Illusions, scalpels and stereotypes - race identity and plastic surgery's gift of invisibility

UNESCO Courier, July, 2001 by Sander L. Gilman

By sculpting a chin or enlarging a breast, aesthetic surgeons appear to be operating on the body. But we know better: they are reshaping our fantasies of ourselves

Must You live with the body you are born with or can you remake it? We have long been confronting this question. Whether it be the removal of body parts in religious practices (such as circumcision), the surgeon's ability to sculpt a chin or the promise of geneticists to alter and improve bodies of the future.

This is the promise of innate malleability that we increasingly take as a given in our world, whether in Venezuela, South Africa or Hollywood. And nowhere is this desire for transformation more clearly seen than in aesthetic surgery.

In the west and beyond, we believe that we have the right not only to remake our bodies, but to control the process. Indeed the patients of aesthetic surgery are the ideal patients of modern medical systems. They are exemplars of autonomy, who question their doctors to explore their treatment options. Breast implants, facelifts and tummy tucks were not pushed upon people by the medical profession or industry. Virtually every procedure in cosmetic surgery has been in response to popular demand.

This desire for individual transformation is a distinctly western notion. It stems back to the Enlightenment ideology (beginning in the 17th century) that each individual could remake him or herself in the pursuit of happiness. Indeed, it is remarkable how often aesthetic surgeons cite "happiness" as the goal of their procedures. They have a utilitarian notion like that espoused by John Stuart Mill (1806-73): the active citizen, working for progress, is a happy one.

This idea took on biological dimensions once surgeons were able to reduce their patients' pain and risk of infection. The anesthesia and antisepsis originally developed by military doctors to heal battle wounds were quickly picked up by surgeons seeking to correct their patients' birth defects and then fulfill their desires. "Happiness" in aesthetic surgery lay in the individual's autonomy to transform him- or herself.

Indeed, by the late 19th century, the Enlightenment notion of self-improvement had moved from the battlefield of liberalism to the laboratories and surgical theatres. The destabilization experienced and repressed during the American and French revolutions reemerged in a sea change in imagining who we are and what our bodies are. The political "unhappiness" of class and poverty, which led to the storming of the Bastille, was experienced as "unhappiness" within the body. Before, it was revolutionary change that would cure the body; later, it was the cure of the individual.

The hygiene of the body thus became the hygiene of the spirit and that of the state. By removing "ugliness," the aesthetic surgeon provided a type of surgical eugenics, a means of improving the individual and ultimately the state. Aesthetic surgery could transform the body into one that fulfilled the expectations of a new society and could change with them.

"Vanishing" into society

So by the turn of the 20th century, it was possible to start altering the body in order to become a "real" citizen in a foreign or hostile land. In the United States, for example, light-skinned African-Americans had their lips thinned and their noses rebuilt so that they could cross the colour line. And if they were too dark, they had their skin lightened. In New York, Irish immigrants had their "pug noses" transformed into "English noses" and their ears pinned back so that this sign of their "degenerate Irish nature" vanished and they could "pass" as American.

In Berlin there was Jacques Joseph (1865-1934), a highly acculturated young German Jewish surgeon. Born Jakob Joseph, he altered his too Jewish name while studying medicine at university, where he joined a dueling fraternity and bore the scars with pride. For some Jews like Joseph, a dueling scar marked the socially healthy individual in German society. But at the very close of the 19th century, after Joseph left university, Jewish men were excluded from the Christian dueling fraternities: they were considered different and thus dishonourable. For a Jew to bear a facial scar was to hide his sickly essence from the mainstream. So Joseph enabled his Jewish compatriots to "vanish" in society. He developed the first procedure of reducing the size and shape of the "Jewish" nose.

In January 1898, a 28-year-old man came to Joseph, complaining that "his nose was the source of considerable annoyance. Wherever he went, everybody stared at him..." Joseph took the young man's case and proceeded to perform his first reduction rhinoplasty, cutting through the skin of the nose to reduce its size and alter its shape by chipping away the bone and removing the cartilage. On May 11, 1898 he reported on this operation before the Berlin Medical Society. He provided a detailed "scientific" rationale for performing a medical procedure on an otherwise completely healthy individual: "The depressed attitude of the patient subsided completely. He is happy to move around unnoticed." The patient was cured of the "disease" of "nostrility." Yet Joseph was not satisfied. The procedure left small scars that revealed the inauthencity of the body.