Venus Envy: A History of Cosmetic Surgery

Cosmetic surgery (or aesthetic surgery), defined as surgery undertaken for reasons of appearance, has long had an ambivalent relationship to the medical profession in general. In the early twentieth century it developed partly as an adjunct to the commercial beauty culture of the era, and it was often practiced by unlicensed “quacks.” During the First World War it was nurtured and legitimized by the necessity for surgeons to reconstruct innumerable faces that were hideously shattered and scarred from bombs, because of the limited protection to soldiers’ heads and necks provided by the trenches that were the main line of defense during that war.

In 1921 a group of trained specialists in the field of reconstructive surgery formed the American Association of Plastic Surgeons. They thereby professionalized their specialty by establishing requirements for admission, while they combined it with the field of cosmetic surgery under the name “plastic surgery.” Their desire to weed out the poorly trained “quacks” is undoubtedly laudable, but they were also responding to the lucrative moneymaking potential of aesthetic surgery, which was closely tied to major themes of the American experience, such as the long-standing drive toward individual self-improvement and the new one toward having a “pleasing personality.” Overriding all was women’s drive to achieve “beauty,” which had become especially commercialized during the 1920s.

Yet physical necessity remained the stepchild of vanity, as in the 1920s a host of largely self-trained physicians continued to attract clients to offices and clinics that advertised services as far reaching as tightening face skin, reshaping noses, enlarging breasts, and even “correcting” large abdomens (p. 79). Not until the end of the Second World War did plastic surgeons manage to oust the quacks. In so doing, they assumed leadership in the trend among physicians toward marketing medical procedures, even as plastic surgery came to be seen as “the quintessential product of postwar prosperity” (p. 145). By the 1980s the commercial trend had proceeded to the point that hospital administrators were encouraging their general surgeons to move into the lucrative field of cosmetic rearrangement of faces and bodies. Throughout this history, cosmetic surgeons justified their specialty by presenting themselves as sculptors holding to high aesthetic standards, and as psychologists able to overcome the feared “inferiority complex” that psychologist Alfred Adler had discovered in the 1920s (and which advertisers characteristically exploited to sell their products).

In this engaging study, Elizabeth Haiken focuses on cultural attitudes and developments as much as on medical ones, while she explores the reaction of various racial and ethnic groups to these procedures. Fanny Brice, Barbra Streisand, and Michael Jackson figure prominently among her cast of characters, in addition to the little-known “esthetic” surgeons of the 1920s and 1930s who walked a thin line between opportunism and idealism in shaping the new specialty. Haiken holds women as consumers partly responsible for the development of “esthetic,” medically unnecessary, cosmetic surgery: without their continual demands for body makeovers, she contends, cosmetic surgery could never have developed so quickly and spread as widely as it has today, with men as well as women embracing it wholeheartedly. Holding the victims responsible as the perpetrators of their oppression begs the issue of the internalization of oppression about which Antonio Gramsci, Michel Foucault, and many feminist theorists have written extensively, but at least Haiken does not let the physicians off the hook. And she demonstrates the extent to which medical history is embedded in broader cultural developments, as well as how deeply medical models of behavior—even in a specialty as commercialized as plastic surgery—have come to dominate the thought and actions of Americans.