| The Fashion Issue | Winter 2007 |
Image Doctoring It often happened just as I was reaching for a canapé: A well-meaning hostess would sidle up to me, introduce me to a middle-aged woman, and Time invariably was the issue—in her worry about the effects of gravity, in her concern about her loss of youth. My reassurance that she looked lovely just as she was would prompt her to smile, but not to lose the flicker of uncertainty in her eyes. As Tallulah Bankhead once remarked, “They aren’t making mirrors like they used to.” When I was recently asked if cosmetic surgery should be considered an accessory to the fashion industry, I properly understood the question to be rhetorical. Both concern appearance, certainly. Yet the stakes are much higher with cosmetic surgery. An Yves Saint Laurent creation can be purchased, worn, discarded, and replaced without scarring and without risk. Not so for a cosmetic procedure. Despite their obvious differences, cosmetic surgery and the fashion industry both reflect a basic human need to embellish our world and, if resources permit, to pursue activities and goals beyond mere survival. Yet even in subsistence cultures, the body is a focus for adornment and tribal identification, traditions that parallel many of the applications of cosmetic surgery in our youth-obsessed society. Our society, in fact, considers aging to be a kind of deformity and pursues infinite measures to fight an unwinnable battle. Sometimes, paradoxically, those who have undergone an ill-chosen procedure or too many procedures emerge with an artificial appearance: a face discordant, perhaps, with the person’s wrinkled hands, stooped shoulders, and tentative gait. Even so, I find it disconcerting that the general public, entranced by celebrities and stoked by the media, equates plastic surgery with only its aesthetic component. Plastic surgery has two major parts—reconstructive and cosmetic—and these overlap. A repair of a cleft lip will ultimately be judged according to aesthetic standards and not solely as an attempt to approximate the normal. In the 38 years I was in practice, about 65 percent of my operations were reconstructive; the rest, cosmetic. This combination, though in varying proportions, characterized the practices of Harvard’s pioneers in plastic surgery: George Monks, Class of 1880; Varaztad Kazanjian ’21; Bradford Cannon ’33; and our Nobelist, Joseph Murray ’43B, an inspiring mentor and friend. Many, even at Harvard Medical School, forget that his career was that of a plastic surgeon, albeit a remarkable one. Although academia may not accord cosmetic surgery the same respect it gives reconstructive surgery, the transformative powers of cosmetic surgery are real. The objective of cosmetic surgery is to improve quality of life by enhancing a patient’s self-image and, ideally, promoting his or her happiness. Cosmetic surgery is elective, yet that does not mean it is surgery on demand. Ethical plastic surgeons act according to the best interests of their patients, balancing a patient’s desire for a procedure with any potential risk. They must also carefully screen those who seek surgery. I recall, for example, a 70-year-old woman who came into my office accompanied by her son, an internist. Her husband had died two years earlier. Her son, wishing to buoy her spirits, had offered her a facelift as a birthday present, perhaps to help her find a new mate. After she and I had spoken, I asked her son to join us. “Your mother is clearly depressed,” I told him. “It’s understandable; she’s lost her husband. Forgive me for saying so, but I think she should consult a psychiatrist, not a plastic surgeon.” The woman reached over, took my hand, and, with tears in her eyes, thanked me. Even in my retirement I continue to field questions from those who want to age gracefully, if artificially so. Their wanting to avoid the inevitable reminds me of an exchange between Gertrude Stein and Pablo Picasso. When she saw his portrait of her, she complained, “It doesn’t look like me.” He smiled and replied, “It will.” Robert M. Goldwyn ’56, an HMS clinical professor of surgery at Beth Israel Deaconess Medical Center and a former chief of the center’s Division of Plastic Surgery, has retired from surgical practice. He has been a member of the editorial board of the Harvard Medical Alumni Bulletin for more than 40 years. Photo: Daniel Day/stone+/Getty Images |
then tell her—in a theatrical whisper—my profession. “You’re a plastic surgeon?” my new acquaintance would gasp. Immediately she would seize her cheeks and temples, push her skin skyward with the heels of her hands, and moan, “Oh, doctor, is it time?”
|