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The Ugly History of Cosmetic Surgery

The Ugly History of Cosmetic Surgery


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Reality television shows based on surgical transformations, such as The Swan and Extreme Makeover , were not the first public spectacles to offer women the ability to compete for the chance to be beautiful. In 1924, a competition ad in the New York Daily Mirror asked the affronting question “Who is the homeliest girl in New York?” It promised the unfortunate winner that a plastic surgeon would “make a beauty of her”. Entrants were reassured that they would be spared embarrassment, as the paper’s art department would paint “masks” on their photographs when they were published.

Cosmetic surgery instinctively seems like a modern phenomenon. Yet it has a much longer and more complicated history than most people likely imagine. Its origins lie in part in the correction of syphilitic deformities and racialized ideas about “healthy” and acceptable facial features as much as any purely aesthetic ideas about symmetry, for instance.

In her study of how beauty is related to social discrimination and bias, sociologist Bonnie Berry estimates that 50% of Americans are “unhappy with their looks”. Berry links this prevalence to mass media images. However, people have long been driven to painful, surgical measures to “correct” their facial features and body parts, even prior to the use of anesthesia and discovery of antiseptic principles.

Some of the first recorded surgeries took place in 16th-century Britain and Europe. Tudor “barber-surgeons” treated facial injuries, which as medical historian Margaret Pelling explains, was crucial in a culture where damaged or ugly faces were seen to reflect a disfigured inner self.

Walter Yeo, the first person to receive plastic surgery, before (left) and after (right) skin flap surgery performed by Sir Harold Delf Gillies in 1917. In the tragic accident he was recorded as having lost both his upper and lower eyelids. The surgery was some of the first to use a skin flap from an unaffected area of the body and paved the way for a sudden rash of improvements in this field. (Daily Telegraph / Public Domain )

Pain and Risks

With the pain and risks to life inherent in any kind of surgery at this time, cosmetic procedures were usually confined to severe and stigmatized disfigurements, such as the loss of a nose through trauma or epidemic syphilis.
The first pedicle flap grafts to fashion new noses were performed in 16th-century Europe. A section of skin would be cut from the forehead, folded down and stitched, or would be harvested from the patient’s arm.

A later representation of this procedure in Iconografia d’anatomia published in 1841, as reproduced in Richard Barnett’s Crucial Interventions , shows the patient with his raised arm still gruesomely attached to his face during the graft’s healing period.
As socially crippling as facial disfigurements could be and as desperate as some individuals were to remedy them, purely cosmetic surgery did not become commonplace until operations were not excruciatingly painful and life-threatening.

Cosmetic Surgery Improves

In 1846, what is frequently described as the first “painless” operation was performed by American dentist William Morton , who gave ether to a patient. The ether was administered via inhalation through either a handkerchief or bellows. Both of these were imprecise methods of delivery that could cause an overdose and kill the patient.

Illustrates the first use of ether as an anesthetic in 1846 by the dental surgeon W.T.G. Morton. (catalogue.wellcome.ac.uk / Public Domain )

The removal of the second major impediment to cosmetic surgery occurred in the 1860s. English doctor Joseph Lister ’s model of aseptic or sterile surgery was taken up in France, Germany, Austria, and Italy reducing the chance of infection and death.

Joseph lister spraying phenol over the wound while the doctors were performing an operation. (Populär historia 2/2015 / Public Domain )

By the 1880s, with the further refinement of anesthesia, cosmetic surgery became a relatively safe and painless prospect for healthy people who felt unattractive.

The Derma-Featural Co advertised its “treatments” for “humped, depressed, or … ill-shaped noses”, protruding ears, and wrinkles (“the finger marks of Time”) in the English magazine World of Dress in 1901.

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From the book "Plastic and Cosmetic Surgery" by F. Strange Kolle 1871-1929 -Nose correction (Wellcome Collection Gallery / CC BY-SA 4.0 )

A report from a 1908 court case involving the company shows that they continued to use skin harvested from – and attached to – the arm for rhinoplasties.

Non-Surgical Treatments

The report also refers to the non-surgical “paraffin wax” rhinoplasty, in which hot, liquid wax was injected into the nose and then “molded by the operator into the desired shape”. The wax could potentially migrate to other parts of the face and be disfiguring or cause “ paraffinomas” or wax cancers.

Advertisements for the likes of the Derma-Featural Co were rare in women’s magazines around the turn of the 20th century. But ads were frequently published for bogus devices promising to deliver dramatic face and body changes that might reasonably be expected only from surgical intervention.

Various models of chin and forehead straps, such as the patented “Ganesh” brand, were advertised as a means for removing double chins and wrinkles around the eyes.

Bust reducers and hip and stomach reducers, such as the J.Z. Hygienic Beauty Belt, also promised non-surgical ways to reshape the body.

The frequency of these ads in popular magazines suggests that use of these devices was socially acceptable. In comparison, colored cosmetics such as rouge and kohl eyeliner were rarely advertised.

The ads for “powder and paint” that do exist often emphasized the product’s “natural look” to avoid any negative association between cosmetics and artifice.

The Racialized Origins of Cosmetic Surgery

The most common cosmetic operations requested before the 20th century aimed to correct features such as ears, noses, and breasts classified as “ugly” because they weren’t typical for “white” people.

At this time, racial science was concerned with “improving” the white race. In the United States, with its growing populations of Jewish and Irish immigrants and African Americans, “pug” noses, large noses, and flat noses were signs of racial difference and therefore ugliness.

Sander L. Gilman suggests that the “primitive” associations of non-white noses arose “because the too-flat nose came to be associated with the inherited syphilitic nose”.

In 1815, Dr. Karl Ferdinand von Gräfe authored the book about rebuilding the human nose. (sammlungen.hu-berlin.de / Public Domain )

American otolaryngologist John Orlando Roe’ s discovery of a method for performing rhinoplasties inside the nose, without leaving a tell-tale external scar, was a crucial development in the 1880s. As is the case today, patients wanted to be able to “pass” (in this case as “white”) and for their surgery to be undetectable.

In 2015, 627,165 American women , or an astonishing one in 250, received breast implants. In the early years of cosmetic surgery, breasts were never made larger.

Changes in What is Fashionable

Breasts acted historically as a “ racial sign ”. Small, rounded breasts were viewed as youthful and sexually controlled. Larger, pendulous breasts were regarded as “primitive” and therefore as a deformity.

In the age of the flapper, in the early 20th century, breast reductions were common. Not until the 1950s were small breasts transformed into a medical problem and seen to make women unhappy.

Flapper from the 1920’s. ( vitaliismulskyi / Adobe)

Shifting views about desirable breasts illustrate how beauty standards change across time and place. Beauty was once considered as God-given, natural or a sign of health or a person’s good character.

When beauty began to be understood as located outside of each person and as capable of being changed more women, in particular, tried to improve their appearance through beauty products, as they now increasingly turn to surgery.

As Elizabeth Haiken points out in Venus Envy , 1921 not only marked the first meeting of an American association of plastic surgery specialists, but also the first Miss America pageant in Atlantic City. All of the finalists were white. The winner, 16-year-old Margaret Gorman, was short compared to today’s towering models at five-feet-one-inch (155cm) tall and her breast measurement was smaller than that of her hips.

There is a close link between cosmetic surgical trends and the qualities we value as a culture, as well as shifting ideas about race, health, femininity, and ageing.

100 Year Anniversary of Modern Cosmetic Surgery

Last year was celebrated, by some within the field, as the 100th anniversary of modern cosmetic surgery. New Zealander Dr Harold Gillies has been championed for inventing the pedicle flap graft during the first world war to reconstruct the faces of maimed soldiers. Yet, as is well documented, primitive versions of this technique had been in use for centuries.

Such an inspiring story obscures the fact that modern cosmetic surgery was really born in the late 19th century and that it owes as much to syphilis and racism as to rebuilding the noses and jaws of war heroes.

Middlemiss, facial wound, plastic surgery. (wellcomeimages.org / CC BY-SA 4.0 )

The surgical fraternity – and it is a brotherhood, as more than 90% of cosmetic surgeons are male — conveniently places itself in a history that begins with reconstructing the faces and work prospects of the war wounded.

What is the Reality of Cosmetic Surgery?

In reality, cosmetic surgeons are instruments of shifting whims about what is attractive. They have helped people to conceal or transform features that might make them stand out as once diseased, ethnically different, “primitive”, too feminine, or too masculine.

The sheer risks that people have been willing to run in order to pass as “normal” or even to turn the “misfortune” of ugliness, as the homeliest girl contest put it into beauty, shows how strongly people internalize ideas about what is beautiful.

Looking back at the ugly history of cosmetic surgery should give us the impetus to more fully consider how our own beauty norms are shaped by prejudices including racism and sexism.

The article ‘ The ugly history of cosmetic surgery ’ by Michelle Smith was originally published on The Conversation and has been republished under a Creative Commons license.


Women’s Health in Context: Cosmetic Surgery Past, Present, and Future: Scope, Ethics, and Policy

Each year plastic and reconstructive surgeons improve the lives of millions of patients with congenital malformations (such as cleft lip and cleft palate), disfiguring wounds, animal bites, and profound burn injuries, as well as those requiring reconstruction after surgery for malignancy or other chronic conditions. This column will not focus on these forms of plastic surgery, but rather on cosmetic surgery, or elective procedures to enhance those not encumbered by such disfiguring conditions.

External motivators for cosmetic surgery include the desire to avoid ethnic prejudice fear of age discrimination and direct or subtle, indirect coercion by a spouse, parent or boss. [2] Internal motivators include the desire to diminish unpleasant feelings of depression, shame or social anxiety the wish to alter a specific disliked feature the yearning for a more youthful, healthy look that signals fertility (usually in women) and the hope to create a strong, powerful appearance that will facilitate career advancement. [2]

A Brief History of Cosmetic Surgery

As early as 600 BC, a Hindu surgeon reconstructed a nose using a piece of cheek. [3] By 1000 AD, rhinoplasty was common, due to the barbaric custom of cutting off the noses and upper lips of one's enemies. In the 16th century, Gaspare Tagliacozzi, known as "the father of plastic surgery," reconstructed noses slashed off by swords during duels by transferring flaps of upper arm skin. This procedure was also used to correct the saddle nose deformity of syphilis. [3]

The term plastic surgery, from the Greek "plastikos" (fit for molding), was coined by Pierre Desault in 1798 as a label for procedures to repair facial deformities. [4] In the 19th century, developments in anesthesia and antisepsis made plastic surgery safer and allowed for improvements in technique. Plastic surgeons further honed their skills during the 2 world wars, then applied their techniques to victims of birth defects and automobile and industrial accidents. [3] The American eugenics movement, with its "Better Baby Contests," post-World War II prosperity, and the advent of motion pictures and television all helped to usher in the modern era of cosmetic surgery. [2] The first modern cosmetic rhinoplasty was performed in 1923, followed by the first public face lift in 1931. [2]

The Scope of Contemporary Cosmetic Surgery

Procedures and Patients. In 2005, there were 10.2 million cosmetic procedures performed in the United States, an increase of 11% from 2004 and a 38% compared with 2000. [5] This number includes 3,839,387 Botox treatments, 1,033,581 chemical peels, 837,711 microdermabrasions, 782,732 laser hair removals, 589,768 vein sclerotherapies (strippings), 323,605 liposuctions, 298,413 rhinoplasties (nose jobs), 291,350 breast augmentations, 230,697 blepharoplasties (eyelid reconstructions), 134,746 abdominoplasties, 114,250 breast reductions, 793 vaginal rejuvenation procedures, 337 calf augmentations, and 206 pectoral implants. [5] Forty percent of those undergoing cosmetic procedures are repeat patients 34% have multiple procedures at the same time. [5]

Eighty-four percent of patients undergoing cosmetic procedures last year were white 90% were female. [5] The top 5 minimally invasive procedures among women were Botox injection, chemical peel, laser hair removal, microdermabrasion, and sclerotherapy. The top 5 surgical procedures were breast augmentation, liposuction, nose reshaping, eyelid surgery, and tummy tuck (see below for statistics on males). [5]

In 2005, 51% of US cosmetic surgery patients and 69% of patients getting minimally invasive procedures were aged 51 years or older. Two thirds of patients reported family incomes below $50,000. Total physician fees for cosmetic procedures, not including anesthesia, operating room facilities, and other related expenses, were estimated at $9.4 billion. [5]

Today, an increasing number of cosmetic surgery procedures are performed in doctors' offices and free-standing surgical centers (as opposed to hospitals), and more procedures are being carried out simultaneously. [6] This increases the risk of rare but potentially fatal infections and anesthetic reactions. Furthermore, some practitioners have not completed the full 5 years of residency training required for certification by the American Board of Plastic Surgery, but (legally) perform procedures, for which they might be inadequately trained, merely to augment their income. [6]

Complications. Complications of cosmetic surgery are rare, but include infection, bleeding, fluid and salt imbalance, and allergic and anesthetic reactions which are sometimes fatal. The recent death of a noted author has heightened public awareness that getting cosmetic surgery is not in the same category as getting a facial or herbal wrap. [6]

Cosmetic Surgery Abroad. Cosmetic surgery's popularity is spreading throughout the developed world. South Korea has the highest ratio of cosmetic surgeons to citizens worldwide, but Brazil has the most cosmetic surgical procedures per capita. [4] The most popular cosmetic procedure in Asia is eyelid surgery. Argentina has the highest ratio of breast enlargements worldwide. [4] Next door in Brazil, breast reduction is more popular. [7]

Breast Augmentation: Then and Now

Procedures and Complications. Large breasts have been in vogue since antiquity, with the exception of a few brief periods in history. Uplifting brassieres and corsets were used at times to enhance the perceived size of breasts. Then, in the 19th century, surgical breast enlargements were attempted using ivory, glass, metal, rubber, and paraffin. [8] In 1895, Czerny did the first reported successful human mammary reconstruction, on an actress who had undergone removal of a fibroadenoma (benign lesion), by transplanting a lipoma from her hip to reconstruct the breast. In 1903, surgeon Charles Miller inaugurated breast augmentation surgery in the United States when he began opening women's chests and inserting "braided silk, bits of silk floss, particles of celluloid, vegetable ivory, and several other foreign materials." [9] The granulomatous (foreign body) inflammatory reactions produced by such odds and ends must have been disfiguring and painful. By the 1950s, petroleum jelly, beeswax, shellac, and epoxy resins had been tried. In the early 1950s, liquid silicon injections were used to restore breast contour. [8] The first US woman to receive encapsulated silicon breast implants was Timmie Jean Lindsey, who was boosted from a B to a C cup in 1962. [4]

In 1992, the US Food and Drug Administration (FDA) banned the use of silicone breast implants except in strictly controlled trials for breast cancer reconstructive surgery due to reports linking the implants with a variety of connective tissue diseases and neurological disorders. Subsequent thorough analyses have shown no such links. [8,10] Even so, breast augmentation with silicone implants is associated with a number of local adverse events, including hematoma, infection, scarring, contracture, rupture, pain, and loss of sensation. A minimum of 15% of modern silicone implants will rupture between the third and tenth year after implantation. [11] Reoperation rates are 20%-26% and removal rates are 12%-14% at 5 years. [12] Complications are more common among individuals undergoing breast reconstruction following cancer surgery than in those having purely cosmetic procedures.

Since 1998, federal law has required insurance companies to cover breast reconstruction after mastectomy. [13] In 2005, the FDA reversed itself, allowing silicone breast implants back on the market under certain conditions, including a registry to track complications. [14] Even so, saline implants, subject to fewer complications, are employed much more frequently today.

Breast augmentation also decreases the sensitivity of screening mammography among asymptomatic women, but does not increase the false-positive rate nor affect the prognostic characteristics of breast cancers. [15] Differences between saline and silicone implants for mammography sensitivity and tumor characteristics are unknown. [15]

New Breasts for Graduating Seniors. In the United States, breast augmentation surgery can be performed on those under age 18 for medical reasons only. [12,16] The European Union Parliament is backing an age limit of age 18 on breast implants for cosmetic reasons its recommendations are likely to be adopted by the European Commission. [17] Nevertheless, there is a growing trend of parents giving implants as gifts to their graduating 18-year-old adolescents. The number of 18-year-olds who underwent breast-implant surgery nearly tripled from 2002 to 2003, to 11,326. [16] This phenomenon suggests poor parenting, through the capitulation of financially well-endowed parents to the whims of their children, who likely have self-esteem problems and are not yet emotionally (nor perhaps even physically) mature.

Men, Cosmetic Surgery, Steroids, and the Adonis Complex

Men are increasingly undergoing cosmetic surgery to enhance appearance, combat the effects of aging, and improve chances for employment in competitive job markets. [18] The most common minimally invasive procedures are Botox injection, microdermabrasion, laser hair removal, chemical peel, and laser skin resurfacing. [5] The most popular surgical procedures among men are rhinoplasty, hair transplantation, liposuction, blepharoplasty, and breast reduction for excessive gynecomastia. [5] Face lifts, ear corrections, and penile enlargements are becoming increasingly popular. [7]

Still, men undergo far fewer procedures than women. One reason may be that male appearance is often judged in terms of muscularity, and there are other approaches to "buffing up," eg, through the use of anabolic steroids. These illegal substances have been used by an estimated 3 million or more American men since the 1960s when they became available on the black market. [19] Two thirds of users are noncompetitive recreational body builders or nonathletes who use steroids for cosmetic enhancement (increased muscle mass and "virile" appearance). [20] By one estimate, 15%-40% of regular gymnasium attendees have used anabolic steroids. [21] "Victims" of the "Adonis complex," [19] these men place themselves at risk of cardiomyopathy, atherosclerosis, hypercoagulopathy, hepatic dysfunction, and psychiatric and behavioral disturbances through anabolic steroid use. [20,21]

Especially troubling is the rise in steroid use among high school athletes, who may get the drugs from their coaches. The use of anabolic steroids to improve performance was first documented in elite athletes in the 1950s. [21] The International Olympic Committee has banned use of steroids, and athletes competing in national and international competitions undergo routine drug testing. [21] Other procedures athletes use to enhance performance are well known, such as blood doping and injecting erythropoietin to increase red cell mass and, theoretically, oxygen-carrying capacity. Such methods are of doubtful efficacy and carry their own health risks.

New procedures are on the horizon. The time may come soon when perfectly healthy pitchers choose to undergo the so-called "Tommy John surgery" (until now performed only to repair ruptured arm ligaments), which can make an elbow even stronger than it naturally was, allowing hurlers to achieve higher throwing velocities. [22] Other predicted enhancements include the removal, re-engineering, and re-insertion of leg, arm, and shoulder muscle cells to add strength, [22] and gene enhancement. [23]

The Future and the Fringes of Cosmetic Surgery

The following describes procedures at the fringes of cosmetic surgery, along with a look at predicted future methods of bodily enhancement:

The JewelEye. Reminiscent of the use of antimony to create conjunctival sparkle among the ancient Egyptians, Romans, and Persians, [9] the JewelEye, invented by a Dutch ophthalmologist, consists of implanting tiny platinum jewels into the sclera, at a cost of $3900 for the 20-minute procedure. [24] The American Academy of Ophthalmology has warned that the procedure has not been proven safe. [24]

Genitalia Redesign. Genitalia redesign is performed on both men and women. Foreskin restoration (circumcision reversal) has been around since the 2nd century BC, can be performed both surgically and with taping and stretching, and is alleged to return the penis to its natural appearance and to enhance sexual pleasure. [25] Cosmetic phalloplasty, building on procedures to correct penile deformities such as Peyronie's disease and hypospadias, is now widely promoted on the Internet to men who want to increase the size of their penis. [26] Other enhancement procedures involve injecting fat or dermal allografts. Postsurgical instructions for penile lengthening procedures sometimes involve the use of stretching devices such as penile weights. Understandably, results have been generally disappointing size is only augmented for the flaccid state, and complications are common. [26]

Female genital reconstructive procedures include vaginal tightening, alteration of the vaginal angle, partial excision of "floppy" or "overgrown" vaginal labia, and the injection of fat into the labia to enhance plumpness. [27] The "Jade Lady Membrane Man-Made Hymen," marketed in China, can be inserted 20 to 30 minutes before intercourse. The combination of natural body fluids and a red dye produce a bloody-type discharge which, according to the package insert, when accompanied by moans of pain, creates the illusion that the female is a virgin, and therefore, a more desirable partner. [28]

Face Transplantation. In November 2005, French surgeons performed the first-ever partial face transplant on a 38-year-old female victim of a horribly disfiguring dog bite. [29] The operation was successful, but the patient will require life-long immunosuppressant medications to prevent rejection. These drugs will place her at increased risk of cancer, infections, and diabetes. Physicians at the Cleveland Clinic in Ohio and at the Royal Free Hospital in London have received permission to perform the world's first-ever complete face transplant, an operation that will require up to 15 hours (including 5 hours for the harvest) and a multidisciplinary team of surgeons. [29]

Facial transplants could significantly improve the quality of life of the severely disfigured, but raise questions of identity -- both to self and to others, particularly those who knew the deceased donor. Patient selection, cost, and reimbursement are other potential issues. [30] Candidates should undergo intensive psychological screening to eliminate those with behaviors that may decrease graft viability (eg, tobacco smoking). Presumed consent, supported by many for other organ donations given the current long waiting lists, will likely not be acceptable for face donation for obvious reasons. [30] Concerns have also been raised that outside the United States, the procedure may be exploited by profiteering plastic surgeons willing to service criminals on the lam or those who have succumbed to the notion that they are irrevocably "ugly."

Prime Time Cosmetic Surgery. Cosmetic surgery has recently gone prime time, with the American Broadcasting Corporation's show, "Extreme Makeover." In episodes of the program, participants chosen from the ranks of hundreds of thousands of willing "patients" undergo multiple surgical enhancements before a national audience of millions of voyeurs. [30] Other, similar offerings have included Fox TV's "The Swan" and MTV's "I Want a Famous Face," on which young men and women undergo cosmetic "enhancements" to make them look like stars such as Brad Pitt, Jennifer Lopez, and even Elvis Presley. And speaking of celebrities, Michael Jackson (with a reported 4 nose jobs, a chin implant, eyelid surgery, facelift, lip reduction, and assorted touch-ups) [7] and Cher (who may have undergone rib removal to create the illusion of a thinner waistline) [9] are among the celebrities well known for their predilection for bodily reconstruction.

Aptoemnophila. Aptoemnophiles, first described in 1977, constitute a small group of individuals who have an attraction to the idea of changing their identities by becoming amputees. [31] This rare paraphilia sometimes leads the afflicted to self-amputation a few physicians outside of the United States have occasionally accommodated amputee seekers by removing limbs for "cosmetic purposes," although this practice would no doubt place the operating doctor in legal jeopardy. Aptoemnophiliacs should be distinguished from acrotomophiliacs, another rare group who are sexually attracted to amputees.

Furries. Furries, lovers of anthropomorphized animals, sometimes adopt the personae of animals, either through costumes or body modification. [32] For example, some tiger furries cover their bodies with striped tattoos, get dental implants with canines sharpened to resemble tiger teeth, have plastic whiskers implanted, wear special contact lenses to make their eyes appear oval, and have mouth, nose, and ear surgery to make themselves more catlike. [33] Extreme furries live as much as possible like animals, have annual conventions, host Internet sites, and have even been profiled on the television series "CSI." [32]

Cosmetic Surgery for Pets. Cosmetic surgery for pets is particularly popular in Brazil and appears to be spreading to other countries. [34] For example, some owners of show dogs "correct" perceived imperfections in ears, teeth, and tails to optimize chances for winning. There is no legal consensus over whether such cosmetic surgery for pets should be classified as body modification or mutilation, and therefore be subject to animal cruelty laws. [34]

Over 100,000 neutered male dogs and cats in 37 countries have had artificial testicular implants called Neuticles surgically implanted in their scrotums, ostensibly to help them "retain their macho swagger." [35] Some US farmers, in hopes of winning best in show at state fairs, have taken to injecting cows' udders with isobutane gas (to increase the size) and covering the teats with silver protein to smooth out wrinkles. [36] Those 15% of US dairy cows injected with recombinant bovine growth hormone also have enlarged mammary glands, which are prone to inflammation and infection (mastitis).(Donohoe MT. Genetically modified foods: health and environmental risks, the corporate agribusiness agenda, and Oregon politics submitted to Open Spaces, April 2006).

Cosmetic Neurology. Interventions to enhance the cognitive and emotional brain functions of the neurologically nondiseased are currently being pursued by the pharmaceutical industry (via drugs to increase intelligence) and the military (via interventions to create more effective soldiers). [37] Cosmetic military neurology dates back to the use of "go-go pills" (amphetamines) by US soldiers in World War II. Military investigators have found that Modafinil (a wakefulness-promoting agent) improves pilot alertness and performance in helicopter flight simulations. [38] Many military pilots today rely on caffeine and other stimulants, including amphetamines, to complete missions. [37,38] Cosmetic neurology raises concerns about distributive justice and, in the military setting or when used in children, informed consent.

Wings, Chimeras, and Stem-cell Cosmesis. At least 1 surgeon has proposed the surgical construction of wings that someday may be functional, a development foreshadowed by the musings of Renaissance genius Leonardo da Vinci. [39] Another physician has promised to create a human/animal chimera, albeit not through surgery but through genetic engineering, just as the military has studied the prospects of engineering a class of super-soldiers. [40]

Beauty salons in Russia have been offering stem-cell cosmetic surgery where fetal, embryonic, or adult stem cells are injected as treatment for baldness and wrinkles. [41] The efficacy and safety of such procedures are dubious at best. There have been reports of the use of stem cells obtained from the aborted fetuses of poor women who are paid about $200 to undergo late-term cesarean abortions. The fetus is then traded and sold on the black market. [41]


Reality television shows based on surgical transformations, such as _ The Swan_ and _ Extreme Makeover_, were not the first public spectacles to offer women the ability to compete for the chance to be beautiful.

In 1924, a competition ad in the New York Daily Mirror asked the affronting question "Who is the homeliest girl in New York?" It promised the unfortunate winner that a plastic surgeon would "make a beauty of her". Entrants were reassured that they would be spared embarrassment, as the paper's art department would paint "masks" on their photographs when they were published.

Cosmetic surgery instinctively seems like a modern phenomenon. Yet it has a much longer and more complicated history than most people likely imagine. Its origins lie in part in the correction of syphilitic deformities and racialised ideas about "healthy" and acceptable facial features as much as any purely aesthetic ideas about symmetry, for instance.

In her study of how beauty is related to social discrimination and bias, sociologist Bonnie Berry estimates that 50% of Americans are "unhappy with their looks". Berry links this prevalence to mass media images. However, people have long been driven to painful, surgical measures to "correct" their facial features and body parts, even prior to the use of anaesthesia and discovery of antiseptic principles.

Some of the first recorded surgeries took place in 16th-century Britain and Europe. Tudor "barber-surgeons" treated facial injuries, which as medical historian Margaret Pelling explains, was crucial in a culture where damaged or ugly faces were seen to reflect a disfigured inner self.

With the pain and risks to life inherent in any kind of surgery at this time, cosmetic procedures were usually confined to severe and stigmatised disfigurements, such as the loss of a nose through trauma or epidemic syphilis.

The first pedicle flap grafts to fashion new noses were performed in 16th-century Europe. A section of skin would be cut from the forehead, folded down, and stitched, or would be harvested from the patient's arm.

Jean Baptiste Marc Bourgery and Nicholas Henri Jacob, 'Iconografia d'anatomia chirurgica e di medicina operatoria,' Florence, 1841.

A later representation of this procedure in Iconografia d'anatomia published in 1841, as reproduced in Richard Barnett's _ Crucial Interventions_, shows the patient with his raised arm still gruesomely attached to his face during the graft's healing period.

As socially crippling as facial disfigurements could be and as desperate as some individuals were to remedy them, purely cosmetic surgery did not become commonplace until operations were not excruciatingly painful and life threatening.

In 1846, what is frequently described as the first "painless" operation was performed by American dentist William Morton, who gave ether to a patient. The ether was administered via inhalation through either a handkerchief or bellows. Both of these were imprecise methods of delivery that could cause an overdose and kill the patient.

The removal of the second major impediment to cosmetic surgery occurred in the 1860s. English doctor Joseph Lister's model of aseptic, or sterile, surgery was taken up in France, Germany, Austria and Italy, reducing the chance of infection and death.

By the 1880s, with the further refinement of anaesthesia, cosmetic surgery became a relatively safe and painless prospect for healthy people who felt unattractive.

The Derma-Featural Co advertised its "treatments" for "humped, depressed, or… ill-shaped noses", protruding ears, and wrinkles ("the finger marks of Time") in the English magazine World of Dress in 1901.

A report from a 1908 court case involving the company shows that they continued to use skin harvested from - and attached to - the arm for rhinoplasties.

The report also refers to the non-surgical "paraffin wax" rhinoplasty, in which hot, liquid wax was injected into the nose and then "moulded by the operator into the desired shape". The wax could potentially migrate to other parts of the face and be disfiguring, or cause " paraffinomas" or wax cancers.

Advertisements for the likes of the Derma-Featural Co were rare in women's magazines around the turn of the 20th century. But there were frequently ads published for bogus devices promising to deliver dramatic face and body changes that might reasonably be expected only from surgical intervention.

Various models of chin and forehead straps, such as the patented "Ganesh" brand, were advertised as a means for removing double chins and wrinkles around the eyes.

Advertisement from World of Dress magazine, June 1905.

Bust reducers and hip and stomach reducers, such as the JZ Hygienic Beauty Belt, also promised non-surgical ways to reshape the body.

The frequency of these ads in popular magazines suggests that use of these devices was socially acceptable. In comparison, coloured cosmetics such as rouge and kohl eyeliner were rarely advertised. The ads for "powder and paint" that do exist often emphasised the product's "natural look" to avoid any negative association between cosmetics and artifice.

THE RACIALISED ORIGINS OF COSMETIC SURGERY

The most common cosmetic operations requested before the 20th century aimed to correct features such as ears, noses, and breasts classified as "ugly" because they weren't typical for "white" people.

At this time, racial science was concerned with "improving" the white race. In the United States, with its growing populations of Jewish and Irish immigrants and African Americans, "pug" noses, large noses and flat noses were signs of racial difference and therefore ugliness.

Sander L Gilman suggests that the "primitive" associations of non-white noses arose "because the too-flat nose came to be associated with the inherited syphilitic nose".

American otolaryngologist John Orlando Roe' s discovery of a method for performing rhinoplasties inside the nose, without leaving a tell-tale external scar, was a crucial development in the 1880s. As is the case today, patients wanted to be able to "pass" (in this case as "white") and for their surgery to be undetectable.

In 2015, 627,165 American women, or an astonishing 1 in 250, received breast implants. In the early years of cosmetic surgery, breasts were never made larger.

Breasts acted historically as a " racial sign". Small, rounded breasts were viewed as youthful and sexually controlled. Larger, pendulous breasts were regarded as "primitive" and therefore as a deformity.

In the age of the flapper, in the early 20th century, breast reductions were common. It was not until the 1950s that small breasts were transformed into a medical problem and seen to make women unhappy.

Shifting views about desirable breasts illustrate how beauty standards change across time and place. Beauty was once considered as God-given, natural or a sign of health or a person's good character.

When beauty began to be understood as located outside of each person and as capable of being changed, more women, in particular, tried to improve their appearance through beauty products, as they now increasingly turn to surgery.

As Elizabeth Haiken points out in _ Venus Envy_, 1921 not only marked the first meeting of an American association of plastic surgery specialists, but also the first Miss America pageant in Atlantic City. All of the finalists were white. The winner, sixteen-year-old Margaret Gorman, was short compared to today's towering models at five-feet-one-inch tall, and her breast measurement was smaller than that of her hips.

There is a close link between cosmetic surgical trends and the qualities we value as a culture, as well as shifting ideas about race, health, femininity, and ageing.

Last year was celebrated by some within the field as the 100th anniversary of modern cosmetic surgery. New Zealander Dr Harold Gillies has been championed for inventing the pedicle flap graft during World War I to reconstruct the faces of maimed soldiers. Yet as is well documented, primitive versions of this technique had been in use for centuries.

Such an inspiring story obscures the fact that modern cosmetic surgery was really born in the late 19th century and that it owes as much to syphilis and racism as to rebuilding the noses and jaws of war heroes.

The surgical fraternity - and it is a brotherhood, as more than 90% of cosmetic surgeons are male - conveniently places itself in a history that begins with reconstructing the faces and work prospects of the war wounded.

In reality, cosmetic surgeons are instruments of shifting whims about what is attractive. They have helped people to conceal or transform features that might make them stand out as once diseased, ethnically different, "primitive", too feminine, or too masculine.

The sheer risks that people have been willing to run in order to pass as "normal" or even to turn the "misfortune" of ugliness, as the homeliest girl contest put it, into beauty, shows how strongly people internalise ideas about what is beautiful.

Looking back at the ugly history of cosmetic surgery should give us the impetus to more fully consider how our own beauty norms are shaped by prejudices including racism and sexism.

Michelle Smith is a research fellow in English literature, Deakin University.


People have freedom of expression. .

Yes because…

A legal argument can be made for cosmetic surgery. Under the Human Rights Act which enshrines the European Convention on Human Rights, we have the freedom to express ourselves, Article 10 ECHR. If we feel that our body does not reflect who we are as people, then we have the right to change it. If we can dye our hair, change our clothes and have piercings, why should we not be able to express ourselves via cosmetic surgery. Now, this right would not extend to NHS payment for the cosmetic surgery, but if someone can afford to spend money on their own appearance, there is no reason why they should not be able to, and there is a legal reason why they should be able to

No because…

It is laughable to think that having larger breasts or lips can be classified as the use of ‘freedom of expression’. How low has our society gone if we think the most valuable use of our right to freedom of expression is the right to have cosmetic surgery and dye our hair? The availability of cosmetic surgery and the making it more acceptable only lets the idea infiltrate society that it is ok to want physical perfection, and that appearance is important. Surely we would want our young to grow up with higher hopes and aspirations.


Unsettling Images of Patients in Hiding After Plastic Surgery (NSFW)

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Western ideals are, for better or worse, infecting the world. From automobiles to iPhones to, well, breasts. In South Korea, plastic surgery is rampant, and the goal is often to look less Asian. While there are plenty of photos of the final results, artist Ji Yeo balances the visual scales by documenting the ugly side of becoming "beautiful."

Yeo found the subjects for her plastic surgery post-op photos by scouring the internet. She offered to help women located in Seoul recuperate in exchange for permission to photograph the process. Her goal was to explore her own feelings around body modification.

"All of them were in pain, they were super uncomfortable, but I could really feel their excitement," says Yeo.

Her photos deliver a skin-crawling cringe, as when a friend describes how he got that scar. Far from being clinical, the images create a fast intimacy, in part because Yeo identifies with her subjects. "I'm at the center of it emotionally. I'm constantly worried about my appearance," she says.

One of Yeo's subjects underwent a chin reduction and full-body liposuction in one session. Three weeks before that she had breast enlargement surgery, and three weeks prior to that, eye widening and a nose job. In all, this woman had more than 16 surgeries over six months.

Yeo says that of the women she met while shooting Beauty Recovery Room, "This is very typical. It's not extreme at all."

For Yeo, 29, the consequences of cosmetic procedures had a personal draw. "I was going to get heavy plastic surgery, like my entire body," she says. "After consultation and consultation, I realized that I hadn't been exposed to the procedure. No one really explained what the side-effects would be, or that going under anesthesia -- I might die."

Rather than hurry into surgery, Yeo decided to investigate the process through her photography. She found that the body-conscious culture of South Korea, and its highly developed plastic surgery industry, was an ideal setting for capturing the "After" photos that no clinic would advertise.

"Finding people willing to stand in front of the camera after the procedure was the toughest thing," says Yeo.

To locate subjects willing to be shot after going under the knife, Yeo avoided contacting clinics, assuming the scrutiny would not be welcome. Instead, she posted advertisements in a then-respected online forum. The forum maintained blacklists of clinics to avoid, and users shared before and after photos, and wrote reviews of clinics and staff.

As is common elsewhere, those recovering from surgery in Seoul sought out privacy while their bodies healed. "They had no friends or family around them," says Yeo. At least one woman Yeo met was attempting to hide her procedure from their significant other.

So, Yeo made a deal with her subjects: "I will wait for you when you come out of surgery." More than this, she helped them to recuperate in the difficult first days after their painful procedures.

"I bought prescriptions, I cooked soup for them, I drove them to the hotel, and drove them to the clinic for post-ops. I let one subject stay at my apartment for a week," she says.

In exchange, they agreed to be photographed. "Even though they were hiding to get healed, they were still excited and confident in front of the cameras," says Yeo.

Most of Yeo's subjects were not wealthy, but rather, highly motivated. One woman took out a loan from the bank for breast enlargement surgery, only to find she had an underlying condition that precluded it in the short-term. Instead of postponing the surgery or paying back the loan, she had a nose job and had her chin narrowed.

"It was surprising at the moment, but now I understand it's about getting plastic surgery, not how or where," says Yeo.

This kind of pressure toward perfection is not new to Yeo, who as a college sophomore found that the darkroom offered a welcome arena where mistakes were allowed, and often rewarded. "In my life, mistakes weren't allowed -- I had to always be perfect," she says.

Yeo says that like America, the media in Korea encourages people to aspire to a Western -- specifically American -- ideal of beauty. This dynamic extends to other aspects of life as well. Corporate jobs often favor candidates who have studied abroad in the U.S., something Yeo herself has done at the International Center of Photography in New York and the Rhode Island School of Design.

While this education gave her broad perspective on how American and Korean culture treat bodies and appearance, her own issues around body image have persisted. In a previous work, Yeo took portraits of friendly acquaintances from an eating disorder support group she attended weekly over a two-year period in college. After striking up tentative friendships with some of the women in her group, she invited them to interview and be photographed at their homes in varying states of undress.

At first, they were reluctant, and even offended. "They would cancel at least four times at the last minute with some excuse," says Yeo. Eventually, however, she would receive a call. They were so exasperated with worrying about their bodies and struggling with food that they wanted to be photographed. Did it help? "Maybe for the short-term, but for the long-term . probably not," says Yeo.

Yeo has also used her own form for her experiments in body-image catharsis. At a Brooklyn riverbank one afternoon in college, she wore a body suit and stood next to a sign inviting people to draw on her body, indicating where she should get surgery. "Not many people wanted to participate. I was there for over two and a half hours. People were watching me and taking photos with their phone. I felt like a monkey in a zoo," says Yeo.

Those that did participate offered positive affirmation rather than criticism, and before long the markings deviated from any discussion of her body. "It became like a whiteboard," says Yeo.

As for her Beauty Recovery Room subjects, Yeo has found keeping in touch difficult. "Most of them didn't reply to my text messages or phone calls after three to six months. It's like they don't want to remember, and they're living their new life with new features," Yeo says.

The "independent" forum she used to reach out to her subjects has since been discredited, the owner revealed to have been receiving money to post fake before and after photos and fake reviews.

"It's been a little over a year since I finished this project. These days it's a totally different scene. It's become way more extreme," says Yeo.

For one thing, the clinics have become practically palatial, with luxuries such as entertainment centers. For another, seeing someone who's undergone today's popular procedures, "You don't realize their face is Asian," says Yeo. "This is my new project."


State Hie Resources

Clearly, looks matter more to us than we would like to admit. We are already inculcated in childhood stories, in which, with Shrek’s permission, the witch is old and ugly, and the prince or princess young and beautiful. And we drag it along as we grow in the personal and work fields. How do you explain why the most attractive candidates get jobs more frequently than others who are perhaps more competent but less physically attractive?

No magic mirrors

The cult of beauty is not something new. The difference is that today there is a wide range of techniques to apply to countless parts of the human body. The plastic surgery is congenital anomalies and those arising from injury and illness. The aesthetic deals with natural (breast “too small” …) and signs of aging (crow’s feet, sagging arms …). The search for ways to stay beautiful has its own wrinkles.

In the Middle Ages, cosmetic surgery became a practice punished even with death.

Already in Pharaonic Egypt, surgeons were concerned with the aesthetic results of their interventions. Edwin Smith’s surgical papyrus (c. 1600 B.C.) details how facial wounds were sutured with animal tendons, or a fractured nose was repositioned with the aid of “two linen plugs saturated with fat,” which were inserted into the holes nasal. Another papyrus that of Ebers (c. 1550 BC) describes dermabrasion, smoothing of wrinkles and scars, with pumice.

In the 1st century Rome, Pliny, the Elder spoke of rudimentary liposuction as the “heroic cure for obesity” of the son of the consul Lucio Apronio. Six centuries later, the Byzantine physician Pablo de Egina devised a system to remove the breasts from men who had gynecomastia, a pathological enlargement of the mammary glands. The cases continued until the Middle Ages when cosmetic surgery became a practice punished even with death.

Not surprisingly, the Catholic Church considered that beauty dragged men into the arms of the devil. It was not until the end of the 15th century and throughout the following century when several syphilis epidemics swept Europe when the techniques of the so-called decorative chirurgy were developed.&hellip

The Stigma Of The Nose

Syphilis, a disease imported from the New Continent, not only wreaked havoc on the population. It also embarrassed those who suffered from it by deforming their noses. A large number of those affected looked in the decorative chirurgy for a remedy to go unnoticed in society.

In his treatise De curtorum chirurgia per insitionem (1597), he documented and illustrated for the first time an intervention to repair a nose lost due to a blow or syphilis. His method, based on skin flap grafts from the inside of the arm, lasted for centuries.

At that time, surgery was a profession of risk. Many of the patients died during the intervention, from complications or pain, and not a few specialists suffered attacks by the operated on, who had been even more disfigured. Tagliacozzi suffered worse luck: he was hunted down and ordered to be executed by the Italian Inquisition.

The rhinoplasty (nose job) charge boom in India, following the custom in this country to cut nose thieves, deserters, and adulterous women. At the end of the 18th century, the West became aware of the different rhinoplastic techniques that were applied there thanks to the descriptions of English surgeons residing in the future British colony.

Goodbye to impossible

The appearance of anesthesia, in 1844, and antisepsis, in 1867, marked a turning point in the history of cosmetic surgery, favoring operations out of desire rather than necessity. This was the case with the mutilated from the First World War. Until then, surgeons had been solely dedicated to rebuilding riddled and deformed body parts. Now they also took into account the aesthetic criteria to minimize the serious psychological consequences of the soldiers.

The number of war-wounded was so high that surgeons had to improvise new techniques in full operation. Those professionals gave surgery an unprecedented boost. Soon specialized centers were opened in Europe and the United States, where the architects of many of the techniques that we use today worked.

The extremely close-up shot, popularized in the twenties of the last century, mercilessly revealed any flaws.

This is the case of Hippolyte Morestin, director of the Parisian Val-de-Grâce hospital, the world’s first oral and maxillofacial surgery center. Morestin tried cartilage grafting there as a treatment for deformations on faces.

The relentless camera

Hollywood stars were the first to benefit from the insights gained during the Great War. The extremely close-up shot, popularized in the twenties of the last century, mercilessly revealed any imperfections on the faces of actors and actresses. Hence, Greta Garbo straightened her teeth, Marlene Dietrich had her nose operated, and Rita Hayworth raised her hairline a couple of centimeters. The relentless camera

Hollywood stars were the first to benefit from the insights gained during the Great War. The extremely close-up shot, popularized in the twenties of the last century, mercilessly revealed any imperfections on the faces of actors and actresses. Hence, Greta Garbo straightened her teeth, Marlene Dietrich had her nose operated, and Rita Hayworth raised her hairline a couple of centimeters.

Cosmetic surgery also opened horizons for those who wanted to change sex. In 1920, Berlin doctors Ludwig Levy-Lenz and Felix Abraham completely transformed male genitalia into female-looking ones.&hellip

The Modern History Of Cosmetic Surgery

The birth of plastic surgery is linked to that of conventional surgery. The ancient Egyptians already treated nasal injuries with very sophisticated techniques that we know thanks to the description that some hieroglyphic texts of 4000 years ago make of them. To this day, the Erbes papyrus, dated to 1500 BC, is considered the oldest medical text in history, for whose translation it was necessary to consult the Rosetta stone.

We will have to wait for the Hindu text of Sushruta Shamita, dated in 500 a. C., to know the ins and outs of nose interventions. Its author, Sushruta, was the forerunner of the flap as a method in nasal reconstruction, a flap made by koomas or potters with skin from the forehead.

During the Middle Ages, surgery, far from advancing, regressed. Innocent III himself came to prohibit surgical operations in the 13th century. During this period of history, it was the Arabs who had the best knowledge of medicine and surgery. The Church did not consider this type of intervention worthy of doctors, who avoided contact with the sick, relegating their care to the barbers, considered then minor surgeons, since they were the ones who healed wounds and practiced the famous bloodletting methods effective to heal any evil.

Renaissance humanism was a moment of splendor that was noted not only in art but also in science and medicine. In the 16th century, Gasparo Tagliacozzi, professor of surgery and anatomy at the Archiginnasio in Bologna, wrote a treatise on nasal reconstruction, surgery to which many patients suffering from syphilis were advocated. This Italian surgeon pioneered cosmetic surgery, in whose book De curtorem chirurgia per insitionem , advocate for the use of forearm skin for nose surgery, developing what has come to be called the “Italian method of nasal reconstruction.” Despite everything, the Church did not look favorably on his work, becoming buried in unconsecrated soil as a method of punishment.

In the 18th century, through the English East India Company, we had the details of a nasal reconstruction performed on a Hindu soldier at the service of the English crown with the Sushruta method, a method that spread throughout the old continent, reaching across the Atlantic.

Despite the fact that Von Graefe was the pioneer in using the term plastic for this type of intervention, as reflected in his work Rhinoplastik, it was the German surgeon Edmund Zeis who extended its use. His book, Handbuch der plastischen Chirurgie , published in 1838, is a benchmark in the study of plastic surgery.

Advances in the field of anesthesia by Crawford Williamson Long, Horace Wells, James Simpson, and Jonh Snow, join Dupuytren’s experiments in the field of palmar burns and fibromatosis. Back then, the English surgeon and professor of Comparative Anatomy, Astley Cooper, made what is considered the first skin graft.


The ugly history of cosmetic surgery

Reality television shows based on surgical transformations, such as The Swan and Extreme Makeover, were not the first public spectacles to offer women the ability to compete for the chance to be beautiful.

In 1924, a competition ad in the New York Daily Mirror asked the affronting question “Who is the homeliest girl in New York?” It promised the unfortunate winner that a plastic surgeon would “make a beauty of her”. Entrants were reassured that they would be spared embarrassment, as the paper’s art department would paint “masks” on their photographs when they were published.

Cosmetic surgery instinctively seems like a modern phenomenon. Yet it has a much longer and more complicated history than most people likely imagine. Its origins lie in part in the correction of syphilitic deformities and racialised ideas about “healthy” and acceptable facial features as much as any purely aesthetic ideas about symmetry, for instance.

In her study of how beauty is related to social discrimination and bias, sociologist Bonnie Berry estimates that 50% of Americans are “unhappy with their looks”. Berry links this prevalence to mass media images. However, people have long been driven to painful, surgical measures to “correct” their facial features and body parts, even prior to the use of anaesthesia and discovery of antiseptic principles.

Some of the first recorded surgeries took place in 16th-century Britain and Europe. Tudor “barber-surgeons” treated facial injuries, which as medical historian Margaret Pellingexplains, was crucial in a culture where damaged or ugly faces were seen to reflect a disfigured inner self.

With the pain and risks to life inherent in any kind of surgery at this time, cosmetic procedures were usually confined to severe and stigmatised disfigurements, such as the loss of a nose through trauma or epidemic syphilis.

The first pedicle flap grafts to fashion new noses were performed in 16th-century Europe. A section of skin would be cut from the forehead, folded down and stitched, or would be harvested from the patient’s arm.

A later representation of this procedure in Iconografia d’anatomia published in 1841, as reproduced in Richard Barnett’s Crucial Interventions, shows the patient with his raised arm still gruesomely attached to his face during the graft’s healing period.

As socially crippling as facial disfigurements could be and as desperate as some individuals were to remedy them, purely cosmetic surgery did not become commonplace until operations were not excruciatingly painful and life-threatening.

In 1846, what is frequently described as the first “painless” operation was performed by American dentist William Morton, who gave ether to a patient. The ether was administered via inhalation through either a handkerchief or bellows. Both of these were imprecise methods of delivery that could cause an overdose and kill the patient.

The removal of the second major impediment to cosmetic surgery occurred in the 1860s. English doctor Joseph Lister’s model of aseptic, or sterile, surgery was taken up in France, Germany, Austria and Italy, reducing the chance of infection and death.

By the 1880s, with the further refinement of anaesthesia, cosmetic surgery became a relatively safe and painless prospect for healthy people who felt unattractive.

The Derma-Featural Co advertised its “treatments” for “humped, depressed or … ill-shaped noses”, protruding ears, and wrinkles (“the finger marks of Time”) in the English magazine World of Dress in 1901.

A report from a 1908 court case involving the company shows that they continued to use skin harvested from – and attached to – the arm for rhinoplasties.

The report also refers to the non-surgical “paraffin wax” rhinoplasty, in which hot, liquid wax was injected into the nose and then “moulded by the operator into the desired shape”. The wax could potentially migrate to other parts of the face and be disfiguring, or cause “paraffinomas” or wax cancers.

Advertisements for the likes of the the Derma-Featural Co were rare in women’s magazines around the turn of the 20th century. But ads were frequently published for bogus devices promising to deliver dramatic face and body changes that might reasonably be expected only from surgical intervention.

Various models of chin and forehead straps, such as the patented “Ganesh” brand, were advertised as a means for removing double chins and wrinkles around the eyes.

Bust reducers and hip and stomach reducers, such as the J.Z. Hygienic Beauty Belt, also promised non-surgical ways to reshape the body.

The frequency of these ads in popular magazines suggests that use of these devices was socially acceptable. In comparison, coloured cosmetics such as rouge and kohl eyeliner were rarely advertised. The ads for “powder and paint” that do exist often emphasised the product’s “natural look” to avoid any negative association between cosmetics and artifice.

The racialised origins of cosmetic surgery

The most common cosmetic operations requested before the 20th century aimed to correct features such as ears, noses and breasts classified as “ugly” because they weren’t typical for “white” people.

At this time, racial science was concerned with “improving” the white race. In the United States, with its growing populations of Jewish and Irish immigrants and African Americans, “pug” noses, large noses and flat noses were signs of racial difference and therefore ugliness.

Sander L. Gilman suggests that the “primitive” associations of non-white noses arose “because the too-flat nose came to be associated with the inherited syphilitic nose”.

American otolaryngologist John Orlando Roe’s discovery of a method for performing rhinoplasties inside the nose, without leaving a tell-tale external scar, was a crucial development in the 1880s. As is the case today, patients wanted to be able to “pass” (in this case as “white”) and for their surgery to be undetectable.

In 2015, 627,165 American women, or an astonishing one in 250, received breast implants. In the early years of cosmetic surgery, breasts were never made larger.

Breasts acted historically as a “racial sign”. Small, rounded breasts were viewed as youthful and sexually controlled. Larger, pendulous breasts were regarded as “primitive” and therefore as a deformity.

In the age of the flapper, in the early 20th century, breast reductions were common. Not until the 1950s were small breasts transformed into a medical problem and seen to make women unhappy.

Shifting views about desirable breasts illustrate how beauty standards change across time and place. Beauty was once considered as God-given, natural or a sign of health or a person’s good character.

When beauty began to be understood as located outside of each person and as capable of being changed, more women, in particular, tried to improve their appearance through beauty products, as they now increasingly turn to surgery.

As Elizabeth Haiken points out in Venus Envy, 1921 not only marked the first meeting of an American association of plastic surgery specialists, but also the first Miss America pageant in Atlantic City. All of the finalists were white. The winner, 16-year-old Margaret Gorman, was short compared to today’s towering models at five-feet-one-inch (155cm) tall, and her breast measurement was smaller than that of her hips.

There is a close link between cosmetic surgical trends and the qualities we value as a culture, as well as shifting ideas about race, health, femininity and ageing.

Last year was celebrated by some within the field as the 100th anniversary of modern cosmetic surgery. New Zealander Dr Harold Gillies has been championed for inventing the pedicle flap graft during the first world war to reconstruct the faces of maimed soldiers. Yet, as is well documented, primitive versions of this technique had been in use for centuries.

Such an inspiring story obscures the fact that modern cosmetic surgery was really born in the late 19th century and that it owes as much to syphilis and racism as to rebuilding the noses and jaws of war heroes.

The surgical fraternity – and it is a brotherhood, as more than 90% of cosmetic surgeons are male— conveniently places itself in a history that begins with reconstructing the faces and work prospects of the war wounded.

In reality, cosmetic surgeons are instruments of shifting whims about what is attractive. They have helped people to conceal or transform features that might make them stand out as once diseased, ethnically different, “primitive”, too feminine, or too masculine.

The sheer risks that people have been willing to run in order to pass as “normal” or even to turn the “misfortune” of ugliness, as the homeliest girl contest put it, into beauty, shows how strongly people internalise ideas about what is beautiful.

Looking back at the ugly history of cosmetic surgery should give us the impetus to more fully consider how our own beauty norms are shaped by prejudices including racism and sexism.

Written by Michelle Smith. Republished with permission of The Conversation.


Courteney Cox realized fillers weren't her friends

Courteney Cox opened up about the work she has had done and what she really feels about it now. On a 2016 episode of Running Wild with Bear Grylls (via Us Weekly), Cox said, "I think there's a pressure to maintain [your looks], not just because of fame, but just, you know, being a woman in this business. Getting older has not been . I don't think it's the easiest thing. I think I was trying to keep up with getting older, trying to chase that . it's something you can't keep up with."

Cox added, "I have done things that I regret, and luckily they're things that dissolve and go away. So, um, that's good, because it's not always been my best look."

In a 2017 interview with New Beauty, Cox spoke about her relationship with plastic surgery and how she didn't stop until a friend told her it was too much. Cox shared, "I've had all my fillers dissolved. I'm as natural as I can be. I feel better because I look like myself. I think that I now look more like the person that I was. I hope I do."

She continued, "Things are going to change. Everything's going to drop. I was trying to make it not drop, but that made me look fake. You need movement in your face, especially if you have thin skin like I do. Those aren't wrinkles—they're smile lines."


Botched Before & After: See the Show's Most Shocking Transformations

For six seasons now, the Botched docs have continually shocked both their patients and those tuning in at home by performing the most complicated of procedures—all to correct former failed surgeries—and delivering stunning transformations. Oftentimes, thanks to the plastic surgery experts, you can't even tell what went wrong with a patient's initial operation!

For the last six seasons, Botched has been packed with "stories that you think would never happen."

"We decided this season to take on those patients that normally we would pass on, that weren't considered fixable," Heather Dubrow's husband told E!'s Justin Sylvester on Daily Pop before season six. "But because we've been doing this for so long, we have sort of special operations and special skills for these incredibly difficult cases."

So far, the docs have certainly delivered.

In past episodes from this season, the two have done everything from correct a breast augmentation performed by a dentist to help a woman with "dead person" breasts! And last season, Terry even invented his own surgical technique to help a patient's botched boobs!


Breast implants: the first 50 years

I t was in 1962 that Timmie Jean Lindsey was offered a solution to a non-existent problem. A factory worker from Texas, she had married at 15, had six children, divorced in her mid-20s, and taken up with a man who encouraged her to have a vine tattooed on her cleavage. Roses tumbled across her breasts. When the relationship faltered, Lindsey decided she wanted the tattoos removed. "I was ashamed," she says, "and I needed them taken off." Her low-paid work made her eligible for treatment at a charity hospital, where she was told the tattoo could be removed through dermabrasion. And the doctors had another proposal. Had she ever thought about breast implants?

Lindsey had not. She'd never felt self-conscious about her breasts – and even if she had, the options at that time were primitive and problematic, involving substances injected directly into women's chests, or implants made of sponge. "The only person I'd ever talked to about breast implants was my cousin," says Lindsey, "who had had some kind of surgery. She said: 'Sometimes I wake up and my breast has moved to another part of my body,' and I thought: 'My God. I never want that.' It wasn't long after she and I talked that I came into contact with these doctors."

The team was led by Dr Thomas Cronin, who had been developing the world's first silicone breast implants. Thomas Biggs, then 29, and a surgical resident under Cronin, says the idea came about when one of his colleagues, Frank Gerow, went to the blood bank. "They'd stopped putting liquids in glass bottles, and begun putting them into plastic bags," says Biggs, "and he was walking in the hall with this bag of blood, and felt that it had the softness of a breast." Around the same time, Cronin travelled "to New Orleans to a plastic surgery meeting and encountered a former resident of his. This fellow told him there was a company who had a new product which was interesting because it had very little body reaction, and could be made into a variety of thicknesses, a variety of viscosities, all the way from liquid to solid. If you can make a solid, you can make a bag – and if you can make a liquid, you can make something that goes in it."

Cronin had the idea for a breast implant. A prototype was created, and implanted into a dog called Esmeralda. "That worked OK," says Biggs, "and so then they got to Timmie Lindsey." After spending some time with the doctors, she says, "they asked me if I wanted implants, and I said: 'Well, I don't really know.' The only thing I'd ever thought about changing was my ears. I told them I'd rather have my ears fixed than to have new breasts, and they said, well, they'd fix that too. So I said, OK. When they put the implants in they said: 'Do you want to see them?' and I said: 'No, I don't want to look at it. You put it in me, and it'll be out of sight, out of mind. My theory was that if you think you've got something foreign inside you you're just going to worry about it." She's 80 today, still living in Texas, working night shifts in a care home, and those first, experimental globes remain in her chest.

The 50-year history of breast implants had begun, a history of controversy and success. What no one knew back then was just how phenomenally popular breast augmentation surgery would become – the last available figures from the American Society for Aesthetic Plastic Surgery show it was the most popular form of cosmetic surgery in the US in 2010, with 318,123 augmentations performed. It is also the most popular cosmetic operation in the UK. While there are no overall figures for cosmetic surgery here, those collected by the British Association of Aesthetic Plastic Surgeons (BAAPS), which represent around a third of the market, show 9,418 women had breast augmentation in 2010, a rise of more than 10% from the previous year.

It's estimated between 5 and 10 million women worldwide have had the surgery, many for cosmetic reasons, and a significant proportion for reconstruction following a mastectomy, or for transsexual people transitioning from male to female. But concern around them has never abated, with the most recent row being one of the most disturbing, and vexed. In 2010, after concerns about ruptures in implants made by French company Poly Implant Prosthesis (PIP), it emerged the company had been filling them not with the medical-grade silicone that had won them a CE mark, and the right to sell them in Europe – but industrial-grade silicone, otherwise used to make mattresses. In December last year it was reported that the faulty implants had been tentatively linked to cancer in France. Eight women whose PIP implants had failed had had the disease, including one who suffered a rare form of lymphoma and died. Street protests began in France, the French state health service said it would pay to remove the implants, and similar calls began here. Last week, the health secretary Andrew Lansley said free removal, but not replacement, would be offered for women who had the surgery on the health service (most of them mastectomy patients), and suggested that private clinics had the moral duty to do the same.

Some clinics are refusing to replace the implants free of charge, and Catherine Kydd, who discovered her PIP implants had ruptured in 2009, has set up a Facebook page for those affected she's outraged the NHS isn't carrying out a full programme of removals and replacements for all the women involved. Her initial breast implant operation was carried out by a private clinic in 2004, after she started feeling self-conscious about her breasts, following the birth of her two children.

In September 2009, Kydd found a lump in her breast. There is a history of breast cancer in her family, and her GP sent her off to have ultrasound. "This showed I didn't have breast cancer," she says, "but my left implant had ruptured, and the silicone had travelled to the lymph nodes in my left armpit." She was one month outside her five-year implant guarantee, and her clinic initially said she would have to pay £6,500 to have the implants removed and replaced. Finally, after much back and forth, they agreed to remove them for free in July 2010.

They were replaced with another brand of implants. "I'm lucky I've had the implants removed, but I have that industrial-grade silicone in my body now, and I don't know whether it's travelled further than my lymph nodes. I've got burning in my arm, in my armpit, every day."

Kydd wishes she had never had implants, and her story raises a familiar question. Why do women risk it? Of all the areas of the body that could be modified, or augmented, why are the breasts the focus of such an enormous proportion of cosmetic surgeries? As the PIP story has unfolded, some have commented that they can understand why mastectomy patients might want the operation, but not women who have it solely for cosmetic reasons. This seems slightly disingenuous. Because if it is, of course, understandable that someone might want a breast that had been removed to be reconstructed, it's surely not such an enormous leap to imagine why someone with very small breasts might want the operation too. Still, the numbers remain astonishing, a testament to discomfort and self-loathing, to a culture that has come to see bodies – especially women's bodies – as endlessly open to modification. The fact that the rise of breast implant surgery has taken place in tandem with the rise of second-wave feminism, only makes this more perplexing.

It's also interesting to consider why the US and UK hold large breasts in such thrall. Because while breast implant surgery is popular in many countries, figures released by the International Society of Aesthetic Plastic Surgeons (ISAPS) show it's proportionately far less popular in China, Japan and India, for instance, where lipoplasty (fat removal), rhinoplasty (nose augmentation) and blepharoplasty (modification of the eyelid) are all much more common surgeries. (The ISAPS figures should be approached with some caution – 20,000 plastic surgeons were asked to participate in the study, and there were 698 replies by the deadline – but they provide a useful general overview.) And even in countries where breast implants are very popular, the overall aesthetic is often different. In Brazil, for instance, there's often a strong focus on the buttocks as well, while some suggest that French women prefer a smaller breast.

Douglas McGeorge, a plastic and reconstructive surgeon, and past president of BAAPS, says there are two groups of women who tend to opt for the procedure. "Those born with small breasts, unhappy with the size, and wanting them to be made bigger, who tend to come in in their late teens and early 20s. Then there are the people who have had babies. Their breasts have got bigger, and now, with pregnancy, they've just emptied, and they're left with a skin envelope, and are wanting something to fill it." All women should be properly counselled before the procedure, he says, but "some of the clinics have counsellors, in inverted commas, who see them, and they're essentially sales people . The counselling process is very important, because [women] should understand the limitations of surgery, and indeed the potential complications."

These complications include capsular contracture, which involves scar tissue forming around the implant, squeezing it into a sphere, and causing hardness in the breast. Lindsey experienced this, as have thousands of women since. "When you cut the skin there's also always a small risk of wound infection," McGeorge continues, "and infection around an implant is a problem, because if you have bugs there, you actually have to remove it in order to treat the infection, allow everything to settle, let the scar soften up, and the implant can't go back in until a number of months afterwards. It's important to discuss infection, because obviously you can get oozing, a collection of blood, a haematoma. There is also a chance of interfering with the nipple sensation, which is usually only temporary."

Many breast augmentation doctors are male, but it's too simple to suggest it's just an operation imposed on women by men. The writer Teresa Riordan, former patents columnist for the New York Times, and author of the book Inventing Beauty, analysed the beauty industry between the mid-19th and mid-20th centuries, "and it was just phenomenal the different contraptions women had used to augment their breasts. I was astounded, because I thought it would be mostly men who had invented these breast augmentations, but actually it was mostly women." She uncovered a 19th-century book called The Ugly-Girl Papers, "which basically advised just rubbing your breasts very harshly with an abrasive towel to pump them up". There were suction devices, and a wire device used to create a bird cage effect around the breasts.

Dangerous substances had been injected into women's chests, "since probably the 1890s," says Riordan. These included paraffin and animal fat, and after the second world war silicone started being injected directly into the breasts of Japanese women, to try to meet a western ideal. The silicone gel implant was clearly a step up, and in the early 1960s, Cronin and Gerow mused on why women might desire it. "Perhaps this is due in large measure to the tremendous amount of publicity which has been given to movie actresses blessed with generous-sized breasts," they wrote. "Many women with limited development of the breasts are extremely sensitive about it, apparently feeling that they are less womanly, and therefore, less attractive. While most such women are satisfied, or at least put up with 'falsies', probably all of them would be happier if, somehow, they could have a pleasing enlargement from within."

Women who have had breast implants are often perfectly open and analytical about the cultural pressures that led them to it. Michell Anne Kimball, president of the San Diego County Equestrian Foundation, had breast implants four years ago, aged 44, when nearing the end of her horse-training career. She lives in southern California, where the western body ideal is especially prized, "and there's a lot of pressure not to age", she says. "Ageing gracefully is a lost concept for us . Advertising is detrimental, and I look at lingerie ads, and they're selling sex, and they're selling this to men, they're not selling it to women. They're creating a situation in which women behave in ways that they otherwise wouldn't." She's athletic, she says, and knows she shouldn't "have these feelings about my body", but is very glad she had the operation.

Virginia L Blum, English professor at the University of Kentucky, and author of Flesh Wounds, a study of cosmetic surgery, says breast implants have become normalised in the past few decades. "I was watching an actress on screen the other day, and it was clear she had breast implants, and I thought, well, actually, I see that all the time. It's unnatural-looking, but it has become natural to see it. It's part of our aesthetic landscape. I think it's now considered not extreme, but rather routine maintenance . saggy breasts are no longer considered an inevitable result of childbirth, but rather experienced as a deficit."

Ninety per cent of all cosmetic surgery operations are performed on women, and Blum thinks this is because "women continue to experience their body as more mutable. I think women are raised around a fashion magazine culture in which we realise we can work on different body parts – we can divide and conquer. Plastic surgery approaches the body in much the same way that women are trained from girlhood to approach their bodies. Male bodies are not quite as available to that model, although I think they are becoming increasingly so".

Blum sees surgery as being related to consumption. "You've consumed this body transformation, and you have a really great feeling, and you want to sustain that feeling. That's the thing with surgery: once you're in it, you're in it. You either have a bad result, and have to re-do the surgery because the result was insufficient, or the result was really great, and you want to reproduce that intoxicated feeling".

Jennifer Hayashi Danns, a former lap dancer who has written about the industry, says there was constant discussion about breast implants. Photograph: Frank Baron for the Guardian

The writer Jennifer Hayashi Danns, author of Stripped, also sees breast implants as an operation keenly related to materialism. Now 28, Danns worked in a lap-dancing club in her early 20s, where there was constant discussion of breast implants – it sounds like a much heightened version of everyday British pop culture, with our ubiquitous breast implant advertisements, bared breasts in newspapers and on magazine covers, women with breast implants filling the casts of reality TV shows, as well as easily available pornography. Danns felt confident about her body when she started at the club, but after eight months she had implants to increase from a C cup to a DD. She regrets the operation now, but at the time there was a feeling of "instant gratification" she says. "It wasn't a question of profound, long-term happiness. It felt like getting a new car, or a new bag."

Danns and I talk about why the implanted aesthetic is so popular. It can't simply be that people fetishise breasts because they're so often covered. In that case, any size or shape would be appreciated. Could it be that, subliminally, it's because men are attracted to women who look like they're nursing, who look supremely fertile? "But if you go down that biological route," says Danns, "we'd also celebrate big, child-bearing hips. And they're a big no-no. It's just a fixation with the breasts. Also, if it was an association with breast milk, then why wouldn't all women be attracted to breast implants too? Women are breastfed as well."

In fact, the aesthetic doesn't seem to be about the functional breast at all. The implanted breast is obviously sexual, but has often lost some, if not all, sexual sensation. It represents fertility, but can interfere with breastfeeding. Kimball sees it as an image of health, which is also often the case for women who have had mastectomies, whose breast implants allow them to look in the mirror without seeing their surgical scars, without being reminded of a horrible disease. But unfortunately the implanted breast isn't exactly synonymous with health. The function of the breast that's enhanced for cosmetic reasons is its sexual display. The implanted breast represents a "perfect, unused breast", says Marilyn Yalom, author of A History of the Breast, "and I say unused, because they're not there for nursing. And that attitude goes back at least to the Renaissance, where you have men not wanting their wives to breastfeed, because the breasts will be used by the babies, they'll change their shape, and so wet nurses come in. There have been times and places, historically, where it was uncommon for women of a certain class to breastfeed."

The popularity of cosmetic breast implants also reflects just how utterly in thrall we are, as a culture, to gender distinctions. The breasts are the biggest physical sign we have of difference, and perhaps, at base, that's why they're so enormously popular. "It's an external symbol of a woman's gender, and we need and want that affirmation," says Biggs. He has been involved in more than 8,000 breast implant operations during the course of his career, and says he "began to realise the magnitude of the importance of the breast to a woman, and to how she feels about herself. So people can make jokes that the breast implants are done to attract men, or maybe to make other women envious. And there may be some minimal elements of truth there. But the real truth is that it helps her confirm to herself her own gender." Biggs and I talk through some of the complications he has seen during his career – of the 11 women who were implanted at the same time as Lindsey, "all were successful, but they all had troubles, and problems" – and I ask whether the experimental nature of what he was doing, in inserting sacks of silicone into women, ever worried him "Oh no," he says. "I'm not a worrier."



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