Aesthetic Surgery

From the close of the nineteenth century to the present, aesthetic surgery has come to be ever more widely practiced. It has also become the focus of ongoing criticism of what limits society and the individual can or should set, with respect to control over our own bodies and the bodies of others. These debates are often undertaken in complete ignorance of the history of aesthetic surgery, which is seen as being an American (read: Hollywood), patriarchal form of the oppression that women were (and are) subject to. The reality is that aesthetic surgery is a classic product of the modern world, with all of its advantages and disadvantages, including our claim to control our bodies. It is the test case for all of the claims about human autonomy that the Enlightenment defined as “modernity.”

The technology of aesthetic surgery, in its modern form, arose out of the anxiety about the visibility of the diseased and damaged body that forms its common history with reconstructive surgery. Wounds of war, lesions of diseases from syphilis to smallpox, and congenital malformations all formed the background to the beginning of aesthetic surgery at the close of the nineteenth century. The Berlin surgeon Johann Friedrich Dieffenbach (1792–1847), a central figure in nineteenth-century facial surgery, wrote in 1834 that

Disability was the product of the physical malformation and (equally important) the stigma associated with it. This the surgeon could remedy.

Here there was little question of the nature of the disability associated with the body. For early “reconstructive” surgeons, disability was defined as lack of function coupled with the stigma associated with perceived deformity. With the introduction of the technologies of anesthetics and antisepsis, the potential of a human being, through surgical intervention, to change his or her body became both imaginable and practicable. Yet the idea of a perceived difference from an implicit norm remains central to this new aesthetic surgery. From the first patients in the 1870s and 1880s to the millions (perhaps billions) having aesthetic surgery across the world today, the idea of surgical manipulation of the body has become commonplace. But at its center is the sense of our desire (through the agency of medicine) to give us the bodies that we want rather than those that we have in order to combat the stigma we associate with those aspects of our bodies that we wish to change.

Given the predilections of our desire to control our bodies, the history of aesthetic surgery can be rather neatly divided into the world before the end of the nineteenth century and the world afterwards. It is between 1870 and 1900 that virtually all of the present procedures for the aesthetic alternation of the body are introduced. They build, of course, on earlier developments in surgery. The initial patients, with few exceptions, were men, a fact seemingly lost in the history of aesthetic surgery. But why was there an explosion of both patient interest and surgical innovation at that specific time? Such surgery prior to the nineteenth century, before the introduction of antisepsis (no infection) and anesthesia (no pain), was undertaken only when it was truly a functional necessity. Aesthetic surgery demanded something in addition.

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