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Before & After
Cosmetic surgery was born 2,500 years ago and came of age in the inferno of the Western Front. The controversy about it is still growing.
February/March 2004 | Volume 55, Issue 1
World War I made plastic surgeons suddenly heroes.
But just as Armistice Day heralded a “return to normalcy” for the rest of society, it sent plastic surgery back to its marginal position in the world of medicine. Some surgeons limited their practices to deformities caused by birth defects and automobile and industrial accidents, but others began applying the skill and techniques they had perfected on wounded veterans to dissatisfied civilians, chiefly women. In 1923 Fanny Brice underwent rhinoplasty to transform her nose from what she called “prominent” to “merely decorative,” but the aura surrounding the operation, which was performed in her apartment at the Ritz-Carlton in New York City, was more circuslike than antiseptic. A year later the New York Daily Mirror ran a contest “to take the homeliest girl in the biggest city in the country and to make a beauty of her.” The paper’s Pygmalion was Dr. W. A. Pratt, owner of the Pratt Feature and Specialty Company of Brooklyn. In 1931 Dr. John Howard Crum performed the first public face-lift on record in the Grand Ballroom of the Pennsylvania Hotel in New York and followed it with several others, during which a pianist accom panied him with appropriate popular tunes, flashbulbs popped, and men and women fainted.
In 1921 the need to screen out quacks and beauty “doctors” and certify reputable surgeons, even if they did perform cosmetic procedures, gave birth to the American Association of Plastic Surgeons. A decade later the American Society of Plastic and Reconstructive Surgeons (ASPRS) merged with it, and a few years after that the American Board of Plastic Surgery joined the association.
Professionalizing the specialty, however, did not eliminate the tension between reconstructive stalwarts and aesthetic enthusiasts. Doctors continued to struggle to justify their positions. In 1926 Dr. John Staige Davis explained, “The abdominal operation is necessary to the health of the patient, the operation for removal of wrinkles is unessential and is simply decorative surgery.” But if a new nose enabled a war veteran to hold a job and marry, could it not also improve the employment opportunities of a civilian man or sweeten the marital and therefore financial prospects of a woman? Many in the profession and among the public, unable to shed their puritan assumptions, hedged their bets. If the aim was to look better, the surgery was unacceptable. If the goal was to be less conspicuous, the procedure was permissible. The problem was where the line should be drawn and who was to draw it. How big or misshapen did a nose have to be to qualify as a deformity? Should the doctor or the patient make the determination? The questions were further complicated by America’s democratic ideals. Wasn’t it subversive to deny an individual the right to self-improvement?
The debate, noisy and often acrimonious, was one of the first casualties of World War II. Surgeons stopped squabbling among themselves and again turned their attention to restoring war-ravaged faces and bodies. As in the last war, the effort was international. A Kansas City physician invented a machine that sliced flesh thinner than tissue paper, and at Queens Hospital in East Grinstead, England, British and American surgeons took bone from the hip to form entirely new noses; skin from the inside of the arm to fashion eyelids, the absence of which caused the men to shed tears continuously; and thick skin from the stomach to create half a missing hand. Advances in anesthesiology made possible longer operations, blood plasma facilitated transfusions, and if infection occurred, penicillin would combat it. Once again the press spoke of miracles, but physicians warned the public not to expect too much. Skin taken from other parts of the body often differed in color, texture, and thickness, and even the most expertly rebuilt face might be incapable of expression. Still, in the first four years of its existence, Queens Hospital not only performed 7,000 operations but witnessed eight marriages between reconstructed veterans and the especially pretty nurses assigned to care for them.
Cosmetic procedures became consumer products.
Though World War II temporarily silenced the debate between reconstructive and cosmetic surgery, it only exacerbated the problem. Not only were the new techniques even more impressive, there were now more surgeons eager to use them. How was the record number of physicians who had trained in this challenging new specialty to make a living once the war was over? Aesthetic surgery held as much promise for practitioners as it did for patients.