Going under the knife for the Venus complex.

　

　

Is it 'fair' that women are born plain, flat-chested, or bandy-legged in today's world where appearances are very nearly everything?

There is a history to why so many women go under the knive to preserve their looks.

The early stages of European portraiture began, the late David Piper suggested in his 1992 study, The English Face, with tomb-effigies in the 12th century. Neither beauty nor individuality were the point of these monuments, it was all to do with rank, wealth and piety.

English history show that it was not until Chaucer’s portrait in Occleve’s manuscript (c.1412) that likeness began to matter. ‘I have had the likeness made here to the end, in truth, that those who have least thought and memory of him may recall him by this painting,’ Occleve said. And, indeed, minus the smock and draped hat, he does look remarkably like my next-door neighbour. It wasn’t until Cromwell’s notion of warts and all that veracity played much of a part in portraiture. For those who wanted their quality – their power, their wealth, their talent – to shine through their face to posterity, court painters functioned in much the same way as 20th-century cosmetic surgeons.

For instacne the images of Henry VIII and Elizabeth I were controlled by the sitters – Henry trusting Holbein to have the good sense, or sufficient self-preservation, to show him as awesome, though with a nicely turned ankle, rather than a fat, self-indulgent tyrant.

Elizabeth not trusting anyone. In 1563 William Cecil drafted a decree demanding that she
Elizabeth, for reasons of state, held back the years in her images, just as Cher, for reasons of occupation, goes under the knife; both being realistic working women. Vanity is in the eye of the beholder; women have always known the material value of looking good.

The scalpels used in cosmetic surgery, however, have largely been in the hands of men, and the profession was developed in the land of opportunity and private medicine, though it began straightforwardly enough in Europe, with reconstructive surgery on the faces of soldiers wounded in World War One.

Maxillofacial treatment progressed not just for humanitarian reasons, but also because it was clear that severely disfigured ex-servicemen were less likely to get work in the postwar world. The urgency was to return the soldiers to economic independence; even then, it was agreed that looks counted when it came to applying for a job.

But once the war was over, the plastic surgeons wishing to form a specialty of their own had fewer and fewer of what they thought of as legitimate customers, while they watched opportunists cashing in on their pioneering work to offer benefits to women who were neither disfigured, family breadwinners nor, in any obvious sense, ill. The quacks were raking it in.

. The original surgeons, worried by their Hippocratic commitment, felt obliged to treat only those who were diseased, not those who were dissatisfied. The solution came with the popularisation in the Twenties of Adler’s formulation of the inferiority complex. The now properly constituted organisation of plastic surgeons could justify performing the cosmetic operations they had previously despised. Mental health became an issue, and to back it up, the economic effects of poor mental health could be cited if a patient was deemed to be at risk.

Market forces clearly had applied to movie stars who wanted to be more glamorous or appear younger for the sake of getting work; now middle-class housewives with noses that made them too self-conscious to be good hostesses for their husbands, or who risked losing their breadwinners to more youthful-looking women, could be helped. By 1941, the first diplomas in plastic surgery were awarded and plastic surgeons had incorporated cosmetic surgery into their practices

There is a parallel here with the abortion on demand debate. Women had to present themselves as, and be deemed by their surgeon to be, at risk of mental illness if their ageing process was to be remedied: they weren’t free to make a personal choice about their appearance. Moreover, men were not just in charge of the surgery, they also provided motivation as husbands or bosses: a woman who wanted to keep her looks to keep her man or her job was considered by the surgeons to have a good case. It appears that the progressive popularity of cosmetic surgery had as much to do with what Haiken calls ‘tyrannical reality’ as it did with fantasies of perfection. According to Haiken, postwar American women found themselves middle-aged and invisible in an increasingly youth-biased culture:
At this crucial juncture, plastic surgeons found that the social and psychological justification for cosmetic surgery ... gave ageing a whole new look, while many middle-class Americans ... found it easier to alter their own faces than to alter the cultural norms and expectations about ageing that confronted them. Together, surgeons and their patients forged a new image of the face-lift as a sensible, practical and relatively simple solution to the social problem of ageing/
 In 1965 a surgeon gave Esquire an example of what he considered to be a bad outcome of cosmetic surgery:
I had a woman patient recently; a very smart, chic, well-dressed woman. Middle-aged. She wanted a face-lift. She was married to a very responsible man in an upper-income bracket, and she wanted to look better for her husband. It sounded okay ... Later on I heard she absolutely ran amok – divorced her husband, ran off to Mexico, took a 25-year-old boy as a lover – the whole route. It was dreadful.
If the cheering has died down, I’ll continue. Contrast this with a case reported to Haiken by the surgeon Donald Moynihan:
The prospective patient was a young black woman whose cornrowed hair and black studies major in college suggested to Moynihan that she was ‘really into the heritage thing’, as did her request that he put a bone through her nose. ‘I respected the deep pride she had in her race,’ Moynihan recalled, ‘but the way I see it, no matter what, a bone through the nose is an unreasonable request. I turned her down.’
Difference became deformity.


For a decade or so, it has been common for men and women to sculpt their bodies, shaping discrete muscles in gyms with specialist machines. In France, the performance artist Orlan takes herself to the operating theatre and films her surgeons reshaping her face into a facsimile of the Mona Lisa. The only change is that new techniques have permitted alterations to be carved out of or pumped into the flesh. Once women suffered the adverse effects of outlining their eyes with antimony: now silicone injections deform and disease. The pioneering plastic surgeon Jacques Maliniak understood this in 1933: if there is any ‘striking difference’ between the old and the new ways of enhancing beauty, he said, ‘it is that on the whole the old were safer’.

But perhaps the enhancing of beauty is not just the self-mutilation by proxy of politically subjugated women (and increasingly men), or a striving for social dominance, but a way of keeping us interested in ourselves. Growing old is also an interesting process, but it proceeds incrementally and without real drama. We should not underestimate the role of theatrical pleasure in the fast, thrilling transformations plastic surgery offers. Most of us know the gratification of seeing ourselves in a new outfit; perhaps it’s not so different getting a new body or face.

It is true however, that there is no record of women asking their cosmetic surgeons to transform their youthful faces into wrinkled age.  On the contrary, an LA surgeon has recently offered injections of botulinum toxin to prevent wrinkles by causing localised paralysis, taking us back to the turn of the century when a practitioner advocated that facial muscles be cut early in life as a preventive measure against wrinkled middle age. Smiling and animation are a real problem: ‘The constantly enforced and exaggerated smile in vogue today [1968] is a major offender in causing wrinkles about the commissure of the mouth, the nasolabial fold and the eyes.’ In 1977, serenity was advised: ‘Profound, uncontrolled emotion leaves its imprint on our faces for all the world to see.’ And I remember a worrying beauty hint from a contemporary beautician who explained that she kept a roll of sellotape in the car and stuck a piece between her eyebrows to prevent dangerous frowning while driving. Our mothers put on clean knickers whenever they went out in case they happened to be in an accident: imagine the humiliation of being caught by paramedics with sellotape between the eyes

　

People try to take control of their bodies in a world that is uncontrollable. But reality is tyrannical, and we might see the refusal to conform to nature as some
kind of guerrilla warfare, of the individual doing at least what can be done.

Finally, it is death, of course, that is immutable, and cosmetic surgery is yet
another brave though futile challenge to its visible advance