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.
Precedents
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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