Sheila Jeffreys' Beauty and Misogyny is a provocative comparison between cosmetic surgery in the developed world and far more widely criticized "beauty practices" in less developed countries. Jeffreys admits that practices like FGM are forced onto women, but questions whether "market autonomy" is more than illusory:

There is, however, a major difference in the way that harmful beauty practices are inscribed in culture and enforced on women in the west. This is the fact that they have been constructed into major industries that make large fortunes for transnational corporations and are a significant force in the global economy. The profitability of these practices to the cosmetics, sex, fashion, advertising and medical industries creates a major obstacle to women's ability to resist and eliminate them. There is so much money in these industries based on commercializing harmful cultural practices that they constitute a massive political force that requires the continuance of women's pain. (172).

One need not accept Jeffreys' larger critique of capitalism in order to take seriously her questioning of the degree to which surgeries like the ones described by Kuczynski really arise out of "free choices." A literature on beauty and workplace competition suggests that those who don't "get ahead" on this plane can be "left behind." Jeffreys' forceful indictment of the industry may shock us into recognition of this point from Carol Rose, on the need to supplement monadic economic models of preferences with a broader awareness of how preferences arise:

Economists generally tend to accept preferences as simply given, or in the economic lingo, 'exogenous,' and to refer most decisions to a kind of core of self-interest that aims to satisfy preferences as 'exogenously' given. But where do people's preferences come from? . . . [W]hat makes people change their minds about preferences, and about working with others? What, in short, persuades? Those questions open the door to expressive issues--that is to say, the humanities.

If for no other reason than helping us understand the origins of preferences for cosmetic surgery, Kuczynski's book does a service. Consider this passage:

Extreme Makeover crystallizes in prime time the belief that our looks and our notions of self-esteem are matters of life and death and that change should not stop short of complete transformation. . . .The term 'self-esteem' is a mantra that is repeated, yogilike, throughout the episodes [of Extreme Makeover]. Through it all, there is never a question that beautiful is good, a way to convey the true identity of the soul underneath, lost behind pounds of fat, submerged by a lifetime of bad habits. Being beautiful is the final path to confidence and to the life that ought to have been lived for so many years.

Given these unmistakable cultural signals, it should come as no surprise that many "Americans are willing to fork over the money, even if that means putting the surgery on a credit card or borrowing from a so-called beauty bank-an agency that loans money to cosmetic surgery patients who are willing to pay interest rates that make the Mafia's vig look like a great deal." Kuczynski notes that "More than two-thirds of Americans who now choose elective cosrnetic surgery make less than $50,000 a year."

Something is amiss here, and I can only hint at the ultimate issue here; suffice it to say, "happiness is in the eye of the beholder." But for now, let me recommend Kuczynski's book as both a symptom of, and an indictment of, a sea-change in our culture deserving some form of legal (or at least tax) intervention.