Plastic surgery can make people feel better about themselves

plastic surgery happens in a culture where we are impaled on the effects of first impressions. Such views reflected and were fed by the physiognomic literature of the seventeenth, eighteenth, and nineteenth centuries: Johann Caspar Lavater, author of Essays on Physiognomy, and others dwelled on the legibility of character through surface manifestations.22 That appearance could induce character was an emergent cultural conviction being directly countered by these seemingly reactionary physiognomic accounts. As Richard Sennett has discussed, by the eighteenth century it was already easy enough to transform one's identity through fashion, mobility, and urbanization, through which anonymity afforded all sorts of social options.

Class lines blurred because one could assume the costume of a higher rank if one played one's part convincingly enough: "If the oil merchant's wife or anyone else could wear a chemise de la reine, if imitation was exact, how would people know whom they were dealing with? . . . the issue was not being sure of a rank, but being able to act with assurance" (69).

As cosmetics and dress in the nineteenth century became associated with the effort to disguise one's true appearance, one could find manuals that would enlighten men about how to "read" the authentic female body through the contrivance of fashion.23 Photography as well participated in fixing the relationship between character and appearance. Alan Trachtenberg remarks that, from its inception, photography was used in the service of solving the nineteenthcentury "obsession" with the origins, cultivation, and representation of character (27). "Photographers adopted the notion that the exterior of a person might reveal inner character, and conventionalized it in a sentimental repertoire of expressive poses" (28). These poses created as much as they reflected material and social accomplishment.

At the same time that this ability to transform value through appearance had the merit of releasing people from the burden of heritage, those who were born with a deformed or less attractive body might be ostracized to a degree less likely in a close-knit traditional community, where ties are based on birth and family connection more than on face value. One famous plastic surgeon was strikingly candid with me about the reallife consequences of his work: "If you want to go out and be attractive to somebody else and start a new life, you've got to face facts the way you look has a lot to do with whether you're going to attract somebody else. To me there's nothing wrong with that.

Let's be pragmatic about the fact that if a woman ceases to be attractive physically, it affects the physical, intimate relationship. I've seen women who have not had particularly good relationships or haven't had a relationship with men for a long time, and I make them look younger and prettier, and they go on to get married and have wonderful, stable relationships. There's absolutely no question that the face-lift helped them. We live in a real, physical world."

As he spoke I felt older, uglier by the minute. I felt the interview time eating into my last remaining years of feminine value. I wanted him to tell me the truth; it was a relief, really, to have this plastic surgeon be so outspoken about the impact of appearance in the culture. Nevertheless, I was plunged into the doubt that he articulated but did not create. I wondered how he saw me what he would do to make me look "younger and prettier." He spoke with such authority.

Yoked to his honesty is a kind of fiction about the transformative possibilities of plastic surgery. You can change her life. You can make her someone whom someone else would be willing to love. More to the point, if she isn't succeeding on the dating /marriage market, it must be because she's not attractive enough. That's the most unsettling part of his account, isn't it? The self-evident undesirability of the woman who isn't young-and-pretty. Young-andpretty. You can't have pretty without the young. As a feminist, I am indignant. Outraged. As a member of the culture, I cannot help but stumble.

I asked him: "Because they measurably really look better, or because they feel better about themselves?"

"Both. People want to pretend it's all psychological, it's just how you feel about yourself. That's not true. You know when you meet somebody at a party, you're more attracted to them if they're good-looking. And the more good-looking they are, the more you want to be with them and get their ideas and interact with them." He paused, perhaps in recognition of the implications of his argument or his sudden recollection of just who was interviewing him. "That's not true if somebody's particularly interesting and charismatic and intelligent if you're bright you go beyond those things." I felt as though he was speaking directly to me then. To avoid offending me, he interjected this point about "intelligent" people like English professors? I see the idea is that smart people don't need face-lifts to be loved? What a relief.

"But there's no question that the way you look has a lot to do with the kinds of relationships you form. They don't just do better in this life because they feel better about the way they look; they do better because they in fact look better. And I've learned that not just from my aesthetic patients but from my reconstructive patients too."

We spoke about the case of one young woman whose face and life he entirely overhauled. She went from plain to noticeably pretty. I've seen the photographs; there's no question that plastic surgery made her a different person. "Their personality changes. When the world reacts to you as if you're a pretty, attractive person, your personality changes, you evolve, you become a different kind of a person, your self changes. It's not something that is cast in stone." He dismissed Freud's notion that our personalities are shaped entirely by the time we are six or seven. "I think our personalities are somewhat malleable for a long time."