Cosmetic surgery is ancient. In the past two decades, however, they have boomed to an extent like never before - with critical side effects. We know the first operations for aesthetic reasons from the ancient Egyptians around 3000 years ago. They were used to correct facial deformities, but the results were disastrous. Hindu doctor Sushruta described 600 B.C.E. to reconstruct in detail the efforts of the doctors, noses and earlobes, which had been cut off as punishment in the then Hindu justice.
Plastic surgery developed in Roman times, but suffered a decline in the Middle Ages. A rebirth occurred in the Renaissance with texts in Turkish and Italian, which show great knowledge of the reconstruction of noses and breast formation in men.
Plastic surgery appears at the end of the 18th century. Having reached Europe at that time, it was progressing slowly but steadily, and the techniques as well as the medical devices were refining. However, cosmetic surgery remained a secondary task of plastic surgery, and the results were aesthetically disastrous for many years.
Cosmetic surgery in the modern age
Cosmetic surgery as an independent discipline only emerged with modern anesthesia in the mid-19th century, during which time it expanded enormously, and the operations became more and more secure because the surgeons could concentrate on their work without paying attention to the patient suffered no pain.
Facial lifting, eyelid and ear surgery developed around 1900. The methods progressed slowly because the doctors secretly carried them out, and this type of surgery was not accepted - neither in the scientific community nor in public.
Before the First World War, cosmetic surgery was considered unethical and immoral. Some plastic surgeons nevertheless practiced in secret, and most of them denied being involved in such operations.
Many "cosmetic surgeons" of that time had no medical training, simply did what they thought was right, and often experimented with the patient to try new procedures. Nevertheless, this time laid the foundations for what we now call cosmetic surgery.
During World War I, surgeons tried to make faces that were shredded by grenades and bullets look halfway human, but the results were often more terrible than the damage caused by the injuries. War wounded, ethically in the worst possible way, became “guinea pigs”.
Some of the patients were no longer able to articulate themselves, doctors thought they had died intellectually and emotionally and cut around them like artists on sculptures made of soapstone. Abrupt movements of her limbs were considered to be unconscious nervous twitches, like a pig after the bolt shot, whose body spreads signals again.
By chance, someone present realized that these supposed nervous twitches were Morse signals. The unfortunate man had previously been a radio operator: he could no longer speak, but begged the surgeons, who cut his body without anesthesia, to leave him alone - with his fingers.
The doctors learned a lot in such a terrible way, especially the Second World War brought huge advances in plastic surgery. Surgery as such was already expanding immensely through the lessons doctors learned in treating war wounds, but also through the discovery of penicillin and new anesthetics.
So surgeons brought their general surgery experience they had during the war to cosmetic surgery, but these developments remained secret for the time being because the press and the public were hostile to the intervention.
In the 1950s, cosmetic surgery was the privilege of the rich and famous who took advantage of the aesthetic benefits of surgery but wanted to keep their secret to themselves. But it didn't remain hidden, and wherever Hollywood stars set the example, the public soon followed.
In the 1960s, the media became aware of technical innovations in cosmetic surgery and public opinion changed. The introduction of the silicone breast implant in 1962, with which the dream of enlarged breasts came within reach, had a major influence on the changed mood.
Another important development that showed the aesthetic potential of the field was the discovery that the endoscope (a small telescope with an attached camera) could be used for operations that left only small scars on the surface of the skin.
Perhaps the greatest impetus for public perception came with the possibilities that opened up in the 1980s from the injection of the lips, which has become the most popular procedure for cosmetic interventions to this day.
The history of such cosmetic injections began with the manipulation of botulinum poison after its discovery in 1895. The next key development was the introduction of injectable collagen, followed by various other fillers. Finally, there was the opportunity to manipulate lasers and heat energy, which makes cosmetic methods more diverse than ever before.
Body dysmorphic disorder
Acceptance of cosmetic surgery is subject to social and psychological factors: self-assessment, body image and conformity work effectively to accept cosmetic surgery.
Individuals sometimes think that they can achieve the ideal image of themselves through cosmetic interventions, although this is never necessary. That is why a psychiatric examination is recommended before anyone undergoes cosmetic surgery.
Body Dysmorphic Disorder (BDD) is a disorder of "imagined ugliness" in the United States. Those affected are obsessed with looking poor in their physical appearance, and this disorder cannot be explained by other mental illnesses. BDD is a serious disorder characterized by the notion of an imaginary defect in appearance or an excessive fixation on a slight physical deviation from the “norm”.
The majority of sufferers believe that they suffer from a deformity that could be corrected by cosmetic treatment and focus on these “defects” instead of seeking psychiatric help.
From time to time almost everyone is unhappy with their looks, but these thoughts come and go and are forgotten. For someone with BDD, however, this thought of deformity causes a lot of stress and does not go away.
Patients who suffer from BDD also immerse themselves in obsessive behaviors or mental acts, they dress up, they constantly compare themselves with others, which is always negative for them, they constantly make sure that they “look good” and if so Annoyed people affirm this, the victims consider them liars - surgery appears to promise salvation. Those affected often have an underdeveloped inner view and tend to commit acts of violence against their surgeon.
Because of their behavior, BDD patients often have broken relationships, live alone and avoid social situations in which their supposed defect could be identified. So BDD is often associated with social phobias and fears of being judged negatively by others.
The BDD syndrome is therefore a mental disorder and not a physical abnormality. However, some people are plagued by real malformations, and even serious doctors consider cosmetic surgery to be useful in order to relieve them of the associated suffering.
Large warts on the face, hanging lips and drooping eyelids, extremely protruding ears, extremely protruding horse teeth, but also crooked noses after a broken nose, crooked pelvis, a shortened leg, deformed skull bones, scars as a result of injuries, or staphilococcal dermatitis are just a few Abnormalities that can spoil social life for individuals - as well as extreme overweight.
Cross-cultural stereotypes such as that of the witch with the crooked nose, drooping lips and warts on the face show that certain abnormalities are generally considered ugly.
The level of suffering is subjective here too, but unlike BDD, it has an objective reason. However, there are people who live with such abnormalities and refuse to have them surgically removed. Some of them have such a high level of self-confidence that they do not care whether they comply with beauty standards, others live in a milieu culture in which they do not come up with the idea of undergoing surgery for aesthetic reasons.
In her parable of Frankenstein's creature, Mary Shelley showed the fate of an individual who lives in a defaced body: Doctor Frankenstein is so obsessed with the idea of creating artificial life that at some point he no longer pays attention to whether the body parts, as in the beginning thought, well-shaped, and he sews a being from different body parts together.
Not only does the creature not have a family, its appearance also makes people flee. A blind old man becomes the first and only friend that the artificial man finds. Ejected by everyone, he flees to the Arctic and directs the marginalized's hatred of Frankenstein, his creator.
Up until a few decades ago, “ordinary people” mostly lay under the knife only because of special anomalies that can also be easily repaired, including in particular protruding ears and particularly large curved noses.
Although these are not monstrous excesses as in the horror film, those affected understandably no longer felt like wearing nicknames like "dwarf nose" or "prince sailing ear" all their lives.
Regular surgery to “optimize” the body, on the other hand, has been a phenomenon in Germany over the past two decades.
Ethnic cosmetic surgery
Since the surge in cosmetic surgery at the turn of the 20th century, individuals have used cosmetic surgery not only as a way to change their appearance, but also to minimize physical abnormalities that they believe mark them as "different", which means unlike the dominant or desired ethnic phenotype.
Ethnic plastic surgery intends to make the appearance of an individual look more or less like another ethnicity. Such ethnicizing cosmetic surgeries are not new: some Jews in Germany changed their appearance when the Nazis came to power, as did some Irish in America in the 19th century so as not to attract attention in societies that mistakenly considered the shape of the ears and noses Looked at indicators of inferiority.
In Central Europe in the 19th century, the “other” was the Jew. Stereotypical images circulated that portrayed the Jewish body as different, deformed and pathological. In these devaluations, Jews had flat feet (which made them unable to do military service), repulsive skin diseases (“Jewish scabies”), protruding ears with fleshy earlobes (“Moritz ears”), characteristic noses (“Jewish noses”), and, of course, deformed Genitals.
These racist traits were associated with social stigmas of weakness, disease, and degeneration, and constructed the external appearance as an obstacle to assimilating Jews into “Aryan society”.
The anti-Semites used established stereotypes of hostility to Jews, the problem with the haters of Jews was that these “characteristics” could rarely be recognized: One of the most respected doctors in Germany, Rudolph Virchow, already explained in 1879, after extensive comparisons of skull shape, eye and hair color, that there are no races in the scientific sense.
But the anti-Semites needed their physiognomic stereotypes, because in the 19th century German Jews emancipated themselves; they were able to work in more and more professions, and the vast majority wanted to assimilate fully in society: they wanted to be Jewish Germans like Catholic or Protestant Germans, and the anti-Semites invented physical characteristics to separate the Jews again.
Plastic surgeon Jacques Josef, a self-assimilated German Jew, developed surgical methods that allowed Jewish patients to become “ethnically invisible”.
In the United States, cosmetic surgery became popular in a large migration wave around 1900. John Roe performed the first nose surgery on the “pug nose”, a nose shape that was placed under the control of Irish immigrants and that was said to have negative character traits, such as dog-like submissiveness (that says Term “pug”).
European immigrants to the United States, Jews, Italians, and Eastern Europeans, underwent nasal surgery, as did white Americans who feared to look “Jewish”.
After World War II, cosmetic operations became popular in Korea, China, Japan, and among Americans of Asian origin; they had the eyelid crease operated to get “western eyes”. African Americans had their noses and lips operated on and their skin bleached.
Plastic surgery is more common today than ever before. Twice as many members of ethnic minorities as ten years ago change their appearance with the scalpel. From 2005 to 2013, cosmetic surgery increased by 126% in Americans with an Asian background, 56% in African Americans and 84% in Hispanics.
Ethnic cosmetic medicine is mostly based on the typically attributed and caricatured face shapes, for Jews this is the nose, for Asians the eyes and noses, and for African-American noses and lips. Nonetheless, no part of the body is safe from being branded racially.
Patients with BDD are well advised to use a psychiatrist instead of cosmetic surgery. However, when people feel compelled to undergo cosmetic surgery because they become victims of racist projections, society is asked to counter racism.
Cosmetic surgery is increasing globally, but what is considered a flaw is very different in the individual countries.
Iran is the country of beauty surgery, and Iranians mainly have their noses operated on. The classic “Persian nose” already shows statues from the time of Darius II - an eagle nose with impressive nostrils, often combined with strong cheekbones. Europeans often see these noses not only as "typically Iranian", but also as distinctive as they are beautiful, and in particular to match the "oriental facial features", dark hair and dark eyes.
In Iran, however, small and straight noses are the ideal. In no other country in the world do you see as many women with a nose bandage after a fresh operation as in Tehran or Isfahan. Many of the operated people also bleach their skin and dye their hair blonde to look “western”.
Other operations are also popular. Older wives often have their labia tightened, and aesthetic tooth corrections are much more of a social standard in both sexes than in the West.
Unlike in the United States or Brazil, breast surgery is not the top priority in Iran, and the focus on the face lies in the political system. The face is the only part of the body that women can show openly. Who, like women in Germany, draws attention to himself with a daring cleavage or tight hot pants, at least ends up in prison in Tehran.
Individual strands of hair, gaudy lipsticks and mascara emphasize the face as well as the operated nose.
Prostitutes do not officially exist under the rule of Islamist mullahs, in reality there are, of course, and they manipulate their bodies to an even greater extent than porn stars in Europe. Breasts, buttocks, hips, armpits, eyelids, lips - nothing escapes the ideal of the perfect body.
In contrast, liposuction is the top priority in the Eastern Mediterranean, especially on the hips and bottom. The female curves that come into their own when belly dancing are often particularly stressful for young Lebanese women.
This pleasure in the slim body shows a break with Arab-Islamic traditions in the war-torn country, in which plump women represented the patriarchal ideal of the good cook and mother. The slim and at the same time womanly body stands for the freedom to enjoy your own life and to escape the traditional role.
In western countries, intimate shaving has been almost standard for young women for a few years now. Why this is so, the sexologists argue: Critical voices in the Freudian sense assume partial castration (as well as circumcision in men) to present themselves as an infantile being without the secondary sex characteristic pubic hair, which subserviently submits to any rule.
Other researchers see the genitals moving more and more from the level of the hidden to the outer presentation, where the hair is now supposed to grow as little as the beard in men. This is indicated by the fact that western porn stars now almost always shave their pubic hair, and often also the male actors.
The spillover of American ideas of hygiene, in which female pubic hair is considered “dirty”, probably influences the trend among young women to completely get rid of body hair.
However, in Korea the opposite is the case. Lush pubic hair is considered a sign of fertility here, and more and more patients are having hair transplanted into the genital area.
Capitalism is booming in China and is creating a middle class as well as the super-rich. Under Mao, plastic surgery would at best have fallen under “bourgeois decadence”; today, instead of the fascistoid discipline of “blue ants”, there is “self-optimization” in corporate competition; the body becomes a profitable product.
Long legs are considered a feminine ideal of beauty in the usually rather short-legged Chinese, and many submit to a brute procedure to increase their chances on the labor and marriage market: surgeons saw up their lower legs and then lengthen them.
The record holder among cosmetic surgeries is Brazil with a whopping 1.49 million interventions in 2013. In the first place is the suction of fat, followed by enlarging the breasts with silicone and tightening the breasts, but hair transplants are also very popular.
The United States is stuck with injections: every fifth botulinum toxin injection is between Alaska and Mexico.
The perfect body?
Studies in the USA show that the trigger for an operation is mostly the ideal of beauty conveyed in the media, and since the celebrities are malnourished, healthy women can only approach this “ideal” through manipulation.
Not only cosmetic operations, but also eating disorders such as anorexia and bulemia are spreading in the industrialized countries.
For teenagers, the “generation porn”, who can watch porn films online around the clock, porn stars are increasingly the yardstick for the female body.
Michaela Schaffrath, aka Gina Wilde, took porn out of the dirty corner and also became a star and actress in “normal” media. She wrote about her transformation from an “ugly duckling”, with whom no boy wanted to dance in the dance school, to a sex idol and frankly told where surgeons had helped.
Female porn actresses are almost always operated on themselves, except in so-called amateur productions that value everyday bodies. Naturally, women have an extremely rare wasp waist with simultaneously round and firm giant breasts.
Cosmetic surgery errors
Cosmetic surgery has been booming in recent years. For a high percentage of people, they are a selectable way to look better and feel better. Others are not so happy and disastrous accidents or illnesses occur during the operations. Whatever the reason for this, many procedures are routine today - but in the end surgery is still surgery and therefore carries a risk.
People trust plastic and cosmetic surgeons to help them look better, and the value of a positive self-image should not be underestimated. However, if a mistake occurs during a cosmetic procedure, the result can be the opposite of the wish: deforming injuries or even death. In the United States, the term “plastic surgery zombies” or “Frankenstein's Monster” is used for those affected by such accidents.
Celebrities and strangers resort to plastic surgery for aesthetic reasons and because they feel unattractive. Today there are surgical changes for practically every part of the body, whether jaw bone implants, breast implants, eyelid operations, po implants, as well as non-surgical measures such as injections in the forehead, cheeks, chin and lips, chemical facial peels and "body reshaping."
Although cosmetic surgery is considered the easiest way to shape the look, there are very real risks and limitations to this surgery. The dark side is the failed operations, either out of incompetence or lack of experience. This side of plastic surgery, which society does not like to talk about, often causes, in addition to the "monster appearance", various wounds and foci of infection.
Cosmetic surgery became the celebrity's best friend. Since celebrities have been in the public eye all the time, the media has been scrutinizing their appearance. In an attempt to maintain a youthful appearance, the host of stars pilgrims to the clinics.
It's an open secret that in Hollywood only originals like Robert de Niro can afford to do without beauty ops. Even older actors who play old people are supposed to look "fresh": age spots, bags under the eyes and orange peel disturb their careers, even if the computer retouches them today. But too much surgery or the wrong methods can also prevent entry on the “Walk of Fame”.
The failed operations of the stars in particular are increasing the requirements of the Yellow Press. For example, supermodel Janice Dickinson hit the headlines because she made a big mistake by lying under the knife too many times. No malpractice happened to the doctors, but after Dickinson had lifted his face, manipulated the breasts and had the lips sprayed on, among other things, she looked like a doll.
In the United States in particular, the problem is often less of a real accident, in which, for example, an implant slips or the upper lip blows up when injected, as in the case of an overbite, the implanted jawbones are slanted, etc., but rather a series of implants that affect the individual make it appear artificial.
At times, perfect hemispherical breasts no longer look natural, sprayed lips look like plastic, botox in the forehead and cheeks tighten the skin, but also “smoothes” the individual facial features.
Donatella Versace is known as a successful fashion designer and at the same time for her extreme plastic operations that changed her face significantly. With cosmetic surgery, she enlarged her lips to twice the normal size, and today her oversized lips are the first thing people notice about her.
With such extreme cosmetic operations, the boundary to body modifications, that is, changes in the body in order to become another person, can hardly be drawn; the most famous example is Michael Jackson, who reversed his appearance from that of a "typical" African American with dark skin and a wide nose to nasal surgery in which he kept his dark skin to a white one with a small snub nose and almost feminine facial features.
Some plastic surgery can even cause death. The human body is very susceptible to becoming infected during surgery - every surgery is an open wound, and the more cosmetic operations a person undergoes, the more of these wounds they have, and the greater the risk that germs will nest .
Miss Argentina Solange Magnano was an Argentine model and a beauty queen who won the Miss Argentina crown in 1994 and later founded her own modeling agency. She died of complications from cosmetic surgery on her bum.
Cosmetic surgery is part of human cultural heritage. As with jewelry, clothing or make-up, people have always used their technical skills to present their bodies in such a way that they meet them or a set standard. However, these norms are very different in the respective cultures.
Photoshop and cosmetic surgery today make it possible for the guiding principles presented in the media to make real people appear imperfect, and young women in particular need strong self-confidence in order not to misunderstand themselves as flawed.
If psychological instability triggers the desire for cosmetic surgery, a social environment is more important than the surgical scalpel, an environment that integrates those affected and shows them that real friends recognize them even if they do not have Michaela Schaffrath's body .
Doctors who perform cosmetic surgery have a special responsibility not to take on every job if they realize that psychological problems are the reason for the decision.
In general, however, it is up to every adult to decide freely about their own body. However, today this means not only the freedom to perform cosmetic surgery, but also the freedom from cosmetic surgery.
If a birthmark on the temple or a tooth gap becomes a career obstacle, and spraying the forehead with Botox from 45 is a must, then we are heading for a new totalitarianism that tricks the individual value of each unique person. (Somayeh Khaleseh Ranjbar)
Jan Stanek with Hayley Treacy, 2007, 10 Years Younger.