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Look Back to Move Forward

By: Steven H. Dayan, MD, FACS
Posted: May 3, 2010, from the May 2010 issue of
Physicians with hands in center

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One post-World War I surgeon was Jacques Joseph, a German surgeon who was known for his skills at reconstructing the complex facial wounds of veterans. He translated his skills and knowledge to alter characterizing facial features, such as the noses of healthy ethnic males and females wanting to look “more German.” And thus was born elective cosmetic surgery. However, the goal of this new trade was not perfecting the human form or achieving ultimate beauty, but making patients happy by allowing them the ability to integrate seamlessly into society.

However, after World War II and the advent of antibiotics and safer forms of anesthesia, cosmetic surgery migrated from a tool of inclusion to a tool of separation. Since the days of Nefertiti and Cleopatra, those who have felt they belong to the elite class of society used whatever they could to separate themselves from the underclass, and cosmetic medicine became the latest instrument of the privileged used to flaunt their identity.

Like many of the newest trends and fads in pop culture, it started with movie stars. Famous pinups such as Marilyn Monroe and Rita Hayworth were getting plastic surgery, and no longer was it a vehicle to blend unnoticed into society. Rather it was now being used to stand out. And cosmetic surgeons, in parallel, responded by offering physically altering treatments that were bold, large and sure to emphasize sexually characterizing features of beauty and youth.

Cosmetic surgery lost some of its original manifesto of allowing one to pass into society unnoticed. Now it became a tool to reinforce class distinction, and a level of being obviously altered was tolerated. Moreover, while wanting to look one’s best is a cornerstone of human behavior, the ability to extend attractiveness or youthfulness beyond what was predetermined genetically became a possibility for an emerging upper class, perhaps leading to its current misrepresentation.

To the masses

However, much of that changed when the cosmetic benefits of Botox were discovered. A wrinkle-reducing treatment that involved no downtime, was reversible and could be performed in a lunch hour, it was a generational drug that redefined cosmetic medicine. The price was attainable and results were almost universally admired by both physicians and patients, creating an incredibly in-demand procedure.