Cosmetic surgery—where does it begin?

Abstract

The word “cosmetic” entered the English language in 1605, when it was used to describe the nature of substances which had the power to beautify the person and especially the complexion. The conjunction of ideas in the modern phrase “cosmetic surgery” would have astounded the surgeons of that day. It would have seemed little short of bathos to equate the brutishness and pain of much that they did with the enhancement of beauty, especially when the results were so often marred by infection and when their patients would so often succumb. The concept of “cosmetic surgery” derives from the Greek icoo,~&v: to arrange, or adorn. In its widest sense it may be thought of as being that branch of surgery which concerns itself with the improvement of appearance by the alteration or embellishment of features. Definitions abound: many of them as incomplete as that found in a well-respected encyclopaedia “. . . a specialisation concerned largely with the removal of the outward signs of ageing”. Nor is it only ‘&. . . plastic surgery for the improvement of a person by restoration of damaged areas of skin and removal of blemishes”. Where lies the dividing line between the surgery of reconstruction and the subtler alteration of deviations which do not in themselves constitute objective deformities? Is there any truth in the view that cosmetic surgery consists of a number of inconsequential procedures, which are performed without medical indications for the gratification of individual vanity? I believe that the answers to these questions may be found if an attempt is made to understand those human needs which have over the years stimulated the development of plastic surgery as a whole. It is also useful to explore the abstract idea of beauty and to question the role that surgery is able to play in attaining it. In simple terms, there are three concepts of beauty. The Realists, led by G. E. Moore, hold that beauty is an intrinsic quality. It matters not whether this beauty is appreciated by others, because its existence is independent of appreciation. A rose is a rose . is a rose. However, aesthetics is not only the study of beauty, it is also the philosophy of taste. There will be times when a chrysanthemum is esteemed higher than a rose, beautiful though both are. Nor does pure aesthetic theory apply to human subjects in its unmodified state. A beautiful woman (that is, one who possesses all the objective attributes which are held to be beautiful) will also be aware of her beauty: unlike a rose or a chrysanthemum she will look at herself in a mirror and she will be aware of the appreciation of others. The subjective theory propounds the opposite belief, that beauty is only in the eye of the beholder. According to Benedetto Croce, beauty is a ‘&. . purely subjective quality, an emotional state arising in the emotional consciousness of the observer”. Does an ugly face become beautiful just because the eyes that look upon it do so in an atmosphere of serenity and warm acceptance? There is some appeal in this view. Julius Caesar’s aquiline nose and blue eyes were accepted in Rome as the epitomy of manhood. Genghis Khan’s epicanthic folds and Mongol features were praised in Tartary in his time. These views of what was good to look at would have been mutually exclusive. The relational theory of Santayana explains the existence of beauty as a particular relationship between the object of perception and the state of mind of he who perceives. This is an alluring concept and strikes a chord with clinical experience. A face may have pleasing features but the extent to which these are thought to be beautiful will depend on the response evoked in the observer. The extent to which the person feels beautiful will in turn depend on the reinforcement of his or her self-image by others. The Greek concept of beauty was a utilitarian one. Beauty arose from an ordered structuring of things and indeed the root of “cosmetikos” lay in the “cosmos”, the ordered system of the universe.