Change of Face...Change of Fate

Is our national obsession with appearance a new sickness or a perennial human concern?

By Jill Neimark, published on May 01, 1994 - last reviewed on March 27, 2006

Is our national obsession with appearance a new sickness, or is it a perennial human concern? And is it a way of revealing—or concealing—the true self?

I spent an afternoon in the office of New York plastic surgeon Joseph Michael Pober, M.D., watching him change a woman's life. She was only 4'11", and before she came to him she had the flat-chested, bony body of a child, a big nose, and heavy-lidded eyes that drooped downward.

He had already given her breasts and reshaped her nose in two previous surgeries. Now he performed a brow-lift. At one point, as he forced gauze through an incision and up into her forehead to soak up blood, he joked that he was like a magician stuffing a white scarf up a sleeve and pulling out red. But there was magic before me, and I was stunned by the truth of the old cliche: a single stitch, lifting a single muscle forever, altered her brow and eyelid about a centimeter and rendered her pretty. Such a small dislocation, such a shift in fate.

When he was finished, I asked if I could see her breasts, and she groggily assented. We pulled down the sterile blue paper. She let me touch them: They were full and firm but pliable, like a taut water balloon. There was no scar except for a faded line in either armpit, barely visible under the creamy talc of her deodorant.

If a single pair of breasts wasn't enough to dazzle me, an hour later one of Pober's secretaries slipped out of her lab coat to show me her implants. She wore a white cotton camisole and the voluptuous curve under the stretchy cotton was breathtaking. Pulling the camisole up, she proudly let me touch her breasts.

It sounds surreal, and it was—but even more so when I went home and examined myself. I usually find my body lovely, but that night I was a troubled Narcissus. My breasts—size 34C—seemed unremarkable, and when viewed from the side they gently sagged. I imagined the doctor's devastating assessment, one I'd heard again and again that day as we flipped through before and after pictures of patients: "Yes, her breasts are nice, they're fine [before], but these are great [after]. It changes her whole look. She looks ten years younger." Inevitably, he was right.

Plastic surgery is one of those subjects that almost everybody gets stirred up about. The mere potential to alter your appearance, and maybe your destiny, raises difficult questions. Is plastic surgery life enhancing? Is our national obsession with appearance a new sickness—or a perennial human concern that has taken many forms, from Chinese foot-binding, to ritual scars tribal peoples adorn themselves with, to corsets and stays? Is it a way of revealing—or perhaps concealing—the "real" self? Is there any moral distinction between a $3,000 suit and a $3,000 nose job? What is plastic surgery—a simple act of self-help or an incredible tangle of contradictions that reflect the complexity of modern culture?

Complex it is. This is a world where postmenopausal women are having babies, where the essential code of life—the human genome—is being mapped, where we've begun to cure illness by altering genes themselves, where antidepressants fine-tune us into happier humans. Plastic surgery is part of this Noah's ark where biology is no longer destiny. We have always attempted to master nature, but the fiercest site of the power struggle is now our body. It's heroic, tragic, comic, incredible, ridiculous, and wonderful by turns—but it's clearly one of the great dramas of our time.

In 1992, nearly 80,000 women had plastic surgery on their breasts; 30,000 had them enlarged, 8,000 had them lifted, and another 40,000 had them reduced. (This does not include the 30,000 who had their breasts reconstructed after a mastectomy.) Sixteen thousand Americans had tummy tucks, 20,000 had chemical peels, 40,000 had collagen injections, 50,000 had nose jobs, 50,000 underwent liposuction, and 60,000 had eye jobs.

Men now make up 13 percent of all cosmetic surgery patients. Baby boomers—age 35 to 50—are the hungriest of all: 41 percent of all plastic surgery procedures are performed on them, compared to 27 for 19-34-year olds and 22 percent for 52-64-year olds. The three favorite procedures among baby boomers are eyelid surgery, collagen injections, and liposuction—clearly intended to ward off signs of aging and preserve perpetual youth.

There has, actually, been a revolution in the field, which has gone from a half-despised stepchild of medicine to a lucrative and respected profession. "Aging is the field of the future," claims Manhattan dermatologist and plastic surgeon Douglas Altcheck, M.D. "When I trained I was an oddball, one of the very few dermatologists who had surgical training. Now almost every medical school in the country has a strong teaching program in dermatologic surgery. Dermatology is now the most difficult residency to get, because it's considered such an interesting field."

From Stepchild To Star

Other surgeons echo him: "When I chose plastic surgery at Harvard it was looked on as a frivolous and unnecessary profession, almost a prostitution of science," says Pober. "And there was a religious overlay to the criticism, as if you were changing God's work. But God doesn't come into the question anymore. Today it's totally different, it's a way of changing your own genetic lineage, your own future, your own fate."

It's the promise of plastic surgery that has invaded our senses, even more than the act itself. At most, half a million Americans undergo cosmetic surgery annually. But the tabloids, talk shows, and media are saturated with the subject—and who hasn't indulged in armchair fantasy about it? We talk about it, think about it, speculate on who's gotten it.