Seeking beauty through the scalpel

How old is reconstructive surgery?

Historians believe reconstructive surgery has roots that reach back thousands of years. Evidence indicates that Egyptians may have experimented with reconstructive surgery before 3000 B.C. Around 600 B.C., a Hindu surgeon named Sushruta Samhita wrote the first known description of a primitive technique used in India to rebuild noses sliced off as punishment for adultery. These early plastic surgeons cut a flap of skin on the cheek and folded it over the area of the nose. Once the flap grew into place, Sushruta wrote, the surgeon then placed “two thin pipes in the nose where the nostrils should go, to facilitate breathing and to prevent the sewn skin from collapsing.”

When did it become more common?

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Plastic surgery began going mainstream after World War I. Before the war, plastic surgeons in the U.S. were commonly viewed as quacks. But the war produced a desperate need for sophisticated procedures to rebuild faces, after scores of soldiers suffered horrific wounds while peering over the rims of foxholes and trenches. As they improvised new cosmetic techniques in battlefield hospitals, reconstructive surgeons began to gain skill and respect. In 1932, a group of specialists in the still-developing field gathered for the first meeting of what would become the American Society of Plastic and Reconstructive Surgeons.

When did vanity enter the picture?

It was always there, but cosmetic surgery was slow to catch on. In the late 19th century, some doctors experimented with paraffin injections to reshape and enlarge women’s breasts, or to fill in oddly shaped noses. But shifting paraffin lumps did not help the doctors shake their reputation as charlatans. The first cosmetic technique to gain a measure of respect was the nose job. As is often the case, a celebrity paved the way: Vaudeville star Fanny Brice caused a huge stir when she had her famously prominent nose reduced in 1923. After that, nose jobs steadily grew in popularity, becoming almost a rite of passage in some ethnic groups.

When did surgeons zero in on the breast?

In the early 1960s. For decades, breast augmentation was a fringe phenomenon, shunned by most women as a bizarre form of voluntary mutilation. But in her book Venus Envy: A History of Cosmetic Surgery, author Elizabeth Haiken argues that the modern media created the market for breast augmentation. Movies and magazines made icons of chesty screen goddesses and busty pinups, such as Jayne Mansfield, Jane Russell, and Marilyn Monroe, giving the large breast fetishistic power. By the 1960s, surgeons began using spongy implants to give small-breasted women the Monroe look; that technique fell into disfavor, though, when the implants turned as hard as rocks. Then silicone implants became the rage, until they were found to leak and cause health problems. More recently, surgeons have settled on plastic bags filled with a saline solution.

How common are breast implants?

In Hollywood, they’re as ubiquitous as Porsche convertibles and capped teeth. Nationwide, surgeons performed so many breast implants in 2001-217,000—that they could replace the entire population of Des Moines, Iowa, with women boasting C- and D-cup bosoms. Annually, implants now outnumber nose jobs (177,400) and face-lifts (117,000). Most popular of all the surgical procedures (with 385,390) is liposuction, which vacuums out unwanted fat deposits. Next in popularity are eye-lifts and other surgeries around that wrinkle-prone area (246,338). Less invasive measures are even more common. They include chemical peels, to remove fine wrinkles and acne scars (1.4 million), and collagen injections, to plump lips and fill in large wrinkles (1.1 million).

What is the most popular treatment?

That title belongs to a new weapon in the cosmetic arsenal, Botox. This drug is made from the neurotoxin that causes botulism. Doctors inject Botox into face muscles to temporarily paralyze them, hiding wrinkles for months, until the drug wears off. Doctors performed 1.6 million Botox injections in 2001. That figure may soon skyrocket. Officially, Botox is intended for the treatment of spasms in eye muscles, but the Food and Drug Administration has just approved it for cosmetic use.

Are women the principal customers?

Yes. More than four out of every five cosmetic surgeries are performed on women. But men, too, are giving in to the lure of surgical perfection, flocking to doctors for hair transplants (150,185 procedures), liposuction (138,394), and nose jobs (47,663), according to the American Academy of Cosmetic Surgery. The final frontier is phalloplasty. Although reliable figures are not easy to come by, experts say thousands of men have sought surgical penis enlargement, paying $10,000 and up or more to feel more secure in the locker room and the bedroom. One procedure adds girth by padding the penis with injected body fat. To add length, a surgeon can slice the ligament that anchors the penis to the pubic bone and pull out an extra inch or two of shaft.

The power of celebrity

Just as they removed the stigma attached to diseases such as AIDS and Alzheimer’s, celebrities have given an aura of legitimacy to plastic surgery. Stars like Cher, who has proudly proclaimed herself “the plastic surgery poster girl,” have freely admitted to remaking their bodies and faces. Cher got hooked by having her Armenian nose carved down to movie-star standards. After growing fond of the larger breasts that come with pregnancy, she had implants installed. “I couldn’t bear to see them deflate,” she said. Pamela Anderson’s fame ballooned when she had her breasts surgically enhanced, a decision she credited for making her Baywatch character more “noticeable.” More recently, she opted for another operation, to ratchet down her chestiness because she “no longer feels right as a large-breasted Dolly Parton.” Twenty years ago, comedienne Joan Rivers asked her surgeon to remove the bags under her eyes. She’s since had multiple procedures to iron out the wrinkles from her face and neck. Rivers says she returns every six months for “touch-ups.” The unchallenged king of plastic surgery, however, is singer Michael Jackson. Surgeons have carved a cleft into his chin, carved his nose down to a narrow nub, thinned his lower lip, and given him more delicate and pronounced cheekbones. Jackson also bleaches his skin, which he says is a response to a skin disease that causes white splotches. In recent years, he’s become whiter than all but the palest Caucasians.