      

I have a question that I didn't pose before. But I am intrigued at this juncture, what happens in the context of mixedness? We have this diverse nation, and that's what makes the nation cohere. And then when a person is mixed-- and that's a very contested term in the United States, definitely. So like, has that in your experience influenced these like very same issues? How does like mixedness come to like, does it become a problem for beauty ideals, and the kind of work that plastic surgeons think they should be doing? 

 

ALKA MENON  

Yeah, so mixness is a problem more of the kind of top down expert discourse logic, rather than from when confronted with the patient not knowing what to do. So one really interesting tension, something like cosmetic surgery is, there's all this knowledge that's created and generated and disseminated, about how you should go about doing things, right. That's what the textbooks are for. That's what the medical journal articles are before these generalizations, and that race is a convenient way to do generalizations. But when it comes to actually practicing on patients, you're confronted with the body in front of you. And you don't usually ask them what what race that they belong to, either in the United States or in Malaysia. That, it may come up in terms of how a patient narrates what they want to look like or why a surgeon says, ‘No, you can't look like that, that what you've just proposed.” “It's not possible,” or “It's not a good idea, and here's why.” So they, they it actually is, it's a problem for creating typologies and maintaining and restoring typologies in a top down way, but it's not it, but it's the reality of what they deal with, right? 

 

They constantly are confronted with patients who don't quite fit the general typology, and they have to figure out what to do for those patients and how to make them apply those standards and practices. And so in practice, there's ways that it can be more or less challenging. Then often the way that this is resolved, is that there's a narrative back and forth of how they're going to talk about whether mixedness is something to be brought to the fore. Whether it's something that is desirable, or just sort of fait accompli, it's there. So you know, we'll work with it, or is it a narration that's more about “Well, you do want to look more like your mom or your dad?” Right? With this clear understanding or awareness that mom and dad are from potentially two different racial groups and that you have pictures of both of them and so But this is done in an even a visual register of what's going on. So that's what I mean by there's ways to try to negotiate this completely without having to explicitly talk about it. And surgeons don't shy away from that when it comes to an individual patient. 

 

But they struggle more with what to do with mixedness or hybridity in the abstract. And there is always a line where it can be if it's too hybrid or too mixed, and it doesn't resemble something that is coherent in a racial way, then that's also a danger. And so as long as it can sort of be fit into some model of what would be an ideal, which includes, in some cases, hybridity itself, right, the idea that many surgeons would talk about how well all of these standards that we just talked about are going to become obsolete, because in an increasingly diverse world, they expect more and more people to intermarry and to mix and to result in new combinations for what people could look like. And so really what for some surgeons, what they would then say is, I expect, you know, to see everything under the sun, but I'm not going to generate everything under the sun, I don't presume to be able to be as creative as nature. I'm more of a technician who is tweaking at the margins here. And so if asked to do too much in the way of transformation in ways that they felt was socially transgressive, then that's when mixture became a problem to be avoided. And so the narrative of change, and how far to push it was what was most important.

 

YESMAR OYARZUN      

That's really interesting. It also reminds me of Eric Plemons’s book, The Look of a Woman, where hybridity is very interesting, because when they're talking about facial feminization, they're like, “No, you can want some masculine traits retained or created even because some of the most beautiful women have one or two, like really masculine features that would like traditionally be like, across the board, not a feminine trait. But on a woman with otherwise feminine traits are beautiful.” Right? And so like, there is a reason to not maybe shape the jaw too much, or things like that. And so that's like one aspect of hybridity. And then in my world, there's also, you know, the dermatology like, “By 2050, half of America where we'll be more like people of color, then run on people of color.”

 

And so the sort of, it's kind of like, like plastic surgery and other sort of aesthetic fields have to have this sort of, like, anticipatory stance where they're like, using population or like population demographics, but like, almost aspirational demographics, I don't really know what they are, but like, sort of like these future demographics to try to stay ahead of the trends, which is like trying to stay ahead of the trends and like a fashion sense, kind of, but also in this racial sense, I guess. I'm contemplating the idea of a trend. And the way that it's like, so very vital to say because you also don't like you don't want to face that's old, I would assume. Right? And you don't want you don't want big boobs anymore. You want, you know, medium boobs and big butt or whatever like those sort of going in and out of trends like dates your body in certain ways is the kind of thing I read in the sociology of plastic surgery and effects, surgery literature that's just like, so very fascinating. Is that like, keeping ahead of what a body should look like. And that is, it's just critical.

 

ALKA MENON  

I think. So what you're saying about this projection element is something that I definitely found and wrote about and wrote about in one of the chapters in my book, that it's the projection of the racial future, the racially mixed future that drives the need for innovation and the creation of new standards. It's usually put as a justification for why surgeons should think and write about this, even though especially in the United States, most patients remain white women, right? And that's sort of changing, but they're disproportionately white relative to the proportion of whites in the population in the United States. So it hasn't happened yet, right? But it's on the horizon. And that's always at the beginning of the article, we're kind of the beginning of explanation for then seeing how things will be different. But surgeons are also very aware, as you know that these things are about trends and that you know that they work on 10 or 15 year cycles, and that there's this balance to be struck between achieving the zeitgeist of a time and not having everybody look exactly the same, which was for a period of time, the goal in plastic surgery that everyone has kind of done, obviously, augmented look, and then still desirable for a subset of the population, right? These things coexist. And so part of the tension with race is that it gives a surgeon a way of differentiating and making themselves stand out with a kind of brand identity that's based on flexibility and about multiple possibilities as opposed to this one size fits all look.

 

YESMAR OYARZUN      

That's so interesting. And I'm so excited to read the book, especially like this projection of racial futures. And it also makes me think about how much these projections are about population, about the amount of people that will be a certain race and how much it is about anticipation of economic or other kinds of trends like, like, anticipation of increased access to plastic surgery rather than interest. Like, I guess there is maybe the idea that maybe more people are interested, but access to it for people of color, for example, will be increased by 2050. And that's also why we have to prepare. I know that I am still in the middle of research, but I think that's partly the case for dermatology, it's that black people are also growing part of the economic sector and Hispanic people. 

 

So like, you have to anticipate these people becoming part of your potential future patient population, whereas before, he didn't have to anticipate it because they didn't have insurance, and they don't have insurance and are not going to see a dermatologist, right? They're just going to get whatever they get from their general practitioner. And that's just going to be it.

 

ALKA MENON  

Yeah, I think that's economic logic. So certainly, in cosmetic surgery, you can't ignore the potential market dimensions, the sort of consumer dimensions, because most of the people getting plastic surgery do not have any insurance coverage for the procedures, if they're cosmetic in nature, if it's about enhancing or aesthetics. And so absolutely, it's about this projection of increased access. And very much this argument unfolds that under the logic of market niches, this is also coming from an impulse that maybe the kind of dominant way we thought about plastic surgery or her aesthetic surgery, specifically, that market maybe is tapped out, right? Maybe surgeons have already reached whatever white patients who could be tempted to do surgery. And so now they're going to have to think about changing or expanding offerings, if they want to be able to continue supporting growth in the business in the future. So both as purchasing power is rising, you know, there's a lot of attention to where it's rising fastest. And that's why Asia is part of that story in a global sense. 

 

But even in the United States, domestically, Asian American become this kind of category, that's very important, because of perceived purchasing power. But it's also, you know, medical credit became available, this is a thing, prices sort of did come down, and therefore access does expand. And that's part of the story, too,

 

YESMAR OYARZUN      

That is so interesting. And also kind of almost gets us into the next area, which is about transnationality. And like that is sort of a common thread in your work, especially as you start to go into Malaysia and sort of even early on, because plastic surgery, even written content is being consumed internationally and produced internationally. What is it that sparked your interest in transnationality, as a concept and as a sort of influencing factor for the kinds of things that you were seeing in the field? And what about transnational flows is so integral to the practice of cosmetic surgery? And why does it matter? Why does transnationality matter? And why should we be thinking about the transnational when we're thinking about things like beauty ideals, and about aesthetic surgery and about the nation event and how those things sort of all come together. 

 

ALKA MENON  

So there's certainly a version of a book on plastic surgery that would focus on the nation, that would be really interesting race in the nation, especially right, that would tell you something about the history of a place, the kinds of origin stories that a country has for its racial categories, and the social myths about why they're still relevant, or what it means about, you know, contemporary society. And there's plenty of scholarship that looks at specific countries and in really illuminating ways that details this relationship between the body race and even cosmetic surgery specifically. You see a lot of this especially in South South American countries. But what I quickly kind of found while doing fieldwork, because I had that opportunity to do pilot research so early in Singapore and Malaysia while I was also forging connections in the United States. 

 

But there's another story that's going on, but I haven't really talked about how countries are not actually islands, when it comes to either cultural trends, or scientific biomedical ones, right? If we take seriously the idea that globalization is transforming how medicine is practiced, that English is this big medium of, of transnational scientific communication, and that people if you just look at who's going where to do what right, for purposes of training, are people crossing international borders for that are they doing that for temporary stents are people crossing international borders to access care why? Why are they doing that? Once you start to look at, if you if you follow the objects, so to speak, if you follow a specific procedure, like a technique for doing an eyelid surgery, for example, instead of thinking about the sort of boundaries of nation states, then you start to see there's a lot of back and forth between places. And that you, you can't really understand how a beauty deal ended up the way that it did in the United States, without looking at that back and forth between South Korea, Vietnam, Singapore, Malaysia and the US, and that it's gone back and forth a few times. And so the narrative of going back and forth is important. From a cultural perspective, you know, how, what kind of what does that look like being called? How do people ask for it? Is it related or seen as related to the history of US military occupation, the Korean War, the Vietnam War, is it seen as different from a Japanese kind of intervention, because there's a history of Japanese colonialism that is strongly being kind of contested and pushed back on in these narrative discursive ways of saying, you know, maybe it would be better to trace the lineage of plastic surgery through the US preferable for some people than to do so through Japan. So all of that actually is pretty important for getting this picture of how things take their contemporary form. 

 

And so what my, what I offer in my work, is this kind of strategy for thinking about how the global national, and then this sort of local, which is really just this interpersonal, in the context of medicine, dimensions together support the existence here. And so it's while race, of course, can be understood in these national terms in a very deep sense, in a historical sense. There's also a way that a snapshot in time across places, gives you a really important perspective on how race is stabilized and supported in something that is a transnational field, whether it's a cultural industry, or medicine, or cosmetic surgery, which is a little bit of both.

 

YESMAR OYARZUN      

That brings me to the end of the main body of questioning, but I wanted to ask, what is next? So what is next? This is a time where you can talk about your book, if you like, if not sort of like the next phase of thinking about these issues. I know you said, you know, if you had come to beauty ideals earlier, you might have gone for the side of beauty contests and things. But what's what's next on the docket? And how can we think about your research and your work and your body of work from here?

 

ALKA MENON  

Yeah, so there's light at the end of the tunnel with the book project, the research is completely done. And the fieldwork component is over. The manuscript has been under review, and so I'm trying to just sort of put the finishing touches on it. But the manuscript is really organized in a way that emphasizes this point about the kind of transnational method that I'm talking about with thinking about and stabilizing racial, the use of racial categories and markets and medicine. And so in focuses on this, it begins with this global expert discourse on standardizing race, you know, that comes in medical journal articles and conference presentations, then it shifts to this national discourses, and narratives of change about what people want to look like by by comparing idealized looks in the United States and Malaysia, and then with their ramifications for race, and then also how surgeons construct brands identities that differentiate them from one another within the country of what they can offer patients, and that some of those brands involve a sort of aesthetic component that has to do with race, whereas others are about cultural competence or cultural sensitivity, and that you see both of those in the US and Malaysia. 

 

ALKA MENON  

But you know, you see a little bit more of one in one place and a little bit more of one in the other place because of the resonance of those potential narratives and the two different societies. And then I end the book with this, the clinical interaction itself, when a patient goes in to see a doctor, what happens, how do they negotiate what a surgical outcome should look like? What tools do they use? How do cameras or mirrors or even just pinching play into it? What kinds of models are brought in from social media? And how does that train the gaze in specific ways? And so basically, how is race made material and visible selectively in the clinic as a visual phenomenon, rather than the sort of categories that are a top down classification scheme? And so that I think encompasses this, the scalar dimension of race that goes across not just countries, right, have these in tracing these back and forth flows, which can I think is something that can be done for other kinds of fields as well, but also think It's about you know, what makes race such a capacious object in general, right? Using, you know, all the ways that race comes up in cosmetic surgery and all the permutations that it takes me a snapshot of time across all these places, and sites, including the clinic, you know, the conference, the general state of discourse about what people should look like. So that's the book, it exists. The idea, scaffolding is all there, very exciting. 

 

But this has left me with two kinds of new directions for thinking about research. And one is much more focused on thinking about beauty trends, and ideals and technologies and thinking especially about mundane technologies, you know, plastic surgery and cosmetic surgery does rely on some new state of the art kinds of biomedical techniques and possibilities like stem cell research was becoming taken up for this when I was doing my fieldwork several years ago in Asia. But really, a lot of what they do involves a scalpel. Right. I mean, this is some cutting and stitching. There's Botox, neuromodulators, fillers, I, you know, I'm interested in in drawing, again, there's continuities with these kinds of things have been done in one form or another since time immemorial, but certainly since the advent of anesthesia in the 1900s. So what is it mean to think a lot about cosmetic surgery in conjunction with things like lipstick, or other low tech, often feminized everyday mundane, mundane kinds of objects? So that's one area that I'm kind of working on and thinking about in a more theoretical way of specifying what that looks like, and where those things are made, who uses them? What class dimensions and, you know, using assistance to do this stuff versus doing it yourself all of those dimensions? What makes us low tech? And how does that matter? And how is that also kind of racialized in a way to in many cases, certainly gender. 

 

So that's one one area. And the other area goes in another, you know, pretty radically different direction that stemming from the project with this thinking through of of standardization in medicine, and how things come to be standardized fully, or partially are the trade offs between standardization and customization. And that focuses much more on the novel technologies. Because those are opportunities when you have to create new standards or decide whether or not the ones you had, will work and think about what makes people trust those new technologies or not. And so that focuses a little bit more on you can click on artificial intelligence, text transcript, relationships, stemming especially now. So find last Minoans for chapter that last level of my analysis of what happens in the room between doctors and patients. And whether it's detection of cancer, you know, of the skin of the breasts of the prostate, or if it's even behavioral risk factor analysis based on interactions that you have with a game or your phone. So those are both kind of capture the poles of where the the first project led me and I'm going to see which which ends up being the next big project, but both both are things I'm pursuing in smaller projects for now.

 

YESMAR OYARZUN      

For more on Dr. Menon’s work, you can click on the links provided at the end of this transcript to access things like the articles we talked about today. You can also find out more about Dr. Menon’s work by visiting alkamenon.com.

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CREDITS:

Hosted by Yesmar Oyarzun

Assistant Produced by Jason Lee and Lauren Ginn

Produced by Lan A. Li

Music by Paolo Pavan