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Paper short abstract

This paper examines how young people with cleft lip/palate in Medellín navigate later-stage surgeries, particularly rhinoplasty. It explores autonomy, gendered aesthetic pressure, and the paradox of being "finished but not done"—navigating polarization between self-acceptance and body modification.

Paper long abstract

For young people born with cleft lip and palate, medical and social scrutiny of their faces begins at birth. This paper examines how young women with cleft navigate late-stage surgical decisions in Medellín, Colombia, particularly rhinoplasty. Drawing on four months of ethnographic fieldwork, it explores how aesthetic pressure and self-making unfold in a context where appearance holds high gendered social value and cosmetic intervention is increasingly normalized, yet aspirational.

Cleft care exposes the false polarization between "functional" and "aesthetic" intervention. By late adolescence, this inseparability peaks as treatment culminates in rhinoplasty—framed as the "final" procedure. Participants discussed it less in terms of functionality and more as becoming beautiful and "fully themselves," finally "graduating" from years of treatment. Rhinoplasty thus emerged as a key moment where clinical care, aesthetic social aspiration, and internal/external transformation intersected.

Agency appeared not through refusing surgery, but through negotiation: participants pushed for accelerated timelines, shaped outcome expectations, and engaged in everyday aesthetic practices. Some declined the lip revision—often performed simultaneously—keeping their scars as markers of personal history and self-acceptance. The rhinoplasty also created paradoxical social capital: participants could proudly disclose a sought-after cosmetic operation while quietly omitting the stigmatized congenital difference that had prompted it.

Despite surgical satisfaction, those who had completed treatment emphasized that "the process" never truly ends; it involves ongoing appearance management and inner work. Rather than representing closure, late-stage cleft treatment highlights polarized meanings in contemporary body modification: between functional repair and aesthetic aspiration, social pressure and empowerment, and self-improvement and self-acceptance.