Before & After


But the ease and acceptability of the procedures have an unexpected side effect. Today the belief holds sway that if something can be fixed, it should be fixed. Whereas once a patient might have undergone a single procedure, now the tendency is two or three or an entire makeover. Michael Jackson’s grotesque metamorphosis is the most celebrated and egregious but by no means the only example of this trend. But the ability to reinvent ourselves physically raises the old question of authenticity, which in turn redefines the relationship between psychology and surgery. While patients seeking transsexual operations speak of bringing their bodies into harmony with their psychological selves, most aesthetic procedures are designed to enable the patient to pass as something he or she does not feel, whether it be younger or sexier or more Anglo-Saxon than accidents of nature and birth have determined. But at what cost do we deny ourselves? If melon-perfect breasts mean decreased sensitivity, a common side effect of augmentation, does the new body signify heightened sexuality or diminished health? Does a fresh face engender a transformed consciousness or merely give the outwardly altered individual more to hide? Some women who have never told their husbands about their rhinoplasties live in fear that their secret will be exposed in the noses of their children.


Even if the psychological toll is bearable, the practical problems can be insurmountable. In Ash Wednesday , a cautionary 1973 film, an aged-by-makeup Elizabeth Taylor undergoes a series of graphic, for the time, procedures to restore her youthful appearance and rekindle the affections of her philandering husband, Henry Fonda. Though the surgery is successful and a moviestar-perfect Taylor re-emerges, when a younger woman enters the frame and Fonda falls for her, the jilted Taylor realizes there will always be an authentically younger model waiting in the wings.

Equally troubling is the problem of homogeneity. “The ability to alter appearances,” the dental surgeon Ronald P. Strauss believes, “has affected how we respond aesthetically to difference … a minor variant of normal becomes a deformity.” These days doctors say they no longer turn out assembly-line cute turned-up noses. But is the trend to longer, more assertive noses that, as one doctor put it, allow his female patients “to go toe to toe with those guys on the stock exchange” a move toward individuality or merely adherence to a new stereotype? Are cookie-cutter breasts a sign of sexual viability or craven conformity? And while the sight of a pretty face or well-shaped body is pleasing, an army of faces that are appealing in exactly the same way and bodies that are molded from the same model can become stultifying.

In Venus Envy: A History of Cosmetic Surgery , Elizabeth Haiken ascribes the current epidemic of plastic surgery, at least in part, to individuals’ feelings of helplessness in an ever more crowded and complex world. The number of people who have the money and clout to make a difference in society and nonetheless choose to go under the aesthetic knife would seem to undermine this argument, but I think she has a point about the contemporary tendency to apply quick superficial fixes to more profound problems. Like Henry Higgins, whose lament about women in My Fair Lady was that “straightening up their hair is all they ever do,” I can’t help wondering why cosmetic patients of both genders don’t “straighten up the mess that’s inside.” But then I remember those face-lifted salesmen who increased their incomes and those breast-enhanced women who changed their lives, and I know the answer is not so simple.

Perhaps total cosmetic makeovers in an era of limited medical resources are socially irresponsible. Perhaps the men and women who undergo painful unessential procedures that may have life-threatening side effects would benefit more from psychiatric than surgical care. But perhaps those same men and women regard my insistence on walking around in an outmoded, imperfect physical plant as churlish. Certainly they are willing to pay the price, in both money and pain, and risk tomorrow’s consequences for today’s pleasures. And if, to araphrase Hippocrates, they first do no harm to anyone but themselves, who would choose to stand in their way?

America has always prized self-improvement, marveled at self-invention, and pledged allegiance to individual freedom. Is it any wonder that plastic surgery, born in foreign wars, flourished on our domestic soil?