Before cosmetic surgery became widely accessible, fads in body fashion mirrored fads in garment fashion. The fragile woman with an 18-inch waist was the ideal in Victorian times and required draconian corseting to effect. Throughout history a pale complexion has nearly always been more fashionable than a tan because pale skin denotes a woman who does not have to labor outdoors. During the mid-nineteenth century, high fashion also dictated tiny lips, produced through creative makeup, and big behinds (thus the bustle).
Those suffocating corsets were the original tummy tuck, and well into the twentieth century they were a cultural imperative. Girls went for their fi rst fittings at age eleven or twelve, women were warned that they had to wear them for physiologic as well as national pride reasons, and a woman who dared to go without one after the turn of the century risked being labeled a Bolshevik. When the iconic Gibson girl appeared with her more relaxed and voluptuous image, the corset industry responded by manufacturing somewhat less restricting models, but this loosening of the grip of the iconic firm, youthful body was short lived. By the 1920s the flapper girl, with her prepubescent flat chest and straight, skinny frame, was all the rage (and completely unrealistic for the majority of women, corset or no corset). In time, accentuated waists came back in fashion, and if an hourglass shape could not be precisely achieved with body molding through constrictive undergarments, it could at least be suggested by clothing with padded shoulders and wide skirts.
During the twentieth century, the “ideal” body as portrayed in the media changed quickly. Models were getting skinnier and the average woman was getting heavier. In 2002 sociologist Debra Gimlin reported that the typical model or Miss America contestant was approximately 5 feet 8 inches tall and weighed 120 pounds, whereas the average American woman was 5 feet 4 inches tall and weighed 140 pounds. Even more significantly, the discrepancy between the two categories had increased dramatically over the preceding decades.
Today’s body fashions for women mandate full lips, an angular face, big breasts, and a thin, hard torso and limbs—an unlikely combination that few women come by naturally. Above all, youthfulness is most prized. Striving to maintain or restore a youthful, thin, prechildbearing look, women enlist the help of diets, drugs, exercise programs, “body shaper” garments, and cosmetic surgery. Body fashions have evolved in other countries as well and frequently reflect the pervasive influence of Western images. In multiracial Brazil, for example, small breasts have traditionally been preferred over large ones for racial identity reasons, but breast augmentation for teenage girls is becoming as popular as breast reduction surgery. In Japan, China, and other Asian countries, surgeries to make eyelids, noses, and breasts more Western in appearance are commonplace. Rhinoplasties are popular throughout the Middle East. Historian Sander Gilman speculates that the goal of much cosmetic surgery is “as much to become a citizen of the new global culture as to become a citizen of any given nation.” Men have also been subject to cultural ideals in body fashion.
Hard as it may be for us to imagine today, in Victorian times the pale, thin, often short male physique in the style of Lord Byron was popular with women and sought after by men. (Not every one at the time was impressed with the trend. In 1858 Oliver Wendell Holmes famously commented, “I am satisfied that such a set of black-coated, stiff-jointed, soft-muscled, paste-complexioned youth as we can boast in our Atlantic cities never before sprang from loins of Anglo-Saxon lineage.”) A more muscular ideal did eventually supplant the Byronic romantic as the outdoorsman style became popular. In time the preferred male image evolved from the merely athletic to the exaggerated form of the bodybuilder that is so sought after today.
Today’s body ideals reflect the often “enhanced” images of people portrayed in media. As one plastic surgeon put it, “our religion is celebrity, and our gods are celebrities.” Yet despite the insistent demands of body ideals, not even professional beauties quite manage to achieve them. Every actor and model can list without hesitation all of her (or his) flaws and limitations, and exactly which “defects” happen to make her list are subject to influence by the current vogue in body contours. Models are hired for specific attributes or body parts, and because computer-editing of images in commercial photography is now performed routinely, perfection is only a click away. Supermodel Cindy Crawford once said in an interview: “Don’t try to look like me. I don’t even look like me.”
Humans since prehistoric times have sought to augment their physical attractiveness. We all, at one time or another, seek to improve our appearance in order to attract a partner, find love, improve our social status, or increase our personal power. Like politicians, we are continuously “spinning” the messages that our bodies broadcast with adornments and alterations. What we are doing when we enhance our physical appearance is hoping to stand out in a crowd, trying to get others to take a second look. The wellspring of cosmetic medicine can be found long before nineteenth-century rhinoplasties or even sixteenth-century nose reconstructions. Humans have used makeup for at least as long as we have created art; remnants of what is thought to be body paint have been discovered dating back at least 40,000 years. In various cultures at various times body painting has been elevated to an art form or decried as immoral or outright evil, perhaps reflecting a primordial distrust of altered forms. Two hundred years ago the English parliament linked makeup to witchcraft, and throughout much of history heavy makeup has been associated with persons (mainly women) of questionable reputation.
For millennia, body parts from teeth to toes have been painted, pierced, banded, scarred, or otherwise permanently altered in the name of beauty. For centuries Chinese women bound their feet to impair growth, whereas Japanese women darkened their teeth with stains and tattooed their upper bodies. Today’s Makonde men of Tanzania and the Maori men and women of New Zealand tattoo and sometimes scar their bodies. Nearly everyone has seen pictures of the Padaung girls of Myanmar who, starting at the age of fi ve, have brass neck rings placed to elongate their spines. In some African tribes the women stretch their earlobes and lips into hanging appendages. Contemporary cosmetic enhancements also include leg lengthening, toe shortening, genital recontouring, and anal bleaching.
Western males have not been immune to the desire for physical enhancement. In America, Colonial men wore makeup and elaborate wigs. Modern men seek to eliminate chest hair and augment their head and facial hair. Today, body piercings are nearly as popular with men in certain age groups as they are with women. Physical enhancements have always included some element of risk. There are many documented cases where ingredients in cosmetics have poisoned people; constrictive garments have caused lung and heart problems; and invasive procedures like piercings have led to infections, troublesome scars, and deformities. Yet invasive procedures designed to change the human body retain the mystique of really being about changing one’s life.
Many scholars trace the roots of the widespread contemporary interest in cosmetic medicine to evolutions of thought that characterized the period in European intellectual history known as the Enlightenment. During this period, which spanned much of the seventeenth and eighteenth centuries, there was a resurgence in popularity of the ancient Greek ideas that man should use reason and rational thought (as opposed to behaving according to medieval religious dictates) to achieve knowledge, freedom, and happiness. New methodologies of rational thought led to dramatic advances in the areas of science, mathematics, psychology, and ethics, many of which form the basis of medicine as we know it today. The application of these advances to the individual’s pursuit of happiness was a natural outgrowth of the ideas of the Enlightenment. The fabled Age of Enlightenment, in which the individual’s pursuit of happiness was glorified, did not last, but its core emphasis on the personal did.
Other theories about the popularity of cosmetic medicine have incorporated ideas from philosophers like Michel Foucault, who wrote extensively about the tendency of societies to operate using “principles of exclusion,” rendering some individuals bereft of the care and consideration automatically extended to others who manifest more desirable qualities. Thus we have the joining of two major veins of philosophical thinking to create a framework for the current popularity of cosmetic medicine: the tendency of society to marginalize, or at least fail to favor, individuals who do not meet certain appearance ideals; and the right, in fact the obligation, of the individual to attempt to rectify that situation.
The changes in American society that marked the beginning of the twentieth century included a growing interest in cosmetic surgery. New economic opportunities led to population shifts from rural areas to the cities, especially to New York City and Chicago. Expanded transportation opportunities aided these migrations, and mass media further weakened the close-knit social structures of small communities. The face of America was changing as large numbers of immigrants arrived to compete for jobs. Women achieved the right to vote and entered the workforce in large numbers. Cultural shifts were profound as well: Religious influences on society weakened, and motion pictures, with their visual imagery, competed with radio as the preferred source of entertainment.
New arrivals in the big cities did what they could to make the best possible first impression on new acquaintances and potential employers. An attractive, youthful appearance increasingly became a job requirement for certain positions, and the idea of cosmetic surgery appealed to aging men and women worried about losing good front office or sales jobs. (The United States did not pass a law prohibiting age discrimination in the workplace until 1967.) Others with perceived negative physical attributes that may have prevented them from obtaining employment sought cosmetic surgery because the well-publicized successes of plastic surgeons during World War I had made correction of their deficits seem less of an impossible dream. Even during the Great Depression the demand for cosmetic surgery remained high as the pressure to look good increased as the competition for jobs stiffened.
The great public interest in psychology, first in the work of Freud and later in that of Adler, helped enhance the appeal of cosmetic surgery. Adler’s writings stimulated a wide-ranging public infatuation with what came to be termed the inferiority complex and how a person could get rid of it if he or she had one. Certainly, cosmetic surgery was an oft-cited solution.
Let us not underestimate the influence of central heating on body consciousness. The Victorians covered their bodies in layers of garments, and changing physical fashions could be accommodated with more or less fabric puffed out here or squeezed in there. With the widespread introduction of more efficient heating systems came a general stripping away of clothing layers, and as more body parts became exposed the demand for cosmetic surgery, perhaps not coincidentally, increased.
Even though by the onset of the First World War there was a significant market for beauty products and cosmetic surgery, plastic surgery did not yet exist as a specialty. So who was selling? The next chapter will tell that tale.
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