Savour International

For cosmetic surgery, it’s been a (very!) long way to Tipperary. Many corporate managers take the view that terrific innovations that meet a key consumer need will, with a little market acumen, pretty much sell themselves. But in some cases, new techniques can take a very long time to come into their own, as the case of cosmetic surgery clearly shows.

The cosmetic surgery industry has been experiencing a veritable boom in recent decades. In 2008 alone, more than 11 million Americans underwent cosmetic surgery, shelling out an aggregate 11 billion dollars for the privilege. In Germany each year more than 800,000 people a year submit to the cosmetic surgeon’s knife. Half of South Korea’s young people have their eyelids westernized, and in Brazil government health insurance pays for cosmetic surgery.

But what a lot of people don’t know is that the basic techniques used in this highly successful sector date back decades and in some cases even centuries. Which apparently means that the desire for beauty is as old as humanity. If the economic theory that markets are merely the confluence of supply and demand is correct, the cosmetic surgery industry would certainly have enjoyed its current level of success at a far earlier juncture. But this has not in fact been the case. In our view, cosmetic surgery is a prime example of why some undoubtedly very promising innovations are unsuccessful – or in some cases only make it in the big time after waiting in the wings for decades.

A slow process of legitimization

It took cosmetic surgery an extremely long time to come into its own as a consumer product. Scholars in various disciplines have done research on this sector, but never from a management perspective. So in the interest of filling this gap, we took a new look at the literature, and in so doing unearthed what appears to be a central factor for the development of new markets – namely legitimacy.

In the sociological theories that we used for our analysis (particularly neo-institutionalism), “legitimacy” lacks the moral overtones that it has in everyday parlance. In a sociological context, legitimacy means that in a specific market or social sphere certain norms, values and institutions need to evolve before a specific product or a management practice achieves legitimacy, i.e. is regarded as normal, suitable, appropriate, reasonable or worthwhile. And when it comes to institutions, the concepts they represent carry far greater weight than their existence as a social organization. For example, money has achieved success as an institution by virtue of the fact that all concerned believe in the value of printed paper.

But it took centuries for cosmetic surgery to gain the requisite legitimacy. On both the supply and demand side, a whole series of changes in social norms and institutions had to occur before cosmetic surgery, which had heretofore been a medical pariah, could achieve such great success.

In our view, the findings of our investigation don’t merely apply to sectors whose products or services are as controversial as cosmetic surgery once was; for today every new product needs to be endowed with a high level of legitimacy; and what happens in its absence is graphically illustrated by the public outcries that companies such as Facebook or Google are confronted with every so often. And even vendors of perfectly banal products are oftentimes forced to contend more with norms and values than “merely” with material values, as is shown by the case of Barbie dolls, which have recently generated considerable controversy over the ideal of beauty Barbie may be pushing.

In the following, we will first address the issue as to which norms and institutions needed to develop on the demand side for consumers to feel that having their appearance altered by cosmetic surgery was a legitimate and desirable goal. We will then discuss how cosmetic surgery techniques have evolved and how various actors created the norms and institutions needed to drive up demand.

The fundamental need for beauty

Beauty – as any social scientist will tell you – is both a cultural and social construct that has undergone countless changes over the course of human history. For example, the Greek ideal of beauty was totally different from our own. In some eras, a large bust has been desirable, whereas during other periods such as the 1920s, the ideal has been for women to be as flat-chested as possible.

But be this as it may, the desire to fit in with the prevailing ideal of beauty is as old as humanity itself. Ideals of beauty are closely bound up with religious beliefs. For example, the Bible says that no man may become a priest if he is a “blot.” The age-old teachings of physiognomy hold that beauty is a sign of character or intelligence. And beauty has always been a status symbol, as it was in ancient Egypt, to take one example.

We know from numerous historical sources that people are often willing to run huge risks and undergo unimaginable pain to fit in with the prevailing ideal of beauty. In ancient Egypt, women applied toxic substances to their skin; the Chinese bound the feet of little girls so that they would remain small; and many of today’s tribal cultures still (or again) find that beauty can be achieved by drilling holes in the ears, lips, or other parts of the body, or by tattooing images on the skin. Thus it is no wonder that inventive individuals began very early on to develop beauty-enhancing surgical techniques.