Elizabeth Haiken

“The Michael Jackson Factor: Race, Ethnicity, and Cosmetic Surgery”

From:

Venus Envy : A History of Cosmetic Surgery

(Washington DC: Johns Hopkins Univ Press, 1999)

______________________________

Nowhere is the never - never land offered by plastic surgery more evident than in the face of musician Michael Jackson. Finely sculpted, with pale, almost transparent skin stretched over high cheekbones, tiny, chiseled, pointy nose, deeply cleft chin, and eyes always heavily lined, the face he unveiled in the late 198os transcended all previously known categories of race and ethnicity (and, to some eyes, gender). As Rolling Stone writers Michael Goldberg and David Handelman described Jackson's "ever - evolving" features in 1987, his "Pale, made - up face with its newly clefted chin looks anything but street; it barely seems of this world." 1

Much of the favorable publicity that cosmetic surgery has received over the years has attempted to place it squarely within the American tradition of self - improvement, which sociologist Frances Cooke Macgregor has called the "American cultural tendency to change rather than to cope, to alter rather than to endure." Entertainers have been particularly enthusiastic about altering features that they believed would limit their careers or their chances for happiness. Jackson's reluctance to discuss his surgical transformation has only encouraged speculation about what motivated him to undertake it, but seen in this light, his surgeries like those of Fanny Brice, Milton Berle, and a host of others - seem a practical response to the limelight's strict requirements.2

As even this brief list suggests, Jackson is only one among hundreds of thousands of Americans who have attempted, through plastic surgery, to minimize or eradicate physical signs of race or ethnicity that they believe mark them as "other" (which in this context has always meant "other" than white). These differentiating (and often contradictory) categories emerged from contemporaneous, and not unrelated, historical processes for example, the impetus toward immigration restriction coincided with whites' increasing discomfort about a growing black presence in northern cities - and they shared the goal of defining "difference." From this perspective, Jackson's surgical choices are predictable. Race - and ethnicity - based surgery has always focused on the most identifiable, and most caricatured, features: for Jews, noses; for Asians, eyes; for African Americans, noses and lips. Most of the operations with which this chapter is concerned, at least before mid - century, were performed on white Americans and European immigrants. Jews, Italians, and others of Mediterranean or eastern European heritage made the "nose job" a household word early in the century. Asians, in the years after World War 11, began to pursue larger noses and folded eyelids. Their numbers are still small, but African Americans, too, have begun to alter their features through surgery in greater numbers than before. Unlike early - twentieth - century surgical pioneers, who were generally satisfied with altering one feature, Jackson has altered everything, but this may be simply a matter of timing: since the end of World War 11, surgeons have expanded their repertoires to fulfill a wider range of requests, making transformations like Jackson's possible.

The extent, and expense, of Jackson's numerous surgeries probably account for at least some of the uneasiness and horror his efforts have generated. Advanced techniques, an adventurous surgeon, and lots of money have produced truly extraordinary results: Jackson looks less like his presurgery self and more like Elizabeth Taylor than either patients or surgeons in previous generations would have believed possible. As pediatrician Benjamin Spock put it in 1984, "He seems partly child, partly adult, partly masculine, partly feminine; he seems to be a person for all ages and all sexes. I don't see that he is doing any harm, but I'm not sure he's doing any good either." Jackson's status as one of the wealthiest entertainers in the world is common knowledge, and Americans have become accustomed to the phenomenon of celebrity surgery, but in this age of declining access to medical care, Jackson's repeated transformations seem like the most conspicuous kind of consumption.3

Fundamentally, however, what bothers Americans about Michael Jackson's face is the race issue. The results of his surgery suggest that if he is not trying to look white, he is at least trying to look less black, and a review of the coverage his surgery has received in the popular press suggests that the majority of Americans believe that Jackson's surgery is, at least in part, about race. The lighter color of Jackson's skin may well be due to a skin condition, as he explained to Oprah Winfrey in his 1993 television interview, but this, to most commentators, does not explain what has happened to his lips, nose, and chin. Jackson's haunting face signals not only that all is not well in never - never land; it suggests that something larger has gone awry in twentieth - century North America. Despite the longevity of the tradition described above, Americans of many colors apparently are not entirely comfortable with what is being changed, and why, and what is lost in the process.4

One of the most important questions raised by Michael Jackson's transformation concerns the role the medical profession has played in shaping standards of appearance. The frequency with which early twentieth - century surgeons performed the classic nose job simply confirmed what most Americans already knew: a nose that called attention to itself and marked its bearer as "different" or "foreign" was a distinct disadvantage. Yet in their readiness to label certain nose shapes and types as deformities, surgeons helped to cement not just standards of beauty but standards of normality and acceptability in American minds. How plastic surgeons assumed the role of arbitrating between the issues of ethnicity, aesthetics, and "normal" or "standard" looks has remained unexamined. It seems clear, however, that as surgeons agreed with increasing numbers of prospective patients that, in fact, certain facial configurations were, if not unacceptable, at least undesirable, cultural standards of the range of acceptable deviation narrowed.5

Jackson's surgery also raises the larger issue of the role Americans have played in shaping these standards. Throughout the twentieth century, Americans have generally professed belief in the truism that norms of beauty are culturally determined; like fashions in clothes, fashions in faces change over time. On another level, however, Americans perceive at least some of these standards as basically unchanging and unchangeable: certain faces never come into fashion. From the early twentieth century on, the reigning cultural norms of beauty have been understood to demand an absence of what surgeons call racial or ethnic stigmata, and cosmetic surgery has consistently focused on altering features that differentiate patients from a norm that is always implicitly, and often explicitly, understood to be not just Caucasian but Anglo - Saxon or northern European.6

A brief review of American immigration and of the "science of race" that it inspired provides essential context for this discussion. Until about 189o, most immigrants to the United States hailed from northern and western Europe. Eighty percent of the fifteen million who arrived between 189o and 1920, in contrast, were from eastern and southern European countries, including Russia, Poland, and Italy. Unlike the "first wave" of immigrants, many of whom took advantage of the federal government's commitment to facilitating white settlement of the plains and prairies by moving west, these new immigrants concentrated in the cities of the eastern seaboard. The widespread overcrowding, poverty, and poor living conditions among the new industrial working class combined to redefine immigration as a problem in the minds of native - born white citizens. In reality, the proportion of Americans who were born abroad increased only slightly during these years, but the prospect of submersion was no less threatening for being largely imaginary.7

The anxious atmosphere created by the new immigration inspired concern among individual nativist politicians and groups, including organized labor. Together, their efforts led, eventually, to the immigration restriction acts of the 1920S, which set quotas based on a nostalgic vision of how the country ought to look (after excluding first Chinese and then Japanese immigrants, legislators set strict quotas that privileged northern and western Europeans over those from the "less desirable" countries that had spawned the second wave). Such efforts also provided fertile ground for new scientific ideas about heredity, ethnicity, and race. In the late eighteenth century, comparative anatomist Johann Friedrich Blumenbach developed a widely accepted scheme for racial classification that depicted the European stock as the original racial type from which all others had degenerated. Swiss physiognomist Johann Lavater's theories similarly found their way across the Atlantic, and for a time the science of physiognomy - whose practitioners believed they could identify and classify facial and other features and from them divine personality traits - enjoyed wide publicity and popularity in the United States. In general, physiognomists believed that "small features indicated virtue and 'great delicacy of sentiment,' while large features indicated sensuality and slothfulness. " Supporters of immigration restriction - such as nativist E. A. Ross, who in 1914 warned of "hirsute, low - browed, big - faced persons of obviously low mentality" - were clearly familiar with such theories.8

It is too simplistic to say that those who sponsored Jim Crow laws across the American South were likewise informed by ideas such as these, but it is true nonetheless. The Civil Rights movement of the 1950s and 196os inspired an entire generation of scholars to explore and explain the historical construction of "blackness" and the mechanisms by which such constructions came to uphold a formidable legal structure that sheltered legalized racism in the southern United States and in the nation's growing empire and ignored the less - formalized racism that held sway elsewhere. A new generation of historians has turned this project on its head: in addition to demonstrating that what was constructed during these years was not just "other" than white but whiteness itself, these new studies of the construction of race remind us that, while their various incarnations may be place - and time - specific, the racial ideologies that permeated American culture in this period provided an all encompassing framework through which Americans viewed the world and themselves.9

During the late nineteenth century, scientific schemes for racial classification and more vague (though no less powerful) ideas about racial definitions and boundaries met with great attention. They combined with Darwinian science, the rediscovery of Gregor Mendel's work on heredity~ and fears of race suicide sparked by a declining birth rate among the white middle class of western Europe and the United States to produce yet another new and popular science. Eugenics was, essentially, the "science" of human improvement in which principles of plant and animal breeding were applied to humans. It taught that hereditary traits were dominant and could not be altered by environmental factors; breeding for the preservation of positive traits as well as for the elimination of negative ones was the only solution. On the American side of the Atlantic, not surprisingly, eugenicists were most often "old stock" Americans who were confused and dismayed by the changes they observed in their world. Geneticist Charles B. Davenport, whose New England Puritan father could trace his ancestry back to io86, for example, was known to mourn publicly that "the best of that grand old New England stock is dying out through failure to reproduce." But the eugenics movement drew interest and support from a wide range of Americans, from social reformers concerned about the new industrial working class to politicians seeking to defend segregation. According to one tabulation, between igio and 1914, general - interest magazines carried more articles on eugenics than on the topics of slums, tenements, and living conditions combined. 10

Eugenics provided a transition to more specific ideas about race that were taken up, in the early twentieth century, by men like William Z. Ripley, a Harvard economist, and Madison Grant. In the encyclopedic The Races of Europe, first published in 1899, Ripley went further than Blumenbach in applying the principles of scientific classification to humans; his system, for the first time, differentiated among white Europeans along "racial lines" (northern, Teutonic "tall, blond longheads," central, Alpine "stocky roundheads," and southern, Mediterranean "slender, dark longheads"). Ripley combined this racial typology with Mendelian theories and proposed, according to historian John Higham, "a thoroughly biological explanation of the foreign peril" - the suggestion that the racial intermixture in America represented an irreversible reversion to a primitive type.' In doing so, he set the stage for Madison Grant, whose alarmist jeremiad about racial purity (The Passing of theGreat Race, first published in 1916) tapped broader currents of popular nativism and raised nativist thinking in the United States to an entirely different level. America, once populated solely by Nordics (in Grant's words, "the white man par excellence"), was being destroyed by Alpine, Mediterranean, and particularly Jewish immigrants, he warned darkly. Popular acceptance of the insidious parable of the American Melting Pot, Grant wrote, was facilitating this decline: contrary to popular belief, race mixing did not result in a blend; rather, it "gives us a race reverting to the more ancient, generalized and lower type' " Thus, the Nordic stock could be destroyed by mixing with lower European races and particularly by mixing with Jews. In one of his most widely quoted phrases, Grant asserted grimly that "the cross between any of the three European races and a Jew is a Jew." Grant was not the first to employ science toward racist ends, but his work pioneered in offering a "systematic, comprehensive world view" based entirely on race. 11

Historian Lois Banner notes that, despite the rampant nativism and prejudice in this period, American ideals of beauty remained surprisingly democratic. Commentators commonly heralded the ideal American female as "an amalgam of ethnic types ... proof that the American melting pot could work ' " The original model for the Gibson girl was rumored to be Irish, or perhaps half - French and half - Cuban. In contrast to reversion theories, as far as beauty was concerned, the process of ethnic mixing was understood to produce a higher type than any of the individual ingredients: "truly unique, democratic, and American." 12

But American ideas about beauty were not entirely unaffected by racist ideologies. Experimental psychologist Knight Dunlap is perhaps best remembered for placing the psychology department at the Johns Hopkins University (and later the departments of psychology, anthropology, and sociology at the University of California at Los Angeles) on firm ground, but early in his career, as did many respectable scientists, he toyed with eugenics. In 192o he brought his combined scientific knowledge to bear on the topic of beauty; the resulting work, Personal Beauty and Racial Betterment, offers a compelling illustration of the way ideas about race and beauty might, and did, intersect. Dunlap identified beauty as a "positive condition" that could be said to be present only if "negative conditions" were absent. The first of these negative conditions identifiable signs of race - was particularly visible in "negroid characters." "Here, where the suggestion or indication is of an inferior race," Dunlap asserted, "the negative condition is especially important." The second negative condition was signs of disease, deformity, or weakness. The third negative condition - significant deviation from the average - seems to imply relativity, but here, too, race was paramount. "The type which is highest in value tends to approximate the European type, wherever the European type becomes known," Dunlap explained. "All dark races prefer white skin," and both men and women tend to choose superior partners (meaning, in Dunlap's terms, a partner with skin lighter than one's own). Dunlap was unusually explicit, but his assumption that "white" features constituted the standard against which all were judged was not uncommon. 13

For those whose features fell short of this standard, cosmetic surgery offered hope. In general, prospective patients viewed surgery as an option according to the amount of prejudice they encountered, the identifiability as ethnic of particular features, the availability of surgical techniques to eradicate the offending features, and money. In the early decades of the twentieth century, Jews and Italians most often met these criteria. They were (or were thought to be) identifiable to American eyes; they encountered prejudice; the feature that most troubled them was the nose, against which surgical techniques had already proved effective; and they were upwardly mobile. Not all who met these criteria, of course, sought cosmetic surgery: those who spent most of their time in. ethnic enclaves probably did not realize the extent to which they were perceived as different; some simply tried harder to surpass the barriers they faced, confident that their success would help to destroy existing stereotypes; still others relied on white Americans' legendary inability to identify ethnicity to claim membership in a less - stigmatized group (according to one account, Italian immigrants seeking clerical jobs often claimed to be French, Spanish, or Turkish). Many new immigrants and members of less - favored ethnic groups, however, came to see cosmetic surgery as the most effective solution to the problems created by features that identified them as something "other" than the AngloSaxon American standard.14

The human costs of this long and often sordid history are visible in Michael Jackson's face. Jackson's injured air and defensive demeanor may arise from his conviction that he has altered everything about his face that might conceivably give offense: Why, then, don't we like him? The answer to this question, of course, has as much to do with Jackson himself as with his face. But the fact that the image of America his face reflects is so unflattering accounts for much of our discomfort. 15

From Fanny Brice to Barbra Streisand

Throughout her life, comedienne and actress Fanny Brice insisted that looking Jewish had played no part in her decision to alter her nose, which she did (to great fanfare) in 1923. She had, she claimed, always been proud of being Jewish, and as she had met with "very little" anti - Semitism, she had no reason to want to look less Jewish. Late in life she recalled, "Nothing ever made me angrier than the gossip that I had my nose operated on so I'd look less Jewish. I wanted to look prettier and my nose was a sight in any language, but I wasn't trying to hide my origin." The explanation Brice offered most often was that she had done it to make herself eligible for a wider variety of roles; she had especially hoped to play Nora in Ibsen's A Doll's House. 16

Despite Brice's denial, most of her contemporaries believed that the desire to look less identifiably Jewish played a role in her decision, and biographer Barbara Grossman concurs: "She must have hoped that the operation would make her look less Jewish.... Ethnicity was definitely not fashionable in the 1920S ' " On a personal level, Brice may in fact have been comfortable with her looks. She publicly proclaimed her pride in her religion and her heritage and indeed built her career on playing Jewish characters to Jewish audiences. On a professional level, however, Brice evidently realized that a successful career depended on beauty~ and that beauty meant the absence of the clear signs of race or ethnicity that could be damaging, if not fatal, to an entertainment career. 17

The first group of Americans to undertake surgical alteration of ethnic features in any numbers were, like Brice, Jews who did not like their noses. Inspired by the work of New York's John Orlando Roe and Berlin's Jacques Joseph, American surgeons had begun to experiment with nasal plastic surgery in the late nineteenth century. While most early reports of nasal operations employed general terms like "overlarge," "humped," or "too - prominent" when describing the kinds of noses that were desirable of improvement, Dr. John B. Roberts's 1892 reference to 11 the Roman nose, the Jewish nose, and the nose with an angular prominence on its dorsum" suggests that, even before the turn of the century, the "Jewish nose" required no further description. Certainly by the 1920S most Americans were aware that noses that fit these categories most often hailed originally from southern or eastern Europe and that many of their bearers were Jewish. Thus, when Brice's nose job became public, Americans were already familiar, in general terms, with the "sciences" of race and ethnicity, as well as with the negative connotations that attached specifically to the "Jewish nose."18

Some Americans fought against the growing surgical trend. In her popular 1927 advice book, Girl Scout advisor Hazel Rawson Cades endorsed the camouflage that clever hat and hair arrangements might provide, but warned young women, "noses may not be cut off, either to satisfy or spite one's type. " Surgeons, however, had already recognized that Jews and other ethnic Americans represented a large potential market for nasal plastic surgery and were making a move to claim it. In 1930 William Wesley Carter noted that the "modification of accentuated family or racial characteristics, such as are sometimes observable especially in sernitic subjects, is not only a legitimate procedure, but it is frequently of great importance to the individual.... In the moving picture field ... the possession of a shapely nose is frequently the deciding factor." While he had originally opposed such surgery, by 1936 Vilray Blair had come to believe that a Jewish nose was as deserving of correction as any other type of nasal deformity. "Change in the shape of the pronounced Jewish nose may be sought for either social or business reasons," he noted. 19

Surgeons and Americans who by the 1930s had defined the Semitic or Mediterranean nose as undesirable had probably become acquainted with the scientific theories that had influenced American ideas about beauty in the previous decades, as well as with the new disciplines of psychology and psychiatry. As we have seen, in the years between the two world wars, the conviction that plastic surgery could be of particular benefit in helping to heal an inferiority complex was widely held. Family members, potential employers, and the general public who revealed their distaste for a physical feature might, surgeons believed, engender an inferiority complex. From this understanding, it was natural that they should begin to believe that a feature commonly defined as ugly - for example, a Jewish nose - might be just as likely to cause an inferiority complex as a congenital abnormality or a traumatically induced defect.

World War 11 gave new impetus to the link surgeons had forged between outer appearance and inner peace or lack of it. The war was crucial to the growth of the psychiatric profession: for the first time, the U.S. Army officially recognized psychiatry as an important branch of military medicine, and the military endorsement meant that psychiatry and psychology continued to receive wide coverage in the popular press. At the same time, the extent of American anti - Semitism was revealed in sharp relief. Laura Delano's response to the Wagner - Rogers bill, which would have relaxed quotas to allow the entrance of twenty thousand German refugee children - that "20,000 charming children would all too soon grow into 20,000 ugly adults" - was in many ways typical of American opinion in 1939. Even watching the 933 refugee passengers on the St. Louis head back to Europe in despair after being refused entrance did not significantly alter the widely shared conviction that Jews were the least desirable addition to the melting pot. After the war, as mental health practitioners joined surgeons in exploring the psychological indications for and implications of cosmetic surgery, a spate of articles that tied the inferiority complex to ethnicity appeared in a variety of medical journals. For prospective patients who carried the facial "stigmata" that identified them as members of minority groups and had inferiority complexes because of this, surgeons asserted, surgery was a positive step. By altering the feature or aspect of a feature that gave offense, surgery could eliminate the reaction it inspired in others and the inferiority complex this interaction had caused. A nose job, in other words, could mitigate the damaging psychological effects of prejudice.20

The image of hundreds of ethnic Americans undergoing cosmetic surgery to mask their ethnicity recalls the stereotype of people of mixed race "passing" as white, which has been well established in literature and film. Plastic surgeons and their patients, however, often explicitly disavowed any connection with this tradition. Surgeons justified their work in medical terms: as responsible and responsive practitioners, they insisted, they were trying to fulfill their patients' requests for a more attractive appearance, as well as a healthier mental outlook. In general, patients too claimed to have limited goals. They had no desire to deny their religion or their ethnic heritage, they asserted; they merely hoped to blend in better, to become indistinguishable and thus to reap the benefits that were generally available to those not perceived as different. This oft - expressed desire for ethnic anonymity suggests the extent to which the stereotypes evoked by the nineteenth - century "sciences" of race - which, by the 193os, had been largely discredited - continued to permeate popular culture and consciousness. This desire was sparked by the knowledge that in the United States the face, or particular features, often led others to attribute to the bearer particular personality or character traits. Facial features that might lead to the attribution of criminality, drug addiction, or disease were and continue to be of concern. A high forehead was often taken as a sign of superior intelligence, while a low forehead or receding chin (immortalized in the popular car to on figure Andy Gump) was taken to indicate poor intelligence, weak character, and, in men, lack of strength, masculinity, and resolve. Racial and ethnic stereotypes, too, were widely recognized. In her path breaking studies of plastic surgery patients, sociologist Frances Cooke Macgregor found that the so - called Jewish nose - "characterized by considerable length and height, convexity of profile, a depressed tip with a downward sloping septum, and thick, flared alae or wings" - was of primary concern to Italians, Armenians, Greeks, Iranians, and Lebanese (who feared being mistaken as Jewish) as well as to Jews. Individuals in all of these groups, she wrote, wanted to alter the noses that they believed offered "visible clues to an ethnic or religious group that they perceived as having unfavorable or stigmatic connotations." "In a milieu where racial or religious prejudice prevails," Macgregor commented, "a large convex nose, the Jewish stereotype, may automatically assign to its possessor all the physical, mental, emotional, and moral characteristics with which that group is supposedly endowed * "

The process of Americanization through surgery is difficult to decipher because no statistics were kept. Generally, patients did not discuss their motivations publicly; when they did, as in the pages of women's magazines, they seldom discussed issues of race and ethnicity openly. Several studies that were completed in New York using data collected between 1946 and 1954 provide clues. One of these found that of seventeen potential patients, fourteen were children of immigrant parents and most of these were from Mediterranean or eastern European countries: six were eastern European Jews, five were Italian, one was Armenian, and one Greek; only one was Irish. Individual surgeons often published their own conclusions, drawn from anecdotal evidence collected in their practices. A unique window onto this world is offered by the patient records kept by New York plastic surgeon Jerome Pierce Webster. Covering primarily the years from 1930 to 1950, these records allow us access to the motivations and desires of patients who came in requesting surgery during these years.22

Of almost 400 patients who came to see Jerome Webster about their noses in these years, almost three - quarters were female. Most of the women (204) were single; 73 were married, 12 widowed, 7 divorced or separated; the marital status of the rest was not given. Of the men, 56 were single, 33 married, 2 divorced or separated. The greatest number of patients (128 women, 32 men) came between the ages of fifteen and twenty - four, although many came later (82 women and 14 men from twenty - five to thirty - four; 37 women and 18 men from thirty - five to forty - four). Given the fact that a nose job is a cosmetic operation - by definition, elective and expensive - the socioeconomic status of these patients is surprisingly broad. For both men and women, student was the occupation most commonly given (54 women, 23 men). Many in this group were already self - supporting (in general, those in college or postgraduate programs such as law school); for minors, parental occupation (not recorded consistently) generally identified the family as middle class (a few, clearly, were wealthy; more often, the family was poor). The two next largest occupational categories for women were clerical (45, ranging from bookkeeper to receptionist to telephone operator) and "at home" (38, mostly housewives). Performing arts came next (23), then beauty and fashion (19). The men, in general, described themselves as white collar (15) or professional (12). A surprising number of men and women named occupations that were clearly either blue collar or working class in nature and in income: Webster's patients included florists, laundry managers, farmers, produce and dairy workers, piano teachers, firemen and policemen, laboratory technicians, electricians, and factory workers as well as aspiring movie stars.23

The nature of their complaints varied considerably: disease, trauma, sinus problems, and infections brought some patients in. By far the largest number, however - 251 Of 376, or two - thirds - were motivated solely by cosmetic concerns. Of these, 17 specifically cited career reasons; an additional 26 cited cosmetic concerns as one of two or more factors. Only a few prospective patients specifically cited ethnic concerns. But the terms they used to describe their noses suggest that many of these patients were aware of racial and ethnic stereotypes and reveal the extent to which "normative" standards had permeated their consciousness. Thus, while only 14 described their noses as "Jewish" (and only 1 said "Italian"), the terms prospective patients used to justify seeking cosmetic correction clearly describe noses that were stereotypically un - American. In descending order: 84 described their noses simply as "bad"; 58 used the word "deformed"; 23 complained of a bump, hump, or lump; 12 thought their noses "large"; the same number complained that the nose tip was unattractive; 7 said "long"; 4 said long with a hump; 2 said "crooked"; 1 used the term "broad"; another, long and thick. Those with what they considered abnormally small noses used similarly coded terms: only one said "negroid," but seven more said "saddlenose"; two said "flat"; one, "broad."

Anecdotal evidence from these patient records allows us to take a closer look at the complex ways in which ethnic and racial stereotypes, self - image, and aesthetic standards intertwined with the perceived demands of consumer culture. First, let us consider those patients whose primary stated concern was to advance their careers. Their stories are predictable, their words generally innocuous. In 1939 Alicia Martin was promised a screen test, contingent on a nose job. Stage actress Audrey Banks came in two years later because she wanted to make the jump to screen; she had passed the screen test, but her nose needed "touching up.5' In 1943 one of singer Alice Hansen's agents suggested that an improved nose might enable her to cross over to film. In 1957 secretary Christina Skouras and model Janet Cameron saw new profiles as stepping stones: Skouras had been invited to Hollywood but cautioned to change her nose before going west; Cameron had enjoyed some success making commercials but "T.V. experts said she is held back by [her] nose, especially profile."24

As these cases suggest, many Americans believed that occupational mobility and opportunity were contingent on a particular facial configuration. Unemployed or underemployed at the time they sought Webster's help, they believed that surgery would enable them to move up within their chosen field or make the jump to a more lucrative and more interesting occupation. Clearly, all of them aspired to careers that would place them (if in some cases peripherally) in the "public eye* " But as the next group of cases demonstrates, many other Americans subscribed to these same standards. Robin Shapiro, Hope Steinberg, Cindy Ross, Rachel Frank, and Marcy Goldberg - all young, single, and Jewish - came to see Webster between 1933 and 1953. Over a two - decade span, their concerns were remarkably similar. Shapiro had inherited her father's nose; it had not bothered her until friends started referring to her "beak" and asking why she did have something done. Steinberg - whose mother, Webster noted, had a "racial" nose - was "absolutely determined" to have hers altered. Ross was "extremely self - conscious" about her "Jewish nose" and was particularly distressed by the "bulbous tip' " Frank, too, had been unlucky: her sister had inherited their father's straight nose, but she had inherited the nose her mother had altered years ago. Goldberg, Webster observed, came by her large nose "honestly" as "father has large nose and mother's is definitely racial."

Americans of other ethnicities shared these young women3s perception that less noticeable noses were desirable. Ida Davis, born in Lithuania and employed as a maid when she saw Webster in 1941, complained of the "prominent tip" of her nose. Reza Hakim, an Iraqi immigrant, had begun to feel while living in Chicago "that the normal hump of the near East people's nose was not satisfactory." Susan Harjanian's schoolmates teased her about the large nose she had inherited from her Armenian parents, while Michael Baglione and Rita Cacciotti were both dissatisfied with large Italian noses. Many of these patients cited the explicit or implicit goal of ethnic anonymity. They did not want to become something other than what they were: none cited a desire to pass, none changed their names, none planned to move away. But they did not want others to be able to identify them on sight as something other than generic American. They wanted to be seen as individuals rather than as members of a group and to be able to control what they revealed about themselves to others. The fact that so many prospective patients from a wide range of ethnic backgrounds cited the issue of "difference" suggests that this concept clearly had as its reference point a standard of appearance that derived from a particular definition of "whiteness" - not just Caucasian, but AngloSaxon. Americans, as Italians and others told sociologist Frances Cooke Macgregor, were quick to categorize people they met, and they often mistook Italians for Jews, or Greeks for Italians, but rarely, if ever, did they mistake "ethnics" for WASPs.25

Potential plastic surgery patients often claimed to hold no prejudices themselves: rather, they asserted, they were simply responding to twentieth - century American social conditions. Rita Cacciotti, for example, told Webster that while she had always disliked her nose, reading magazine articles had increased her dissatisfaction. On this point, however, no words are more revealing than those of non - Jews who feared and resented being mistaken for Jews. Eleven prospective patients - seven women, four men - came to see Webster with this specific complaint between 1929 and 1957; the following stories are representative. Gretchen Algren, a thirty - five - yearold housewife, was married to an army officer stationed at Fort Leavenworth, Kansas. She had always been teased about her large nose, she explained, and had learned not to mind; recently, however, several people had revealed in chance remarks that they had [mistakenly] assumed she was Jewish, and she feared that she was holding her husband's career back. Webster's notes on Vivian Wolf's 1938 appointment read, "She is frequently mistaken for a person of Jewish heritage, although she is Catholic. At the New Haven Hospital the Jewish interns ask her to make dates." The twenty - six - year - old medical technician had been engaged to an Irish medical student, but he broke it off - in large part, she suspected, because his friends kept asking him why he was marrying a Jewess. Jane Hatch arrived from England in 1941 to find that her nose - which in England was acceptably British - was, in the United States, assumed to be Jewish. She believed an operation would enable her to find a job that would better support her two children. William Gordon was the most plainspoken of this group. In 1957 he was twenty - four; he had recently moved from New York's West Side because "every Jewish rabbi would talk to him in Yiddish." Gordon had been horrified by being "taken for a Jew," because (Webster recorded) "his great hero is Hitler." Gordon's attitude was extreme among this group, but the sentiment was not unusual. Several complained that they had developed inferiority complexes because of these experiences. In all cases, patients were insulted that others had mistaken them for Jewish and were convinced that a nose job would eliminate the "social handicap" under which they labored.26

Like their fellow immigrants who made a point of losing their accents, learning English, and wearing typically American clothes, most of those who sought the more drastic solution of surgery wanted to blend in with people around them; they wanted to look "American." This desire was complicated by the fact that the face of America differed from region to region and had changed considerably due to successive waves of immigration and migration. But many Semitic and Mediterranean your brother look like an Irishman - not that I have anything against the Irish.,29 Some were more analytical and thoughtful about their motives than others, but most patients were aware that their desire for surgery had to do with what they perceived as the social realities of the United States. In other words, they were responding to standards of appearance and beauty peculiar to their adopted culture rather than to objective "aesthetic" norms. As surgeon Adolph Abraham Apton put it in his 1951 book on the psychological importance of plastic surgery, I have operated on many persons of different ethnic groups who doubtless would never have considered surgical correction ... if they had remained within their native borders. A nurse, of Lithuanian origin, confessed as much. She was anxious to be rid of her broad 'Slavic' nose and to have one in conformity ... to that of the average American. A similar expression was that of an Armenian whose dominating desire was... [for] a nose along what he considered American citizen lines - a nose that would not be 'too different."' In their belief that a clear norm existed, that deviation from it had costs, and that surgery was the best solution, patients were encouraged by the surgeons who offered correction. "What is considered a shapely nose in one culture might be considered a handicap in another," Oklahoma City surgeon Gilbert L. Hyroop observed in 1965. "There are certain persons who feel their racial characteristics are a hindrance to them, that they set them somewhat apart." In America, Hyroop contended, the outcome was obvious: big noses - even classical Greek or Roman noses, long considered the height of artistic beauty - were simply no longer fashionable."

Again, Jerome Webster's case files offer an illuminating view of how the aesthetic standards and ethnic prejudices to which surgeons and patients subscribed intertwined with the propensity of medical practitioners to view requests as purely medical challenges to create powerful incentives toward homogenization. Audrey Scott came to see Webster in 1941. She was twenty - nine and single; she worked at the Metropolitan Museum of Art. She had been "conscious of her nose all her life," but this consciousness did not keep her from accepting invitations, and (Webster noted with relief) she was not neurotic. She was "occasionally told that she is Jewish, or asked if." Webster then described the complaint in clinical terms. "Nose is fairly long, has a very slight hump, is somewhat broad near the tip and the tip bends down, giving somewhat the appearance of a Jewish nose." In words that reveal his own aesthetic patients were not at all confused about what constituted the American face. The nose that looked most American, they believed, was the one that a few generations earlier had been widely caricatured as decidedly foreign. It was Irish.

The story of twenty - eight - year - old "Arthur Steelman," n6e "Arthur Schulbergerl" who participated in one of the studies documented by sociologist Frances Cooke Macgregor, is illustrative. Steelman had been conscious of anti - Semitism throughout much of his life. He was particularly sensitive to Jewish stereotypes and resented the extent to which Americans subscribed to them. "They try to put me in a category," he explained, "and Lord help me if I did anything vulgar or loud, or if I cheated.... Socially and economically I could be strangulated by this [his nose]." In the army, Steelman's ideal had been "any good - looking Irishman with a turned - up nose," and he had "a burning desire to be accepted" by gentiles. He did not want to "pass," however, but to subvert the stereotype he was sure others held: "If my nose is changed, then I can show [gentiles] by my behavior that there are nice Jews. I'll be a goodwill ambassador. I can prove to people that I'm not only a 'white man' but a 'white jew."'28

Like many Jews of his generation, Steelman left the operating room with the turned - up nose he had requested. Adjusting to a new selfimage was, at least initially, more difficult than he had anticipated: he was badly shaken by his first look in the mirror. "It's like ... having someone else look back at you," he recalled. "A Jew has tremendous pride. That's why it's so difficult to get other Jews to admit their reasons for wanting a nasal plastic.... I wanted a Jew to know I was a Jew.... At the same time I didn't want others to know I was a Jew. At first I was horrified when I looked like an Irishman. I was a man without a country. Now I'm beginning to get used to it." Once accustomed, however, Steelman claimed that not looking identifiably Jewish had enabled him to accept - even to enjoy - being Jewish, in his own way. "I think I'd prefer to marry a Jewish girl ... we'd be the kind of Jews they'd like," he noted. "I can afford to be generous and accept Jews now because I know I don't look like one. Before, I identified myself with them and resisted them." Steelman's family also had to adjust. In front of Steelman, his brother told the interviewer that he had no problem with the surgery. Alone, however, he revealed the complexity of his own feelings about the operation. "Now I'll tell you how I really feel," he confided. "You see, I'm a Jew and I'm not ashamed of it, but it's a shock to have features, but so she could be considered as an individual personality rather than a stereotype. "32

Doctors focused increasing analytical attention on rhinoplastyoperations in the postwar years in part because of the rapid and significant increase in requests for them. Psychiatrist Joost A. M. Meerloo, in 1956, noted that he became interested in plastic surgery when he realized that "an epidemic of plastic surgery is going on among teen - agers wanting to correct prominent'semitic'(Armenoid) noses, " The postwarexpansion of the middle class made this increase possible. In the years before the war, patients were often in their mid - twenties to mid - thirtiesby the time they had saved enough money for surgery. After the war, young people who wanted plastic surgery could have it - courtesy of their parents - before college or even in high school.33 Postwar publicity also fueled the increase in requests for plastic surgery. After World War 11, advertisements for appliances such as the Anita genuine nose adjuster and M. Trilety's nose shaper, which appeared in Photoplay during the 1920S, were supplanted by articles heralding the wonders of nasal plastic surgery, but the significance of the nose as a focal point of beauty remained undisputed. In 1954, journalist Geri Trotta brought this point home to Harper's Bazaar readers. Describing the accompanying photograph of a lovely model, the copy read, "By any standard, this is a pretty face.... But what if the nose were a horrid shape or an awkward size? How inconsequential the large eyes would seem then, how irrelevant the apricot - gold skin, the nicely curved lips. For, while an imperfection can be a delightful distraction ... a malproportioned feature is downright ugly; a defect no amount of make - up artistry can ever quite deny. It calls for more than camouflage. It calls for alteration. Frankly, it calls for surgery - " Cosmopolitan similarly encouraged readers to change noses they did not like. Writer Elizabeth Honor noted in 1956 that the "most dramatic and popular of corrective operations is the nose operation to correct a humped, hooked, or over - long nose." Newspaper supplements spread the news to an even wider audience. "First of all, let's face the fact that there are few naturally pretty noses" began one article published in the mid - 195os. Another reassured its readers that nose surgery was safe and more common than ever: "More than 50% Of plastic surgery is performed on the nose."34

Like surgeons, authors of popular magazine articles attempted to normalize the nose job; they stressed that patients were not neurotic but simply motivated by the healthy desire to fit in. In 1959 an American Weekly prejudices, he concluded, "I think there is sufficient deformity to warrant changing the nose." While nose jobs could facilitate adjustment to American society for white ethnics, they might create unanticipated problems for patients, particularly if they had children, surgeons noted. In 1949, Drs. Lewis Linn and Irving B. Goldman described one such case. The woman in question was Jewish but had been raised in a gentile community and had had a nose job at nineteen. She had never told her husband about her nose job (it is unclear from the article whether or not he too was Jewish); now,at thirty - five, she had become obsessed with the fear "that her secret would be exposed in the noses of her [three] children." The doctors expressed their concern that this patient was deeply neurotic, but concluded that, in her case, surgery had been appropriate. "Where antisemitism and xenophobia are widespread," they noted, "specific nasal configurations add to feelings of loneliness and rejection.... Alteration of their features in the direction of greater conformity to the social average helps overcome this sense of 'not belonging.’” In addition it facilitates identification with certain culturally determined aesthetic norms. "31

Several studies in the next few years corroborated the hypothesis that the desire to avoid discrimination inspired many cosmetic surgery patients. One group of physicians noted that nine of eleven girls in their study group were Jewish, but none was anti - Semitic. instead, the girls expressed "the wish not to be looked at in a stereotyped way ... to be looked at as an individual rather than as a member of a class." A larger study that compared the requests of Jewish women and Italian men for nasal plastic surgery revealed that "wishes not to be stereotyped as alien contribute to desires for physical conformity ... we suggest that conscious motivation concerns itself with the patient's desire to be viewed as an individual rather than as a member of an alien group." None of the Italian men, the physicians reported, wished to change religions or to deny Italian nativity, but "they did find unacceptable those class attributes of poverty, crudeness, alcoholism and brutality." Another study, completed in 1961, came to similar conclusions. "Nearly all of our patients under 20 years of age were Jewish and many attended the same high school," the study's authors noted. None desired to abandon or disassociate themselves from their religion, but "there seemed to be a,wish not to be socially stereotyped as 'alien,"strange, ' or ‘foreign."' Another surgeon recounted a similar case of a young Jewish girl who wanted her nose changed "not with the idea of obliterating her racial features.” An article noted, "Where plastic surgery is concerned, doctors are increasingly aware that it is not a desire for beauty, but a healthy minded wish to 'look as good as' everybody else, that this year will swell their waiting lists." In Family Weekly, another supplement, author Terry Morris quoted "a leading plastic surgeon," who told readers, "It is not empty vanity that drives them to the decision.... The majority of our patients seek the contrary effect. They want to be inconspicuous. " Such comments confirmed the normative nature of beauty. A 1960 Life magazine photo essay about a young couple and their infant daughter made the point even more plainly. Inspired by her husband's new nose, Mom had hers done as well:"Everything's the same, yet it all seems different.... It's like being born all over again" she gushed. Everything was so much better with a small nose that baby, too, would be taken to the surgeon's office when the time came. "I'm not going to let her go through life with the kind of nose I had," the mother vowed.35

Popular magazines that carried news about plastic surgery to the public continued to speak of "large" or "humped" noses rather than to identify the ethnicity of such features. The ease with which popular magazines referred to these noses, however, suggests that they simply saw no need to define their terms. Writers and publishers believed that Americans shared a common cultural definition of the limits of the acceptable nose. It was assumed that readers would understand exactly what was meant by "over - large," "oversized," "excessively large," "humped," or "hooked" and that they would be able to judge their own (and others') features accordingly. This was the world that greeted Barbra Streisand, the woman who would cement her reputation and her career by playing Fanny Brice, just forty years after Brice's celebrated nose job. In the early ig6os, everything about Barbra Streisand seemed to amaze the media. She was young, and she had made the move from Brooklyn to Broadway, which Brice and others of her generation had found so difficult, with ease. She emphasized her status as the first star of the youth generation and of the 196os by wearing her hair long and straight, dressing in unusual combinations of thrift store clothes, and ignoring the conventions according to which entertainment personalities had traditionally dealt with the press. And, of course, there was her voice.36 But, above all, there was her nose. The New Yorker described it as "aquiline." Newsweek, less kindly, termed it "absurd." The Saturday Evening Post called it "the nose of an eagle," but to Life, Streisand had a "nose like a witch." Almost all of the many articles about her in these early years (more than twenty ran in national magazines in 1963 and 1964 alone) mention her nose. As if to forestall anticipated questions, many specifically informed readers that Streisand not only had a big nose but planned to keep it. The Saturday Evening Post, for example, told its readers that Streisand "has firmly decided against doing anything to her prominent proboscis."37

The national preoccupation with Barbra Streisand's nose is easier to understand if one recalls the context. By the middle of the twentieth century, the American ideal of beauty was understood to require a small nose, and the nose job had become a routine operation. After World War II, plastic surgeons spread out across the country, making nose jobs available almost everywhere, and Americans became accustomed to thinking of them as an option for many and a rite of passage for some. Chief among this latter group were girls like Barbra Streisand: as one article described them, "Jewish and Italian teenage girls" from urban centers "who get nose jobs for their high school graduation presents" or for their birth days. In "rarefied, sophisticated" circles like New York and Los Angeles, a nose job before college was "as routine as the SAT," and for some people "fell almost into the same category as having teeth straightened ' " In 1961 a major Sunday supplement told hundreds of thousands of Americans that between thirty thousand and sixty thousand rhinoplasties were performed each year; sixteen - to nineteen - year - old girls constituted the largest group of patients.38 Streisand's nose was so surprising because it was so different from the nose then in fashion. In the early 196os, when Streisand entered the scene, the Jackie Kennedy nose - "a small, slightly turned up nose on the short side" reminiscent of the Irish nose that had so enthralled Jewish immigrants decades earlier - reigned supreme. This style was so common that "in some circles ... an upturned nose had practically become a middle - class status symbol, and hundreds of teenage girls in New York seemed to be wearing the same design. The bone was narrowed, the tip pinched into a triangle, and there were two distinct bumps above the nostrils' " To the American people, the most amazing thing about Barbra Streisand was that she had not bobbed her nose.39

Some commentators theorized that by her courage Streisand might break the mold not only for herself but for others as well. In 1964, less than a year after it had likened her to a witch, Life noted simply that her nose was "big" and forecast, "it may be only a matter of time before plastic surgeons begin getting requests for the Streisand nose (long, Semitic and - most of all - like Everest, There) * " James Spada, one of Streisand' many unauthorized biographers, credits her with ending, once and for all, restrictive standards of beauty that emphasized a white, AngloSaxon norm: she was a symbol to millions of hopeful girls who "could realistically feel it wasn't necessary to be beautiful to succeed * " But as Newsweek noted in 1966, Spada and the millions of hopefuls for whom he claimed to speak were due for a disappointment. For a short time, nose jobs had seemed to be on the decline: "First there was the Mediterranean look, personified by Melina Mercouri, whose long classic nose was thought to be 'more sensual' than the Hollywood bob. Then Barbra Streisand became a coast - to - coast sensation, a fashion beauty and glamour queen." Now, however, "bobbsy girls" were back in town, participating in a new "teen - age frenzy for physical perfection," which involved looking less Jewish, less Italian, or perhaps achieving the ultimate, "a profile like Grace Kelly." Even Streisand, according to Newsweek, was only the exception that proved the rule. She was popular among teenagers, but her success "had little effect on the way they wanted to make themselves look." As one fifteen - year - old at New York's Lenox School asked the reporter incredulously, "Streisand? ... That's her look. Would you believe it on anyone else?”40

Streisand's reception suggests that Americans in the 196os had not adopted significantly broader standards of beauty than those that had inspired Fanny Brice to bob her nose. Although they were willing to make an exception in the case of Streisand's significant talent, most Americans continued to see her as just that - an exception. As eminent New York surgeon Clarence Straatsma told Newsweek in 1966, "Nothing changes. Today I'm doing the daughters of mothers I did before they were married." Several years later, nineteen - year - old Barbara Wagner of Flushing, New York, told Seventeen magazine readers a similar story. Wagner, whose mother claimed that her first thought in the delivery room had been, "Oh no. We'd better start saving money for a nose job!" had recently gotten a new nose from the same surgeon who had operated on her mother twenty - three years earlier. "It won't solve all your problems and it didn't solve all mine," she told her readers, "but yes, yes, it's worth it! "41

That Barbra Streisand, despite the star power she pulled in the early 196os, could not single handedly change the standards by which American beauty was judged is not surprising. Americans continue to voice plastic surgeons begin getting requests for the Streisand nose (long, Semitic and - most of all - like Everest, There) * " James Spada, one of Streisand' many unauthorized biographers, credits her with ending, once and for all, restrictive standards of beauty that emphasized a white, AngloSaxon norm: she was a symbol to millions of hopeful girls who "could realistically feel it wasn't necessary to be beautiful to succeed * " But as Newsweek noted in 1966, Spada and the millions of hopefuls for whom he claimed to speak were due for a disappointment. For a short time, nose jobs had seemed to be on the decline: "First there was the Mediterranean look, personified by Melina Mercouri, whose long classic nose was thought to be'more sensual' than the Hollywood bob. Then Barbra Streisand became a coast - to - coast sensation, a fashion beauty and glamour queen." Now, however, "bobbsy girls" were back in town, participating in a new "teen - age frenzy for physical perfection," which involved looking less Jewish, less Italian, or perhaps achieving the ultimate, "a profile like Grace Kelly." Even Streisand, according to Newsweek, was only the exception that proved the rule. She was popular among teenagers, but her success "had little effect on the way they wanted to make themselves look." As one fifteen - year - old at New York's Lenox School asked the reporter incredulously, "Streisand? ... That's her look. Would you believe it on anyone else?”40

Streisand's reception suggests that Americans in the 196os had not adopted significantly broader standards of beauty than those that had inspired Fanny Brice to bob her nose. Although they were willing to make an exception in the case of Streisand's significant talent, most Americans continued to see her as just that - an exception. As eminent New York surgeon Clarence Straatsma told Newsweek in 1966, "Nothing changes. Today I'm doing the daughters of mothers I did before they were married." Several years later, nineteen - year - old Barbara Wagner of Flushing, New York, told Seventeen magazine readers a similar story. Wagner, whose mother claimed that her first thought in the delivery room had been, "Oh no. We'd better start saving money for a nose job!" had recently gotten a new nose from the same surgeon who had operated on her mother twenty - three years earlier. "It won't solve all your problems and it didn't solve all mine," she told her readers, "but yes, yes, it's worth it!"41

That Barbra Streisand, despite the star power she pulled in the early 196os, could not single handedly change the standards by which American beauty was judged is not surprising. Americans continue to voice admiration for those who resist the pressure to conform. At the same time, however, the belief that large noses are identifiably ethnic and therefore something "other" than American, and that possession of such a nose is likely to limit its bearer's social and economic options, remains common. By the time Streisand emerged on the scene, the nose job was so well established that Americans had come to expect that those with large noses would have them reduced. That journalists and other commentators publicly voiced their surprise at Streisand's refusal suggests the extent of the change that had occurred in the forty years since Fanny Brice was called upon to explain why she had given up part of her nose.

From Shima Kito to William White

In 1926, with the headline, "Changes Racial Features: Young Japanese Wins American Bride by Resort to Plastic Surgery," the New York Times reported what was perhaps the first plastic surgery in the United States to westernize Asian features. Shima Kito of Boston and Mildred Ross of Dubuque, Iowa, first met in Detroit in 1925. Kito eventually proposed, but Ross felt she could not accept his offer: although she "preferred him to other young men of her own race whom she had met ... sheloved her parents and would do nothing that would hurt them" (especially, the article implied, marry a man of a visibly different race). The situation seemed hopeless, but love - and news of "the wonders accomplished by plastic surgery" - ensured a happy ending. Kito "consulted Miss Ross and then put himself into the hands of a surgeon," who "cut the eye corners so that the slant eye so characteristic of the Japanese race was gone. He lowered the skin and flesh of the nose so that the upturned trait disappeared, and he tightened the pendulous lower lip." Evidently, Ross - and perhaps more important, her parents - judged Kito's surgery to be successful, and the couple became engaged. Kito told the Times that he intended to complete his transformation by changing his name to William White, "which is nearly an English equivalent to his native name."42

William White's story may have suggested to some Asian Americans that the road to happily ever after led through the plastic surgeon's office, but despite widespread racism and prejudice, particularly on the west coast, Asians did not seek plastic surgery in significant numbers until after World War 11. After the war, however, surgery to westernize Asian eyes became increasingly popular, first in Asia and then in the United States. With the American occupation of Japan and the conflict in Korea, American films, magazines, and soldiers familiarized Asians with western models of beauty, and surgeons began to explore what they called

"revision" of the "Oriental eye.'"43

Some surgeons were troubled by this trend. In his autobiography, surgeon Donald Moynihan recalled his experience with Mrs. Muncie, a Korean war bride who came to him in the early 1950s requesting doublefold eyelids and a new, more American nose. Her husband had fallen in love with her in Korea, she explained, but now that they had returned to the States he was ashamed of her. Moynihan was outraged, but after discussing the situation at length he decided that "Mrs. Muncie's problem wasn't all that different from a prominently hooked nose.... If it was making her unhappy, she had a right to have it altered." Moynihan performed the surgery to the satisfaction of Mrs. Muncie and her husband but continued to ponder the case. "With all my rationalizing," he recalled, I still wasn't too happy with the outcome. Had I been writing the script, her husband would have materialized with the assurance that he loved her exactly the way she was. But I guess that's not the way the world turns."44

Moynihan was clearly troubled not only by Mr. Muncie's boorish behavior but by the larger implications of such surgery. The reaction of Miami surgeon D. Ralph Millard, however, was more typical. In early 1954, Millard was stationed in Korea. In response to requests to change oriental eyes to occidental eyes, he began to research the process and found that little had been published, so he devised an original solution and in 1955 published a report of his work in Plastic and Reconstructive Surgery. Millard was surprised and offended when a "communist magazine" picked up the story and "devoted a two - page spread ... stating that 'Herr' Millard had taken it upon himself to improve, by westernizing, the races of the population of the entire Orient." He commented, "By neglecting to mention that this surgery had been carried out at the request of the patients, facts and motives were twisted out of all proportion."45

Millard's indignation may have been due in part to the fact that Asian surgeons were also performing such surgery. When he traveled through Asia, he found that different techniques prevailed in different places, but already in Seoul, Hong Kong, Tokyo, and the Philippines, surgeons were daily westernizing hundreds of Asian eyes. Millard's contention that he was only performing such surgery in response to patient requests, phenomenon. According to Boo - Chai, Asians wanted surgery for several reasons. One was socioeconomic: western eyes could be a status Symbol and might aid in finding a job. A second was "domestic": double - fold eyelids might ensure personal happiness and domestic tranquillity. Finally, local beliefs and superstitions also played a part. Boo - Chai explained that, for example, the trait known as the "mouse - like eye" was particularly unpopular in China, and girls who possessed it "find it rather difficult to acquire a husband.47

By the early ig6os, Tokyo, with io8 clinics serving two hundred thousand women each year, was the destination of choice for Asian women who wanted plastic surgery. Dr. Furnio Umezawa, director of Tokyo's Jujin Hospital of Cosmetic Surgery, told the New York Times that he often operated on as many as forty patients each day and that the hospital's one - day record for all cases was 1,38o operations, performed on a wide range of Asian women who shared "a general desire to look like Elizabeth Taylor." At Jujin in 1957, the double - eyelid operation cost $8.33. By 1965 the cost had increased substantially to about $56, but Umezawa believed it was still underpriced. Suggesting that Americans had succeeded in exporting not just the practice of cosmetic surgery but the philosophical basis for it as well, Umezawa asserted that a price of a million yen (about $2,8oo) would be reasonable, because the operation would "release a woman from neuroses to enter a life of happiness. ""The women treated here become happier and more joyful as they discard their inferiority complexes," Umezawa explained. "When women are confident of themselves they look prettier. To beautify women by measures endorsed by science also benefits men and therefore society itself." As in America, performing such surgery was gratifying for the surgeon as well. "The thing I like best," Umezawa noted, " is to stand at the door and watch the faces of the patients as they leave. The happiness they feel enhances the work we have done for them. They look beautiful.”48 The escalation of American involvement in Vietnam extended Americanized visual culture farther around the globe. As well as internalized standards of female beauty, American GIs brought with them external representations in the form of Playboy magazines and pin - up posters. In what observers insisted was not a coincidence, more and more Vietnamese women began to seek plastic surgery. Some of these women were famous: Madame Nguyen Cao Ky, wife of the premier of South Vietnam, registering at Jujin in 1966, commented only, "I want to be more charming to my husband." Most Vietnamese women who sought however, reveals more about why the story troubled him. To Millard, as to most plastic surgeons, features that patients identified as sources of distress were surgical challenges. Medicine, in general, trains its practitioners to meet such challenges rather than inquire into the cultural and philosophical issues surrounding them. For Millard and many of his colleagues, then, Asian eyes were, in technical terms, merely eyes in which the superior palpebral fold was absent or indistinct. In responding to requests to create this fold surgically, Millard believed he was fulfilling his responsibility as a physician and surgeon.

Like Millard, most surgeons - Asian and American - defended eyelid surgery. Leabert R. Fernandez, reporting in 196o on the popularity of such surgery in Hawaii, noted that although the single eyelid fold is genetically dominant, the request for such surgery "should not be considered abnormal because, in one - half of the Orientals, this fold is normally present." In addition, Fernandez noted, "Those desiring [the operation] ... usually have a strong complex about the lack of the folds and derive a psychologic lift from the procedure. " When they did criticize such surgery, surgeons tended to make their objections on technical grounds. In 1963, surgeon George V. Webster noted that "the urge to Westernization of the Japanese people has created a demand for cosmetic improvement of the essentially small breasted Japanese women, and the excessively flat nose and heavily padded Oriental eyelids." Webster was highly critical of the methods some practitioners were employing: "Correction of hypogenetic defects, such as small breasts and flat nose by the use of implant materials has led to the employment of a great variety of foreign bodies, some of which are unquestionably poorly tolerated by the human host. A reversion to the injection of paraffin - containing materials is especially to be condemned." Significantly, however, he voiced no misgivings about the goals.46 Like American surgeons, Asian surgeons had few qualms about performing eyelid surgery and were matter - of - fact about the reasons such requests were increasing. Khoo Boo - Chai, who practiced in Singapore and published extensively on this topic, acknowledged in 1963 that westernization was sweeping the East: "Our Eastern sisters put on western apparel, use western make - up, see western movies and read western literature. Nowadays, there even exists a demand for the face and especially the eyes to be Westernized." Boo - Chai asserted that such a demand had existed for decades in both China and Japan, but that English language medical journals had only recently begun to document the say she was an entirely different woman." Like other plastic surgeons, Ban believed his surgical skill offered more than just "superficial beauty." "By removing a woman's complexes we give her confidence and transform her psychology," he asserted. "It's a lot of fun. And it's an art form in itself." Dr. Ban particularly prided himself on his ability to remove “natural Asian defects" in an hour.51

The surgical craze that swept through Asia in the years after World War 11 influenced Asians living in the United States as well. Jerome Webster saw his first case in 1946. Mrs. Anna Lee, then twenty - four, told him she believed "reduction of the upper lids" was essential to her plan for an acting career. Webster was unsympathetic, noting, "Patient has typical Chinese eyes, somewhat full on upper edge but I feel that operation is not indicated * " In Hawaii, where the phenomenon was particularly evident because of the large Asian population, teenagers who could not afford such surgery (or whose parents would not allow it) often used cellophane tape, which - left on the eyelid overnight - created thedesired effect, at least for a day. According to one Honolulu surgeon,Chinese Hawaiians were more conservative than other ethnic groups and did not seek surgery in large numbers. "Percentagewise, Koreans and Southeast Asians probably avail themselves more than the others,"he noted, "but numerically, the largest group is still Japanese."52

Coming of age in a country that had historically described them and their communities as "Oriental" - in scholar Elaine Kirn's words, "east of and peripheral to an unnamed center" - and that had recently defined as alien and incarcerated more than a hundred thousand Japanese Americans, posed particular problems for young Asian Americans. Attempting to make a place for themselves in the affluent consumer culture of post - World War 11 America, young men and women of Asian origin were as aware as their Caucasian peers of the reigning economy of appearance. As historian Beth Bailey suggests, in this "culture of consumption," dating "afforded public validation of popularity, of belonging, of success.... In this system, men and women often defined themselves and each other as commodities, the woman valued by the level of consumption she could demand (how much she was'worth'), and the man by the level of consumption he could provide." Repeated reminders from magazines, movies, and their peers that this culture ranked blonde above dark, buxom above flat, wide - eyed over narrow, and pale above all could not help but have some effect on the way young Asian Americans saw themselves.53

Saigon surgeons had no doubts about what inspired plastic surgery's popularity in Vietnam. "Vietnamese girls have beautiful, classic faces, but remove their clothing, and they look like boys with long hair," one surgeon told Time magazine in 1966. Surgeons Pham Huu Luong and Pham Ba Vien offered a similar explanation for the marked increase in plastic surgery since the American buildup in 1965. "A bargirl's capacity to earn is based on her ability to attract American males," Dr. Luong told the journalist. "Many desire operations to make themselves more beautiful to them. Others just prefer larger noses and breasts. Some are giving into the fad of the time." Vietnamese surgeon Vu Ban also cited the American buildup. "The bargirls said the GIs preferred them with rounded eyes and big breasts and hips.... It became part of their livelihood. Then they found it helped them get jobs and American husbands' " Dr. Ban told the New York Times in 1973. Mrs. Ngo Van Hieu, owner of a well - known Saigon clinic, told another reporter that bargirls who were influenced by magazines like Playboy made up 40 percent of her customers: "Vietnamese see pictures of the girls in the magazines and this becomes a standard of beauty," she explained.50 Some Vietnamese physicians found the increase troubling. Although cheaper in Vietnam than in the West, surgery was still costly, and, according to several surgeons, amateur clinics offering cut - rate procedures were springing up to meet the growing number of requests. Dr. Thai Minh Bach thought the phenomenon had gone too far: "They're just pumping in silicone everywhere," he complained. Years later, Jerome Webster saw evidence of such practices. Linda Wong told him that in Hong Kong in 1942 she had gone to a doctor who had injected both her breasts with paraffin; her condition necessitated multiple operations and resulted in severe disfigurement. Like their American colleagues, however, Vietnamese surgeons were more likely to voice concerns about the practical problems of bringing cosmetic surgery to the public than about the underlying cultural implications. They were concerned about untrained practitioners and dangerous procedures, but they were proud of the operations they had pioneered. Dr. Ban claimed to have given thirty - four - year - old Tham Thuy Hang, South Vietnam's top film star, new eyes, nose, breasts, hips, thighs, and even fingers: "She has even had dimples put in her cheeks and a cleft in her chin. You might supporters of "natural" (and, thus, more inclusive) standards of beauty find that images and ideals long held and deeply engrained cannot be easily or quickly altered by reason and logic. 55

According to scholar Judy Wu, the Miss Chinatown U.S.A. Beauty Pageant drew on all of these traditions when it was founded in San Francisco in the 1950s. Chinese American businessmen organized the pageant both to foster pride within the community and to raise the community's stature in relation to the larger city - in other words, to draw tourists to Chinatown. The winner - described in the evocative phrase, "loveliest daughter of our ancient Cathay" - would, pageant sponsors proclaimed, represent the best of both worlds, combining the grace, modesty, and beauty of traditional Chinese women with the ambition and talent (including the ability to walk in high heels and wear a bathing suit onstage) necessary to succeed in America's modern consumer culture.56

Despite the pageant's name and proclaimed purpose, however, some contestants charged that the standards on which pageant judges relied reflected preferences shaped by the standards of beauty valued in the dominant Caucasian culture. Some contestants believed that taller candidates were preferred. To others, it was clear that larger eyes with double - fold eyelids and longer lashes offered an advantage. A 1973 contestant, asked if she had any special attributes, cited her eyes, which were "larger than some of the girls' ' " The souvenir book from the 1970 pageant carried an advertisement for a surgeon who claimed a special technique for converting "Oriental eyelids" to "Caucasian eyelids" and a clientele of ,'movie actresses, singing stars and participants in beauty contests." Today the "double eyelid" operation is the top choice among Asian American patients. According to the American Society of Plastic and Reconstructive Surgeons, surgeons certified by the ABPS operated on 39,ooo Asian patients in 199o; since many Asian Americans go overseas or to other practitioners, the real number is likely much higher.57

Commenting on an increase in nose augmentations among Asian Americans, several San Francisco plastic surgeons, in 1970, expressed surprise and resignation that a desire to appear more "western, " or more Caucasian, had inspired many of their patients: "In a time of social upheaval, with emphasis on self - determination and ethnic pride, it seems paradoxical that the number of non - caucasians undergoing cosmetic surgery is increasing. It appears that attainment of a caucasian aspect is desirable to these patients." Other surgeons, however, insist that race has nothing to do with such surgery. Double - fold eyelids, a Chinese surgeon insisted in 1987, were not "western" but "pretty." Two years later a group of surgeons from Seoul, Korea, Fukuoka, Japan, and Los Angeles similarly insisted that the objective of the eyelid operation was not "caucasianization of the Oriental eye" but, rather, the creation of subtle, "aesthetically pleasing supratarsal folds" that were naturally present in 30 to 6o percent of Asians. Such surgery often resulted in a more western appearance, but this, the surgeons asserted, was not patients' primary goal. The "over whelming majority of patients" who request such surgery, they explained, are merely trying to look more attractive within the current aesthetic norms of their own culture. It is believed that the 'double fold' makes the eyes look bigger and hence more attractive." Nor was the question of how norms are produced, reproduced, and disseminated surgeons Iconcern. The San Francisco surgeons concluded, "Nature inexorably mixes the races of man, while legislatures ponderously seek to equalize them. And plastic surgery, committed to the goal of helping each patient achieve social maturity, adds a measure of 'instant homogeneity - '... The socioeconomic and psychological impact of the final results has been visibly significant ... and highly gratifying to the surgeons. "58

As anthropologist Eugenia Kaw noted in a recent article, despite surgeons' and patients' protestations to the contrary, cosmetic surgery among Asian Americans is about more than objective aesthetic standards. just as decoding the terminology used to discuss Jewish noses suggests that many nose jobs are about erasing visible signs of ethnicity, decoding the terminology used to discuss eyelid surgery among Asians suggests that here race (and the meanings attributed to it) is also the central issue. For Asians - as for Jews, who feared that their noses would be taken to indicate undesirable character traits - the long tradition of the 11 sciences of race" looms large. Asians who seek cosmetic surgery often do so because they believe that, in the United States, negative characteristics attach to Asian features. As one of Kaw's informants explained, singlefold eyelids evoke "the stereotype of the'Oriental bookworm'... who is dull and doesn't know how to have fun." Surgeons, in general, have confirmed these readings; as one surgeon explained to Kaw, "the upper eyelid without a fold tends to give a sleepy appearance and therefore a more dull look to the patient. Likewise, the flat nasal bridge and lack of nasal projection can signify weakness in one's personality and by lack of extension, a lack of force in one's character." The centuries - old practice of divining character traits from facial configuration continues to shape the perspectives of surgeons and patients alike. The generally unspoken standard to which surgeons hold patients and patients hold themselves is, just as clearly, Caucasian, as the comments of two Beverly Hills plastic surgeons suggest. In 1989 Ronald Matsunaga said of his patients: "They get the magazines, the movies, they see all the models. They're looking at the Western world"; of himself, Toby Mayer said, "I realize my judgments are by Western standards."59

Surgeons and patients, in short, are confident that, by altering individual facial configurations, cosmetic surgery can confer a wide range of benefits that together add up to the American dream - and they are right. But as prospective patients hurry to stake these individual claims, all the while congratulating themselves on their perspicacity in dealing with the world as it is, they sanction, if unintentionally, the belief that social problems can be ameliorated only by individual solutions. There are, still, other voices - voices that call for pride and acceptance and confidence and hope, voices that proffer a vision of the world as it might bebut the chorus singing the praises of individual self - improvement gets louder and more relentless every day.

Ebony and Ivory

Michael Jackson's transformation has allegedly inspired an increase in requests for plastic surgery among young African Americans, including members of his own family, but until recently blacks have been less likely than members of other racial or ethnic groups to seek plastic surgery. That dark skin is particularly likely to develop keloid scars probably accounts for some of this lag: the formation of large, hypertrophic scars may be judged inevitable when surgery must be undertaken for reasons of health, but the possibility that they might result from an elective operation designed to improve appearance has meant that many surgeons and patients have judged the risk too great. The melanin that gives skin color also affords protection against ultraviolet rays, which means that black skin is less prone to sun damage and generally shows age less quickly than white skin. Until late in the twentieth century, many African Americans were unable to afford the high cost of elective surgery, which must be paid for in advance. Finally, as Lawrence Otis Graham points out so eloquently in his memoir, black skin is a marker that no amount of plastic surgery can hide.60

The fact that black Americans have not, in large numbers, had plastic surgery, however, does not mean that black features have been considered attractive. Facial characteristics such as wide noses and thick lips have been featured prominently in caricatures ranging from political cartoons to salt - and - pepper shakers to films like D. W. Griffith's epic Birth of a Nation. Images like these - and the character traits such representations were intended to evoke - were often explicitly cited as the basis for anti - miscegenation laws and for the widespread adoption of Jim Crow laws at the turn of the century; they offer convincing documentation of the distaste with which whites viewed black features.61 The questions of how African Americans have defined beauty in their own communities and what effect white standards have had upon those definitions continue to generate debate. Historian Jacqueline Jones notes that "in some slave quarters mulatto children were scorned as the master's offspring," while other accounts hold that even under slavery lighter skin and smaller features were prized, taken as evidence of higher class status (deriving from indoor work rather than agricultural labor), income, and education. Whatever their genesis, standards of appearance that helped enforce the color bar between blacks and whites - and that created a hierarchy of color among blacks - were clearly in place by the turn of the century. The significance attached to the "Black Is Beautiful" movement of the 196os suggests just how oppressive American standards of beauty seemed to many African Americans, and that movement's evaporation suggests just how tenacious such standards have been.62

That fear of being thought black could drive white Americans to plastic surgeons suggests the power with which Americans invested these standards. The number of cases is apparently small, but over the course of the twentieth century surgeons have reported cases in which whites requested surgery to forestall accusations or suspicions of having black blood. Surgeon Adalbert G. Bettman recounted such a case in 1929. "A young woman," he told his colleagues, "had protruding lips which raised the question as to Ethiopian origin. When the deformity was removed without leaving tell - tale scars, no more questions were asked and she went among her friends, freed of her psychologic as well as her physical impairment." Surgeon Jacques Maliniak noted that "a negroid nose is a distinct social and economic handicap to a dark - skinned Caucasian," as was the "negroid lip": "Except in certain primitive races," Maliniak explained, "a heavy mouth is not considered a social asset. The negroid lip does not satisfy the artistic canons of the present day."63 Henry Junius Schireson's veracity is questionable, but his tales are revealing nonetheless. "Miss M," a forty - year - old nurse, was heavily freckled; she wanted Schireson to remove the freckles because in dim light she looked to her patients "like a Mulatto." In a more problematic instance, a young man was brought to Schireson by the woman who had adopted him as an infant; she was disturbed because now that he was grown he showed "unmistakeable signs of black blood." These signs, Schireson wrote, included a distinct negroid upper and lower lip, dilated flaring nostrils, extreme length of legs, absence of calf, and an extra ordinarily forceful thumb. Schireson explained to the disappointed woman that surgery had not advanced to the point where all of this could be changed; in 1938 "the youth could not escape his race." In other instances, however, he noted, "it is a simple matter to make the necessary corrections to lips and nostrils. "64

Surgeons did not always respond positively to such requests for surgery, even from Caucasians. Several New York surgeons jointly reported an instance in which they had refused a patient's request. A thirtyseven - year - old woman, married but childless, requested a third nose job. "She was born in the South, to a family of fading aristocracy," the surgeons recounted, and had not known her father. "Early in life the patient developed the fantasy that her conception occurred in an assault, and that her father was a Negro. The 'flatness' of her nose was a constant reminder of her past; unconsciously, she wished to remove this hated stigma." The surgeons advised the patient to pursue psychiatric treatment rather than additional surgery. In this case, the surgeons involved were curious enough about the patient's motives - and probably tipped off to what they termed a psychological disturbance by the patient's previous surgery, which she judged unsuccessful - to ask more questions and eventually to refuse surgery. Jerome Webster's files contain two similar cases. In one, he noted that the patient had told another doctor that "she thought she had negro blood but didn't say so to me"; he suspected a "complex" and refused the request. In another instance, he received a letter from Elizabeth Cole, who explained, "The trouble is that my nose is absolutely flat, just like a negro's. In fact I have been afraid since I was a child that people would think I was part negro on account of it." His response has not survived.65 Other surgeons, however, took such requests at face value as surgical challenges and did not ask too many questions. Spokane surgeon Charles M. MacKenzie, in 1944, noted that maxillary protraction (protruding jaw) cases sometimes involved "abnormally thick lips, in some instances approximating the negroid type," which were simple to revise. Charles Firestone of Seattle regarded this challenge in a similar light. The "full, everted lower lip," Firestone noted in 1946, was exclusively a cosmetic problem of "unesthetic anatomy." The medical literature contained reports of lips everted because of scarring, Firestone continued, but not the "congenitally unesthetic" lip that was the subject of his paper.66

New York surgeon Milton Tuerk stated explicitly his belief that no explanation was required of a patient who desired lip reduction surgery. "If the end result produces patient gratification," Tuerk asserted, "the procedure is self - justified." The operation Tuerk recommended for what he called this "ubiquitous deformity" was not original, but he considered it worth describing because as of 196o it had not been discussed extensively in the medical literature. Tuerk had begun to perform the operation because of requests from women who were distressed by the "moist and quite pallid" appearance of the everted portion of the lower lip. The "wetness and texture" of this part of the lip meant that it would not take a lipstick; "to many girls this is especially discomforting and objectionable,"67 Tuerk explained. Articles and comments like these recall those Italians and Greeks who suffered what they perceived as the "undeserved" penalties of antiSemitism earlier in the century, as well as the reactions of Jews themselves. The rhetoric here is dearly about race; the goal, just as dearly, about what it means to look "American" (with "whiteness" the implicit frame of reference).

Although surgeons were generally willing to fulfill requests from African American patients, some did so only to the extent that such requests were consistent with their own ideas about what constituted improvement in appearance. Surgeon Donald Moynihan, in his auto biography, recounted an example of a case he had refused. 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, "butthe way I see it, no matter what, a bone through the nose is an unreasonable request. I turned her down."68 Reports from African Americans who have pursued the option of plastic surgery are few, but those that exist suggest that it was not the belief that their features were "congenitally unesthetic" that drove them to have surgery. Rather, they were responding to the limitations on their lives and careers that their identifiably black features imposed. As a nineteen - year old model explained to sociologist Frances Cooke Macgregor about the time of the Montgomery bus boycott, I don't find it advantageous to have decisive Negro features. The less you look like a Negro, the less you have to fight. I would pass for anything so long as I'm not taken for a Negro. With a straight nose I could do costume work and pose as an Indian, Egyptian, or even a Balinese, " Sometimes, black patients were open about their desire not only to look less black but to look more white. In 1971 a Miami plastic surgeon reported that in a case involving a "young Negro female school teacher.... There was full knowledge that her basic desire was to resemble the caucasian; she thought this might enhance her future teaching ability in the public school system. Her husband was tolerant of this desire. ,69 Many African Americans, however, dispute the contention that race has anything to do with plastic surgery. Ouida Lindsey, a Chicago journalist, told Ebony magazine in 1977 that after her nose job a friend had accused her of trying to "be Caucasian." Lindsey, pointing to others in the room, asked: "'Why couldn't you feel that I wanted my nose to be like a sister's whose nose was straighter than mine?' People tend to think there is a stereotyped look that all black people have. That is ridiculous." Lawrence Graham, similarly, protests that the very fact of his curly black hair and dark skin prove his nose job cannot be about whiteness and reminds us that black Americans have the same rights to determine their appearance as white Americans.70

Coverage of plastic surgery in black magazines has not been extensive, but it has generally been positive, contending that self - improvement is just as laudable a goal for black Americans as for white. That African Americans generally use words like "prettier" rather than "Caucasian" or "white" to describe the look they want is not surprising. Such usage is consistent with the way members of other ethnic and racial minority groups have framed their desires, as well as with the terminology surgeons have employed. Words like "prettier" and "better," however, are explicitly comparative in nature; they beg the question, "than what?", as well as the more complex question of how definitions and standards of appearance came to be. Once that historical question has been raised, accepting such terms at face value becomes more problematic. On the one hand, "the 'denial of heritage' accusation that is leveled at Black women" would seem to deny them the right to "have fun" with their appearance that white women claim so casually. On the other hand, as Essence editor Elsie B. Washington noted in 1988: "The wish to acquire what we were not born with, to adopt the coloring that has for centuries been touted as prettier, finer, better, carries with it the old baggage of racial inferiority and/or superiority based simply, and simplistically, on physical traits. "71

Until recently, most surgeons have been as reluctant to confront the implications of cosmetic surgery in African American patients as they have to discuss similar implications in relation to Asian patients. In 1969 surgeon Thomas D. Rees commented on the increasing numbers of African Americans who were requesting nasal surgery. "It is sometimes thought that the Negro who seeks rhinoplasty is attempting, symbolically at least, to deny his heritage," he noted, but - like those who insisted that Asian patients were inspired by aesthetic, rather than ethnic, concerns - Rees expressed his belief that African Americans were seeking improvement according to objective, aesthetic standards: "Most Negroes who desire this operation simply wish to obtain a measure of improvement in personal appearance. They want a nose that is smaller, more symmetrical, and pleasing in three - dimensional contour." The complaints voiced by the increasing numbers of young African Americans seeking nasal surgery, surgeon Ferdinand Of6dile noted in 1984, encompass any or all of the following conditions: a wide bridge, a depressed or "low" bridge, a prominent or bulbous tip, and flared nostrils. Many request "the same type of procedure done on Michael Jackson," and they often bring photographs. Usually, Of6dile asserted, prospective patients are "attractive ... with slender features in whom parts of the nose are disproportionately large. What they are seeking, therefore, are finer nasal features to match the face. There is no desire ... to 'Caucasianize' their noses." In 1983 two Israeli surgeons concurred. Although they cautioned against extrapolating from the small sample Of 289 patients they had questioned, the surgeons concluded, "In our experience, certain ethnic groups are blessed more bountifully in the area of their olfactory organs. Individuals so blessed are often not pleased with their noses and turn to the cosmetic surgeon to help alleviate their problem. We feel it is simply a matter of aesthetics and not stereotypes. 72

Still, the issue of "Caucasianization" remains troubling. Thomas D. Rees, who in 1969 claimed that the issue was purely aesthetic had, by 1986, revised his interpretation. "In my 1969 paper," Rees wrote, "I made the point that most non - Caucasians seek rhinoplasty without a conscious desire to achieve Caucasian features. I am now not so sure of this interpretation, since Asian plastic surgeons assure me that it is the influence of Western movies and television that has increased the requests for such surgery among Asians. It seems to me that many, if not most, Negro prospective rhinoplasty patients are mightily impressed with the Caucasian - like transformation of the previously Negroid features of Michael Jackson, the noted entertainer." Compared to statements made by other plastic surgeons, Rees's comment is unusually prescient - or unusually candid. Like most Americans, plastic surgeons have found it difficult to discuss openly issues of race and ethnicity. But while Rees's interpretation of the meaning of such surgery had changed, his attitude about the role surgeons should play in it had not. The homogenization of world cultures, Rees noted, meant that more of these requests were inevitable, hence surgeons "should be aware of safe and reliable techniques for effecting these changes." Like generations of plastic surgeons who preceded him, Rees defined the field of plastic surgery as driven by public demand, in other words, by patients and their requests. This position is very much in line with past and current trends in the field of plastic surgery, but it leaves unexamined the role that surgeons' attitudes and actions have played in shaping American standards of beauty.73

A review of medical literature on non - Caucasian plastic surgery suggests that "Negro prospective rhinoplasty patients" are not the only ones who are "mightily impressed" with Caucasian features. In the same way that "over - large" came to be used to describe Jewish noses, were understood to be excessively large in the implied comparison to the Anglo - Saxon norm, words such as "too - wide" and "flattened" are commonly employed to describe typical noses of nonwhite patients. With the goal of educating their colleagues about the anatomical differences between Caucasian and non - Caucasian noses, thus enabling them to operate more effectively, two San Francisco plastic surgeons, in a 1987 article, described some of the differences: "the non - caucasian nasal tip is usually flattened, bulbous, and lacks the subtleties of lights and shadows of definition," the surgeons wrote. "The base of the bony pyramid appears widened in non - Caucasians. The dorsal bridge seems depressed or saddle - like, and is broad. A deepened nasofrontal angle exaggerates the flattened look." Nowhere in the article is it stated that either the patient's or the surgeon's goal is to achieve a more Caucasian nose, yet the message is clear. All of the above - described conditions of the nonCaucasian nose are defined in relation to the appearance of the nose in Anglo - Saxon Caucasians. The postoperative photographs - which show narrower, pointier, higher - bridged noses in black, Asian, and Chicano patients - make this point explicit.74

The Caucasian orientation of plastic surgery is, of course, most clearly evident in Michael Jackson's face. Exactly what Jackson has done, and has had done, remains in dispute. In Moonwalk, his 1978 autobiography, he admitted to two rhinoplasties and an artificial cleft in his chin, but has consistently denied having additional surgery. At a September 1984 news conference, Frank Dileo (then Jackson's personal manager) read a statement that included the assertions, "No! I've never had my cheekbones altered in any way. No! I've never had cosmetic surgery on my eyes." Most observers, however, doubt these claims. According to biographer J. Randy Taraborrelli, by 1991 Jackson had had four primary rhinoplasties and two "touch - ups." Surgeons and others who have observed his transformation believe the number of procedures is higher - that cheekbone implants, permanent eyeliner, and surgical reduction of the lower lip may have played a role in Jackson's transformation. 75 Although Jackson's motivations remain opaque, accounts of his life suggest that the question of self - hate - which most of the rhetoric concerned with cosmetic surgery and race emphatically denies - is worth considering. Jackson became aware early in his career that, in the world of American entertainment, being too black was a disadvantage. Motown president Berry Gordy reportedly warned the group that they could not afford to appear to be too black or too militant lest they alienate their white audience. "Listen, Diana Ross didn't become a star by being black. She became one by being popular," Gordy explained to one publicist. "As far as I'm concerned, The Jackson 5 aren't black either. So let's have none of that black stuff." In June 1971, when MGM records released Donny Osmond's first single, most entertainment world observers agreed that The Jackson 5 could not hope for similar teen idol status, because the teen magazines that created and awarded such status were predominantly white. On a more personal level, too, identifiably black features troubled Jackson; family nicknames like "Big Nose" and "Liver Lips" caused much pain. Jackson's personal history, as well as his current appearance, suggests that at the very least he is in pursuit of the same "ethnic neutrality" so many Americans have desired.76

It is the tension between politics and play that makes cosmetic surgery so problematic in this context. Tired of talking about oppression, which they relegate to the same cellar as the other "dreary and moralizing generalizations about gender, race, and so forth that have so preoccupied liberal and left humanism' " those who insist that cosmetic surgery is simply one more way we amuse ourselves tend to affect what philosopher Susan Bordo describes as a uniquely postmodern sensibility, in which "all sense of history and all ability (or inclination) to sustain cultural criticism, to make the distinctions and discriminations that would permit such criticism, have disappeared." The postmodern conversation, Bordo writes, exhibits "intoxication with individual choice and creative jouissance, delight with the piquancy of particularity and mistrust of pattern and seeming coherence, celebration of 'difference'along with an absence of critical DersDective differentiating and weighing 'differences' 'suspicion of the totalitarian nature of generalization along with a rush to protect difference from its homogenizing abuses" - in brief, it flattens the "terrain of power relations." Its effect is destabilizing much as television is: its endless "pastiche of differences" prevents us from making any positioned social critique, formulating any critical generalizations, discerning any patterns. What is effaced is the "arduous and frequently frustrated historical struggle that is required for the subordinated to articulate and assert the value of their'difference' in the face of dominant meanings - meanings which offer a pedagogy directed at the reinforcement of feelings of inferiority, marginality, ugliness. '77

What is effaced, in other words, is history itself - in this case, the long history of racism and oppression that makes us wonder if the efforts of some Americans to remake themselves in the image of other Americans is not by definition a politically charged act. The difficulty, here as elsewhere, is that the kinds of transformations that are being effected are unquantifiable, even though there are visible differences among them. Consider the face of singer Patti LaBelle, who recently told talk - show host Oprah Winfrey that she once had a nose that "went from here to here" and is thrilled at her surgeon's work. juxtapose her face with that of LaToya Jackson (whose surgery was obviously much more extensive): the contrast is noticeable - but that does not necessarily make it easier to talk about. The question of what is effaced raises the related question of what it is that cannot be effaced. What is, in fact, lost in Michael Jackson's face? Jackson's case tells us not only about a general disquietude respecting alteration but about the impossibility of actually losing racial identity. After all, how improbable, for black Americans, is the idea of looking into the mirror and seeing "a man without a country" - and yet how often has it happened (think of Paul Robeson, W, F. B. DuBois, Josephine Baker) that white racism has inspired precisely this emotion?78

Just as they mourn the blurring of once - distinct regional accents that has attended the proliferation of national media, some cultural critics have lamented the homogenization of appearance that has resulted from the acceptance of plastic surgery. In 1945, Time magazine interviewed Manhattan plastic surgeon Jacob Daley, who prided himself on trying to talk prospective patients out of having nose jobs. "Art takes the high road and seeks to create the unusual ... rhinoplasty takes the low road and seeks to remove all traces of it," Daley told Time. To support his point, Daley showed Time the tracings he had had an artist make of the Mona Lisa, Titian's Man in a Red Cap, and Holbein's Erasmus, altered to demonstrate how "dull and uninteresting" the paintings'subjects looked with noses reduced to suit modern [1945] standards. "As further evidence," Time noted, Daley had "kept his own magnificently large, arched, craggy and overhanging neb." The New York Academy of Art's Xavier de Callatay visited a plastic surgeon's convention in 1984 to urge surgeons to preserve patients' individuality. I can admire their desire for harmonious proportions," Callatay told a reporter, "but the artist I am worries about the uniformity this model implies. I was taken aback by the book cosmetic surgeons published for themselves, showing all those cute, bland faces. What happened to mortal beauty and divine beauty?79

Almost unanimously, plastic surgeons counter that they are inspired by an abstract, artistic ideal of beauty rather than one that is culturally defined. Throughout the twentieth century, surgeons have claimed that they are artists, veritable sculptors in human flesh. Where once they relied on geometric measurements, they now claim to carve and mold according to their own highly developed aesthetic sensibilities. In a statement representative of such claims, which are legion throughout surgeons' writings, surgeon Murray Berger, in 1951, described the process of surgical artistry: "The well - informed plastic surgeon - essentially a sculptor studies the proportions of his patient's facial features.... He has a sculptor's concept of the features that form the particular face under study and consequently can obtain a gratifying surgical result - gratifying to himself and patient alike. Some Americans have found this explanation persuasive. Repeating a message that hundreds of other publications had passed along to their readers over the previous decades, writer Jane Fort told Teen magazine readers in 198o, "The goal of cosmetic surgery is to normalize appearances so that your nose enhances the rest of your features."80

The mantle of artistry has allowed surgeons to claim a disinterested position - a position outside of culture. Their standards, their values, and their artistic sensibility, they say, derive from the same timeless canon of craft, skill, and beauty that produced David and the Mona Lisa. Always suspect, this claim is simply no longer supportable: their own history demonstrates that American plastic surgeons are both products and producers not only of a culture of medicine but of a culture that is unique to modern America. And an enormous, and impressive, number of recent historical and literary works have demonstrated that no canon is timeless. In a poignant piece that appeared in Mademoiselle in 1978, Diana Stephens recounted how her own thinking about this issue had changed. Stephens wrote that while she had never liked her nose, it was surgeons'claims to artistry that had persuaded her to alter it: "As the doctors said, there was a nose other than the one I possessed which belonged with my face. It was a nose determined not by genetics, but by an abstract, artistic idea of what nose was aesthetically most suitable for my eyes, my mouth, my chin, my face shape, my size. And this aesthetic quality~ like art itself, seemed to extend beyond culture and be independent of it." After surgery, Stephens reevaluated her decision, and her surgeon's words; eventually, she decided that she did not believe in pure art, at least when it involved changing the human face. "One cannot separate the aesthetic norm from cultural conditioning," she wrote. "Aesthetic values can and do change from culture to culture, from century to century... I went to my surgeon to have my nose bobbed because my society and culture prefer small noses to larger ones. As if it makes any difference."81

There has been some evidence in recent years that the voices that have decried the homogenization of appearance are now falling on more receptive ears. Some Americans believe that the standard of American beauty - and with it, the goal of cosmetic surgery - is beginning to change. Surgeon Samuel Bloom, in 1970, cautioned his colleagues against making women's noses too small: "Although a 'cute' nose may be acceptable to a woman in her 20'S," he noted, "in later years it becomes inappropriate." In response to the requests of modern American women, who had concluded that the pert, turned - up style popular in earlier decades was no longer appropriate, New York's Dr. Norman J. Pastorek began to create noses for women that are "slightly assertive, longer and straighter, closer to handsome." Paraphrasing the explanations women gave him, Pastorek explained that women say, I don't want to look too sweet.... When I'm toe to toe with those guys on the stock exchange, I don't want to look ineffective and vulnerable." Minnesota surgeon William J. Carter agreed. "The executive woman is in," he told Newsweek in 1985. "The Debbie Reynolds look with the cute turned - up nose is out the window." In 1987, Health similarly told readers, "These days, more assertive noses with stronger, straighter lines are in; cute little turnedup noses are out.).82

By the mid - 1980s, many commentators asserted, American ideals of beauty emphasized a more natural, and more ethnic, image. "More plastic surgeons now strive to preserve a person's ethnic look, rather than making everyone into the same Anglo Saxon mold," Health writer Paula Dranov told readers in 1987. According to New York plastic surgeon Henry Sackin, the "squashed - tip - nose variety of the '4os" and the "scooped - outbridge - pug - nose one of the '6os" were side effects of surgeons'emphasis on uniformity. Dr. Thomas J. Krizek of Chicago similarly noted that "the scooped - out nose, which used to be popular, just didn't occur in nature very often, and that bothers people today." New York surgeon Blair 0. Rogers credited the sixties' generation with changing the bland standards that had held sway in previous decades. "A Mediterranean, Italian, Greek, near - Eastern look is coming in.... A lot of young83 patients today don't want to lose their ethnicity"' Rogers noted. Stars like Cher, Dustin Hoffman, Al Pacino, and Ali McGraw, whose looks do not fit the typical movie - star mold, have been credited with fomenting a veritable revolution in America's attitude toward ethnicity. As Dr. Alvin Mancusi, a New Jersey surgeon, asserted in 1974, "People ... are increasingly proud of their ethnic backgrounds. " They want to "enhance, rather than change, their existing features. " In the late 1970s, Susan Taylor, beauty and fashion editor of Essence, was similarly optimistic that standards of beauty would broaden still further in the years to come. And as M. G. Lord documents in her fascinating study of Barbie, there is considerable evidence that this "broadening" is occurring in a number of different arenas. In 198o, Black Barbie and Hispanic Barbie were introduced as the sole representatives of their respective cultures; today consumers select from a variety of Barbie dolls with complexions ranging from beige to mahogany (although most still come only with long, straight hair). The recent demise of the Crayola "flesh tone" crayon was heralded by many commentators as evidence of this trend, as was the 1993 Time magazine cover that carried a computer - generated portrait of the "new Eve" - a hybrid of every conceivable heritage heralded as the "new face of America. "84

Indeed, widespread admiration for those who have chosen to keep unusual features suggests that conformity is not as enticing as it once was. Barbra Streisand continues to top this list. Physician Kurt J. Wagner, an outspoken critic of plastic surgery, has cited both Streisand and Sophia Loren as "true originals" and "non - conformists." In 198o, Seventeen magazine relayed a surgeon's message to its readers: "There are times when some girls must realize what Barbra Streisand knew years ago: that some noses - though not your standard, turned - up buttonare beautiful." Four years later, Seventeen again cited Streisand as an example some teens might want to emulate: "Certainly we're not suggesting that a less - than - perfect nose or anything else has to be changed. Many people are content with their distinctive features. They know that an unusual nose - or any other feature - can be special. Consider Barbra Streisand: Throughout her life, she has resisted suggestions to have a nose job, and it hasn't affected her career in the least." In their 1996 book Divided Sisters: Bridging the Gap between Black Women and White Women, psychologist Midge Wilson and poet Kathy Russell expanded the list but continued the tradition: "Certainly Barbra Streisand and Whoopi Goldberg are not traditionally beautiful ' " they wrote, "yet each has successfully managed, through her inner beauty and personality, to enlarge ideas of attractiveness in ways previously not thought possible."85

But if Americans continue to admire Barbra Streisand's character, most still do not want to look like her. In 1976, Julie Smith, a Florida student who had a nose job at seventeen, recounted the glee she felt when people who used to tell her she resembled Streisand began to say, "You look just like Barbra Streisand - except for your nose." In 19go, Streisand's profile was still haunting America's young (white) women. "They tormented me, first with Jimmy Durante and later with Barbra Streisand," Kathleen Rockwell Lawrence told Glamour readers about her childhood. A nose job later, the teasing had stopped. Philadelphia surgeon Julius Newman found Streisand's profile equally distressing and told an interviewer of his desire to work on her. "'She'd be beautiful,' he predicted, 'I don't think I'd charge her."'86

While moderate ethnicity may have become more acceptable, as New York Times personal health columnist Jane Brody cautioned readers in 1989, too much ethnicity is still considered undesirable. Her assertion that "a good surgeon will not try to erase ethnic features but merely modify those that are considered too extreme" suggests that when it comes to standards of beauty, changes have been less significant than constants. To eyes that in the 1970s saw actress Bo Derek's cornrowed hair as a positive comment on African American styles, Barbara Hershey's newly plumped lips signal a like acceptance. Yet to others, white women's indulgence in such experimentation seems to signal not genuine plurality but an unthinking display of privilege. "Cherry - picking" the best of all cultures, they enjoy the benefits of "exotic" looks without the oppression. The appeal of the "exotic" has its own long tradition in western culture, and the contemporary shift to exoticism may signal nothing more significant than advertisers' need to create ever new products and palettes that demand acquisition.87 What has indisputably changed, in the field of ethnic plastic surgery, is the number and range of available remedies. In her introduction to Frances Cooke Macgregor's 1974 study of plastic surgery patients, anthropologist Margaret Mead foresaw this trend. "Once there is a possibility that the defect can be reduced or minimized or compensated for,"Mead noted, "our attitude changes from one of painful inattention to active concern. Something should be done.... Whatever is wrong that can be fixed, should be fixed." Popular knowledge about plastic surgery encouraged this process, as "those who know that something can be done are freer to say that something ought to be done." On one level, such predictions spark unlikely futuristic images straight out of science fiction. On another level, however, they contain more than the proverbial grainof truth. Dental surgeon Ronald P. Strauss, in 1983, offered the "relative maxillary protrusion, the class II malocclusion" as a compelling example of how this process works on a practical level to alter the way patientsand surgeons define medical categories and allocate medical care. "The ability to alter appearance," Strauss asserted, "has affected how we respond aesthetically to differences." "A child who may have been acceptably 'bucktoothed'in the 1940s and who may have been a candidate for orthodontic braces in the 195os and 196os, now often has a dentofacial deformity, the treatment for which is maxillofacial surgery. The expansion of medical attention toward this non - life - threatening condition serves to increase its unacceptability as normal. As a result, a minor variant of normal becomes a deformity." As Strauss noted, "there does not appear to be a broad understanding of how medicine became involved in decisions about integrating or altering individual appearances differing from cultural norms. "88

The project of redefining normal to encompass a broader range would require such an understanding, but if surgeons have been reluctant to dig too deeply into their own motives, so too have their patients. Strauss suggested that surgeons move from their patient - demand orientation toward a more active "surgical gatekeeping" role, but it is unrealistic to expect that they will pioneer in formulating standards of beauty that will diminish their incomes and decrease their social significance; nor is it likely that the ideals to which surgeons adhere will differ significantly from those admired by their culture. As M. G. Lord observes, the common thread in Mattel's Dolls of the World collection "involves Mattel's coding of an 'American' identity"; the original, "American," Barbie remains the standard against which these "aliens" are compared. Certainly, pluralism - however limited, however conditional - is better than no pluralism. But as yet Americans have only begun to chip away at the standards of beauty that were constructed early in this century.89

Ironically, what hope there is for change is embedded in reactions to Michael Jackson's masklike countenance, which suggest that the pursuit of sameness elicits a level of discomfort comparable to that once evoked by difference. Americans have made remarkably little progress in the past century when it comes to talking about race and racism, and in some sense this failure is understandable. As writer Marita Golden notes in her introduction to Skin Deep, a 1995 anthology on this topic, there is truth in the truism that "race is the tar baby in our midst; touch it and you get stuck, hold it and you get dirty." But if it offers nothing else, the haunting face of Michael Jackson provides a none - too - gentle reminder that the tar baby, like the proverbial elephant in the living room, does not vanish just because it is ignored.90