January 20, 2005
Making the Cut
When my aunt Arlene was 24 years old, she paid $500 to have her nose done. The year was 1957. Her father was against it, so she paid for it herself with money she earned at her first teaching job.
"This was the '50s, mind you, and I think there was an underlying fear of elective surgery. The philosophy was, 'Don't jeopardize your health unnecessarily. Don't look for trouble,'" she told me.
But she was resolute. Despite her family's assertions that "you're beautiful the way you are," she said, "it did not assuage my needs not one single bit. It was something that had been bothering me since adolescence, a nose that was not perfect, was just not right for my face, I thought."
Although it had been around since the late 1880s, plastic surgery didn't gain wider acceptance until the 1950s. Middle-class Jews like my aunt were early consumers when it came to rhinoplasty. The goal was to rid yourself of your Semitic-looking proboscis, and the movement only continued to grow as one by one, Jewish noses were shrunk.
Forget the bar mitzvah. Today, nose jobs for American Jews have become so ubiquitous a rite of passage, they're a cliché. And little did the Jews who got their noses "fixed" in the '50s realize they were in the vanguard of a grander American obsession: combating the aging process.
Today, plastic surgery has become part of the cultural zeitgeist. There's no escaping it in media and our everyday lives. Plastic surgery and makeover television shows draw huge audiences, running the gamut from reality programs like "The Swan," in which real-life ugly ducklings undergo multiple surgeries to compete in a beauty pageant, to fictionalized dramas like "Nip/Tuck," that romanticize the lives of plastic surgeons. Americans also participate -- more than 8.7 million of us last year, according to the American Society of Plastic Surgeons (ASPS) -- going in for "procedures," and attending botox parties. We have come a way since the 1950s nose job, and with the wide appeal that plastic surgery holds today, you could say that Jews were some of the early trend setters. Consider this: Jews, who have always had a love/hate relationship with plastic surgery -- and their own appearance -- have helped create a trend that has now exploded into the mainstream. They were "early adopters" of a surgical technology that has since gone from rare to ubiquitous, from stigmatized to embraced. Jews, out of their very desire to appear less Jewish, made plastic surgery acceptable to the very people whom they were trying to look like.
"Certain kinds of noses speak Jewishness.... Jews assimilating into a largely gentile culture thus strip from our features the traces of our ethnicity. We have other aesthetically assimilating rituals. We straighten curly hair, dye dark hair light. We get very thin to disguise what we often imagine are Jewish-coded thighs and hips. What we choose to treat are precisely the features that are culturally selected as our distinguishing physical traits," writes Virginia L. Blum in her book "Flesh Wounds: The Culture of Cosmetic Surgery" (University of California, 2003).
Historically, Blum is correct in her observation. This has been our tradition, but in the early years of plastic surgery, it was a survival mechanism against anti-Semitic eugenic philosophies as much as an effort at social acceptance. Supposed ethnic identifiers like Jewish or Irish noses and "Dumbo ears" were a major target of plastic surgery in its earliest stages, as were facial deformities resulting from disease or genetics.
With the advent of antisepsis and anesthesia in the late-18th century, the science of plastic surgery truly began to flourish, with nose jobs the major focus. The first real nose job by modern standards was performed in 1885, by Jaques Joseph, a Jewish surgeon, on a Jewish patient. Other doctors worked to help rid the Irish of the "pug nose" and Jews of "a large, massive, club-shaped, hook nose," to quote one eloquent anthropologist of the time, Robert Knox. Social outcasts of a different sort, syphilitics often suffered nasal deformities like sunken nasal bridges or the lack of a nose altogether. Recreating noses in entirety, then, was also part of the early focus of rhinoplasty. These surgeries were done to help outcasts pass within mainstream society, according to University of Chicago professor Sander L. Gilman, author of "Creating Beauty to Cure the Soul: Race and Psychology in the Shaping of Aesthetic Surgery" (Duke, 1998).
Other surgeries to help ethnic others "pass," included the pinning back of "Dumbo ears" and decircumcision, according to Gilman. "In the 19th century those ears were absolutely identified as signs of ethnic difference. In New York, Irish, and in Germany, Jewish," he said. Decircumcision, too, was a procedure undergone by Jewish males, who were thought to be effeminate. Foreskin restoration was considered to also restore a man's damaged masculinity.
Slowly, new strides were made in the field. In World War I and World War II, facial reconstructive surgery began to give the plastic surgeon -- until that point as much an outcast as his patients -- more acceptance in general society. With the popularity of movies in the 1920s, film and stage stars also began to get plastic surgery, giving it broader acceptance. Jewish comedian Fanny Brice was one of them. In 1923, she famously had her nose done, causing Dorothy Parker to comment that Brice had "cut off her nose to spite her race."
So then, "what begins in the 1890s, becomes in the 1950s," Gilman said. In post-Holocaust, anti-Semitic America, a nose job became a gift bestowed by Jewish parents, usually on their daughters. It made it easier to join a country club, and "move into general society," Gilman said.
My aunt's story is only atypical in that her parents made her pay for her nose job herself, and that she had it done after she was married.
"It was not uncommon in my generation at that time.... I think it was common among Jewish girls. The reason was to enhance your looks to get a guy," she said.
My grandparents' disapproval was actually a more traditionally Jewish response than many other Jewish parents of that generation seemed to have, at least in respect to the Jewish law banning self-mutilation. But most Jewish theologians actually make allowances for plastic surgery, depending on the situation.
"From a Jewish perspective, you're not allowed to intentionally injure your body, because your body belongs to God and you have it on trust during your life," explained Rabbi Elliot Dorff, author of "Matters of Life and Death: A Jewish Approach to Modern Medical Ethics" (JPS, 2004). However, he added, "we do have the permission and even the mandate to heal. The Jewish tradition understood mental illness to be a serious matter."
In other words, therapeutic plastic surgery, to cure burn victims, for example, is allowed by Jewish law. So is the removal of a big mole, argues Dorff. "Even some things that are not physically problematic, but are nevertheless very distasteful, I think that would be very reasonable," he said, noting the immediate gray area that arises. "You clearly are allowed to do other things to look better, like dress better or pierce your ears, to feel good about yourself. The question is whether you are allowed to undergo surgery to look better -- the degree to which surgery is the proper response to the feeling," Dorff said.
Dorff's argument takes on greater resonance when one considers the actual risks involved. In the case of liposuction, one of the top five most popular plastic surgery procedures today, patients were facing death rates higher than those from traffic accidents, according to a survey conducted by the ASPS in January 1999. Furthermore, the risks of plastic surgery like liposuction can be difficult to gauge because according to a quote in the FDA's consumer magazine, "there is no national group of consumers, nor one group representative of all clinicians, that is organized to oversee liposuction procedures and results."
For 19-year-old Rachel (not her real name), however, the benefits of plastic surgery outweighed the potential risks. She had a nose job during her senior year of high school to fix the size, which she felt was too big for her face, and to get rid of "the Jewish bump in the middle." She's not alone. More than 300,000 Americans underwent rhinoplasty operations last year, according to the ASPS. But Rachel eschews the idea that her nose job perpetuates a tradition of assimilation, or that it is in any way an act of self-hatred.
"None of my motivations had anything at all to do with trying to seem less Jewish. I wear a Jewish star necklace. You can tell I'm Jewish. No one would need to stereotype me by my nose size," she said.
Beauty, essentially, was the motivating factor. The size and proportion of facial features in relation to one another has been considered the essence of beauty since Leonardo da Vinci, and the Greeks before him, sought formulaic answers to the elusive concept of what is beautiful.
"When you look at studies of what people feel is attractive, it's symmetry. Things that are out of proportion are viewed as unattractive. This is across cultural lines," said Dr. Jonathan Hoenig, an oculofacial plastic surgeon and a Modern Orthodox Jew. "I come from a family where four out of five kids wanted rhinoplasty," he said. "I don't think they wanted to look Swedish. I think they all had beaks."
Hoenig said he never finds a contradiction between the work he does and his spirituality. His work is 30 percent reconstructive and 60 to 70 percent cosmetic, by his own estimation. But, he said, "there are people who have droopy eyelids and they say that they always have to raise their eyebrows to see. The surgery allows them to see better. It's functional and it's also cosmetic," he said.
He added that he turns away patients about 30 to 40 percent of the time.
"I always tell them the enemy of good is better," he said. "Sometimes the cure is worse than the disease ... but there are 20 doctors who will have them in surgery the next day," he said. "It doesn't say much for our profession, but unfortunately it's true."
Nor does it say much for our society. Dorff worries about the emphasis we place on physical attractiveness nowadays.
"One of the problems we have in American society is that we idolize youth," he said, "whereas the Jewish tradition appreciates old age. You gain honor as you age."
While it's true that stories mythologizing beauty exist in every cultural tradition -- from Helen of Troy, to "Beauty and the Beast," to Queen Esther -- Dorff also noted the proverb Eshet Chayil, which praises a woman, but not for her beauty: "Beauty is false and is worthless. It is a woman who respects God that is to be praised."
In that respect, our Jewish tradition is much more in line with American culture of the 19th century, according to the findings of Cornell University professor Joan Jacobs Brumberg, author of "The Body Project: An Intimate History of American Girls" (Vintage, 1998). Brumberg researched the book using historical documents, including many diaries of adolescent girls from 1830 to 1980. One thing she noticed was a shift in emphasis from good works to good looks. A girl's self-worth today is more likely to be focused on how she looks than on how she behaves in the world, Brumberg noted.
Of course, men are neither immune nor removed from this. The rise of the metrosexual proves men are quickly gaining on women in their obsessions over beauty and youth. While men only made up 18 percent of people who underwent plastic surgery procedures last year, the number is up from 15 percent the year prior, and almost double from 1996, when it was 11 percent.
If there was once a stigma associated with cosmetic surgery, television shows like "Extreme Makeover" and "The Swan" prove the atmosphere has changed, even as they continue to push those boundaries.
"Between 1995 and today, plastic surgery went from something you did not talk about to people now having public discussions and Botox parties, and it is truly a matter of the number of people having these procedures," Gilman said. "You couldn't have had the show 'Extreme Makoever' 20 years ago."
The aging of the baby boomers means the market for youth prescriptions is higher than ever. In his practice, Hoenig noted that "the baby boomers have changed things a lot because these are people who have retired a little earlier and have more money. They want to continue looking good. They're interested in vitamins, skin care, jogging, gyms. I think it's a global thing. This generation is more concerned with health and wellness.... People want to feel better. Not just to look better."
With the rise in nonsurgical procedures like Botox and microdermabrasion, or minor procedures like mini-facelifts, looking better has become less invasive and risky, and has blurred the line even further between cosmetic procedures and cosmetic surgery. Consumer demand for minimally invasive plastic surgery jumped 41 percent last year to more than 6.9 million procedures, according to the ASPS.
"It's an incredible trend," said Dr. Helene Rosensweig, of Indianer, Lask and Rosensweig Dermatology Group in Encino.
"Part of it has to do with how well it works and how few the side effects are," she said. Rosensweig added that when she began offering Botox injections in her office several years ago, she'd see about a patient a week. "Now we do between three and 10 a day."
Of course, Botox injections, which are the most popular of what Rosensweig terms the "easy procedures," are only FDA approved for use on the top one-third of the face. She said patients who are still unhappy with the other two-thirds sometimes seek out more invasive surgeries like face lifts: "I think you want your entire face to look good."
You could say that we Jews have come full circle, from setting the trend by being outsiders in the last generation, to embracing it as part of our American culture in this one. Strides have been made since my aunt went in for a "perky little Doris Day" nose, as she described it. In the '70s, for example, the "ethnic look" came into fashion, and even today, African Americans and Jews going in for nose jobs generally don't ask for perky upturned noses, but rather, more refined variations of the ones they were born with.
As for our youth culture, according to Gilman, the first facelift was done in 1904, so perhaps the emphasis on youth has been around longer than we imagine. My aunt didn't go under the knife again for 35 years, but in 1992, she decided to have upper eyelid surgery to remove some puffiness, she said. Since then, as she has felt her age catch up with her over the last 12 years, she's had a number of procedures, including laser resurfacing, liposuction under her chin, a general facelift, and Botox a couple of times. Whatever else you want to say about her choices, and minus recovery times and a few weeks along the way when the first Botox injection caused one of her eyes to droop, my aunt has always looked good, and that's something that has always been important to her.
My aunt said she has plans for another mini-facelift at some point.
"It's one of the aspects of my life to plan for the future," she said. "Just like I don't have to stop working because I've reached a certain age, I don't have to stop looking better because I've reached a certain age. It makes me feel there's unfinished business. I always leave a few dishes in the sink."