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Journalism and Mass Communication, ISSN 2160-6579 May 2013, Vol. 3, No. 5, 281-291

DAVID

PUBLISHING

The Framing of Cosmetic Surgery, 1914-1950 Lisa Pecot-Hebert DePaul University, Chicago, USA

This research seeks to add to the body of scholarship on the history of cosmetic surgery and American journalism and is guided by the following two-part research questions: How did newspapers and magazines frame plastic surgery between 1914 and 1950 and did the frames vary by year or did they recur throughout the time period studied? The purpose here is not to argue that the press had a direct effect on the way beauty was defined within the cultural landscape of the early 20th century, but to examine the way plastic surgery‟s frame in the popular press shifted from reconstructing war-maimed soldiers to beautifying ordinary citizens. Keywords: cosmetic surgery, journalism history, beauty doctors, framing, identity

Introduction A 2012 global study of 25 countries conducted by the International Society of Aesthetic Plastic Surgery (Retrieved May 13, 2013, from http://www.isaps.org) estimates that there were 14.7 million worldwide invasive and non-invasive cosmetic surgery procedures performed in 2011, with the U.S. dominating the market at number one. That same year, U.S. surgeons performed 3.1 million cosmetic surgery procedures, which is roughly 21.1% of all procedures worldwide. While America currently hosts the largest number of board certified plastic surgeons in the world, this was not always the case. In the early 1900s, surgical training in the U.S. fell behind European countries like France and Great Britain, who were discovering new plastic surgery techniques during the First World War. The American press heavily covered the war, however their coverage of war casualties did not stop with the number of men being killed or wounded. The press also focused on how the emerging medical technique of plastic surgery was being used to fix the faces of wounded soldiers. What was at one time referred to in the press as a “reconstructive” procedure to save the faces of battle torn men, by 1920, was being referred to as a “cosmetic” procedure to change the faces of women, immigrants, and aging post-war consumers. American surgeons who trained to reconstruct facial aberrations during the war found themselves without jobs and unsure of how they would utilize their new skills back home. With no more male faces to reconstruct, many surgeons turned their attention to women, and played on their insecurities about getting older, which for some translated to becoming less attractive. As surgeon Thorek (1943) explained in his book A Surgeons World: An Autobiography: If soldiers whose faces had been torn away by bursting shells on the battlefield could come back into an almost normal life with new faces created by the wizardry of the new science of plastic surgery, why couldn‟t women whose faces that had been ravaged by nothing more explosive than the hand of years find again the firm clear contours of youth. (p. 164)

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Lisa Pecot-Hebert, assistant professor, College of Communication, DePaul University.

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This statement speaks to the similarities between reconstructive and cosmetic surgery and shows how the skills once used to reconstruct male faces were being repositioned to beautify predominantly female faces. This study began in 1914 with the start of World War I and ended in 1950, five years after World War II. These dates are significant as the First World War was when American, French, and British surgeons pioneered the art of maxillofacial surgery, a type of reconstructive surgery. Once the war was over, American and non-American surgeons came to the U.S. and fostered the growth of cosmetic surgery. The years between the end of the Second World War (1945) and 1950 also saw a postwar boom in cosmetic surgery, thus leading to the legitimization of the specialty. This research seeks to add to the body of scholarship on the history of cosmetic surgery and American journalism and is guided by the following two-part research questions: How did newspapers and magazines frame plastic surgery between 1914 and 1950 and did the frames vary by year or did they recur throughout the time period studied? The purpose here is not to argue that the press had a direct effect on the way beauty was defined within the cultural landscape of the early 20th century, but to examine the way plastic surgery‟s frame in the popular press shifted from reconstructing war-maimed soldiers to beautifying ordinary citizens. This study draws from scholarship in the fields of history, sociology, and communication and borrows media historian Kitchs‟ (2001) words, “seeks to examine what we think of as a modern-day issue by searching for its historical roots” (p. 3). In order to analyze how surgery was framed in the popular press, an understanding of plastic surgery history within the emerging beauty and consumer culture of the post-war era are imperative.

The History of Cosmetic and Reconstructive Surgery The field of plastic surgery, taken from the Greek plastikos meaning to shape or mold, has branches that should be defined. Cosmetic surgery was born out of reconstructive surgery. The difference between the two is that reconstructive surgery aims to improve the function and appearance of abnormal body structures caused by congenital defects, developmental aberrations, trauma, or disease. In contrast, cosmetic surgery is performed to reshape normal structures of the body in order to improve the patients‟ appearance and self-esteem. Although the reconstructive surgeons‟ primary goal was function, they also worked to cosmetic ends. As historian Haiken (2000) asserted “during and immediately after the First World War, surgeons spoke and wrote that their goal was to recreate a face that would enable its wearer to function in a society in which the male role was well defined” (p. 82). To say that cosmetic surgery was grounded in issues of gender and identity would be putting it mildly. It was believed that if a man whose face was not aesthetically pleasing enough to secure a job and provide for his family, as one surgeon put it, “What is the use of life if he is not in the position to seek and earn a livelihood?” (Haiken, p. 82). As the previous statement suggests, appearance was linked to social identity and self-presentation. At the same time surgeons were benefiting from America‟s changing cultural landscape, which was becoming decidedly more urban, they were also helping to create a culture that placed value on external appearance.

Beauty Doctors Physicians who performed surgery for purely aesthetic reasons earned the pejorative title of “beauty doctor” and were ostracized from the “legitimate” surgeons who concentrated on physical abnormalities like cleft palates. During the war, the newly-formed American Medical Association (AMA) (Retrieved December

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12, 2011, from http://www.ama-assn.org) participated in a campaign to expose medical professionals who engaged in irregular practices that threatened the viability of the medical field. This rift between physicians was so commonplace that historian Feldman (2004) said “no set of medical procedures save abortion has aroused so much controversy” (p. 2). The commercialization that beauty doctors played into created a larger divide between cosmetic and reconstructive surgeons. Although the AMA Code of Ethics banned all physician “direct advertising and patient solicitation” in 1847, calling it “unethical and undignified”, many physicians continued to advertise their cosmetic surgery services in urban newspapers and women‟s magazines (AMA). The years between the two world wars saw a significant increase in the number of plastic surgeons. In this study, press coverage shifted from a general non-acceptance of operations for beautification in the 1920s to tell readers that an unattractive appearance can be a handicap easily fixed by a cosmetic surgeon in the 1940s. As Feldman (2004) noted, “in the years between wars, plastic surgery had succeeded in professionalizing itself, now it had to market itself” (p. 4). Cosmetic procedures became products to be consumed by a youth oriented post war culture that placed social and economic importance on external appearance.

Methodology and Theory A two-pronged approach was used to gather primary sources. First, a comprehensive study of two major newspapers, the New York Times (NYT) and the Washington Post, was undertaken. The NYT was chosen because the bulk of plastic surgeons that came to America after World War I settled in New York, thus press coverage was abundant and local. In addition, “by the 1920s, the NYT had established itself as the official paper of record, the standard other newspapers emulated and libraries throughout the country stocked to document important daily occurrences” (Campbell, Martin, & Fabos, 2005, p. 274). Although the Post‟s circulation lagged behind its competitors the Washington Star and Times-Herald during much of the time period studied, it was chosen because it had one of the most established women‟s page at the time, which, according to Yang (1996) was a part of the Post‟s effort to increase advertising revenue (pp. 367-368). Both newspapers were available in fully searchable indexes and yielded 27 articles between 1914 and 1950. To gain a broader view, 47 magazine articles were identified using Reader’s Guide to Periodical Literature, searching key words “plastic surgery between 1914 and 1950” and “cosmetic surgery between 1914 and 1950”. Six of the identified articles were news briefs and were therefore not used in this study. Ten of the identified articles were either available in periodicals that were not carried in the library or torn out of the periodical. Thus, 31 magazine articles were actually used in this study. Magazines were used in this study not to be compared or contrasted with newspapers, but to be analyzed in conjunction with newspapers. Furthermore, using both newspapers and magazines to examine emerging themes provided a more comprehensive sample for this study. Textual analysis was used to determine the voice and message of the articles. Textual analysis is an interpretive method that assumes meaning is a social production, therefore, the construction of meaning through the text becomes the object of analysis. Framing analysis was also applied to discern patterns in reporting. “My use of the word framing refers to the way news stories are organized by patterns of selection, emphasis, interpretation, and exclusion” (Caragee & Roefs, 2004, p. 216). Entman (1993) said a news frame is achieved when certain parts of events or issues are emphasized and others are downplayed, thus, creating a point of view. Directly speaking to how audiences receive news frames, Entman (1993) stated, “Journalists may

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follow rules for „objective‟ reporting and yet convey a dominant framing of the news text that prevents most audience members from making a balanced assessment of a situation” (p. 56). In addition to shaping knowledge, sociologist Tuchman (1978) argued that the “news media have the power to shape news consumers‟ opinions about which they are ignorant” (p. 95). This statement becomes particularly relevant when applied to the emerging field of cosmetic surgery, which was legitimizing itself as a specialty at the same time it was being reported and introduced to the public. In order to understand how Westernized beauty standards became the measurement for determining levels of attractiveness, one must first understand how identities were constructed in the early 20th century culture.

Findings An analysis of 58 cosmetic surgery articles produced six frames that were repeated throughout the articles. Findings are organized based on the following six frames: surgically altering racial identity, the feminization of the specialty, “normalizing” as opposed to beautifying facial features, natural beauty versus artificial beauty, the legitimization of the specialty, and the psychological and social benefits of surgery. Many of the results of this study are descriptive, yet through an in-depth qualitative analysis, which looked at how cosmetic surgery was framed in the press, as well as the changes in coverage between decades, clear patterns emerge. Cosmetic Surgery Across Decades The above six frames were present across the time period studied and will comprise the majority of this analysis. However, findings in this study discovered some noteworthy differences in coverage within each decade that will be discussed first. Articles about plastic surgery were not present in the popular press with any regularity until 1915 when the specialty began to define itself in the midst of World War I. No articles were found in 1914, however, by the end of the decade, nine articles were written about the innovative field. The number of articles increased in the next two decades, with the 1920s producing 17 articles and the 1930s producing 18 articles. A slight decrease occurred in the 1940s, which produced 13 articles, possibly due in part to World War II and the fact that plastic surgery managed to legitimize itself through medical associations within the previous two decades. 1914-1919 The majority of the articles in the 1910s referenced the surgical innovations created during the war on male soldiers. The face was the part of the body most written about, as it was believed that a pleasing face was the most important to maintaining a man‟s livelihood when he returned home from the war. Headlines reinforced this sentiment, such as this 1917 The 19th Century and Beyond headline “The Men With the New Faces” , this 1918 Scientific American headline “New Faces for the Shell-Torn Faces of Soldiers”, and this 1919 Current Opinion headline “Restorations of the Warrior‟s Lost Face”. The term “plastic surgery” was the only one used by the press to describe the new specialty, as the term “cosmetic surgery” did not enter the lexicon of the articles analyzed for this study until a 1919 Post article defined the term as “operations… performed mainly for the purpose of beautifying the patient” (Hubbard, 1919). 1920-1929 The coverage in the 1920s was primarily focused on the use of plastic surgery for purposes of vanity, not reconstruction. It was in this decade that the coverage became “feminized” as articles directly referenced women with words and phrases such as “homely girl”, and “recapture your feminine charm”. Male surgeons

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were targeting women and playing on their insecurities. The glamour of Hollywood films and female movie stars were adding to the discontent women felt when they looked in the mirror and surgeons were creating cultural beauty norms based on an increasingly popular visual culture that was gaining popularity in the U.S.. It was also in this decade that the term “beauty doctor” was present in several articles and the schism between the “authentic” plastic surgeon and the cosmetic surgeon was beginning to unfold. Four of the articles in this decade were written by practicing surgeons, which was due in part to the ongoing public relations and promotion efforts by the American Academy of Plastic Surgeons, formed in 1921. While the stories were framed as journalism, they read more like public relations promotional material. In sum, physicians were using the print media to sell the idea of cosmetic surgery to a naive public. 1930-1939 The battle between the legitimate surgeon and beauty doctor continued in the 1930s. The majority of articles, even if this was not their primary purpose, took on the role of educating the public on the dangers of plastic surgery when done by a non-board certified surgeon. Articles began appearing in women‟s magazines and in newspaper columns written by women more frequently than in the previous two decades. Similar to the 1920s, articles were feminized for the reader and continued to correlate surgery with beauty, as this 1930 NYT headline explains, “Women Who Want Faces Beautified Are the First to Appeal to City‟s New Plastic Surgery Unit”. Drawing on the existing cultural elements that privileged beauty and likened cosmetics as “hope in a jar” (“Beauty for Sale”, 1931, p. 42), publishers seemed to be targeting the increased number of working and single women who were measuring success and happiness on the ideals of a youth-oriented postwar culture. 1940-1950 Press coverage in the 1940s took a turn back to the 1910s and focused on the improvements that were made since the First World War. The majority of articles were descriptive, and covered new ways that surgery has been able to benefit veterans and newly-wounded soldiers. Another interesting development was the increase in articles about the psychological and social benefits that surgery could have, specifically on children. Lastly, magazines were overwhelmingly represented in the 1940s, providing 11 out of the 13 articles for the decade. The remainder of this study will focus on the six frames that were present across the decades. The first two of the six frames are directly related to the construction of identity. Racial Identity and the “New” America The combined processes of industrialization, urbanization, and immigration were responsible for transforming the U.S. set amidst an influx of nearly 10 million (Retrieved from http://census.gov/population/www/documentation/twps0029/tab01.html) immigrants into the country by the turn-of-the-century, many early newspaper articles discussed an “American identity” and “race” as one and the same. Discussions of race and the Americanization of racial features were seen in both the NYT and Post as early as 1915 and continued until 1926. Oddly, there was no mention of race in any of the magazine articles analyzed for this study and racial references were not present after 1926. Several stories focused on the eyes as markers of race. Eye color was not as important as eye shape in determining racial inferiority. According to a 1915 Post article, “… The future well being of the race was dependent on the eyes of the women who are its mothers” (“Women With Baby Eyes”, 1915). The reporter

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continued to focus on the advantages of keeping the race pure by saying, “ Her type is disappearing as the race becomes more highly developed… which is the reason for the ever-increasing race suicide” (“ Women With Baby Eyes”, 1915). Articles during this time that focused on “race suicide” were closely tied to the concept of eugenics, or selective breeding, which was at its peak of popularity in the early 20th century, and played on the fears of what interracial marriage could do to the purity of the Anglo-American race. Men and women were defining their identities by the face, as indicated by unwanted racial markers like Asian eyes or Jewish noses, and cosmetic surgery was a way to change or enhance their identity to look decidedly more “American”. Some of the stories about plastic surgery and eyes focused specifically on the Asian race, which was born out of America‟s growing racial intolerance against Asians, as indicated by restrictive laws like the immigration act of 1924, which barred immigration from the Asia-Pacific Triangle. Several articles played upon this notion of Asian inferiority and fear, such as a 1924 Post article which insured readers seeking a knifeless face lift that “There can be no danger of having the expression „ironed‟ out of the face, or the eyes and eyebrows given an oriental tilt upward at the corners” (Holland, 1924, p. 12). Similarly, a 1926 NYT article addressed interracial marriage between a Japanese man and an American woman, focusing not on the legal ramifications of such a union, but how the groom-to-be underwent “plastic surgery to obliterate racial characteristics” and “cut the eye corners so the slant eye characteristic of the Japanese race was gone” (“Changes Racial Features”, 1926). Articles referring to race were also directed toward the nose, which was described by a 1919 Post story as “the most prominent part of the race” (Hubbard, 1919, p. SM4). Some of the articles did not identify the nose as having a problem (i.e., too big); they identified the nose by a racial marker. This is important as the first wave of European immigrants that came to the U.S. in the late 1800s were mainly of British decent and were able to assimilate into American culture. However, the second wave of immigrants in the early 1900s were from countries in southern and eastern Europe, such as Italy and Greece and were visibly different from Anglo-Americans. A 1921 Post article discussed before and after photographs of plastic surgery on a Jewish patient that were reported to have even “amazed the surgeon himself” (Hirshberg, 1921b, p. 9). In this article, reporter Dr. Leonard Hirshberg, who also happened to be a physician exclaimed, “Like Mephistopheles and Faust, the fine looking individual could scarcely be taken for the one who previously had a Turkish or Asiatic hooked beak” (1921b, p. 9). Not only is ethnicity posited in this article as something unwanted and unattractive, a nose that gives away ethnicity is derogatorily referred to as a beak, and a name more akin to an animal part than a human. According to Haiken (2000), this dominant cultural mindset spoke to the belief that Americans in the early 20th century “read” faces, ran them against common stereotypes, and made assumptions about their character (Haiken, 2000, p. 85). Therefore, it can be argued that those seeking to assimilate into American culture were altering their faces not because of racial self-hatred, but because they were seeking to avoid unfair treatment from others based solely on how they looked. Gender Identity and the Feminization of the Specialty Issues surrounding gender and identity were present in the majority of the articles reviewed for this study and focused on the importance of a pleasing appearance for women. As early as 1915, newspaper articles examined for this study began discussing what made a woman beautiful and how an imperfection of the face, especially the nose could make a woman “ugly”. Several articles blatantly told women that surgery was a necessary step toward becoming more beautiful. Newspaper and magazine discussions touted “homely girls” as

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being unfit to marry, and plastic surgery was posited as a cure all for those who did not fit into society‟s definition of beauty. The narrative in most of the articles spoke of surgery only in feminine terms, specifically using the word “women” or “girls”. Statements like “It is hoped that women are becoming less haphazard in solving their medical and cosmetic problems” (Maliniak, 1934, p. 202), and “Surgeons will not accept cases that are concerned only with women‟s vanity” (“Beauty for Sale”, 1931) are but two examples of the way language was used to directly single out females as surgical consumers. During the 1910s and early 1920s, the notion of an ideal feminine nose found a home in the press. According to a 1919 Post article, women undergoing nose reconstruction usually seek a “straight nose, following the Greek ideal of beauty” (Hubbard, 1919, p. SM6). This article further genders the nose by stating, “No woman can be really beautiful or attractive with a misshapen nose” (Hubbard, 1919, p. SM6). A similar statement about women and their noses was found in a 1925 NYT article that quotes surgeon J. Paul Fernel who said, Time and again I have discovered that a woman‟s success in life has been determined by her nose. It is the most predominant feature she has, and it should be perfect… There is no longer any excuse for not being beautiful… The girl will be turned over to the plastic surgeon and all will be well. (“Synthetic Noses”, 1925, p. 1)

Statements like these underscore the dominant male power structure prevalent at the time. Press coverage also played into women‟s fear of getting older by constructing the aging female face as something undesirable and unattractive. Newspaper and magazine narratives devoted several articles to the face-lift, or as one NYT article called it, “the rejuvenation of women‟s faces” (Feld, 1926, p. X17). The face-lift was discussed in nine articles and was touted by the NYT as the “most expensive and certainly the most spectacular angle of the racket” (p. X17). Interestingly, analysis of the articles showed no difference between the way newspapers, general interest magazines and women‟s magazines covered the discontentment surrounding female aging. For example, a 1939 Ladies Home Journal article provides a similar perspective to the above NYT article stating, “There has never been a time when so many women have been discontented with their appearance” (Palmer, 1939, p. 21). This discontent is best articulated in a 1931 The New Republic article titled “Beauty for Sale” which told women: If you‟re getting on, and are beginning to be psychopathic about your appearance, regaining a semblance of youth may mean more to you than anything else in the world. And an operation including many injections of Novocain, cutting, fifty stitches or so, five hundred to a thousand dollars, very real danger of infection and the chance to be disfigured for life, may seem a small price to pay for the possibility of looking younger again. (p. 40)

According to the Bureau of Census, the beauty industry escaped much of the depression in 1931. For as the above article so aptly stated, “No matter what the condition of international affairs, beauty must go on” (“Beauty for Sale”, 1931, p. 40). Normalizing Features Through Surgery The disagreement between beauty doctors and “reputable” surgeons regarding how surgery should be used encompassed more than a discussion about vanity. Articles found within this third frame either focused on the use of surgery for cosmetic ends or as a reconstructive procedure. Cosmetic surgery, however, was often justified in the press if the procedure made the patients features resemble “normal” ones. As a 1920 NYT article explains, “People do not laugh at other deformities, but they will laugh at a nose. Most of my patients do not come, necessarily, to be made more beautiful. They want to be made inconspicuous… they just hope to be

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unnoticed” (“Cosmetic Surgery”, 1920, p. X6 ). Several articles discussed the plastic surgery units that were opening in New York City hospitals. The press coverages of these units were framed as places of healing, not beauty. An example of this sentiment was found in a July 1939 Independent Woman article, which stated that although “many large hospitals in New York and other cities maintain regular departments and clinics where plastic surgery is available to rich and poor alike… here the purpose is not to beautify but to normalize appearances” (Mattox-Miller, 1939, p. 201). The normalizing of “disfigured” features was not just applied to adults, but to children. There were three articles that specifically discussed children and plastic surgery, however a 1935 Hygeia article best explained the complex relationship between “beauty” and “normalcy”. In all fairy tales, when friendly spirits assemble about the cradle of a newborn child to bestow their treasures, beauty is one of the most prized gifts. Each mother covets it for her child. If it is not given to every one to be beautiful, every baby is entitled at least to a normal face. (Maliniak, 1935, p. 413)

The dominant message was that cosmetic surgery was not solely reserved for those seeking beauty, but also for those seeking societal acceptance. Natural Versus Artificial Beauty While some physicians were justifying cosmetic surgery as long as it was used to normalize, not beautify features, other physicians were discouraging the practice altogether and encouraged the public to embrace natural ways to beautify. Articles on this subject ranged from a 1922 Ladies Home Journal story that claimed women who washed their face daily with pure soap and water would be better off in the long run (Patterson, 1922, p. 28), to a 1924 Post article that told women as soon as they noticed their face sagging they should wear a chin strap to bed to hold the muscles of the face together (Holland, 1924, p. 12). The merits of plastic surgery were rarely discounted in the articles analyzed for this study, however some encouraged readers not to alter their God given features. As this 1945 Time article explained, “… When it comes to noses, nature knows best. Many a far-from-ideal nose should be left as it is” (“A Nose”, 1945, p. 69). Other alternatives to plastic surgery that suggested natural methods to readers instead of seeking the work of surgeons, ranged from changing bad eating habits to diminish blemishes to decreasing exposure to hot weather which “creates old looking skin that can be camouflaged, but rarely eliminated by beauty doctors” (Hirshberg, 1921a, p. 10). Other stories directly touched on the natural/artificial binary, focusing particular attention on the increasing consumerism prevalent in the 1920s. A 1926 NYT story examined this paradox of artifice versus nature and provided a window into the difficulty of negotiating between the two. The development of the factory system has brought comforts and even luxuries within the reach of the masses… it is an age, which simultaneously preaches the return to nature and expends hundreds of millions of dollars on cosmetics. For the better part of a generation the doctors have preached hygiene—with a tranquil soul—as the only way to true beauty; and one result has been a tremendous increase in beauty doctors. (“The Pursuit of Beauty”, 1926, p. 22)

This quote is telling in that it infers the public was not satisfied with discussions about natural beauty, and explains why the press began to carry stories that urged plastic surgeons to recognize cosmetic procedures as legitimate in an effort to do away with the less reputable surgeon or beauty doctor. The emerging technology of the early 20th century changed the way Americans judged each other. Beauty (through the guise of cosmetics) became an accessible consumer product and cosmetic surgery fit perfectly into

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a culture that equated good looks with success. The Legitimization of the Specialty Conservative surgeons were still “holding aloof from all connections with the beauty racket” and would not “accept cases that are concerned only with women‟s vanity” (“Beauty for Sale”, 1931, p. 40). While this schism was originally based on the premise that surgeons heal, not beautify, eight of the articles written between 1923 and 1933, gave warnings by surgeons of the disfigurements caused by untrained beauty doctors. As one surgeon cautioned in 1923, “There are beauty doctors who are not skilled and whose administrations are likely to do the patient more harm than good” (“Old Faces Made New”, p. XX2). These sentiments filled the pages of magazines and newspapers, but as disfigurements at the hands of beauty doctors increased, conservative surgeons began to think twice before turning away purely “cosmetic” cases. There was a noticeable shift in coverage during the mid 1920s that told surgeons to embrace cosmetic cases, which would do away with unsafe practices and legitimate this new branch of surgery. Six articles specifically mentioned this schism within the profession. A second shift in coverage occurred in the early 1930s which ran articles that told the public, especially the female public, how to differentiate between reputable and non-reputable surgeons. Countless articles, often written by surgeons themselves, urged readers to ask about board certification, which was posited in the press as the litmus test for surgical legitimacy. For example, Dr. Maliniak (1934; 1935) wrote two of the articles analyzed in this study and was quoted in two others. This is important to note, as Dr. Maliniak was not just a well-known surgeon at the time, he was also the co-founder of the American Board of Plastic and Reconstructive Surgeons, which was established in 1931. In sum, many of the articles read less like journalism and more like self-promotion. Psychological and Social Justifications Once surgeons understood that embracing the specialty would rid the profession of incompetent beauty doctors, some also realized that the healing properties for cosmetic surgery patients were more than just physical. Articles repeatedly articulated the psychological, social, and economic effects that a deformity of the face could have on a person throughout life. According to one surgeon quoted in a 1921 Post article, “Serious social banishment and business embarrassment, as well as lifelong unhappiness come at times from facial disfigurement” (“Old Faces Made New”, p. XX2). A 1935 Post story almost mirrors what was said 14 years earlier. The paper stated “… Aside from the more serious disfigurements resulting from accidents and disease, lesser cosmetic defects need correction because of their psychological effect on the patient and also because they actually are handicaps in economic and social success” (Smith, 1935, p. R14). It was believed that a person with any visible deformity would be unable to obtain meaningful employment or find a spouse, thus resulting in an inferiority complex, a concept that was gaining attention within the emerging field of psychiatry. According to the press, the way to rid oneself of this feeling was through the miracles of plastic surgery. Stories about the psychological effects of surgery coincidentally began to arise in the press around the mid 1930s; the same time surgeons and psychiatrists were fighting to legitimize their respective specialties. An article in Independent Woman titled “Surgery‟s Cinderella” discussed the endless physical and psychological good that resulted from plastic surgery. The promise it (surgery) holds is heartening. Not only can it correct visible defects of the face and figure, but by doing so, it can banish the feeling of shame and inferiority that is often the worst part of deformity. Psychiatrists are

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THE FRAMING OF COSMETIC SURGERY, 1914-1950 convinced that many cases of mental illness have been cured by the correction of facial abnormality through plastic surgery. (Mattox-Miller, 1939, p. 201)

Social and psychological justification was especially prevalent in the argument for plastic surgery on children. Posited in the press as an effort to build up the child‟s morale, plastic surgery was also a way to rid children of potential teasing and torment at the hands of other children. A 1935 Hygeia article called “Your Child‟s Face and Future” best explained this argument. “The correction of a striking imperfection at this time allays the intense suffering of adolescence and helps to restore a normal psychic balance” (Maliniak, 1935, p. 414). Surgeons were taking a holistic approach to medicine and believed that physical health was intrinsically linked to mental health.

Conclusions This research has been primarily concerned with charting the changing rhetoric found in newspapers and magazines on the history of cosmetic surgery, and examining how plastic surgery was framed between 1914 and 1950. With the burgeoning of the beauty industry in the 1920s, cosmetic surgery found a natural partner with which to collaborate and the feminization of the specialty was driven as much by the public as it was by the surgeons and the press. Surgeons targeted women by playing on their insecurities about aging and marriage and positioned surgery as a way to ensure societal acceptance by others, especially men. Thus, the relationship between the physical face and body became intrinsically tied to how female identity was constructed. As the specialty found legitimacy and became a product to be consumed, surgeons found it in their best interest to embrace and promote their new craft. Unlike all other forms of medicine, cosmetic surgery did not presume that there was a valid medical reason for undergoing a surgical procedure. This made cosmetic surgery unique in that surgeons had to seek out patients, not the other way around which was customary for most medical specialties. However, once cosmetic surgeons and psychiatrists joined forces, they realized that for some patients a more pleasing outward appearance resulted in psychological well-being. What both types of physicians did not realize was that people, particularly women, would now be judging their faces and bodies based on social norms and subjective body flaws would be considered valid medical reasons for seeking out cosmetic surgery. As the culture of early 20th century America began to shift from a rural self-sustaining society to an urban self-determining society, the values of some in America became pre-occupied with appearance and the social and economic benefits that presumably came along with it. Cosmetic surgery was introduced to a public that was coming to terms with its “Americanness” set amidst an influx of immigrants and technological advancements. Identity became purchasable and surgeons became the purveyor of that identity. Today, improved technology and surgical techniques have contributed to the large number of people (mainly women) undergoing cosmetic surgery. The transformational logic present within our consumer culture posits beauty and acceptance as accessible to all, with America leading the world as the country with the largest number of cosmetic procedures.

References A Nose Is a Nose Is a Nose. (1945, October). Time, p. 69. Beauty for Sale. (1931, November). The New Republic, pp. 40-42. Campbell, R., Martin, C., & Fabos, B. (Eds.). (2005). Media and culture. Boston: Bedford/St. Martin‟s. Caragee, K., & Roefs, W. (2004). The neglect of power in recent framing research. Journal of Communication, 54(2), 214-233.

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