9.1+ million procedures

Dermatologist waiting rooms are becoming an interesting site for ethnographic research, what with all of the beauty junkies and the nipping and tucking and feeling bad about necks. Almost 11 million cosmetic procedures performed in the U.S. in 2006, no doubt up a good 6-7% in 2007, unless of course the drying up of home equity stabilizes those numbers. More than 9.1. "minimally invasive procedures" performed, including of course all the peels and the fillers and what not. Even assuming a sizable number of those procedures were part of a comprehensive treatment plan, extreme makeover style, that is quite a few people in the waiting room. Hence, this is a good site for some participant-observer research.

- There are of course those on health plans waiting to be treated for suspicious moles and varieties of skin infections. They tend to be older, or, rather the older people in the waiting room are presumably not there for cosmetic procedures. Unless of course they are wearing pant suits, in which case see below.
- Primarily one sees scores of women of indeterminate age waiting for procedures that seem quite mysterious. The flaws they are there to correct, in other words, are not really visible across the room. Sometimes they come out holding ice packs to their faces; sometimes they come out looking exactly the same as they did when they entered.
- The relatively new thing: men in their 40s clearly there for cosmetic work. These men are are either entirely casual about the whole thing, with no doubt whatsoever as to the significance of their attention to appearance, or somewhat sheepish. In a few months the latter will morph into the former.

What I find remarkable almost above all else is the fact that so many people electing for these procedures are self-diagnosing. The evidence is there in the waiting room: piles of health & beauty magazines for nearly all demographics with some discussion of cosmetic work in all of them; brochures from old and new pharmaceutical companies advertising procedures I had never heard about, all of them meant to be taken home by the patients and discussed with friends and family; the ubiquitous "as seen on" and "as seen in" stickers attached to the OTC products for sale at the desk. It's the old story: first create needs, then help. But it's also a new story: don't trust the experts, trust yourself. Don't visit a dermatologist to ask for help with a skin condition you don't understand but that you suspect might be dangerous in the long term; visit a dermatologist so s/he can perform the very procedure you demand, because you have spent endless hours online researching nasolabial folds and know precisely how your problem is to be cured.

At any rate, shows like Extreme Makeover might lead us to think that an expert culture persists -- what one seems to need is an entire team of specialists working on one's body and face -- but in fact we are deeply skeptical of professionals. We're been trained not to trust institutions, to think that we, the amateurs, are best capable of self-assessment, diagnosis, and improvement. Is this not the essence of self-help? So dermatologists might advise and consult, but in the end I suspect many decisions about cosmetic procedures are made before people even enter the waiting room. Hence, too, the rise of non-medical or even "medical" spas, where one can get any number of non-invasive cosmetic procedures performed by a nurse practitioner or aesthetician -- in other words, by an amateur. If even aestheticians are not to be trusted, there is of course a whole range of products for cosmetic "improvement" available over the counter: DIY cosmetic treatments.