Not just a pretty face; Making the body beautiful: a cultural history of aesthetic surgery; Sander L. Gilman; Princeton University Press, Princeton, NJ; 1999; 396 pp. US$29.95 ISBN 0-691-02672-6
I read Sander L. Gilman's Making the Body Beautiful for the first time on a five-hour flight from Toronto to Vancouver to attend the annual meeting of the Canadian Society of Aesthetic Plastic Surgery. It is a wonderful book, and I couldn't wait to read it again. You need to read it twice to put everything in perspective. Drawing on expertise in Germanic studies, comparative literature and psychiatry, Gilman provides a comprehensive cultural history of aesthetic surgery. He is as comfortable discussing Nietzsche, Yeats and Darwin as he is the fathers of plastic surgery or the nasal anatomy of Bill Clinton.
Gilman opens the book with the statement that "in a world in which we are judged by how we appear, the belief that we can change our appearance is liberating." Central to his thesis is the concept of "passing." Aesthetic surgery can allow a person to "pass" in a desired social group. It changes not only the present but also the future, "overrides the genetic code," and has been used on every conceivable part of the body.
"Passing" depends on many factors, including historical context, age and sex, and racial or ethnic issues. In earlier times, fat was perceived in some cultures as a positive sign of prosperity. By contrast, by the end of the 19th century it was usually perceived negatively, as a sign of poor health. Today the young and the old want to "pass" as slim and fit, and older people want to "pass" as younger.
"Passing" is often culture dependent. Breast size is cited as a classic example. Breast reduction has become commonplace among upper-middle-class Brazilian families to distinguish their daughters from the lower classes. "Brazilian breast reductions" are often given to young women as "sweet-sixteen" birthday presents, enabling them to "pass" as members of a more erotic cohort and find appropriate mates. By contrast, Argentinian women, who have the highest rates of silicone implantation in the world, are much more likely to pursue breast augmentation, fulfilling the "Spanish fantasy" of the large-breasted woman as the icon of the erotic. By comparison, standards of breast beauty in Europe shifted between the 19th and 20th centuries. Smaller breasts became associated with a new erotic image, enabling a woman to "pass" into the age of the "New Woman."
Gilman's many references to racial difference may seem somewhat provocative. Taken in context, however, they serve to emphasize the cultural determinants of aesthetic norms. Gilman relates that Israel has become the aesthetic surgery capital of the Middle East, where the most common procedure among both men and women is rhinoplasty. He describes a Jewish girl who undergoes the procedure to "pass" as more Gentile. In young men, aesthetic surgery is usually performed before compulsory military service so that they can look like their peers. In some instances, the urgency of disguising racial origins diminished with the dawning of ethnic pride and with greater racial tolerance. More subtle changes in ethnicity were in order. One can look different, but not too different. It may be desirable for Japanese people to appear Japanese, but not too Japanese. Thus, 32 different operations have been developed in Japan to create a westernized double eyelid-fold. FIGURE 2
Throughout the book the evolution of aesthetic surgery is traced from the quack beauty doctors of the 1880s to the modern, board-certified aesthetic surgeon of today. The designation of this surgical specialty also changed, from "cosmetic" to "esthetic" to "aesthetic," as the specialty seemed to emerge with a classical lineage. Aesthetic surgeons overcame their low status to attain respectability and even adulation. Contributions from reconstructive surgery are recognized, particularly procedures to restore the collapsed syphilitic nose and the soldier's face ravaged by war. Surprising contributions are described from well-known figures not generally considered to be "aesthetic surgeons." These include Ambroise Paré, Theodor Billroth and orthopedic surgeon Jacques Joseph.
There are many graphic descriptions of early surgical procedures. In 1892 Robert Weir brought a live duck into the operating theatre, killed it, and used its fresh sternum to rebuild the collapsed syphilitic nose of a 26-year-old man. There are vivid reports of paraffin being injected into breasts, faces and other anatomical areas, resulting in dreadful complications. There is a memorable story of a German lad who, after winning a lottery, consulted an aesthetic surgeon with the hope of surgically creating artificial duelling scars so that he could pass as a man of honour. The surgeon refused. Subsequently, the man sought treatment from a barber, who obliged with a straight razor, causing severe damage to the salivary glands.
This is a well-informed and engrossing study of a hot contemporary subject. It will be valuable to plastic surgeons and to other physicians who are interested in a comprehensive history of the cultural and aesthetic side of plastic surgery.