*Article* **Because You're Worth It! The Medicalization and Moralization of Aesthetics in Aging Women**

**Chiara Pussetti**

Institute of Social Sciences, University of Lisbon, Av. Prof. Aníbal Bettencourt 9, 1600-189 Lisbon, Portugal; chiara.pussetti@ics.ulisboa.pt

**Abstract:** In this article—based on the fieldwork I conducted in Lisbon (Portugal) between 2018 and 2021, employing in-depth ethnography and self-ethnography—I describe the experience of the medicalization and moralization of beauty in Portuguese women aged 45–65 years. I examine the ways in which practitioners inscribe their expert knowledge on their patients' bodies, stigmatizing the marks of time and proposing medical treatments and surgeries to "repair" and "correct" them. Beauty and youth are symbolically constructed in medical discourse as visual markers of health, an adequate lifestyle, a strong character and good personal choices (such as not smoking, and a healthy diet and exercise habits). What beauty means within the discourse of anti-aging and therapeutic rejuvenation is increasingly connected to an ideal gender performance of normative, white, middle-class, heterosexual femininity that dismisses structural determinants. The fantasy of eternal youth, linked to a neoliberal ideology of limitless enhancement and individual responsibility, is firmly entrenched in moralizing definitions of aesthetics and gender norms. Finally, my article highlights the ways in which the women I interviewed do not always passively accept the discourse of the devaluation of the ageing body, defining femininity and ageing in their own terms by creating personal variants of the hegemonic normative discourses on beauty and successful ageing.

**Keywords:** ageing; anti-ageing; gender; beauty; cosmetic medicine; body; appearance; aesthetic surgery

#### **1. You're Worth It!**

"Forever young I want to be forever young" (Alphaville, 'Forever Young')

When we say: "You're Worth It!" or "These Days, Age is a Choice"—quoting two famous L'Óreal slogans—we are not only enouncing a tagline, we are also proclaiming a moral message. The first slogan has been translated into 40 languages, becoming a global moral imperative that encourages women to control their life and their body, to assume responsibility for the way they look and to believe in their self-discipline every day. The message is clear: you have to do it for yourself. Taking your beauty into your own hands is empowering. Investing in your beauty and in your youth is something no one else can do for you. You deserve to be beautiful, you must love yourself and you have to believe in your self-worth every day, establishing yourself as Glam-ma and not as Grandma. Only if you are thinner, firmer, smoother and younger, will you be better; you will have a more passionate relationship, a better career, more friends and success; you will be happier. Otherwise, if you are unable to 'fix' your aesthetic 'problems' and to 'solve' the signs of bodily ageing, you should consider yourselves to have failed. The age-related bodily changes are redefined as defects or problems that can be improved, repaired or corrected through products and procedures from both the medical–pharmaceutical and beauty industries. In every supermarket, perfumery, pharmacy, beauty salon, shopping mall, hairdresser, and doctors' and gynaecologists' waiting rooms, we find direct-to-women advertising proposing miraculous aesthetic anti-aging products and procedures to restore

**Citation:** Pussetti, C. Because You're Worth It! The Medicalization and Moralization of Aesthetics in Aging Women. *Societies* **2021**, *11*, 97. https://doi.org/10.3390/soc11030097

Academic Editors: Violeta Alarcão and Sónia Cardoso Pintassilgo

Received: 13 July 2021 Accepted: 10 August 2021 Published: 12 August 2021

**Publisher's Note:** MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

**Copyright:** © 2021 by the author. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

the lost youth and the beauty of the past. Keeping yourself physically attractive for as long as possible is a question of personal responsibility, but also an expression of self-love and self-esteem, because you deserve it.

In Portugal, the slogan produces a few declinations that always appeal to the self-esteem of women "Because I'm worth it" or "Because I/We/You deserve it", employing feminist values—such as independence, choice, responsibility, empowerment, liberation, radical change and self-worth—to promote the consumption of beauty products as a worthwhile pursuit and expense, a practice which Goldman [1] terms "commodity feminism". This proliferation of moralizing messages in advertising campaigns, asking women to assume responsibility for the way they look, is a key way for major cosmetics brands to build a customer base and reap financial benefit [2–8]. The female body is always problematized, represented as a malleable entity that can be shaped and perfected by the discipline and hard work of its owner. Women's bodies are never perfect enough, and are potentially open to reconstruction: at any age, women are engaged in a project that is always in-progress, trying to correspond to a hegemonic beauty ideal that denies ageing. It is therefore unsurprising that most academic research centred on the body/ageing paradigm focuses on the female perspective. Appearance remains an important issue for women, even as they age: there is a varied body of research on the ways in which women experience and feel towards physical signs of ageing, including white hair and wrinkles [9–13].

Wrinkles, body fat, cellulite, sagging skin, the greying of the hair, skin spots, the loss of firmness, and every other bodily alteration that accompanies aging should be fought with the energetic maintenance of the body with the help of the medical aesthetic, cosmetic, fitness and food industries (protein diets, superfoods and supplements). The inspirational women who front the brand worldwide make the moral imperative of 'self-care, because you deserve' relevant for women of any age, proposing unrealistic beauty standards that ultimately reinforce the sense of inadequacy, increasing women's insecurities. With their imperative tone and the positive verbs denoting transformative actions ('change', 'empower', 'decide', make', 'evolve'), these messages encourage women to maintain their beauty at any cost [14–21].

Women are told that they are unstoppable: they can change or obtain anything they so desire, with sheer willpower. It depends entirely on them: with willpower and discipline, nothing is impossible. Women can control the tangible, physical, somatic reality, but also more abstract processes such as 'the ageing process,' 'time', 'gravity' and 'the future'. The battlefield is their body, in an inexorable war against oneself and the natural course of life. The loss of beauty as people grow old, however, is not perceived as a normal consequence of the passage of time. It is rather considered a lack of discipline and will, an inability to dedicate oneself to a goal that requires effort and discipline with dedication and constancy. The age that you show becomes the reflection of your moral qualities, of your lifestyle and of your life choices. Regardless of the circumstances, your appearance reveals your essence.

Even in these very complicated pandemic times, with people staying indoors, scared and confused, covering their face with masks, the desire for facial cosmetic procedures and aesthetic surgery increase. In reaction to this new normal, L'Óreal Portugal launched the campaign "Make up Everyday" ("*Porque Tu Mereces*"), which encourages Portuguese women to maintain their beauty and to combat ageing during the pandemic. To boost this campaign, the brand joined four influencers with an unstoppable routine who are the protagonists of each of the key moments of this campaign—non-stop routine, movie night, meeting and special dinners. If, during the first months of the pandemic, I noticed a certain 'moralization' regarding the consumption of aesthetic interventions and luxury cosmetic items in a moment of global sanitarian crisis, however, the discourse quickly changed.

In Portugal, cosmetics sectors such as hairdressers and beauty salons were the first commercial activities to reopen after the lockdowns. Even more surprisingly, plastic surgery and aesthetic medicine clinics stayed open during the lockdowns. All of the beauty industry has largely proven to be recession-proof. In fact, in Lisbon, we witnessed the opening of at least two new centres during the pandemic in order to respond to customer

pressure, investing surgeons and healthcare practitioners in aesthetic clinics. In a recent article, I addressed the impact of the pandemic on our appearance-enhancing practices, highlighting that the social pressure to emerge from the pandemic as a rejuvenated version of oneself resulted in stigma for those who haven't used the time for self-improvement or who haven't the money to pay for the treatments. If the pandemic is not a nuclear aspect of the present paper, I cannot ignore, however, that the fieldwork took place in large part in exceptional times. My interviews highlighted how the lockdown increased the fear of 'wasting time' and of ageing faster and losing wonderful things that previously occupied our time and gave our life purpose. The feeling of lost time during confinement reinforced the desire to restart normal life with a younger appearance. If my fieldwork conditions weren't optimal due to the lockdowns, the pandemic—among immense other things—has nevertheless revealed a veritable epidemic of problematic personal and social issues tied to the obsession with appearance and staying or looking young. Many of the women interviewed expressed fears that the stress of the pandemic would make them look and feel older, claiming that they would be disposed to do anything and to pay any price to get out of the pandemic with a younger and better appearance.

Always during the pandemic period, the Portuguese advertisement for L'Oreal's Age Perfect cream, which contains the slogan "These Days, Age is a Choice", was widely disseminated throughout the country. The campaign works to equate ageing with the look of ageing, to problematize ageing appearance, and to offer marketized solutions to the 'problem' of ageing. According to L'Oreal's brand ambassador, saying that today "age is a choice" means that women can be beautiful, well groomed, active and confident after 60 years of age, investing in maintaining fitness and beauty as ways to boost their selfesteem. One can claim the appearance of youth until later: it is in one's hands; it depends on one's determination not to give up. It means believing that "we deserve it". If, in the United States, Jane Fonda personified the cream Age Perfect, in Portugal the promoters of the brand were singer and actress Simone de Oliveira, and actress and television presenter Lídia Franco. The two ladies represent the so-called "sexygenarians", a category that today encompasses one third of Portuguese women, and represents an important market niche.

The campaign, accompanied by the slogan "It's the difference between a Granma and a Glam-ma", problematizes bodily ageing, and in particular facial ageing (skin, eyes, cheeks, lips), as a serious issue. Beautiful bodies are, overall, presumed to be young bodies, and the look of ageing is considered to be a problem and pathologized. The narrative format of this type of advertising messages is that of 'problem/solution', with ageing as the 'problem' and technologized/scientized/medical/pharmaceutical (even before than cosmetic (of which, more later)) products as the 'solution'. The consumer is persuaded of two important things: (1) that it is undesirable to appear to be ageing, and (2) that she/he must assume responsibility to stay young-looking, controlling, slowing or reversing the effects of ageing.

This article is organized into three parts: (i) a brief premise about the research methods employed and the ideal of ageless beauty from a gender perspective; (ii) a self-ethnographic narrative of the incorporation of hegemonic beauty norms and the desires of eternal youth, based on my life history as a medical cosmetic patient and on my dialogue with other women 'over-fifty'; (iii) a final reflection on the intimate and personal ways in which we incorporate contradictory socio-cultural expectations about how our body should be. Although many of the participating women have narratives similar to mine, each of us has a unique story to tell.

#### **2. The False Hope of the Timeless Beauty**

"Will you still love me

when I'm no longer young and beautiful?"

(Lana del Rey, Young and Beautiful)

This article is based on the fieldwork I conducted in the last 36 months with Portuguese middle-class women aged between forty and seventy years old, investigating

their anti-ageing practices in the city of Lisbon. I carried out a multimethod research strategy employing in-depth ethnography and self-ethnography. All of the participants were recruited through my personal networks. All of the interviews were recorded and transcribed with the participants' consent, and were conducted under the guidelines, codes of conduct and ethical procedures commensurate with anthropological and ethnographic research standards. Participation in this study was always entirely voluntary, and all of the participants were informed about the contents and objectives of the research, as well as the intended outputs. Regular, unobtrusive contact with the research participants allowed me to build intimate ties to capture a wide range of perspectives, pinpoint the different kinds of experiences and reveal contradictory attitudes.

Even though aesthetic is also an important issue for male subjects, I conducted my interviews predominantly with women. In comparison to women, the heterosexual men with whom I talked did not consider ageing as a problematic process due to the loss of beauty, but rather as a limit on their professional climbing opportunities, sexual potency, or relational choice. While fitness regimes, dietary control, the usage of hair care, shaving or skin moisturizing products and the purchase of consumer goods including clothing, accessories and cosmetics were reported without shame, the issue of beauty rituals remains a very intimate topic, especially for heterosexual men. In my interviews, I noticed an inclination of heterosexual men to value success rather than beauty regarding the social construction of their image. Topics such as hair transplants, masculinization fillers to build a 'powerful profile' as an indicator of leadership competences, or of surgical implants to redefine the chin and to build a strong 'superhero' jawline to achieve a more masculine look are in my opinion incredibly interesting, but unfortunately these are not the theme of the present paper.

I undertook participant observation in private aesthetic clinics, beauty salons and wellness centres, interviewing eight healthcare professionals and 23 middle-class, heterosexual and cisgender Portuguese women who identified themselves as white (adopting the method of theoretical saturation), accompanying them in their aesthetic transformations before and during the lockdown periods. Obviously, ageing is not an issue of concern for middle class 'white' women only. In the last few years, I conducted research and published specifically on the aesthetic labour of immigrants and Afroeuropean women in Portugal, observing the emergence, in the Greater Lisbon Area, of a new market of cosmetic products partly aimed at clarifying the skin and correcting age spots.

If other aesthetic interventions are much more transversal—in relation to social divisions around gender, class, race, ethnicity, social status, sexual orientation, age, or nationality—in the anti-aging and skin clinics of the centre of Lisbon, I only met middle class women who identify themselves as white. Speaking of Portugal as a European 'white' nation—despite decades of immigration, despite the complexity of colonial and post-colonial relations, and despite the presence of non-white Portuguese citizens—in all my interviews with patients and cosmetic practitioners, the ideal beauty appeared as a depoliticized, race-neutral model.

Most of the women I interviewed validated the extensive literature dedicated to the predominance, on a global scale, of a Eurocentered ideal of beauty: white and smooth skin; a thin, tonic, youthful, muscular body; regular lines, big eyes and brilliant long hair [21–27]. In my interviews, I noticed that there are alternative aesthetic models—desirable, however non-hegemonic [28–31]—however, as far as aging is concerned, people's apparent tolerance does not withstand the test of analysis. The aging bodies occupy a unique position in aesthetic norms. The women aged between forty and seventy years old that I interviewed in Lisbon agreed that youth is essential to beauty, and that during their lifespan they are faced with the somatic reality of this process. Confronted with moralizing discourses about fighting the war on wrinkles, they discover that, at the end of the line, aging is inevitable. Losing youth means losing beauty and the power of sexual attraction: they discovered that they are no longer considered beautiful or attractive because they have aged. In Euro-American contemporary "aesthetic economies" [32] (p. 535) the value of

a woman depends in large part on attributes (beauty, sexual attractiveness, fertility) that irrevocably fade with age.

As Kathleen Woodward states in her 1999 book, *Figuring Age: Women, Bodies, Generations*:

*Women today begin to experience ageing around the age of fifty, and this process is considered in terms of decay and loss of aesthetic and erotic value, and not in the neutral terms of natural evolution and transformation.* [33] (pp. 10–13)

My interviewees confirmed that "beauty is worth riches", "beauty attracts more than gold", that "she who is born beautiful will never be poor", that "beauty is power", and that "she who is beautiful will always be queen". Being attractive was, for many centuries, the only way for women to obtain power and to improve their social position. Despite the legacy of feminist writers like Simone de Beauvoir, whose work *La Vieillesse* first appeared in 1970 [34], and Susan Sontag, who already in 1972 spoke of the "double standard of ageing" [35], which combines gender and age discrimination, more mature women must fight the signs of ageing, attempting to escape time in order to not be relegated to invisibility. Portugal is considered—at the European level—an 'aged country'; a 2010 study by Margarida de Melo Cerqueira showed that:

*From television (series, game shows), newspapers (news reports, comic strips), radio, to various forms of art (cinema, theatre, dance, painting, sculpture, literature), elderly characters are referred to in a derogatory manner, portraying them as having a health problem that weakens them in some way, as being dependent and not very competent.* [36] (p. 339)

In order to retain their value, women invest energy, time, effort, money, and physical suffering into attempting to escape time. Many women are willing to suffer physically to be beautiful, to undergo elective cosmetic surgery carrying great health risks, and to develop eating disorders to remain attractive according to society's unrealistic 'forever young' ideal. In order to maintain their social value, they must appear youthful, thin, with well-groomed skin, hair shiny as silk, preferably dyed. Preserving a beautiful youthful appearance for longer is not only an aesthetic, but also rather a moral obligation. "Letting oneself grow old" coincides with "letting oneself go": it implies a lack of discipline, laziness, and sloppiness—all traits of a morally deplorable personality. As I have pointed out in my recently published volume [31], the "body-norm" works as a morality tale that blames those outside the norm for their condition, portraying them as "unruly or negligent" for having bodies that do not measure up. Our apparent 'freedom' of growing older 'naturally' or of gaining weight, refusing cosmetic imperatives, is constrained and shaped by embodied forms of inequality that push us to see ourselves as imperfect, and to find in aesthetic biotechnologies the solution to those imperfections.

Supported by modern medicine, anti-ageing equates old age with physical deformity, disability, illness and dependence [37] (p. 9). Margaret Gullette [38], an important feminist theorist in the study of ageing, calls all of the narratives that invariably associate an individual's ageing with a loss of physical and cognitive function "decline narratives". The newly established "anti-ageing medicine" is confused with self-care practices by including a series of physical procedures that tend to mask the signs of ageing [39] (p. 699), promoting the concept of "age" as a target for biomedical interventions [40]. Paradoxically, while trying to stimulate the idea of an "ageless" appearance, these practices reinforce the fear of ageing [41] (p. 81).

Modern anti-ageing aesthetic medicine offers a panoply of treatments and products which are minimally invasive, low-cost, "lunchtime" and more democratized, which promise to block the passage of time, freezing our beauty to the present. The past fifteen years have been marked by an exponential increase not only in consumption but also in innovation in the anti-ageing industry. The term 'anti-ageing' is everywhere in Portugal (it is common to find the expression in English, together with its portuguese translation '*anti-envelhecimento'*): in drugstores, perfume shops, supermarkets, hairdressers, beauty salons and clinics.

These types of interventions—designated by Abigail Brooks [42] as friends or foes of older women—are part of a double paradigm: if, on the one hand, they provide the chance and freedom of a technological response to alleviate the social pressure imposed on women, on the other hand they accentuate the anxiety of growing old, reconfiguring the ideology that age is something subjective: an attitude, a choice, rather than a biological fact, something that must be actively resisted. Women, in the popularized medical discourse, are encouraged to take control of their body and the ageing process, but have to discipline it according to the sociocultural norms where they are inscribed [43].

Anti-ageing aesthetic medicine is ever more high-performance and high-tech, and it reports details that give a scientific feeling, such as 'Mesoestetic Stem Cells', 'Genomics', 'Regenerative Cellular Reconstruction', 'Receptors for Peptides', 'Molecular Biology', 'Molecular Chemistry Rheology', 'Intercellular Resonance and Amplification', 'PhytoCellTec', 'Celergen' and 'Hydro MN Peptide', and so on. These are designations embedded in the promise of the progress designated to raise hopes for both new anti-ageing solutions and better ageless futures. What makes the anti-ageing industry distinctive is being essentially a 'hope economy' [44] that aims to fulfill what we desire and to provide us products and procedures to pursue a longer, more beautiful and more enjoyable future. These 'regimes of hope' [45] justify any kind of economic investment.

#### **3. Fake Plastic Me**

"He used to do surgery For girls in the eighties But gravity always wins" (Radiohead, Fake Plastic Trees)

#### *3.1. 'Chi Bella Buol Venire Un Po' Deve Soffrire': My Family Legacy*

Analytically, by resorting to the intersection between experience in the field, the subjective perception of the ageing process, and the daily confrontation with hegemonic discourses on femininity, youth and beauty, I present through an autobiographical narrative my own transformation into a consumer of anti-ageing aesthetic procedures. Here, my personal experience enters into a dialogue with women of the same age group who have agreed to share their stories with me.

*"À quarante-sept ans, je n'avais toujours aucune ride du lion, du front, aucune patte d'oie ni ride du sillon nasogénien, d'amertume ou du décolleté; aucun cheveu blanc, aucun cerne; j'avais trente ans, désespérément"* (At forty-seven, I still had no frown lines, forehead, crow's feet or nasolabial folds, bitterness or cleavage; no white hair, no rings; I was thirty, desperately) (Delacourt 2018, p. 169). Like Betty, the protagonist in Grégoire Delacourt's book, I am forty-seven years old and I understand perfectly well what it means to desperately try to appear thirty years old. Ever since I was a little girl, I always used to ask my boyfriends the question that was made famous years later by Lana del Rey: "Will you still love me when I'm no longer young and beautiful?" The idea of one day losing my beauty and growing old seemed terrible to me, and I wondered if I would still be worthy of being loved, desired and appreciated. In my grandmother's house, the mirrors were covered with heavy velvet cloths. In her inability to compare her aged image in the mirror, she repeated to me that my useful time would be short and that, like all the most beautiful and delicate flowers, I would wither quickly.

The ideal of feminine beauty that I was taught to value entails a slender, delicate and sensual frame, with abundant, shiny hair (as long as it is tidy, entwined in complex hairstyles), immaculate porcelain skin, without marks and imperfections. "Fat is cute, beauty is thinness", my grandmother used to recite. She also used to say: "it's no good being young without beauty, nor beautiful without youth". Then she'd look at me eating biscuits and say: "OK, fine, eat your snack! Blessed youth! Youth is already beauty itself!" And, again: "Enjoy now, my granddaughter, because the beauty of youth is a gift that

nothing can replace". My parents were proud of me because I was a good student, but also—and perhaps above all—because I was a beautiful child and their friends praised me.

I thus learned that being beautiful was a value and an obligation, and that it goes hand in hand with youth. This association is present in many proverbs, popular sayings and other commonplaces that I have collected over years of research: "youth and beauty are worth riches"; "youth in itself is already beauty"; "beauty and youth are a woman's most important assets"; "youth without beauty is fine, but beauty without youth is not"; "beauty soon runs out"; "beauty has an expiry date"; "beauty is a recommendation letter valid for a short time"; "beauty is fragile like a flower: it is born and quickly dies"; "every beautiful shoe becomes an old slipper"; "growing old is a woman's shipwreck"; "to grow old is to pass from passion to compassion", "desire is linked to beauty, and beauty, to youth"; "beauty and youth are lovers: they stay a little and it will be painful when they go away"; "beauty is like a house: you have to bet on constant restoration".

The world around me taught me that youth was worth even more than beauty. I often heard it said at home, and in my peer group, that "young women are beautiful by themselves"; "when young, everyone is beautiful"; that "the woman was a beautiful lady, but her lover was twenty years younger, of course there was no comparison possible"; that "Marilyn Monroe's luck is that she died young and her beauty remained eternal"; or "poor Brigitte Bardot, she should hide!"

Like the protagonist of Delacourt's novel, I realized from my adolescence onward that getting fat and getting older are the most dangerous enemies of female beauty. I always tried to submit my body to exercise and undergo strict diets, to try to correspond to a model distant from my corporeality. The positive perception I had of my pregnant body was shattered by the comments I received about motherhood as the dramatic end of my girl body and the beginning of a mother's body—generous, welcoming, with breasts that nourish and a gentle embrace that soothes. All very tender, but clearly not sexy. One day, glued on the refrigerator in the kitchen, I met the image of the Venus of Willendorf to remind me of the real shape of my fertile body. In front of my perplexity, my (ex)husband replied that it was an incentive, to give me strength in the battle that I would have had to fight to get back to what I was.

However, if we can eventually recapture an anachronistic teenage body, combat ageing, fight wrinkles, sooner or later we will lose the battle. Like Betty, I grew up amid warlike metaphors, images of restoring and recuperating buildings as well as aesthetic economies, moral imperatives of beauty. Military allegories like "fighting ageing", "fighting wrinkles", "the war against weight", "winning the battle against age", "conquering beauty" have punctuated my entire life, denoting the idea of effort and suffering linked to the work that goes into preventing, maintaining, delaying, reversing or masking the effects of ageing.

"*Chi bella buol venire un po' deve soffrire*" (translated from the Italian: "whoever beautiful wants to become, must suffer a little") recited my grandmother, when she combed and braided my hair. "A woman has to suffer to be beautiful, pain is the price of beauty; a woman is made to suffer, to endure pain, to close her mouth, to shape her body". This was the legacy my family passed on to me: beauty has risks and takes work, but I had to be beautiful at any cost. The conquest of the aesthetic ideal usually entails economic efforts, strict rules and routines, and even health risks. My body was mouldable and controllable. It depended on my discipline to stay in control, shaping me to better match up with the hegemonic beauty norms. To take my experience seriously means understanding the reality of a looks-based culture, exposing the entangled relationship between physical attractiveness, identity as a woman and social value. I grew up cultivating my physical appearance as a gift, a positive value and a possible resource from a very young age. The project of being beautiful occupied a big part of my life and somewhat constituted my identity—a woman who draws attention. Maintaining a youthful, attractive appearance was a strategy to maintain my identity, to not vanish in a kind of social invisibility, with my reflex hidden by velvet curtains.

#### *3.2. I Want to Look Like Me Forever: The Gullible Anthropologist*

My interviews highlight that the visible signs of ageing—such as wrinkles, sagging, a lack of muscular toning, or grey hair—are more threatening and problematic for women than for men, and that female rituals aimed at rejuvenation begin significantly earlier. Ageing is thus a phenomenon experienced within a broader system of gender inequality, in which the loss of youth in the female body is considered a loss of social value.

While it is very true, as Radiohead say in the song 'Fake Plastic Trees', that "gravity always wins", it is also true that women are encouraged to undertake aesthetic activities, interventions or procedures to try and counter the physical law of gravity. Their social identity is located on the surface of their bodies. Daily make-up; hair, eyelash and eyebrow maintenance; manicures and pedicures, waxing, intermittent diets and fasting, exercise, facial gymnastics, expressive re-education, yoga and pilates, cosmetic products for face and body, teeth whitening, aesthetic medicine and plastic surgery are just some of the weapons one can use to fight the battle against time. The range of products and services which are available to slow down ageing and preserve beauty is almost endless.

Most of the women I interviewed conform to the hegemonic, Euro-American ideal of beauty: thin, white, regular lines, and skin almost without imperfections. We have to consider that this youthful and attractive appearance is always presented as the result of a lifetime of effort and economic investment in the prevention of ageing and the maintenance of beauty. Throughout the ethnographic process I was urged, by the people I interviewed, to intervene quickly to counter the dramatic effects of ageing, to soften the cartography that wrinkles already drawn on my face, and I was often scolded for not having thought about prevention, in advance.

On the one hand, I assimilated a whole lexicon akin to banking or the stock market: invest, value, lose value, preserve capital, monetize, trade, write off. After hearing so much talk about investment, I tried to calculate my monthly expenditure on beauty (considering also gym costs and a certain type of dietary care), and realised with some surprise that I spend something close to a quarter of my salary. On the other hand, I incorporated the discourse concerning the accountability (or lack of care) about the ineluctable process of ageing.

Here, I refer to an interview with Clara, 51 years old:

Many women think they are powerful and well-adjusted, because they do nothing against ageing, grey hair, fat, face falling off ... They even try hard to be seen as feminists, against the dictatorship of beauty: but it's all a façade! They are lazy, careless, negligent and slovenly women who don't value themselves. They have not *self-esteem* and self-respect: they let themselves go, they are a real failure. (*Clara, 51 years old, beautician*)

Along with the words of Ana (46 years old):

*Yes, I spent a lot of money on fillers and botox, and luxury creams such as La Prairie, so what? Maybe you spend more on a Chanel bag. But you get that bag of lard on your belly, which is an old woman's [belly]. Each person decides how to grow old. You don't want to strive to be better? You don't want to make an effort to be better? Then don't do anything. Then you'll see what your life will be like: old, ugly, sloppy, alone.* (Ana, 46 years old, designer)

According to Armanda, 54 years old, all the effort is worth it:

*Looking at me it's easy to say: this woman has gone crazy with this diet, sport, aesthetics stuff. And they still say* ... *ah, but you're lucky, you have good genetics. Lucky? Do you know what I have? I have strength, will, constancy and the ability to endure pain and sacrifice. Not luck! Being in shape, being well groomed involves constant commitment. Vanity has a high price. But idleness, yeah, that is wasting your life.* (Armanda, 54 years old, entrepreneur)

Finally, Catarina, 56 years old, stated that:

*What I would like to explain to you, and what I even tell my own daughter, is that having good genetics helps, yes, but sooner or later beauty will leave you all the same, if you don't help yourself. You age* ... *but it is not true that against time nothing can be done. Nothing here, in my body, happened by chance: it's pain, sacrifice, effort, regimes, and a lot of money invested. I've been in menopause for eleven years, but nobody believes me, and you know what?* ... *Neither do I, because I still look like a woman of forty, forty-five. But my life since then has been a constant battle against nature. Why do I have to let myself grow old and lose this battle? I have done, and continue to do, everything in my power, sacrificing money and time just for me. If you want to, you can. And if you're still fit and beautiful after sixty, know that you owe that only to yourself, to the work and sacrifice of a lifetime. Because life is long* ... *but as an old person it is long, not as a young one. Preserving the body is not the frantic pursuit of "à la recherche du temps perdu". It is more like fighting so that time leaves no marks: it is war!* (Catarina, 56 years old, counsellor)

My interviewees have in common a consideration of themselves as physically attractive and sexually desirable women, and they are used to receiving positive feedback and being socially appreciated. None of them accepts the loss of her value and social impact, or being cast aside. They are afraid of feeling disconnected from their ageing bodies. They don't want to look old, because they don't feel old, as if there was a gap between their exterior appearance and their inner and true selves.

Cristina, 62 years old, explained to me:

*I look tired, I look sad, but I feel as if I had thirty years. Sometimes, I see my image reflected in a showcase and I think: But who is that lady? It feels like she's not me. I don't recognize myself. I don't look to myself like the image I have in my mind. My ideal self is younger Cristina. My real self is who I am at present. I don't want to look in the mirror and see my mother. I would like to see me. The young, beautiful and sexy me. The dissociation I feel is this, between what I think I am and what I appear. And then come others, and my relationship with others. Which has to do with my personality. I don't see myself at all as a typical, traditional sixty-year-old woman. I feel better with younger people. I find younger people more attractive, physically speaking. It is consistent with my view of life, of the world, of people, with my profession as a teacher: for me it is very easy to relate to younger people. In mental terms, for me it is perfectly natural. One day you will understand: you will be old enough to don't recognize yourself anymore in the mirror.* (Cristina, 62 years old, teacher) Maria, 64 years old, confirmed this sensation of dissociation:

*My face is what I see in the mirror. My self image. My self-perception of myself depends on the face, where I see the traits of my personality that, despite age, remain the same. That's why I make aesthetic changes to my face: to continue to correspond to the mental state that hasn't changed, because it's my way of being. I want to continue to correspond to myself. To recognize in the mirror the person I think I still am. To rediscover myself in the average of the person I am, between my mental image of myself and the biological reality in terms of appearance.* (Maria, 64 years old)

It happened suddenly. By participating as an ethnographer in all arenas of the beauty market, constantly confronted with hegemonic discourses on youth and beauty, I became increasingly attentive and permeable to the ways in which my interlocutors in the field commented on my appearance. In every interview taking place in aesthetic and cosmetic medicine clinics, the professionals held up a mirror in front of my face, directing my attention to the imperfections of my skin texture, the enlarged pores, the lack of youthful radiance and glow, the expression wrinkles, the marionette, the bar code, the crow's foot. Only hyaluronic acid and botulinum toxin filling could soften the signs and bleakness of ageing.

Abruptly, I looked at my image reflected in the doctor's mirror and realised that I was no longer young. Still attractive, yes, but "the expiry date was approaching", as my former mother-in-law later commented. It was a real shock. Until recently, I found it curious when people addressed me in the street calling me "madam", because it seemed obvious to me that I was still considered a girl, with that typical naivety of young people who believe they will be so forever. However, during fieldwork, consumers, professionals and colleagues constantly reminded me that the time of youth was gone and that lost beauty would never return.

*For you to change your place of work would be complicated. The university today thinks like a corporation: they are much more willing to hire younger people, [rather] than forty-seven-year-old women. It's like in relationships. The MILF (corresponding complete terms for acronyms: Mother I'd Like to Fuck) is no longer in fashion. Now is the time of the WHIP (corresponding complete terms for acronyms: Women Hot, Intelligent and in their Prime) And okay, the young girls. Those are an evergreen.* (Simão, researcher, 31 years old)

*It is like in the dating apps!—explains Isabel, 32 years old—It is worth lying about your age. Everybody lies about height, weight or age. If you're a woman over 45, listen to me: change your age in your Tinder bio. It is better to erase something like mmm 10 years?* (Isabel, 32 years old)

I was talking with Simão, a colleague in his thirties, and Isabel, a PhD student, in an informal conversation in the college canteen, comparing professional and social opportunities and discussing the power of sexual attraction. A few months later, in an academic job application in which I placed first, on an equal footing with a colleague in his thirties, I discovered that Mauro was right, and the final choice was explained to us on the basis of age. In the same period, I had a date with a 33 years old boy and I realized that I was not comfortable to reveal to him, i.e., that I already have 47 years. The Portuguese slogan of ERA®, the famous real estate agency, comes to mind: "It's Gone!". My Goddesses of the universe, it happened: "I'm Gone!". I began to seriously worry.

In the course of the fieldwork, I approached dermatologist doctors, spent a lot of time in aesthetic clinics, and created relationships of trust. I then asked the research subjects what I could do to block this ageing process. The answers I got from these professionals surprised and scared me even more:

*I would say that you should have had this concern at least ten years ago. You should have thought about prevention. The ideal was to intervene before the structure collapses. What's more, a woman with your profession: classes, conferences, and public exposure. And divorced to boot. Look, competition at work and in love is tough! Keeping a youthful appearance is a strategy to maintain a competitive advantage, my dear.* (Miguel, dermatologist)

*Chiara, the face* ... *the face is like a calling card. You can tell you haven't used sunscreen* ... *see these little spots? They're not freckles, no. They're ageing spots. For women, I always say that caring for the facial skin is an obligation. If we then want to be accomplices of the disgrace* ... *that's something else!* (Pierre, dermatologist)

*If you had asked me, I would never have told you not to intervene, even if you had made an appointment at twenty or thirty years old. It's called prevention, you know what it is, right? You should have intervened to prevent the appearance of the first expression lines, before wrinkles create marks. And then, yes, our work becomes more difficult and we no longer achieve that result. Now we can try to treat, to attenuate: but the damage is already done.* (Sofia, dermatologist)

In that mirror, which was a constant presence in my interviews, I began to examine my face in detail and to notice details that the medical eye, with the force of its authority, had transformed for me into defects that needed to be corrected. I might even have remembered to put on moisturizer or sunscreen, but suddenly I felt irresponsible and careless. I explained that I didn't want to change my appearance, that I don't like "botoxed" faces, "duck-billed" lips, cheek fillers that create a "cat cheek" effect. The doctors reassured me about "natural" results, presenting several alternatives:

*On your face it would just be baby botox, don't worry, or a biorevitalisation. It could even be something very soft like micro-needling. Nothing invasive. Radiesse maybe, or* *Sculptra. It would just be softening, you're still yourself, but an improved version of yourself. Like you've had a lot of rest on holiday.* (Manuel, dermatologist)

*This would be to brighten, refresh the skin a little, tone it up. It's just a few injections, it's not hard. Here we have to replace the lost volume with hyaluronic acid* ... *but Botox (botulinum toxin) you can't escape: you don't want to have those awful glabellae, which make you look angry and very masculine. Let's put a little bit on the eyebrows to open up the eye and take away that tired look.* (Miguel, dermatologist)

*None of the hyaluronic acid fillers that then look all the same, all puffy. Absolutely not. for volume, only collagen stimulators so your body reacts and does its job again. These are new generation products. Like Radiesse. The name says it all, doesn't it?* (Pierre, dermatologist)

*Fillers and botulinum toxin are the most common, but it is the last thing I advise. You can also use your body's resources, your own blood. Let's do Platelet Rich Plasma, which stimulates cell growth factors and promotes collagen synthesis. In my opinion, it would be radiofrequency before, vitamin mesolift after. And I recommend botox, hyaluronic acid and sculptra, in a unique session. In winter you should think about a good peel or ablative laser resurfacing, for those enlarged pores on your forehead, which are really awful.* (Sofia, dermatologist)

I became lost in this panoply of possibilities and contradictory advice. Only one message came through loud and clear: "I deserve and must value myself", "love myself", "take care of myself" and "be a better version of myself". With one injection, I can look less tired, more relaxed, like I'm coming back from a long holiday. My life is still stressful, of course, but I can exhibit an air of youth, rest and repose. Gradually, I came closer to my subjects' perspectives, seeing my body through their lenses. I went from observer to observed, and began to incorporate a medical view that pathologized the signs of my ageing.

When I decided to get my first 'baby botox', I entered into an ethical and intellectual conflict. How could I participate in the same discourse that I critically analyse, that of the aesthetic dictatorships over women's bodies, the myth of perfection at any cost? Feminist sociologist Dana Berkowitz reported an analogous reflection on the conflict experienced between her activism denouncing the dangerous consequences of beauty culture and her consumption of botulinum toxin, speaking of "cognitive dissonance" [20] (p. 95). I would say more about the confluence of the different roles required of me. Chiara/anthropologist is the one who discusses the social construction of gender, the power relations implicit in aesthetic hierarchies, and the disciplinary practices that shape the female body. Chiara/woman is the one who nevertheless replicates in her daily life all of the micro-practices that constitute the performance of femininity, who wishes to preserve the beauty and the power of attraction of youth, who is afraid of losing value with age. Clearly, figuring myself as a consumer proved to be useful during fieldwork, from the phenomenological point of view of sharing experience with my interlocutors and for the privileged ties I created in the field.

Botox and hyaluronic acid filling are almost painless procedures, which carry some risks and of which the effects are not immediate. The first changes appear within a fortnight. I observed the small changes in my face, hardly perceptible, except for the blockage of the corrugator and procerus muscles, between the eyebrows (in the glabella). After a week, I had the sensation of looking more rested and relaxed, with a more open and smoother look. Not exactly younger, but certainly more beautiful and luminous, to the point that I reduced the use of make-up, as I do when I'm on holiday. With a few injections, I had achieved the same effect I was trying to create by altering my digital photos with skin beautifying filters, to soften wrinkles and dark circles. The only problem is that the effect is ephemeral and transitory, and after four or five months everything returns to the initial state. The desire then immediately arises to reinject the products to recover that distended aspect. I had heard many times about addiction and compulsive use of fillers and Botox, and suddenly I

realised how difficult it would be for me to stop now. There, I was already in the process of becoming addicted.

The "shelf life" of my botox expired during the confinement period, due to the COVID-19 pandemic. As soon as the deconfinement was announced, I called my dermatologist to immediately schedule the next treatment. I was told that I could be put on a waiting list, because requests had increased exponentially, and the clinic's phone kept ringing. The cosmetic, aesthetic medicine, hairdressing, and beauty salon sectors reopened on 4 May 2020, a fortnight before all of the other services. All of the people I spoke to were eager to perform some kind of aesthetic service as the first stage of their return to social life. I then confirmed my botox and filler sessions, the beautician, and the hairdresser straight away. Aesthetic medicine had already entered into the normal routines of my beauty regime, such as hair maintenance, waxing, manicures and pedicures. The only question was: would I talk about it publicly or not? Would I admit to it, write about it? Would I assume that I have a chemical as well as a digital body, that I embody liquid biotechnologies, along with the models of beauty they represent, underpinned by the aesthetics industry and the multiple power relations involved?

#### **4. Conclusions: Freedom of Choice and Its Contradictions**

"I wanna have control I want a perfect body I want a perfect soul" (Radiohead, Creep)

The anti-ageing products on the market show the smiling faces of women who manage to cheat time. The names of the facial creams allude to treatments in aesthetic medicine (fillers, botox, laser), or incorporate terms belonging to the scientific fields of biology, genetics and biotechnology: "Cell Renewal", "Repairwear", "Biotechno-performance", "Revitalizing Supreme", "Replumping", "Regenerating", "Treats Wrinke Lifting", "Laser Focus", "Recovering Filler", "Lift Repair Extreme", "Lift-designer", "Sculpting-lift", "Botulin Effect", "Cellular Boost YouthFX", "DNAge", "LASER X3", "Genefique" and "Hyaluronic Filler Extreme". Their effectiveness is largely symbolic: substances such as collagen or hyaluronic acid are large molecules that do not penetrate the dermis, nor do they alter the volume and structure of the skin. Consumers have changed the way they buy and use anti-ageing cosmetics products: they talk about beauty therapy, self-care routines, health and natural products, preferring to buy products labelled "cruelty-free" "clean" "hypoallergenic" "nontoxic", "organic", "paraben-free" and "natural". Consumers want to know more about key ingredients, looking for example at the percentage of vitamin C, niacinamide, zinc, retinol or hyaluronic acid.

Almost all of the women interviewed, however, admitted to spending a lot of money on anti-ageing creams and serums for the face, and reported devoting much more time and energy to the face than to the body, with the exception of slimming products.

*Age can be seen mainly in the face. The body is easier to hide: it's enough to wear the right clothes to camouflage flabbiness. For example, after forty, I recommend wearing shirts with three-quarter or long sleeves. It is necessary to hide the 'goodbye muscle', the one that wobbles when you wave goodbye. You know, the 'bat wings'. The rest, we have no way of disguising. And the face is the first thing we see of a person, where our attention is focused. The wear and tear caused by the sun, the wrinkles, the spots, the irregularities, the loss of tone in the jaw line, the jowls, the drooping eyelids* ... (Catarina, 54 years old, ex-model)

*I need, first of all, to feel good when I look in the mirror. I need to have moments of satisfaction—or at least prolong a moment of well-being in my most visible part, which is my face. I want to meet expectations, mine in the first place. Not other people. Is it to please my partner? I've never had any problems with my body. I like using my body. But* *there is a contradiction. I feel relaxed, but I am aware that something has changed and now I want less and less light in the bedroom* . . . (Inês, 60 years old, teacher)

*I've never liked old people. Imagine what it's like to see in the mirror that I'm starting to look like an old woman myself. I don't want to indulge in the ease of accepting old age; I want to continue to feel good about myself. To accept ageing is precisely to age. I want to grow old in a lazy way. Like those who always talk about illness, oh my god! I can't stand it. If there's one topic that's completely unsexy, it's talking about illness. I don't want to relate to people who are completely sloppy and relaxed. They're already beaten out of life. And I'm not like that. It's a question of aesthetics, but also of coherence with what I am.* (Cristina, 65 years old, chartered accountant)

Even it's not difficult for interviewees to talk about beauty rituals involving creams or serums, the conversation becomes more arduous when we move on to less-light interventions, from the surface of the skin to deep procedures, commonly known as "minimallyinvasive" procedures (botox injections, fillers, peelings, tensor threads, ablative laser treatments). At first, most of the people interviewed hid their recourse to aesthetic medicine and—even in the face of evidence—answered that they had never done anything, and that perfect skin depended on a balanced diet and a daily intake of two litres of water to hydrate the tissues.

The reasons for shyness in confessing to aesthetic interventions are multiple: from the attempt to create the illusion of a total "naturalness", to shame about the money spent for "vanity"; from embarrassment in revealing one's real age to the stigma that this search for beauty can create in more critical or militant feminist contexts. Even the few women who spoke calmly about the aesthetic procedures carried out always gave "morally acceptable" reasons to justify this choice: personal and family issues (separation, divorce, illness, the psychological need to take care of oneself, low self-esteem, or even relationships with younger partners); professional issues (the importance of image at work, public relations, media exposure); even clinical (botox to reduce migraines, laser for sun exposure damage, vaginal rejuvenation to increase sexual pleasure, blepharoplasty to improve eyesight, rhinoplasty to breathe better). My decision to reveal the aesthetic manipulations of my face to the informants obviously had an impact on the fieldwork. The sharing of the experience immediately created a greater ease in the telling of stories and desires, providing an atmosphere of complicity and trust. There were even proposals and invitations from friends and colleagues to accompany them for various rejuvenation treatments.

*I do tell what I do* ... *to my daughter, my sister, you and some gay friends, who are super supportive. If someone insists, like: did you do something? At first I don't say anything, but then, if they insist a lot, I don't deny it at all. But I'm not the one who has to tell everyone that I do this or that. Only people close to me know. But I feel a degree of pride in telling you. I even feel a certain feminine empowerment. I do it because I want to, because I can, because I am the one who sets my priorities and because I want to feel good about myself. I do it with a lot of determination.* (Joana, 56 years old, entrepreneur)

*I feel a contradiction regarding telling. To my students, for example, I couldn't tell them. We come from different historical, political and cultural backgrounds. I was born during the period of repression; I lived through the April 25th revolution, with a communist father who always taught me to take responsibility for all my attitudes, good or bad. There are many layers. The aesthetic question has to do with a whole life story. I live in a constant contradiction: is it for others or for me? But, at the end of the line* ... *it is for me.* (Sara, 60 years old, teacher)

*To remain youthful and attractive brings you advantages, to be young and beautiful is not a disgrace, it is a privilege. I pity the people who don't understand that, if you ask me. In certain jobs it is necessary to look beautiful, in others less so, of course. University, for example, is a world somewhat apart. There are women who criticize those who make aesthetic alterations because of a dimension, which I would define as ideological. Who*

#### *are these people who criticize the option to get aesthetic interventions? What is their background?* (Claudia, 60, researcher)

Thus, I already joined, such as the women who had the generosity to share their experiences with me, the club of those Berkowitz calls "body entrepreneurs" [46] (p. 95)—that is, people who strategically improve their own appearance to increase their social, cultural and economic power, and the chances of professional success and in love relationships. Beauty, like youth, has an effective social value. Extending the privileges associated with beauty and youth means preserving one's own body capital to ensure social capital (social integration, the power of sexual attraction), symbolic capital (status and prestige) and economic capital (better salaries, professional mobility). Both are, however, ephemeral privileges and involve hard work, maintenance, and much economic investment, as well as suffering. At the same time, cosmetic procedures and choices are informed by cultural, economic and political structures and material inequalities. With amped-up betterment messaging on social media about getting in shape and staying young and beautiful, we know that we have to "improve" and "fix" our body, using drastic measures to keep up. The social pressure to maintain a youthful, attractive appearance results in stigma for those who have not the money to pay for the treatments. Attractive bodies are produced, regulated and disciplined on the basis of power relations experienced not as "obligations" but as aspirations, desires and values, encouraged and legitimized by various discourses—medical (care, control and prevention), moral (personal valuation, responsibility, willpower) and social (the globalization of virtual images of beauty, youth and success). The economy of anti-ageing is linked to segmented marketing: the personalization of enhancement products is clearly addressed to people based on gender, social class, economic status, age, education and profession. The pressure for women to conform to the dominant aesthetic standards is extremely high and entails unrealistic demands, considering the natural process of aging. For this reason, women make decisions about their bodies, assuming possible risks not on the basis of health problems but on the basis of the forever-young beauty ideals proposed by consumer culture. The access to anti-aging technologies is not equal for all, reproducing and contributing to the amplification of social inequalities. The body appearance carries with it a dense history of meanings regarding race, class, gender, sexuality, disability and age. The technologies of self-improvement in our contemporary era are, using Donna Haraway's words, "knowledge-power processes that inscribe and materialize the world in some forms rather than others" [4] (p. 7). These knowledge–power processes reinforce the body-norms that end up excluding the most vulnerable people in society. In our very unequal world, this means that a wide swath of humanity is largely excluded from these technologies of self-improvement, as the more desirable technologies become branded as luxury items limited to those with access to the best health care systems, or to those with the purchasing power to buy the ideal body. None of the women I interviewed, exploring the ways we age, can be judged a superficial person for spending energy and money trying to maintain her beauty, wanting to look "like her" again. In fact, there is nothing superficial about body appearance or beauty, and that's why they matter so much. So, no—age, today, is not a choice. Or, at least, it is not an equal choice for everyone; we do not all have access to the same resources or the same possibility to choose: a certain configuration of the social order restricts the ability and freedom of choice of certain individuals or groups, even when we are talking about access to beauty or the preservation of a youthful appearance.

**Funding:** This research was funded by the project EXCEL, "The Pursuit of Excellence: Biotechnologies, enhancement and body capital in Portugal" (PTDC/SOC-ANT/30572/2017), financed by the Portuguese Foundation for Science and Technology and coordinated by Chiara Pussetti (Website: www.excelproject.eu, accessed on 10 July 2021).

**Institutional Review Board Statement:** The Ethics Board of the Institute of Social Sciences of the University of Lisbon supervises the project, according to the ethical requirements of the European Research Council. The Ethic Board is aware of and complies with European and national legislation and fundamental ethical principles, including those reflected in the Charter of Fundamental Rights of the European Union and the European Convention on Human Rights and its Supplementary Protocols. The participation in the study will be entirely voluntary and all participants will be informed that they can withdraw from the study at any time and with no consequences to them. The confidentiality of information supplied by research participants and the anonymity of respondents will be respected. Demographic data collected as part of the project (name, age, gender, family status, etc.) will be anonymized and will be stored separately to the qualitative data collected. All participants will receive a clearly formulated document of informed consent in advance—written in a language and in terms they can fully understand—describing the aims, methods and implications of the research, and the nature of their participation.

**Informed Consent Statement:** Informed consent was obtained from all of the subjects involved in the study.

**Data Availability Statement:** Data from the research was recorded in handwritten form and as such avoids the need for online data protection. Demographic data was anonymized and stored separately from the qualitative data. Identification codes and personal data will be stored in an encrypted file. References to informants in the outputs will be given through codes of identification. Data will not be used for any other purpose other than that purpose for which it was obtained.

**Acknowledgments:** I am grateful for the opportunity to collaborate with the editors of this special issue. I would like to sincerely thank the reviewers for taking the time to read my paper, and for their very generous comments and feedback. In the fieldwork process, I have benefited from the support of many people and I am particularly thankful to the women who shared with me their intimacy with intellectual generosity. I want to thank my daughter, Sole, who warms my heart.

**Conflicts of Interest:** The author declares no conflict of interest.

#### **References**

