All anxieties live in our bodies, but anxieties about our bodies feel particularly urgent. And since famous bodies are used to sell salve—cosmetics, waist-shapers, soft drinks—meant to soothe those anxieties, we’re almost constantly embracing standards that even celebrities cannot maintain without intervention. Often, that comes in the form of cosmetic surgery.

Scores of Americans are remaking their bodies. According to the American Society of Plastic Surgeons, 15.6 million cosmetic procedures were performed in 2014. Plastic surgery sells norms of youth and beauty by offering consumers opportunities to recreate their appearance. It promises to fix socially undesirable physical features or delay the point at which we begin to show aging, a process framed by youth-centered culture as a slide into decrepitude, cultural irrelevancy, and death.

But these procedures entail an internal tension: Their results exist to be viewed, yet they are also meant to remain invisible, undetectable. The plastic surgeon is a sculptor who can remake the body in a way that looks natural while not betraying the artifice of their work. However, they don’t always succeed. It’s when plastic surgery is visible—think of Michael Jackson’s infamous nose—that social fears of disfigurement manifest as revulsion.

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The shape of the nose, in particular, is imbued with assumptions about one’s character and place in society. Various efforts to fix undesirably shaped noses by way of plastic surgery have been employed over two millennia. In Venus Envy: A History of Plastic Surgery, Elizabeth Harken details one of the first recorded rhinoplasty procedures, performed in ancient India in the sixth century B.C. A flap of skin from the patient’s cheek was repurposed to mold a new nose. However, it wasn’t until a European syphilis epidemic in the late 16th century that cosmetic nasal surgery garnered much attention in the West. One of the unfortunate symptoms of advanced syphilis is soft-tissue decay, which affects the nose and leaves a gaping hole in the middle of one’s face. Such a disfigurement carried the social stigma of disease and infection, even if the afflicted had lost their nose by another means. Different methods were employed to recreate noses. One of the most popular procedures involved taking skin from the patient’s arm and grafting it to their face in an effort to make a new nose (or something resembling one, anyway).

Given its prominence on the face, even healthy noses can shame their bearers. The pseudoscience of physiognomy, which experienced a modern revival in the 19th century, claimed that the shape of the nose could tell you about a person’s moral character. As Gabrielle Glaser explains in The Nose: A Profile of Sex, Beauty, and Survival, a straight nose signified refinement, while a “hawk” nose signified a cunning moral character. (This perpetration of this myth was not just pseudoscientific, but anti-Semitic as well.)

It was not until the late 19th century that plastic surgery began to gain popularity in North America. Americans wishing to cure themselves of socially undesirable features such as large noses, undistinguished jaw lines, or any features that did not conform to contemporary ideals of beauty could readily find a doctor who would cut and sculpt their face. These pioneers of cosmetic surgery included patients who went under the knife to remove racial signifiers. Procedures included making eyes, lips, and noses look less foreign, a dirty word in the early lexicon of American racism.

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By the turn of the 20th century, advancements in war—poisonous gases, sniper rifles, and trench warfare—had made the jaws, lips, and noses of soldiers newly vulnerable. Facial injuries prompted surgeons to experiment with techniques to replace lost or damaged appendages. Soldiers such as John Bagot Glubb, who was also a scholar and renowned author, were offered surgery to fix facial disfigurements. Murray C. Meikle documents the mixed blessing of Glubb’s fortune in Reconstructing Faces: The Art and Wartime Surgery of Gillies, Pickerill, McIndoe and Mowlem: “As most of my lower jaw had gone, I was shown an album of photographs of handsome young men and asked to choose the chin I would like to have!”

Even with these medical advancements, plastic surgery could only do so much. During World War I, London General Hospital established the Masks for Facial Disfigurement Department. The Tin Noses Shop, as the soldiers called it, brought together American and European doctors and sculptors who worked to create individualized metallic masks, which then covered deformed or missing jaws, eyes, lips, and noses of wounded men. Though separated by a century, photographs of these men echo those of present-day celebrities with excessive or mask-like plastic surgery.

In his book Making the Body Beautiful, Sander L. Gilman argues that by the 1920s, the reconstructed faces of war veterans helped the public begin to accept cosmetic surgery. Although the benefits of medical advancements made in reconstructive surgery during the war were available internationally, plastic surgery began its boom in the United States during this time. The society that would later become the American Association of Plastic Surgeons was founded in 1921, right after the war and during the rise of a consumer culture that sanctions the exchange of money for beauty (and noses). The popularity of cosmetic surgery grew quickly, assisted by the normalizing presence of reconstructive procedures among veterans.

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While modern war destroys noses by mishap, cultures have long employed nasal mutilation as a punishment. During the middles ages, a woman’s hacked-off nose was a sign of disobedience or sexual promiscuity. In A Social History of Disability in the Middle Ages, the historian Irina Metzler explains that adultery was punishable by severing the nose in the Kingdom of Jerusalem of the 10th century. But even half a millennium earlier, the Vandal king Gaiseric “ordered his Gothic wife’s nose and ears mutilated, having accused her of plotting against him.”

These atrocities are still committed. In 2010, Aesha Mohammadzai’s nose-less face was featured on the cover of Time magazine under the warning, “What Happens If We Leave Afghanistan.” Mohammadzai’s story is a harrowing account of life under Taliban rule. When she was 12, her father sold her to a Taliban fighter to pay off a debt. After she attempted to run away, her Taliban family cut off her nose and ears, leaving her for dead.  She was rescued by aid workers, who then brought her to the United States.

Mohammadzai’s post-Afghani life and the reconstruction of her nose have been widely covered in the press. CNN’s Jessica Ravitz documented Mohammadzai’s American integration, where she received a degree public of attention typically reserved for celebrities:

In sunny Southern California, she bounced between lavish homes in gated communities. She was trotted out at a pricey gala dinner in Beverly Hills, where she debuted her prosthetic nose, a preview of what the surgery would do for her. She walked the proverbial red carpet, met Laura Bush and was honored by California’s then-first lady, Maria Shriver.

When the time came for Mohammadzai to begin a marathon of surgeries, The Daily Mail updated its readers on reconstruction efforts, detailing the various procedures required to build her new nose. The techniques employed were similar to those used in ancient India: doctors used skin from her face to provide tissue for her new nose. Unlike celebrity body shaming or botched surgery rubbernecking, Mohammadzai’s reconstructive process has garnered positive attention. Four years after the Time cover story, the media continues to document her progress. The tenor of this coverage harkens to Victorian freak shows, in which indigenous peoples from Britain’s imperial conquests were displayed in Europe as primitive savages in need of saving. Media coverage of Mohammadzai similarly casts Western culture and technology as both civilizer and savior.

The aesthetic value assigned to a person’s nose reflects historical and cultural beliefs on beauty, disease, race, war, and gender. The nose’s prominence—projecting from the face for all to see in the flesh—turns out to make it a potent symbol, whether the for the sake of consumer culture, ideals of beauty, the violence of war, or the power of the state.