Before & After

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While face-lifts and breast augmentations were on the rise in postwar America, rhinoplasty, the earliest plastic procedure, remained the most popular operation. From the end of World War I until our current era of medical tourism, which sends patients hurrying around the world in search of good treatment at the right price with the best views, cosmetic surgery was a particularly American specialty, and the “nose job” was the typical American procedure. Before we were a multicultural society, we were a melting pot. Successive generations of immigrants left their names at Ellis Island, shed their accents, and graduated from Ivy League schools; but a family nose still carried a whiff of the old country. If face-lifts were the product of ageism, and breast surgery of sexism, then rhinoplasty was a response to racism. Fanny Brice told the press she underwent surgery “in order that her nose may return to normalcy,” but Dorothy Parker quipped the comedian had “cut off her nose to spite her race.” In fact Brice never tried to hide her background and made her reputation performing Jewish material, but her conflict is typical of several generations of women who followed in her surgical footsteps. One postwar study revealed that most Jewish girls who underwent rhinoplasty practiced their religion, hoped to marry Jewish men, and insisted they had no desire to pass as gentiles. The reason they gave for undergoing the surgery was that they wished to be judged as individuals rather than part of a group, even a group to which they claimed they wanted to belong. For other ethnics the motives were less tortuously reasoned. Italians, Greeks, and Armenians who had nose jobs admitted they did not want to be mistaken for Jews. Perhaps the supreme irony of this postwar epidemic of rhinoplasty was that in the mid-twentieth century most Jewish girls opted for the tiny turned-up model that Irish immigrants had suffered to have lengthened and straightened at the end of the nineteenth. Although plastic surgeons, some of whom likened themselves to artists or sculptors, spoke of a single timeless standard of beauty, too often the noses, breasts, and other features they turned out were merely this year’s model.

Plastic surgeons joined hands with psychiatrists.

In 1958 Pope Pius XII condemned this catering to “the caprice of fashion.” While admitting the legitimacy of much plastic surgery, he warned that operations for mere “vanity” or to enhance the “power of seduction, thus leading others more easily into sin,” or “to hide a criminal from justice” were not in keeping with the church’s teachings. As requests for guidance on the issue poured into churches of all denominations, a minister, a priest, and a rabbi came together to debate the issue under the auspices of the American Society of Facial Plastic Surgeons. All three agreed on the value of reconstructive surgery, but they took different theological positions on the virtue of aesthetic surgery. The minister addressed the problem of authenticity and cited the warning “that a man should be as he is created to be; that David should not parade in Saul’s armor.” The rabbi condoned cosmetic surgery only if it enhanced a man’s ability to support his family or a woman’s to find or hold a husband. The priest found no sin in cosmetic surgery, as long as it carried psychological benefits.

The priest had put his finger on one of aesthetic surgery’s major marketing tools. Since the early post-World War I days, plastic surgeons had been happy to join hands with their psychiatric colleagues. Both specialties were young, gaining a public following, and fighting for professional recognition and respect. They also shared the same goal: to make the patient happy. Some surgeons went so far as to describe their procedures as psychiatry with a scalpel. The assertion, in the 1930s, by J. W. Maliniak, a founder of the ASPRS, that deformities may cause insanity carries a touch of self-promotion, but studies by child psychiatrists during the same decade demonstrated that physical abnormalities led to feelings of inferiority, which could produce antisocial and even criminal behavior. In his best-selling 1930 book The Human Mind , Dr. Karl Menninger not only explained Freudian theory to the American public but also recommended that, “when it is possible by means of medical, surgical, dental, or other devices to correct some of the actual inferiorities, such treatment is, of course, indispensable.” Three years earlier San Quentin Prison launched a plastic surgery program for inmates “intended to give them a better chance to go straight.”