Historian Elizabeth Haiken begins her enlightening new book on plastic surgery, "Venus Envy," by comparing the noses of Fanny Brice and Barbra Streisand. "In 1923, Americans clamored for an explanation of why Fanny Brice, beloved vaudeville actress, successful comedienne, and star of Florenz Ziegfeld's new Follies, had bobbed her nose. Forty years later ... When Barbra Streisand emerged on the national scene, Americans wanted to know why she had not."
In "Venus Envy," Haiken tells the story of plastic surgery's ascent from the exception to the rule. Her narrative is as much about changing American attitudes toward the body and unspoken conflicts over racial characteristics as it is about the medical technology that has made increasingly radical transformations possible. In tracing the development of cosmetic surgery, Haiken examines the intertwining influences of wartime medical advances, pop psychology, racism and, oddly, a certain strain of feminism that champions surgery as a path to self-determination and self-improvement.
Plastic surgeons returning from World War I, where they had made revolutionary advances in reconstructing the faces of injured soldiers, realized that "beauty, as a business, offered seemingly limitless potential," Haiken writes. At the time, however, cosmetic surgeons were regarded as quacks, and something of the Victorian opposition to vanity still prevailed. "It is the duty of every physician and surgeon to try and argue with [patients], to convince them that correction is unnecessary," one surgeon wrote.
Ironically, it was the seemingly unrelated field of psychology that catapulted cosmetic surgery into the mainstream. In the '20s and '30s, Haiken writes, Americans became obsessed with Viennese psychologist Alfred Adler's theory of the "inferiority complex." The notion that physical deformities led to inferiority complexes, which in turn caused a host of other dysfunctions, was so widely accepted that in 1927 plastic surgery was performed on prisoners at San Quentin as a rehabilitative measure. "In breaking down the barrier restricting them to reconstruction," Haiken writes, "surgeons laid claim to the whole body and mind of healthy individuals by linking physical abnormalities to psychological problems for which cosmetic surgical intervention was the prescribed cure." By the end of the '30s, the idea that surgeons should avoid operating in all but the most desperate cases had been wholly reversed. "The disgrace, if any, is in allowing a manifest deformity to remain," said surgeon Adalbert G. Bettman.
Haiken is obviously troubled by the rampant spread of cosmetic surgery, especially operations that straighten Jewish noses, put folds in Asian eyelids and lighten black skin. But she avoids placing all the blame on doctors, understanding that women were demanding many procedures and getting them illegally if legitimate surgeons turned them away. "Venus Envy" ends on a resigned, slightly mournful note, because Haiken believes cosmetic surgery is creating a world where beauty standards are brutally conformist and stringent. "Most Americans probably would not go so far as to deem the decision not to have cosmetic surgery antisocial, but they are more ready than ever to concede that it may be impractical," she writes. "And as Americans and their surgeons have come to see cosmetic surgery as the most practical solution for an ever-larger number of problems, not having surgery, like tilting at windmills, can seem hopelessly naive, at the very least outdated."