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Books Beauty Under the Knife

Illustration by Philippe Lardy

In some circles in New York and Los Angeles, our reviewer writes, "no one knows anymore what a fifty-five-year-old woman really looks like"

by Holly Brubach

(The online version of this article appears in two parts. Click here to go to part two.)


by Sander L. Gilman.
Princeton University Press,
396 pages, $29.95.

WORKING in the fashion business for the past twenty-some years, I have frequently had cause to contemplate beauty in its most conspicuous forms and also the apparent lack of it. We are raised on stories in which some ravishing heroine, the soul of goodness, is menaced by a wicked witch recognizable by her ugliness, and there is a kind of justice in this that we are loath to relinquish. I myself subscribe to the notion that by the time you're fifty, you have the face you deserve, which might seem no more than a cynical, grown-up attempt to keep alive that fairy-tale law of nature except that there is indeed some truth to it: after five decades of repetitive scowling or laughter or worry, one's attitude toward life is etched on one's face. And here is where the issue gets complicated -- because in the end it is not the geometry of one's nose or the shape of one's eyes or mouth that makes a face attractive. Rather, it is that "raw material" as manipulated by our expressions over time. The older we get, the more expression takes over, until the faces of the elderly are so full of personality -- so dominated by it -- that the actual contour of their features seems immaterial. If some of us find the prospect of plastic surgery unsettling, that is, I think, largely owing to some deep-seated suspicion, borne out by observation, that appearances aren't purely arbitrary -- that they contain important information, and by altering those appearances we falsify that information.

And yet who hasn't felt misrepresented by the face in the mirror, or registered the discrepancy between the people we know ourselves to be and the way others perceive us? We identify with Cyrano's suffering -- that of an exquisite soul eclipsed by a single unfortunate feature. Today, of course, a plastic surgeon could intervene, rendering Cyrano every bit as handsome as Christian, his rival for Roxanne's affection, and the story would have a happy ending. Or would Cyrano, an outcast and a laughingstock all his life, so readily accept the privileges that good looks confer? His is the soul of a poet, and his experience, however excruciating, has taught him tenderness, irony, reflection, and compassion. Similarly, in Little Women, Amy learns to live with her anomalous nose, and is the better for it.

Discuss this article in Post & Riposte.

More on books in The Atlantic Monthly and Atlantic Unbound.

From the archives:

"The Plight of the High-Status Woman," by Barbara Dafoe Whitehead (December, 1999)
Recent fiction, essays, and self-help books (Dumped!, for one) suggest that a harsh new mating system is emerging.

"Buffed and Polished," by Deborah Fallows (July, 1996)
Health spas are more numerous and diverse than ever before.

A friend recently remarked that in some circles in New York (and I would imagine it's true in Hollywood as well) no one knows anymore what a fifty-five-year-old woman really looks like. The face that has been lifted has become the norm. Certain women I know, now in their forties, have already undergone what one surgeon refers to as "preventive" face-lifts. At the risk of sounding a puritanical note, I confess that there is still for me a certain Dorian Gray-like creepiness about this business of attempting to reset the hands of time, a sense that one doesn't get away without paying a penalty of some kind -- in some cases an enormous price, when something goes awry. Take, for instance, the fate of Consuelo, the Duchess of Marlborough, a legendary beauty who underwent a series of paraffin injections to fend off the effects of aging and, disfigured by the results, became a recluse for the rest of her life. And yet, despite this and any number of other, more recent cautionary tales, denial springs eternal.

AMONG the before-and-after pictures, the diagrams depicting physiognomic ideals, the occasionally ghoulish close-ups of faces disfigured by war or disease, that illustrate Sander Gilman's Making the Body Beautiful: A Cultural History of Aesthetic Surgery are two photographs reproduced from an early textbook on rhinoplasty and identified as "images of happy patients." In one a woman is smiling broadly, her face tilted to the sun, her arms spread as if she were about to fly; in the other a man and a woman dance in the street. They are still sporting bandages, so it is too soon to tell what changes their surgery will bring about in their lives -- how different a stranger's response to them will be, or which of the doors previously closed to them will now swing open. Rather, the patients' glee is in proportion to their conviction that they have been transformed, that what was wrong with their lives has at last been righted.

Related links:

The American Society of Aesthetic Plastic Surgery
National statistics and information about plastic surgery in the U.S.

Plastic Surgery Information Service
This site provides background on the history and variety of cosmetic and reconstructive plastic surgery procedures.

Gilman calls happiness "the central goal of aesthetic surgery" ("aesthetic" with an ae because, he explains, that's the way it is most often spelled by the surgeons themselves, who confer on their work "a classical lineage" by harking back to ancient Greece). Face-lifts, nose jobs, liposuction, decircumcision, buttocks implants, breast augmentation, and breast reduction, among other procedures, present themselves, Gilman drily notes, as surgical cures for what is often essentially a psychological problem -- a persistent sense of discontent. That more and more Americans are resorting to these remedies is borne out by statistics: in 1981 there were 296,000 such operations in the United States; in 1995 there were 825,000 on the face alone. Strikingly, the numbers indicate that altering one's appearance is no longer the exclusive prerogative of Michael Jackson, movie stars, and New York socialites: in 1994, Gilman tells us, 65 percent of plastic-surgery patients had household incomes of less than $50,000.

The discretion and shame once associated with "cosmetic" (or "plastic," as it is more colloquially, if less elegantly, known) surgery seem quaint hallmarks of a bygone era -- albeit the day before yesterday -- when people still had secrets, when women might sneak off for an extended "vacation" and come back looking "rested." Celebrities now publicly acknowledge the work they have had done: Gilman cites Roseanne's example -- an overhaul that included new eyelids, cheek implants, liposuction, a face-lift, a nose job, a chin implant, and breast reduction. An article in the August issue of Vogue, written by a woman who treated her fifty-five-year-old mother to a face-lift, describes it as a bonding experience. Evidence of just how commonplace these procedures have become now crops up everywhere, not only in mainstream magazines but in the far corners of the culture. The French artist Orlan, born in 1947, has made a career out of a series of operations that have turned her into a human compendium of art-historical "quotations," incorporating the chin of Botticelli's Venus, the lips of Moreau's Europa, the eyes of Gérôme's Psyche, the brow of Leonardo's Mona Lisa.

With its bizarre amalgam of new developments in medicine and prevailing trends in fashion, "aesthetic surgery" is a phenomenon that begs for examination, and Gilman, as both historian and critic, proves equal to the task. The medical history will come as a surprise to anyone who assumes, as I did, that cosmetic procedures were a luxury that surgeons got around to developing only after they had perfected life-saving techniques such as appendectomies and tracheotomies. Gilman traces the field's origins to a sixteenth-century epidemic of syphilis, which corrodes the noses of its victims and, in its hereditary form, the noses of their children. The most popular (and, presumably, effective) solution entailed grafting a flap of skin taken from the forehead, the cheek, or the upper arm; the scarring, however, was a giveaway. Finally, in the 1880s, a surgeon by the name of John Orlando Roe, in Rochester, New York, devised an operation that, by entering through the nostrils, would leave no trace, and modern rhinoplasty was born. That so much of the history Gilman recounts pre-dates anesthesia and antisepsis is testimony to the astounding determination of early patients to undergo surgery. That determination was -- and still is -- fueled by a certain fetishism, the tendency to fixate on a single aberrant feature and to blame it for one's social, professional, or personal misfortunes. Gilman demonstrates that this may be simply a more obsessive form of the fetishism with which we routinely size one another up (the better part of his first 200 pages is devoted almost exclusively to the nose, that badge of ethnic identity).

Reconstructive techniques developed in the aftermath of war -- the First World War in particular -- eventually proved useful for other, cosmetic purposes. With the onset of the twentieth century, aesthetic surgery began to address the effects of aging. The first face-lift, Gilman tells us, was performed on a Polish aristocrat in 1901. New procedures have been introduced as a perceived need for them has arisen. Whereas corpulence was admired in previous eras for its connotations of prosperity, thinness is idolized in ours. Hence liposuction, first performed in 1977.

However, what is beautiful or erotic can be defined only within the context of a given culture at a given moment; the definition varies not only from one era to the next but also from one society to the next. Gilman marshals any number of examples to demonstrate how remarkably capricious the trends in physical features can be -- among them, what he calls the "dialectic of the breast." During the twenties the flat-chested flapper epitomized the modern woman, free to lead a life of her own choosing, unencumbered by the duties of reproduction. As that ideal gradually became démodé, breast reduction gave way to augmentation, until, Gilman says, "beginning in the United States in the 1950s, there was a concerted effort to search for cures for this new disease of 'too-small breasts.'" Ample breasts went out of style again in the anorexic sixties, presided over by Twiggy and Penelope Tree, and made a comeback in the eighties, which were dominated by a new generation of shapely models, many of them with silicone implants. Cross-cultural differences prove to be equally dramatic. Gilman quotes one plastic surgeon in Brazil, where small breasts are the ideal, who speculates that many of the same women now undergoing breast reduction there would most likely want breast augmentation in America. Nor are these whims limited to women's bodies. In a chapter on procedures for men Gilman weighs the appeal of decircumcision: in gay circles in Germany, he tells us, it is in to be "cut," whereas in gay circles in New York it is in to be uncut.


(The online version of this article appears in two parts. Click here to go to part two.)

Holly Brubach received a National Magazine Award in 1982 for her dance criticism in The Atlantic. Her most recent book is A Dedicated Follower of Fashion (1999).

Illustration by Phillipe Lardy.

Copyright © 2000 by The Atlantic Monthly Company. All rights reserved.
The Atlantic Monthly; February 2000; Beauty Under the Knife - 00.02; Volume 285, No. 2; page 98-102.