Cosmetic Surgery

Cosmetic surgery   is  an  invasive  medical   practice that  was  developed mainly in  the  late  19th  century. According to  the  American Society  of Aesthetic and Plastic  Surgery, over  10  million  people  had  cosmetic surgery  in  2008  in  the United States  alone.  This   is  an  overall  increase of  446  percent since  1997. The  term  cosmetic surgery  (from  Greek  kosmetikós, “adornment”) can  mean  either  plastic  (from  Greek  plastikos, “fit for  molding”) surgery, to  restore or  repair  body  parts,  or  aesthetic surgery, which  refers  to  a body  part  being  made over  surgically  to  appear   more  beautiful. The  medical   field  of  cosmetic surgery has  evolved  from  the  expertise gained  in the  field of reconstructive surgery, focusing on  patients with  physical  problems or  deformities present at  birth, such   as  cleft  syndrome, caused by  accidents, or  related   to  illnesses   such   as syphilis  or  breast  cancer (mastectomy and  lumpectomy). The  10  million  people  in  the  United States  who  underwent  cosmetic surgery  in  2008  were  not those who  were  either   born with  deformities or  developed  deformities  due to  accidents  or  illnesses;   rather, this  figure  exclusively  counts those people who  wanted to  improve their  appearance on  their  own  account and  for  aesthetic   purposes only.  Worldwide, the  International  Association for  Aesthetic and  Plastic  Surgery  estimates an  increase in  cosmetic surgery  of about 15–20 percent each  year since  2004.


The  first part  of the  body  to be altered  surgically  for aesthetic purposes was the nose.  Even  today,  rhinoplasty remains one  of the  top  five cosmetic surgeries. In 2008,  there  were 152,434 such  procedures performed in the  United States.  Rhinoplasty dates  back  to 600  b.c.e., when  it was performed by the  Indian surgeon Sushruta, and  the  tradition of the  Ayurveda  Indian aesthetic surgery. The  Sushruta Samhita, a Sanskrit text, suggests a procedure for restoring a “nose  that  had been  cut off” (as a result  of trauma or injury) with the use of a pedicle  flap of skin taken  from  the  cheek.  The  first Western manual of plastic  surgery  in which  the procedure of the  flap graft  used  to replace  a missing nose  is described dates  to the  Italian  Renaissance. Physician Gaspare Tagliacozzi included such  a description  in his De curtorum chirurgia (1597). Tagliacozzi, who pioneered the method of nasal  reconstruction in which  a flap from  the  upper arm  is gradually transferred to  the  nose,  expressed his  ethics  as a physician as follows: “restore, repair,  and make  whole  those  parts  of the  face which  nature has  given  but  which  fortune has taken  away.” He further pointed out that  the most  important principle for the restoration of a nose  was symmetry, not  just to “delight  the eye” but  to “help  the mind  of the afflicted.” This  is one  very important early example  of the attempt to address and change an individual’s state of mind  through a surgical  intervention. The  view that  being  unhappy about one’s  body  image  may  produce unhappiness of the mind, described as body dysmorphic disorder in today’s Diagnostic and Statistical Manual, is at the forefront of the cosmetic surgery  revolution of the late 19th  and early 20th  centuries, and coincides with the invention of psychotherapy around the  same  time  period. However, the  impression an individual has  about her  own appearance that  feeds the  desire  for surgically  altering her  body  did not come  out  of nowhere. Indeed, it has been  fueled  by the  science  of physiognomy, in  circulation since  antiquity, which  tries  to  read  the  body’s  appearance in  relation  to  the  character. Most  notably, the  Swiss  pastor Johann Kaspar  Lavater produced a doctrine of physiognomy in the late 18th  century that  spelled  out  an objectifying reading of character traits  by classifying “the visible signs of invisible powers.” In the  19th  century, such  knowledge was easily co-opted for racist  discourses and biological determinism by such  anthropologists as the Italian Cesare Lombroso, who  believed  that  southerners were more  prone to becoming criminals  than northerners due  to their  physical  appearance. Another guiding idea of 19th  century ethnology was the similarity  of the Jewish nose  to the African  nose. Again, the  nose  became of utmost concern to Jewish people, who started having cosmetic surgery  in order  to pass  as non-Jewish Europeans. Anti-Semitism and other racist discourses are thus  deeply rooted in the tradition of physiognomy.

20th Century

By the  late  19th  and  early  20th  century, cosmetic surgery  had  became a common  practice, allowing  people  to express  and  realize their  desire  to look  like the norm within  their  culture, or to rid themselves of what was often  referred to as an inferiority complex. With  this,  the  possibility of looking better than others came into  the  picture as well. In 1921,  the  first Miss  America  pageant tried  to  evaluate and  objectively  classify American female  beauty. Despite the  controversy that the  nose  job of the  1920s  actress  and  comedienne Fanny  Brice had  stirred, such early celebrity  makeovers helped to engrave  the image of the perfect  and  famous face into  the cultural imagination even more.  Even outside of such  issues  of body image,  the  two world  wars produced an unprecedented number of facial injuries that were met with new reconstructive surgical methods, helping to rapidly develop this medical  field, which  had  been  organized formally  by the American Society  of Plastic  and  Reconstructive Surgeons (ASPRS) since  1931. After World  War II, the United States  witnessed a significant growth in cosmetic surgery. In 1949,  about

15,000 people  had had cosmetic surgery  in the United States; by 1969, that  number had risen  to about a half million. Women became particularly concerned with aging. The  common face lift was seen  to help  them feel better about themselves and their  world rather than changing society’s image of beauty.

Contemporary Trends

Women have  had  90–95  percent of all cosmetic surgery  procedures carried  out since the 1970s. In 2008, the top five surgical  interventions for women were breast augmentation, liposuction, eyelid surgery, abdominoplasty, and  breast  reduction. In summary, these  procedures express  a desire  to look  more  feminine, to eliminate the traces  of childbirth or motherhood, to pass as Western, and to slim one’s figure to appear  healthy and fit. Such  makeovers are still often described as an expression of a desire to match one’s inside to the outside, according to the old rules of physiognomy. Many  women report that  they feel more  sexual,  young, healthy, and  beautiful in their  hearts than they  appear, and  are  seeking  to  express  such feelings  through  cosmetic surgery—not to  alter  themselves, but  to  reveal  their real selves. The  idea that  a more  beautiful appearance brings  more  success in life has long  been  proven. In today’s Western culture, people  are surrounded by and immersed in the  idea of cosmetic surgery, makeover’s quintessential expression, via reality television makeover shows  (e.g., Extreme Makeover),  computer games (e.g., Sims), and  imaging  technology that  mathematically calculates an ideal self. However, from  2007  to 2008,  the American Society  for Aesthetic Plastic  Surgery (ASAPS) noticed a 12  percent decrease in  overall  cosmetic surgery  procedures (11 percent decrease for women and  21 percent for men). This  is possibly  a sign that  noninvasive procedures such  as Botox  have  become an  even  faster  fix, or simply that Americans have become oversaturated with images  of ideal beauty.

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