Before & After


But if plastic surgery was possible, it was not always advisable or even safe. Tagliocozzi’s method, for example, entailed a variety of separate procedures over a period of several months, as well as a sort of cast that kept the arm elevated and attached to the nose. Moreover, the pain was excruciating and the risk of infection great. There was one more insurmountable obstacle. The fearless patient who endured the agony and survived the operation was left with scars that might not be as unsightly as the original condition but were far from attractive and, more to the point, dead giveaways to what he or she had been up to.

During the nineteenth century, developments in anti-sepsis and anesthesia made surgery both safer and less painful, but scarring, and the past it signified, remained a problem. If the point of the operation was to pass—as physically and morally whole, as naturally beautiful, as a member of another group—secrecy was essential.

The act of passing and its opposite, the state of authenticity, run like parallel fault lines through the plastic surgery terrain. Facial features frequently hinted at national and racial background. They also revealed character, or so it was believed. In the late nineteenth century John Orlando Roe, a Rochester, New York, surgeon, listed five kinds of noses—Roman, Greek, Jewish, Snub or Pug, and Celestial—and the character traits they signified. “The Roman indicates executiveness or strength; the Greek, refinement; the Jewish, commercialism or desire of gain; the Snub or Pug, weakness and lack of development; the Celestial, weakness, lack of development, and inquisitiveness.” Roe was not alone in having such theories, of course, but he was rare in that he did something about the assumed inequalities. In the 1880s he developed a procedure that worked from within the nostrils and left no exterior scars. Now an Irish immigrant—Roe’s first operations were on pug noses, which were considered Celtic—could pass as a real Anglo-Saxon American, and no one would be the wiser.

Late-Nineteenth-Century methods were primitive by post-World War I standards, but the intent was sweeping. Plastic surgery aimed at nothing less than fostering human happiness. “Few patients suffer more of mental discomfort than the unfortunate possessors of some unsightly disfigurement on the face which attracts constant notice, few are more solicitous for any operation which promises relief, and none are more grateful for the slightest improvement in their condition,” wrote one surgeon. The reference to “mental discomfort” is telling. Plastic surgery and psychology, two initially suspect and subsequently extremely popular specialties of modern medicine, were entering their long and volatile love-hate relationship.

World War I turned plastic surgery’s attention from the inequities of birth and the promise of happiness to the destruction of war and the battle for survival. As physicians and dentists rose to the occasion, headlines and articles proclaimed supernatural achievements. Varaztad Kazanjian, chief dental officer of the Harvard Unit, became known as “the miracle man of the Western Front” for his inventive wiring and splints of vulcanized rubber to keep wounded faces from contracting before they reached a hospital for bone grafting. “There is nothing impossible in dental surgery now,” a Red Cross nurse told reporters. Great expectations would continue to foster, and haunt, the specialty.


Returning from her third visit to Paris since the outbreak of the war, Mrs. William K. Vanderbilt told The New York Times of the extraordinary work the American Ambulance Field Service was doing on “these torn, mutilated human beings, without any faces, who would otherwise be unbearably repulsive and almost certainly economically dependent.… I have seen a man brought into a hospital with his jaw bone shot away. The lower part of his face was just—gone. What remained of his chin was hanging against his chest, as if it were a beard. And I have seen that man leave the hospital, scarred of course, but normal again.”

Success in restoring these “unbearably repulsive” veterans to a semblance of the sons and husbands and fathers who had gone off to war ennobled the entire specialty. Once vilified for frittering away their expertise on sexual degenerates, pushy immigrants, and vain women, plastic surgeons were suddenly heroes, honored along with the veterans they had mended.