Fw: Prozac, with Knife.(plastic surgery)

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Subject: Prozac, with Knife.(plastic surgery)

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Prozac, with Knife.(plastic surgery)

Author/s: ph Epstein

Issue: July, 2000

IMAGINE TYLER and Tucker--as I like to think of them--on the

first night of their honeymoon, in a glow of happy confidence that

sets a mood for postcoital intimacies. Tyler opens by confessing to

his bride that his thick hair is the result, partly, of hair plugs,

implanted three years before he met her. admits in turn that her

high cheekbones, which Tyler has so often remarked upon, are the

consequence of silicone injections. He allows that, at age sixteen, he

rid himself, through surgery, of the aquiline Tucker nose. She

confides that her once weak chin has been augmented, her front teeth

are capped, and six of her back teeth are implants. Finally he shares

the news of his penile enlargement. Her breasts, she whispers back,

have likewise been enlarged, her thighs and bottom reduced through

liposuction. In a swoon of candor they embrace--though Tyler, a former

fat boy, has still to divulge his tummy tuck.

"Beauty fades," says the character played by Albert in I'll Do

Anything, bemoaning his weakness for knock-out young women. Then he

adds, "but it fades so slowly." Not slowly enough, apparently, for the

Americans, Europeans, Latin Americans, and Israelis who have been

going in for plastic surgery in continually larger numbers. The

statistics on these procedures--also known as cosmetic surgery, less

frequently as aesthetic surgery--show them to comprise a flourishing

business. In Making the Body Beautiful,(*) Sander L. Gilman, a

professor at the University of Chicago, reports that from 1981 to

1984, the number of such surgeries in the United States rose from

296,000 to 477,700. By 1995, 825,000 operations were being performed

on the face alone--quite apart from procedures to lift the skin of the

upper arm; breast work (implantations, reductions, removal of earlier,

faulty implants); buttock and thigh lifts; rummy tucks; liposuctions

of various sorts; calf and other implants; foreskin reconstitutions;

penile enlargements and implantations; and--the ultimate surgical

alteration--sex-change operations.

Plastic surgery--from the Greek plastikos, meaning "fit for

molding"--has, we learn from Gilman, a long history. The 7th-century

andrian physician us of Aegina thought that the growth of

breasts in men was something to be dealt with surgically. Later,

surgery was called upon to camouflage wounds incurred in dueling or

warfare, or to hide the depredations of advanced syphilis on facial

bones, particularly the loss of cartilage in the nose. Surgeons also

did their best through the centuries to undo nature's dirty

tricks--repairing cleft palates, constructing missing body parts,

reducing hideously outsized organs and appendages. But it was during

and after World War I, when physicians worked to reconstruct faces

destroyed in combat, that plastic surgery obtained its best press.

This may also have been the last time it was not bogged down in the

swamps of controversy.

The first of these controversies had to do with whether plastic

surgery strictly qualifies as medicine, especially when its intentions

are purely cosmetic. If the patient seeks the treatment, decides what

is needed, and then is the chief judge of its success, is this really

medicine? Plastic surgeons themselves used to worry over such

questions, and in the first decades of the 20th century many refused

to take on cases that they deemed trivial or requests for reasons that

went no deeper than vanity.

But help was at hand by the 1920's with the widespread publicity

given to the psychiatrist Alfred Adler's notion of the inferiority

complex. The important word here is "complex," implying that feelings

of inferiority are unnatural, an aberration, needing to be altered,

cured, or ... cut away. (The alternative, of convincing individuals

that they, really are inferior, and hence relieving them of the burden

of carrying around a complex, has apparently never been tried.) Thus,

cosmetic surgeons soon found themselves able to say that they were not

only performing surgery but supplying therapy. With a cut here, a bob

there, they combined the work of a sawbones with that of a shrink,

turning a sad person--a person with too large a nose, a weak chin, big

ears, a squint--into a happy person. In effect, they were supplying

Prozac, lint with a knife.

Leaving aside the recent scandal over the possible consequences of

silicone breast implants, physicians doing cosmetic surgery probably

feel rather better about their work today than ever before. Cosmetic

surgery is even creeping into other branches of medicine:

dermatologists, for example, have begun doing skin peels, collagen

injections, and liposuctions. A physician I see told me recently that

if he had his medical career to plan over again, he would be a

cosmetic surgeon. The work requires artistry, it makes most clients

quite happy, and it is profitable: an eastside Manhattan facelift from

a swank practitioner might run, with all the extras--consultation fee,

nursing, anesthesia, recovery hotel--somewhere near $20,000.

The profit most often comes in the form of cash on the barrelhead.

Since insurance companies reimburse only that portion of the surgery

that is truly reconstructive or directly related to health, much of

the usual bureaucratic-financial headache connected with the practice

of medicine is eliminated. Fees are paid up front, which does away

with bill collecting and also prevents unsatisfied customers from

withholding payment (though a few have returned to murder their

surgeons, causing many nowadays to screen for potential maniacs). As

for patients who go to law to complain about the quality of the

surgery they have received, juries tend to be most unsympathetic,

viewing them as members of two vaguely but genuinely despised groups:

the pathetically vain and the antipathetically wealthy.

VANITY ASIDE, what is cosmetic surgery really about? In my high school

in Chicago--this is going back 40 years or more--a small but not

negligible number of girls had already begun to have their noses done.

"Done" invariably meant shortened, often made retrousse, or slightly

upturned. Different surgeons conferred different looks: I seem to

remember something called a Becker nose being popular in Chicago; in

New York during those same years, Long Island girls went to a cosmetic

surgeon named Diamond to acquire a Diamond. A few among these

girls claimed they needed to have an operation because a "deviated

septum" was giving them trouble breathing. Most, of course, simply

disliked the shape of their noses sufficiently to undergo the pain and

general unpleasantness--they would show up at school with blackened

eyes and vast quantities of tape across the middle of their

faces--required to change it.

The younger sister of a close friend of mine in those days had a

distinctly non-Beckerian nose. Like her mother's, it was slightly

aquiline and with flared nostrils--clearly, as the old anti-Semites

had it, one of the chosen noses. She also had an attractive shyness, a

slight holding-back of herself that I found winning but that may well

have been traceable in part to her unhappiness with her looks. At

fifteen, she had her nose fixed. The operation was an almost

unqualified success, definitively solving the problem of both

aquilinity and--as writers on the subject call it--nostrility. Now

altered by the knife, my friend's sister descended into the great

adolescent female herd of the merely cute, losing, so far as I could

determine, all distinctiveness whatsoever. Yet, I have no doubt, she

was happier.

What this suggests is that cosmetic surgery is "about" the specific

form of happiness that can accompany passing: becoming invisible by

melting into the mass. Not that passing is necessarily the same thing

as hiding out altogether. My friend's sister, for example, certainly

did not want to de-Judaize herself--her name was Jewish, she went on

to marry a Jewish man and bring up her children as Jews. She only

wanted a face that more closely conformed to the then-prevailing

American standard of beauty. In the 1960's, the ideal American nose

was said to belong to Bouvier Kennedy Onassis. Study of

that famous appendage--small, short, just slightly upturned--reveals

no oddity or distinction of any kind. And that is just the point: it

was a nose that gave no clues to origin, no hostages to ethnic

identity.

Passing can take many forms. Some people wish to escape or elide their

ethnic or even racial heritage: Asian girls, for example, who want

western eyes. Others ( Dillinger is the famous example here) may

wish to avoid detection by the cops. Some wish to add to their erotic

cargo, which is what breast implants are about. Others--these days,

they are the majority--wish to seem younger than they are. And some,

as with the singer 's estimated 31 operations, may not

be quite sure what they are after but are confident that, in one way

or another, cosmetic surgery will alter their lives for the better.

And it may well do so. Most studies report that handsome or beautiful

men and women tend to do better in the job market and also--golly,

Mom, wouldya believe it?--tend more easily to find partners for sex.

Beauty is a quality, noted Montaigne in the 16th century, "that gives

power and advantage"; to Aristotle, it was "a greater recommendation

than any letter of introduction." True, in certain circles beauty can

come under suspicion: I once heard two great scholars--the historian

Arnaldo Momigliano and the social scientist Shils--discuss in

perfect earnestness how a graduate student's handsomeness seemed to

suggest an incapacity for serious scholarship. Still, given the

choice, most of us would undoubtedly prefer to come into the world

beautiful, and most of us are also likely to have at least one

unbeautiful physical quality that we feel may have held us back from

the greater triumphs that were surely meant to be ours. Are not such

flaws more costly to us than the price of eliminating them through

cosmetic surgery?

Not that most people who enter into such surgery do so wholly without

trepidation. A piece of flesh, after all, is hardly a piece of cake,

and the literature is strewn if not with corpses then with

post-operatively misshapen or malfunctioning body parts. There are

women whose skin becomes stretched so tight from facelifts that they

cannot close their eyes at night, or from whose faces the makeup

slides off. There are women with silicone inserted in their cheeks in

the hope of attaining the look of Audrey Hepburn who, when the

silicone falls, end up looking more like Alvin the chipmunk. There are

the noses that emerge snouty, the lips that curl or fall to one side,

the scarring, the infections, the long-term slippage that, over time,

needs to be redone, the occasional death.

Consider lipoplasty, better known as liposuction and employed to bring

about what were once called "contour improvements" by vacuuming or

sucking out fat from the face and neck, abdomen and flanks, thighs,

hips, knees, calves. Because licensing laws are unclear in some

states, and nonexistent in others, incompetent practitioners--not to

say outright quacks--can never be ruled out. But even under good

conditions, and in good hands, serious screw-ups can occur. In The

Unofficial Guide to Cosmetic Surgery, E. Bingo Wyer notes that "In all

forms of lipoplasty, ... too great a loss of fat can result in a

rumpled or unbalanced appearance, which can be difficult to correct."

She then adds a brief but horrific list of possible side effects,

including pain, bleeding, temporary numbness, excessive fluid buildup,

clots that block the flow of blood, infection, shock. In Lift, an

account of her own "brow lift, nose nip, secondary facelift, and lip

peel," the journalist Joan Kron mentions matter-of-factly the

post-operative removal of "fifteen or twenty annoying metal staples

used to close the incision in the back of my head." A routine matter,

this--and yet, one cannot help thinking, maybe it isn't merely not

nice but not too smart to try to fool Mother Nature.

BUT PEOPLE do continue to try. For one thing, new techniques keep

being invented and put into practice. For another, fashions change.

Rhinoplasty (nose jobs) has dropped off in recent years--although some

people, no longer shamed by their ethnicity, are going back to their

cosmetic surgeons to have their old bumps or beakishness returned. The

notion of "passing" has itself passed from the wish to seem normal, or

invisible, or WASPish, to the wish, mainly, to seem young. Facelifts,

along with eye- and brow-lifts and various skin peels (collagen and

Botox injections, dermabrasion, laser resurfacing), lead all other

forms of cosmetic surgery today.

And what is wrong with the wish to remain youthful-looking? Medical

technology has given us a great gift, one that enables us to fight

off, for as long as possible, nature's slow, inexorable onslaught, to

cheat that great sculptor, Time. If we want to make ourselves seem

younger and therefore (by our own lights) happier, and can afford the

cost, why not?

One answer is that heredity and time--or, if one prefers, the heavens

and fate--deal us a much more interesting hand than doctors can ever

hope to do. Think, in all its immense variety, of the nose: from

Gogol's long sharp proboscis to Tolstoy's potato nose to W. C.

Fields's empurpled lighthouse nose to Jimmy Durante's two-pound

cucumber nose to Igor Stravinsky's isosceles-triangle nose to Bob

Hope's ski-jump nose to Barbra Streisand's grand depressed-tip,

sloping-septum nose. Interesting faces, oddly beautiful faces, are not

created by surgeons, no matter how skillful, but by the years, working

in conjunction with character. Who would have wished to subject the

rhino-hide face of the older W. H. Auden to a face-lift, or to change

in any way the countenance of the novelist Marguerite Yourcenar, with

its strong lines, shadows, dark nostrils, sagging eyelids, and more

than a hint of a mustache?

Novelists have long depended on the relation of physiognomy to

character; Balzac speaks with pity of people who have not yet learned

to read moral character in a face. And if beauty, as the cliche has

it, is in the eye of the beholder, here is the twenty-six-year-old

Henry , the subtlest of beholders, writing home to his father

after meeting the English novelist Eliot:

To begin with she is magnificently ugly--deliciously hideous. She

has a low

forehead, a dull gray eye, a vast pendulous nose, a huge mouth,

full of

uneven teeth and a chin and jaw-bone qui n'en finnnissent pas....

Now in

this vast ugliness resides a most powerful beauty which, in a very

few

minutes, steals forth and charms the mind, so that you end as I

ended, in

falling in love with her. Yes behold me literally in love with this

great

horse-faced blue-stocking. I don't know in what the charm lies, but

it is

thoroughly potent.

This suggests a philosophical question for cosmetic surgeons: does a

change in one's body bring about a corresponding change in one's moral

character? And if so, can we be sure it is for the better? In his

introduction to a 1937 book rifled New Faces, New Futures: Rebuilding

Character with Plastic Surgery, Alfred Adler answered in the

affirmative: after such surgery, "the personality relaxes into

naturalness and character is transformed." But one may be permitted to

doubt this. Even, it turns out, radical feminists do. Fifty years

after Adler, a writer in Ms. confessed, "Before the operation I

rationalized how I wanted my face-lift so my exterior would match my

interior.... I realize now I was lying to myself. I just wanted to

look younger and prettier."

I am not sure that Orwell was correct when he claimed that at

fifty a man gets the face he deserves, but at sixty, I can attest, he

tends to get reconciled to it. I look in the mirror and consider my

ample, stick-out ears; my mottled complexion, with a beard that

confers a five o'clock shadow sometime past noon; the impressive

bags--two-suiters--under my eyes, which go so nicely with the sag that

has shown up in my right eyelid; the slightly off-center circumflexes

that my eyebrows have begun to form; the strong downward lines running

from alongside the bridge of my nose to the top of my upper lip; the

fairly recent addition of two further lines, running from the corners

of my lower lip down to my jaw, giving my mouth the look of a

ventriloquist's dummy and a not-so-gentle hint of pervasive

depression. A face, clearly, begging for the knife. Yet, just as

clearly, it is not going to get it: for I have grown accustomed to

this face, a poor thing but mine own.

From both limited personal acquaintance and photographs in various

books on the subject, I have noticed that cosmetic surgeons are not

themselves a notably handsome bunch; yet most do not seem to have done

anything about it. Why not, when the remedy is so obviously and easily

and literally at hand? An old joke about psychoanalysts is that, after

conferences in Vienna, they get drunk together and sing, "I want a

girl/just like the girl/that married dear old dad." Can it be that

cosmetic surgeons begin each day by crooning into their mirrors: "But

don't change a hair for me/Not if you care for me/Stay, little

Valentine, stay"? I would like to think so, at least for a few happily

cynical souls among them.

(*) Princeton, 544 pp., $29.95.

JOSEPH EPSTEIN, a veteran contributor to COMMENTARY, is the author

often books of essays and a collection of short stories. His article,

"Intellectuals--Public and Otherwise," appeared in our May issue.

COPYRIGHT 2000 American Jewish Committee

COPYRIGHT 2000 Gale Group

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