Women’s Studies International Forum, Vol. 22, No. 5, pp. 473–488, 1999Copyright © 1999 Elsevier Science LtdPrinted in the USA. All rights reserved

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COSMETIC SURGERY IN A DIFFERENT VOICE: THE CASE OF MADAME NOËL

Kathy Davis

Institute Media and (Re)presentation, Utrecht University, Kromme Nieuwe gracht 29,3512 HD Utrecht, The Netherlands

Synopsis —

Cosmetic surgery emerged at the end of the 19th century in the United States and Europe.Like most branches of surgery, it is a ‘masculine’ medical specialty, both numerically and in terms ofprofessional ‘ethos’. Given the role cosmetic surgery—and, more generally, the feminine beauty sys-tem—play in the disciplining and inferiorization of women’s bodies, a feminist cosmetic surgeon wouldseem to be a contradiction in terms. It is hard to imagine how cosmetic surgery might be practiced in away which is not, by definition, disempowering or demeaning to women. In this article, I explore the un-likely combination of a feminist cosmetic surgeon, using one of the pioneers of cosmetic surgery, Dr. Su-zanne Noël, as an example. She was the first and most famous woman to practice cosmetic surgery,working in France at the beginning of this century. She was also an active feminist. Based on an analysisof the handbook she wrote in 1926,

La Chirurgie Esthétique, Son Rôle Social

in which she describes herviews about her profession, her techniques and procedures, and the results of her operations, I tacklethe question of whether Noël’s approach might be regarded as a ‘feminine’ or even feminist way of do-ing cosmetic surgery—in short, an instance of surgery in ‘a different voice’. © 1999 Elsevier Science Ltd.All rights reserved.

The primary requisite for a good surgeon isto be a man—a man of courage. (Andrews,1861; quoted in Cassell, 1998, p. 182)

Surgery involves bodies—those of surgeonsas well as of patients. . . . What does it meanwhen the body of the surgeon—the intrusivegazer, the violator, the recipient of sensoryassaults—is that of a woman? (Cassell, 1998,p. 31)

Several years ago, I did research on women’sinvolvement in cosmetic surgery which re-sulted in

Reshaping the Female Body

(Davis,1995). In this book, I provided a feminist cri-tique of cosmetic surgery as one of the primary

ways women’s bodies are constructed as ugly,deficient, and in constant need of improve-ment. I argued that cosmetic surgery belongsto the practices and technologies of the femi-nine beauty system—a system which is one ofthe primary sites for the exercise of gender/power in contemporary western cultures.

When I began this research, I assumed thatthe current cosmetic surgery craze was a fairlyrecent phenomenon. I vaguely rememberedreading about breast augmentations in theearly 1960s, when Carol Doda, a toplessdancer in California, made the headlines byhaving silicone injected directly into herbreasts. The enormous expansion of cosmeticsurgery procedures in the years that followedseemed to be a typical by-product of westernculture in late modernity—a culture wheremedical technology has made the surgical al-teration of the body a readily available and so-cially acceptable ‘choice’ and where the beliefin the makeabiliy of the body reigns supreme.As my research progressed, however, I discov-ered that cosmetic surgery was not nearly asrecent as I had initially imagined. In fact, it was

I would like to thank Willem de Haan, Barbara Henkes,renée hoogland, and Dubravka Zarkov for their thoughtfulcomments on an earlier version of this paper. I am alsoindebted to Ms. Bakker-Leentvaar of the Soroptimistorganization in the Netherlands for her help.

All figures in this article are reproduced from

DieÄesthetische Chirurgie und ihre soziale Bedeutung

by A.Noël (1932) and are used with permission of J. A. BarthVerlag, Heidelberg.

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highly popular at the turn of the century and,to my surprise, one of the pioneers was awoman—a French surgeon, known to her col-leagues as Madame Noël. She practiced duringthe period that cosmetic surgery was becominga respectable branch of medicine and wroteone of the first medical handbooks about cos-metic surgery in 1926, thereby laying thegroundwork for the profession as we know ittoday (B. Rogers, 1971). Madame Noël wasnot only a cosmetic surgeon, however. She wasalso a feminist; a suffragette, an advocate ofwomen’s right to work, and one of thefounders of soroptimism, an internationalwomen’s organization.

I was intrigued. Who was this woman andhow did she manage to reconcile the seeminglyirreconcilable: being a feminist and being acosmetic surgeon? After all, cosmetic surgery,like all forms of surgery, is today a male-domi-nated medical specialty.

1

Female cosmetic sur-geons are few and far between. Surgery is in-hospitable to women, in part, because its longtraining period and demanding work schedulesmake it difficult to combine career and family.However, the surgical ethos appears to be no-toriously masculine as well. The anthropolo-gist Joan Cassell (1991) has studied surgeonsat work and concludes that, as a group, theytend to be arrogant, adventurous, ruthless, andcompetitive. In short, surgeons possess charac-teristics which in western culture tend to be as-sociated with men and masculinity.

2

As Cassellputs it, to be a surgeon, one has to be—literallyand figuratively—‘ballsy’ (p. 35). While practi-tioners in ‘softer’ specialties like internal medi-cine or general practice are like statesmenwaiting to see how the illness progresses andtrying with pills and potions to cooperate withthe body, the surgeon behaves like a warrior,armed to the teeth. He acts (or cuts) first andthinks later. The world of surgery is a dog-eat-dog world and surgeons tend to be highly com-petitive with one another. Surgeons are theconsummate machos of the medical world, ac-cording to Cassell. They are prepared to oper-ate for 7 hours without a break, look down onpeople who complain or look tired, and gener-ally like to ‘live on the edge’ (Cassell, 1991, pp.42–43). Surgeons belong to the masculineworld of fast cars and sports and many hold in-tensely polarized views of women as either the‘nice’ women they marry or the ‘bad’ womenthey ‘play around with’ (Cassell, 1991, p. 41).

Given the ‘masculine’ underpinnings of cos-metic surgery as a medical specialty as well asthe role it plays in the inferiorization ofwomen through their bodies, a feminist cos-metic surgeon would seem to be a contradic-tion in terms. It is hard to imagine how a femi-nist could become a cosmetic surgeon or, bythe same token, how cosmetic surgery could bepracticed in a way which is not, by definition,disempowering or demeaning to women.

In this article, I will explore this unlikelycombination, using Madame Noël as an exam-ple of what can happen when a feministwoman engages in the most masculine profes-sion of all—cosmetic surgery. Although sherepresents only one case, she provides aglimpse of a surgical ethos and practice whichdiffer considerably from what Cassell foundamong modern-day surgeons. After taking abrief look at Noël’s life and the context inwhich she practiced cosmetic surgery, I exam-ine the handbook she wrote in 1926,

La Chiru-rgie Esthétique, Son Rôle Social

in which shedescribes her views about her profession, hertechniques and procedures, and the results ofher operations. In conclusion, I tackle thequestion of whether Noël’s approach might beregarded as a ‘feminine’ or even feminist wayof doing surgery—an instance of surgery in ‘adifferent voice’

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and what this might mean fora feminist critique of cosmetic surgery as, al-most by definition, ‘bad news’ for women.

MADAME NOËL

The life and work of Suzanne Noël (Figure 1)have been recounted by Paule Regnault (1971),who studied surgery with her from 1942 to1950

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and Jeannine Jacquemin (1988) who wascommissioned by the Soroptimist Interna-tional to write a biography of Noël as one ofthe Soroptimist ‘founding mothers’. Both pro-vide glowing accounts of Noël as a courageousand unusual woman, a highly skilled and origi-nal surgeon, and a famous and respected apos-tle of the international women’s movement.

Suzanne Blanche Marguerite Gros wasborn in 1878 in Laon, France of well-to-do par-ents. As the only surviving daughter of fourchildren, she was doted on by her parents andreceived the usual education reserved for mid-dle-class girls: classics, embroidery, and paint-ing. At 19, she made a ‘good marriage’ to adoctor 9 years older than she, Henri Pertat. In

Cosmetic Surgery in a Different Voice 475

1905, she embarked on her medical studies;studies which she probably could not have un-dertaken without the consent and active sup-port of her husband (Jacquemin, 1988, p. 13).(Noël later claimed that she became a doctorin order to work with her husband in his der-matology practice.) She excelled in her studiesand, following an illness and the birth of herdaughter, passed the highly competitive ‘Inter-nat des Hospitaux de Paris’ in 1912 as the 4thof 67 students. This was an exceptional perfor-mance for a woman—one which, as her officialbiographer notes, ‘could only have beenachieved by extremely hard work and a bril-liant intelligence’ (Jacquemin, 1988, p. 16). In1919, her husband died and she remarried afellow student in dermatology, André Noël,who had just returned from the front. Hequickly finished his ‘Internat’ (graduating atthe bottom of his class) and handed in a thesiswhich was probably based on work which hiswife had been doing on the ‘douche filiforme’(an installation for bathing patients with skin

problems). Their marriage was short-lived.Following the death of Suzanne’s daughter,André became severely depressed and in 1924,he threw himself into the Seine in front of hiswife. Devastated, Suzanne Noël turned to herwork for solace and it was to remain her pas-sion until her death in 1954.

Noël first became interested in cosmeticsurgery in 1912 when she noticed that the fa-mous actress, Sarah Bernhardt returned fromher American tour miraculously rejuvenated.(Bernhardt was, at that time, well over 60.)Curious, Noël began experimenting by pinch-ing the skin of her own face in different placesto see if she could get the same effect. Sur-prised at what she was able to accomplish, shebegan to experiment more seriously, operatingon anesthetized rabbits whose skin is similar in‘delicacy and elasticity to human skin’ (Noël,1926, p. 7).

The advent of World War I allowed Noël togain expertise in treating wounded soldiers forfacial injuries and in 1916 she undertook fur-ther surgical training for operating on disfigur-ing scars as well as her old ‘hobby’, the rejuve-nation of wrinkled faces. Noël situates thebeginning of her devotion to cosmetic surgeryin one of her first face-lift operations on awoman who ‘due to her age was not able toearn her own living’—an operation which wasapparently so successful that the patient wasimmediately able to find a job. Noël claims tohave been so impressed by this fortuitous re-sult that she decided to make cosmetic surgeryher vocation and from that point on, did notlook back (Noël, 1926, p. 9).

Noël’s medical career spanned the periodfrom 1916 to 1950 and can be separated intotwo distinct periods. When she started practic-ing, plastic surgery was not an established spe-cialty and hospitals did not admit surgeonswho did plastic surgery exclusively. Noël set upher own clinic at home, becoming one of thefirst cosmetic surgeons in France. Her opera-tions were limited to minor surgery, most nota-bly, face-lifts and eyelid corrections. She ap-parently quickly became well-known, drawingmany ‘world-renowned persons of the fashionworld and of the European aristocracy’ (Reg-nault, 1971, p. 134).

With the onset of World War II, she gaveup her private clinic and performed operationsin the Clinique des Bleuets in Paris, where shecould do major surgery. According to her stu-

Fig. 1. Photo of Suzanne Noël in 1926.

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dent, Regnault, Noël was a versatile surgeonwho performed many different and often quitebold interventions—reshaping the breasts,slimming the abdomen and arms, excising fatfrom the legs, and eliminating wrinkles in thehand by injecting a sclerosing solution into theblood vessels. Although she is credited withinitiating the Biesenburger method of mam-moplasty in France, it is her technique of face-lifting, in particular the ‘petite opération’ or‘mini-lift’, for which she continues to be knowntoday (see, e.g., González-Ulloa, 1985b; B. Rog-ers, 1971; Stephenson, 1970).

At a time when women were struggling togain a foothold in the medical profession, Noëlappears to have won considerable recognitionfor her work. She was awarded the Legion ofHonour from the Foreign Office in 1928 forbeing a ‘doctor of unusual skill’ whose lecturesand methods were a credit to her country (Jac-quemin, 1988, p. 33). In addition to writing awidely-read book about cosmetic surgerywhich was translated into German in 1932 (

DieÄesthetische Chirurgie und ihre soziale Bedeu-tung

), physicians from all over the world vis-ited Paris to observe her work. She traveledextensively in the United States, Germany,and Austria, giving lectures and demonstratingher surgical techniques. In 1930, two documen-tary films showing Noël operating were madein the Charité in Berlin and later written up in

Medizinische Welt.

She was the first woman inFrance to become the president of a medicalsociety—that of aesthetic morphobiology. Hername is included in most historical accounts ofmodern cosmetic surgery where she is referredto as ‘the world’s first famous female cosmeticplastic surgeon’ (B. Rogers, 1971).

Noël’s career as a feminist ran parallel toher professional career as cosmetic surgeon.She was an ardent believer in women’s right tovote and participated in speeches and parades,wearing a ribbon on her hat with the words ‘Jeveux voter’. In an attempt to embarrass thegovernment so that they would give womenthe right to vote, she organized a strike on thepayment of taxes, convincing women that theyshould not be paying taxes over the use ofwhich they had no control (Jacquemin, 1988, p.23). She studied medicine at a time when Eu-ropean women still had considerable difficultytraining and qualifying as doctors and wasfirmly committed to a woman’s right to a placein the professional and business world. In

1923, she became acquainted with soropti-mism, when a representative of the rapidlygrowing movement in the United States visitedParis to recruit new members. Soroptimism

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was a women’s organization connected to theRotary Clubs for men which promoted thesupport of professional women as well as theideals of service and internationalism. En-thralled by the soroptimist principles, Noël setabout organizing the first chapter in Europewhich was founded in Paris in 1924. During thenext 30 years, she played a crucial role in ex-panding the organization throughout theworld. She lectured extensively, traveling asfar away as China and India, using her renownas a surgeon to establish new clubs. Noël ismost well-known for the role she played in ini-tiating soroptimist organizations in Europe(she single-handedly founded chapters in 11European capitals). She became the first Presi-dent of the European Federation in 1930 andin 1943 a Noël Fund was established to sustainthe expansion of international soroptimism(Jacquemin, 1988, p. 46). Even after she wasnearly blind and well into her 70s, she contin-ued to attend international meetings up untilher death at the age of 76 (Figure 2).

In summary, the picture which emerges ofSuzanne Noël based on accounts of her stu-dents and sister soroptimists is nothing short ofheroic. At first glance, it would seem that shemanaged to do the impossible—namely, tocombine the practice of cosmetic surgery withan active commitment to feminism. But whatdid this combination mean for how Noël actu-ally practiced cosmetic surgery? Before takinga closer look at her approach to cosmetic sur-gery, let us take a brief look at the context inwhich she practiced this new kind of medicine.

SURGICAL PIONEERS

Suzanne Noël belongs to one of the early pio-neers of what is now known as modern cos-metic surgery.

6

Cosmetic surgery—that is,surgery undertaken solely for reasons of ap-pearance—emerged at the end of the 19th cen-tury in the United States and Europe (Ger-many, England, and France). Plastic surgery,which includes both cosmetic or aesthetic sur-gery and reconstructive surgery—is mucholder. The first rhinoplasty (nose reconstruc-tion) was reported as early as

a

.

d

. 1000 in In-dia, where a thief’s nose might be cut off as a

Cosmetic Surgery in a Different Voice 477

form of punishment or, in the case of an adul-terous Hindu wife, bitten off by the wrongedhusband. Gaspare Tagliacozzi, often creditedas the ‘father of plastic surgery,’ wrote the firstbook about plastic surgery in 1597, in which hegave an illustrated account of his successful re-construction of a young nobleman’s nose,which had been sliced off during a duel. Plasticsurgery did not become popular until the 19thcentury, when the discovery of antisepsis andanesthesia made operations feasible. Eventhen, most surgeons were more interested in‘cavity surgery’ than in repairing the body sur-face (McDowell, 1978). It was not until the be-ginning of the 20th century that cosmetic sur-gery was performed on a large scale. Twoseparate, but related developments accountfor its emergence at this particular moment inhistory (Haiken, 1997).

The first development—often ignored in of-ficial histories of plastic surgery—was the massbeauty culture which flourished at the turn ofthe century. Cultural prohibitions againstolder women attempting to look young and

beautiful were dropped and a democratic ide-ology of self-improvement emerged which ad-vocated making the tools for achieving beautyavailable to all women, regardless of their so-cio-economic circumstances (Banner, 1983). Inaddition to beauty parlors and hairdresserswhich sprang up all over the United States,cosmetic ‘salons’ were established where peo-ple could have their faces ‘lifted’ and theirnoses corrected. Advertisements appeared indaily newspapers from surgeons expoundingthe wonders of cosmetic surgery.

Many of the early cosmetic surgeons oper-ated on the fringes of the medical establish-ment. Cosmetic surgery was associated with‘quackery’—untrained charlatans or ‘irregulardoctors’ with an eye to earning a fast buck byoperating on vain and silly women who werepreoccupied with their appearance. Althoughthese surgeons were not taken seriously by theestablished medical professionals, they devel-oped many of the techniques which were em-ployed and continue to be employed by cos-metic surgeons today. B. Rogers (1971) arguesthat many of these early pioneers, in fact,showed great inventiveness and foresight, butwere mistakenly ‘brushed aside or ignored’ bytheir surgical contemporaries.

The second development leading to theemergence of cosmetic surgery was WorldWar I and its large numbers of soldiers with fa-cial damage, burns, and lost limbs who re-quired reconstructive surgery. This gave sur-geons the chance to practice their surgicaltechniques and gain experience performingoperations. The negative associations of bodilydeformity with syphilis or divine retributionfor sins committed were dispelled by the nobleand deserving soldier, disfigured in the defenseof his country. Plastic and reconstructive sur-gery became acceptable or, as Raymond Passot,a contemporary of Noël, put it, the war gainedit the ‘keys of the city’ (B. Rogers, 1985, p. 13).

Cosmetic surgery remained controversialfor many early plastic surgeons—a controversywhich continues to play a role in contemporarydiscussions about surgery for reconstructivepurposes (disfigurements through birth or ac-cident) and surgery for aesthetic reasons.However, by 1921, plastic surgeons—anxiousto find a market for their newly-won skills, de-cided to include cosmetic surgery as a sub-spe-cialty of plastic surgery. The first professionalassociation for cosmetic surgery was estab-

Fig. 2. Madame Noël in 1952.

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lished in Chicago, laying the foundation forwhat was later to become one of the largestspecialties in American medicine (Haiken,1997).

Suzanne Noël, like many early plastic sur-geons, gained experience in operating onwounded soldiers during the first world war.After the war, however, she directed her atten-tion toward a new group of patients and beganoperating mostly on women who wanted toimprove their appearance. Like her contempo-raries, she brought the fields of reconstructiveand cosmetic surgery together. Like most pio-neers, she was interested in gaining recogni-tion for a new and controversial medical prac-tice as well as perfecting its procedures andtechniques. To this end, she wrote

La Chirur-gie Esthétique, Son Rôle Social

, which ap-peared in 1926 as the fourth handbook de-voted entirely to cosmetic surgery.

7

Her booknot only served to sum up and document sev-eral decades of work in the newly-emergingfield of cosmetic surgery, but became the stan-dard text on cosmetic surgery for many yearsafterwards. According to B. Rogers (1971),Noël’s book marked the end of the ‘pioneeringperiod’ of cosmetic surgery and since then, sur-geons have only been concerned with ‘techni-cal variations and improvements in the opera-tions of their predecessors’ (p. 266).

THE TEXT

Medical textbooks in the field of cosmetic sur-gery tend to adopt the same general format.They begin with an attempt to justify the im-portance of cosmetic surgery as a medical spe-ciality. This somewhat defensive stance is dueto the controversial features of cosmetic sur-gery—features which place the author in theposition of having to explain the usefulness ordesirability of surgery on an otherwise healthypatient for beauty reasons. This is followed byattention to patients’ motives for having cos-metic surgery. Some attempt is made to advisethe surgeon on which patients are suitable can-didates for surgery and when caution is indi-cated. And, finally, the would-be surgeon isprovided with necessary information about op-eration techniques as well as the kinds of re-sults which can be expected. To this end, visualmaterials are provided: anatomical drawings,operation photographs, and before-and-after

sequences which enable the reader to assessthe results of surgery.

Noël’s book (1926) also has a typical text-book format and, therefore, resembles manylater books on cosmetic surgery. It is dividedinto two parts. In the first part (roughly onethird of the book), she sets out why cosmeticsurgery is important and provides several vi-gnettes of patients who were helped by aes-thetic surgery. The rest of the book (roughlytwo thirds) is devoted to how she performs theoperations, including a description of the in-struments used, various techniques for makingincisions, how to do sutures and apply ban-dages, and the outcomes. She closes with aword on possible negative side-effects and fur-ther applications of aesthetic surgery. Thebook is relatively short, only 71 pages. Its mostdistinctive feature is the wealth of photographsand illustrations, all of which were done by theauthor herself. She was one of the first cos-metic surgeons to provide photographs of theentire operation instead of the ubiquitousdrawings of classical Grecian female heads,which her contemporaries seemed to prefer,where dotted lines and arrows denoted thecorrect location for the incision or the more re-cent predilection in surgical texts for photo-graphs of isolated body parts. Noël’s book alsocontains a large collection of before-and-afterphotographs of her successful as well as herless successful operations, thereby enablingthe reader to assess the results of her proce-dures.

I shall now take a closer look at the text, fo-cusing on why Noël thought cosmetic surgerywas important (how she justified it), how shethought it should (or should not) be done, andwhat constituted in her view a successful oper-ation. By comparing her to other surgeons ofher day, I will show what makes her approachto cosmetic surgery distinctive. I will then turnto the question of whether she might beviewed as a ‘different voice’ in the history ofcosmetic surgery.

JUSTIFYING COSMETIC SURGERY: ‘THE BITTER NEED . . .’ (Noël, 1926, p. 10)

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Noël, like her contemporaries, was a ferventbeliever in cosmetic surgery, describing it as a‘boon to mankind’ (p. 9). While she acknowl-edged that, as a new profession, aesthetic sur-gery often met with ‘ridicule’ or a ‘shrug’ (p.

Cosmetic Surgery in a Different Voice 479

10), she did not dwell on such skepticism. Un-like her contemporaries, she did not defendher specialty against the disbelieving medicalestablishment. Instead, she announced her un-shakable conviction that such attitudes woulddisappear as soon as surgeons understood the‘bitter need’ behind patients’ wish to havetheir appearance altered surgically (p. 10).

The ‘bitter need’ to which she refers is aneconomic one. Her patients—most of whomare women—come to her because they areafraid of losing their jobs as their faces beginto show the first signs of age. She proceeds toprovide a series of dramatic ‘cases’ which willestablish her defense of cosmetic surgery: theaging opera star who is no longer asked to sing(‘in spite of her fame and beautiful voice . . .she wasn’t even allowed to sing without pay inhospitals for veterans’, p. 11), the widow whocannot support her young son (‘abandoned byher husband and financially ruined, she wasforced to seek employment’, p. 12), and theseamstress in the sweatshop who wants to im-prove her situation by becoming a supervisor(but ‘like other Parisian workers, long years ofhard work, insufficient sleep, and poor nutri-tion had taken their toll’, p. 14). Noël justifiesher profession with sympathetic accounts ofwhy her patients want surgery and how itmakes a difference in their life circumstances.

Let us take a closer look at one of thesecases—her description of a ‘distinguished-looking, 60-year old woman whose formerbeauty is clearly visible in her countenance . . .in spite of creases and wrinkles’ (p. 10):

She comes asking me for help. The war andher old appearance have caused her to loseher job as manager of a small firm in luxurygoods. Her excellent references and experi-ence and her acknowledged good tastecouldn’t help her: wherever she applied for ajob, she received the same answer: ‘We’lllet you know’ and that was as far as sheever got. She was in the deepest distress; Iagreed to undertake the rejuvenation of herappearance.

Even after the first operation, she gatheredfresh courage. I discovered just how desper-ately she needed my immediate help on theday I removed her stitches. She fainted andhad to admit that she hadn’t eaten anythingfor 48 hours. A meal was set before her and I

encouraged her with all my powers. The nextday she found some work—and it was in oneof the firms where she had been so roughlytreated before.

I have operated on this patient three timesmore in the course of a two month period.Since then, she is able to earn her living withthe same ease as for the past 15 years and shewas so busy in the last three years that shedidn’t have time to undergo the fourth oper-ation which I considered necessary.

I see her frequently; she has gained a re-markably youthful demeanor, together witha feeling of security that she will be able totake on what life brings. This is certainly thebest payment a surgeon can receive. (Noël,1926, pp. 10–11)

While Noël’s contemporaries were wont to de-fend cosmetic surgery by referring to the valueof beauty in abstract terms or citing the psy-chological distress of their patients, Noël justi-fies operations for social or material reasons.As the title of her book suggests, she viewscosmetic surgery as a social necessity, particu-larly for women. She sees her vocation as away to help women support themselves ormaintain their professional positions. As afeminist, Noël was herself a staunch advocateof women’s right to work and had personal ex-perience in the obstacles facing workingwomen in her day (she was forced to practicesurgery in her home as women surgeons werenot admitted to hospitals).

In her book, Noël provides tongue-in-cheekobservations about her patients’ husbands whoare reluctant to let their wives have surgery,remarking that French men exhibit the ‘moststrenuous resistance’ to cosmetic surgery andthat ‘the wish of their wives to preserve theirbeauty and youthful appearance unsettlesthem to a high degree’. Remembering her ownactivities as a suffragette, Noël concludes:

It is the same as with our right to vote. No-where did women meet with such headstrongresistance, nowhere was it made so difficultfor them to openly admit their wish to re-main young. (Noël, 1926, pp. 19–20)

She suggests that this accounts for why manywomen may prefer to keep their surgery a secret

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from their husbands. Others may engage in whatNoël with unmistakable irony refers to as a ‘littlesubterfuge of war’. By encouraging their hus-bands to have surgery to rejuvenate

their

ap-pearance, these astute women pave the way fortheir own face-lifts—the strategy of ‘what’s goodfor the gander is also good for the goose’ (p. 20).

In short, Noël justifies cosmetic surgery interms of material necessity and women’s rightto a youthful appearance. She employs a femi-nist discourse which situates women’s right tochange an ‘ugly face’ or ‘humiliating body’ totheir right to vote and demand political rights:a matter of being able to ‘choose one’s owndestiny’ (quoted in Haywood, 1985, p. 30). Sherefers to power hierarchies in gender relationsin tongue-in-cheek accounts of men’s resis-tance to change and how women might employtheir feminine wiles in order to get what theywant in the battle between the sexes.

TECHNIQUES AND PROCEDURES: ‘IT MAY BE MY WOMANLY CHARACTER

WHICH LED ME TO CHOOSE THIS PARTICULAR METHOD. . . .’

(Noël , 1926, p. 57)

Noël wrote her book at a time when many ofthe techniques and procedures of cosmetic sur-gery had not yet been recorded and many werestill in an experimental stage. Like her contem-poraries, she would have been concernedabout staking out a claim in a new field. How-ever, the manner in which she set out her tech-niques and procedures stands in marked con-trast to the writings of her contemporaries.

While they used abstract or technical lan-guage in their texts and tended to positionthemselves as a distanced observer, ready toopen the body and reveal its secrets,

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Noël’stext is completely devoid of technical jargon.She writes in a refreshingly down-to-earthstyle, providing frequent anecdotes and hu-morous observations. For example, she em-ploys the domestic metaphor of sewing to de-scribe her technique for removing a ‘bag underthe eyes’:

I use . . . a straight or half-curved needle andan ordinary thimble which has been sterilizedlike the rest of the instruments. It may be mywomanly nature which led me to choose thisparticular method, but I believe that the open-ing through which a needle is thrust is less

likely to be pulled out of shape if the needlereceives steady support [from the thimble].

And I have always produced perfect seams.(Noël, 1926, p. 57)

She demystifies surgery as a craft rather thana magical power—something to be learnedthrough practice and attention to details. Herdescription is accessible; she seems to be writingfor colleagues with an eye toward helping themperform operations in such a way that the bestpossible result will be achieved, rather than cor-nering a part of the surgical market for herself.

It was not uncommon for the pioneers ofmodern cosmetic surgery to give detailed ac-counts about which instruments to use, whereto place clamps and what kind of materialshould be used for suturing, or how to bandagethe wound (Stephenson, 1985, p. 14). How-ever, while most of these early surgeons fo-cused on the incision—the numbing of theskin, the actual cutting, and the closing of thewound, Noël pays attention to the operation asa whole. Beginning with the preparations foran operation, she describes experimentingwith different possibilities with the patient,pulling back the skin and adjusting the direc-tion according to the patient’s wishes. She mo-bilizes the patient’s skills in preparing the op-eration, asking her to experiment in front ofher own mirror at home in order to see whichkind of pull yields the best results.

My experience is that the patient is alwaysthe one to find the best place [to make theincisions]. This is a small trick which I canheartily recommend to anyone doing cos-metic surgery. (p. 24)

Once Noël had determined the best place tomake the incision, she made crescent-shapedappliqué-patterns which were placed at differ-ent locations along the hairline. She developeda special measuring band called a ‘craniome-ter’ which she placed at the center of the pa-tient’s forehead and used as a guide for ensur-ing that one side of the patient’s face would bealigned with the other.

Her attention to the details of the procedureis apparent throughout her description of the op-eration. For example, she provides a list of the in-struments to be used in the operations, includingthe number of each, the best kinds of needles

Cosmetic Surgery in a Different Voice 481

and suturing material, and which kinds of ban-dages are most effective. It is almost like readinga recipe whereby the cook is given all the neces-sary information in order to prepare a particulardish. She reminds surgeons not to forget to checkwhether the patient’s face is numb after adminis-tering the local anesthesia or to be sure to coverthe patient with a blanket so that she will not getcold during the operation (Noël, 1926, p. 24).

Noël took pictures of the entire procedure,beginning with the preparations (measuringthe patient’s skull, applying the patterns) (Fig-ure 3) and ending with the patient perchedhappily on the bed after the operation, fixingher hair or drinking a cup of coffee (Figure 4).In this way, the reader is given a blow-by-blowaccount of the operation rather than a diagramof where to place the incision. The patient ispresent in the photographs as is Noël herself—sometimes shown in full view, operating on thepatient or just as a hand, gently resting by thepatient’s head following the surgery (Figure 5).

Noël’s concern for her patient’s well-beingextends beyond the actual surgery. She antici-pates how the patient will have to return homeafter surgery and confront her family and col-leagues, many of whom do not know that shehas had an operation. Noël imaginativelyplaces herself in her patient’s shoes when shemakes incisions behind the hair-line or dyesthe bandage to match the patient’s hair or ad-vises her patient to change her hair style orbuy a new hat so that she does not have to ex-plain why she looks so much better. Her goal isthat her patient can ‘return home and immedi-ately go about her daily activities’ (Noël, p. 37)without having to explain her actions to curi-ous family members or friends.

For most surgeons working in the first halfof this century, the patient was an absent pres-ence. Their attention was focused on the bodypart upon which the operation was performed.If patients appear at all in early textbooks oncosmetic surgery, it was to warn the would-be surgeon about the dangers of ‘femininepersuasion’. For example, Eugen Holländer(1932) writes retrospectively of being a ‘victim’to a Polish aristocrat who insisted that he per-form a face-lift on her in 1901 at a time whenthe operation was totally unknown (quoted inB. Rogers, 1971, p. 274). Surgeons like CharlesConrad Miller elaborated the potential diffi-culties in managing operations with womenwho he referred to as ‘high-strung, modern

types who suffer enough from nerves already’and advised maintaining a calm and unhurrieddemeanor and avoiding subjecting the patientto the sight of blood (Miller, 1925, quoted inStephenson, 1985, p. 32). In contrast, Noëltreats the operation as a collaborative en-deavor. The patient is present in her text as anactive and knowledgeable participant in thesurgery. From the initial consultation to thefollow-up, she draws the patient into the pro-cedure, making use of her ideas about how theoperation should be done. She acknowledgesthat patients may be often ‘more alert’ to thefirst signs of aging and, therefore, are in a bet-ter position than Noël to decide whether anoperation is necessary (p. 41). She never belit-tles nervous patients, but maintains that all herpatients ‘behave in a calm and sensible way

Fig. 3. Surgical preparations.

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during surgery’ (p. 10). If a patient fails to re-turn for an additional operation, Noël noteshumorously that she was probably just toobusy with her job to be bothered.

In short, Noël portrays the techniques andprocedures as an ordinary skill not unlike sew-ing. She values experience, patience, care fordetails, and dexterity rather than scientificknowledge and the daring incision. She is colle-gial toward her fellow surgeons, seeminglymore intent on sharing her knowledge thantaking credit for innovations. But, most impor-tant, she takes a respectful and collaborativestance toward her patients, never losing sight ofthe context in which they decide to have theiroperations as well as live with the outcome.

RISKS AND RESULTS: ‘THIS BRANCH OF SURGERY IS FULL OF AMBUSHES

. . . CARE IS IN ORDER IF TRAGIC ACCIDENTS ARE TO BE AVOIDED.’

(Noël, 1926, p. 70)

During the first half of the century, there wasconsiderable controversy even then about the

best technique for a face-lift.

10

Noël was astaunch opponent of the heroic measures fa-vored by many of her contemporaries like SirHarold Gillies, Robert Ivy, Otto Bames, andErich Lexer. She advocated what she called a‘petite opération’ for face-lifting (sometimescalled the ‘timid intervention’ or ‘mini-lift’).This involved making small elliptical excisionsaround the hairline where they would be invis-ible and suturing the skin without excising theunderlying tissue. She removed just enoughskin to create the necessary tension to bringabout improvement. This was in contrast toher contemporaries who experimented withbolder incisions stretching from the patient’stemple to behind the earlobe or advocated un-dermining large areas of subcutaneous tissuein the interests of a more durable result. Forexample, the American surgeon Otto Bameswas openly disparaging of what he called the‘timorousness’ of ‘would-be surgeons’ whowere afraid to adopt radical procedures (mostnotably, his own) in the interests of achieving‘permanent results’ (Bames, 1927, p. 86,quoted in González-Ulloa, 1985b, p. 46).

Fig. 4. Surgical aftermath.

Cosmetic Surgery in a Different Voice 483

While Noël was not alone in her skepticism of‘la grande opération’, she was unusual in herconcern for preventing scars and her cautiousapproach toward experimentation. Her inter-ventions were invariably designed with an eyeto preventing scars. She preferred to do a se-ries of smaller interventions over a period ofyears, sometimes doing one side of the facefirst and waiting to see how it turned out be-fore doing the other side. She believed that itwas better to leave no traces and avoid risks ofblood clots or paralysis of facial muscles (a po-tential side-effect of undermining) even if itmeant having to do further surgery. She didnot see the necessity of accomplishing every-thing in a single operation.

Noël’s contemporaries emphasized thespectacular improvements which could beachieved with cosmetic surgery and were pre-pared to take serious risks in the interest of re-fining their techniques. They rarely mentionedunsuccessful or failed operations.

11

Noël pro-vides photographs of her own less-than-satis-factory results. She devotes an entire chapterin her book to scars, showing what could hap-pen when incisions are inappropriately made(incisions which are not in the right place, un-sightly scars due to the development of keloidtissue, or scars where the ear lobe is pulled outof shape). For Noël, scars were not an un-avoidable accouterment to surgery, nor didshe blame the patient for being too picky.She readily admitted that her work was experi-mental and that she often began an operationwithout quite knowing what she was gettinginto. However, she seems less cavalier thanmany of her contemporaries about the dangersof her interventions. For example, in describ-ing her first operations, she notes that her pa-tient, a man, ‘stoically refused to be anaes-thetized’ and she made mistakes which notonly complicated the procedure, but causedthe operation to last longer than planned andthe wound to heal more slowly. Fortunately,the results were excellent and, in hindsight,she notes that this was the operation where she‘learned more than all the others that fol-lowed’ (p. 8).

Some of her operations did fail, of course.This is not surprising, given that Noël per-formed operations at a time when surgeons didnot have access to some of the technologyavailable today and when precautions to avoidinfection were less stringent. For example,Noël’s book contains numerous photos of heroperating on her patients without gloves andone of her students remembers that Noël lefther watch on her wrist during surgery and toldher laughingly afterwards not to worry be-cause ‘this watch is very good’ (Regnault,1971, p. 137).

Noël was apparently devastated by hermore serious failures, however. For example, a‘leg defatting’ turned out so badly that sheworried about it for a long time afterward,tending to justify herself and speak in a ‘verysharp tone that even her friends recognized’(Jacquemin, 1988, p. 33).

On the whole, Noël’s results were surpris-ingly good. According to Regnault (1971),

Fig. 5. Finishing up.

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. . . the delicate way in which she handled thetissues (avoiding forceps, pressure, and ten-sion) was certainly a great factor in her goodresults. If she were alive today, her surgicaltechnique would certainly include the latestadvances, but her basic philosophy about theplace of esthetic surgery would undoubtedlybe the same as it always was. (p. 13)

It was Noël’s attention to the results and herdesire to avoid side-effects which enabled herto achieve outcomes which, judging by the pho-tographs of her patients, were at least as goodas many of the face-lifts performed today (Fig-ures 6 and 7). Although Noël might have modi-fied her ‘timid’ procedure, had she lived longer,it seems unlikely that she would have everadopted the heroic stance toward cosmetic sur-gery favored by her male colleagues. As sheherself put it, there would probably always bewomen who would forgo a more dramatic im-provement if it meant that their working or liv-ing situations would not be disrupted. For thesepatients, two or three operations over a periodof several years would be preferable to the sin-gle, more radical intervention. For Noël, pa-tients were individuals with different needs anddesires. Even if more radical interventionswere advisable from a surgical point of view, itshould still be left to the individual woman todecide. A woman’s special circumstances mightmitigate against radical surgery, causing her tochoose surgery which does not ‘show’ andwhich can easily be integrated into her currentlife situation. In her view, the patient, not thesurgeon, is the final arbiter.

GENDER AND THE SURGICAL ETHOS

The surgical ethos described at the beginningof this article is not limited to modern-day sur-geons, but is echoed in the writings of the earlypioneers as well. González-Ulloa (1985a) pref-aces his history of cosmetic surgery by calling it:

. . . a story of discovery. It describes how

men

[my italics] explored and charted the realmof possibilities, bringing into existence newactivities which today—in our present age—constitute an integrated geographical guideto the possible. (González-Ulloa, 1985a, p. i)

Early cosmetic surgeons like Charles ConradMiller, Jacques Joseph, or Otto Bames main-

tained and helped construct the image of thecosmetic surgeon as a rugged, male explorer,embarking on exciting adventures in unknownterritory. These men were lonely heroes whowere highly competitive and did not hesitate totake credit for one another’s discoveries (B.Rogers, 1971). The first books on cosmetic sur-gery were full of daring experiments of medi-cal men who were more interested in novel so-lutions than careful trial and error. Theytended to treat their patients as mere objectsfor their scientific endeavors and some werequick to ridicule their patients as vain societywomen engaged in the trivial pursuit ofbeauty. A case in point was Charles ConradMiller, the first surgeon to write a textbookabout cosmetic surgery, who was well-knownfor his ‘megalomania’ and ‘messianic egotism’and who quite literally believed that he coulddo no wrong (B. Rogers, 1971, p. 267). Millerexperimented with various questionable mate-rials for facial implants, including braided silk,sponge rubber, pieces of ivory, or gutta perchawhich he ground up in an ordinary spinachgrinder, injected paraffin into his patient’s

Fig. 6. Before and after eye surgery.

Cosmetic Surgery in a Different Voice 485

faces, and daringly advocated cutting facialnerves and muscles as a preventative measureagainst ‘expression lines’ to which he believedwomen were particularly prone (Miller, 1923,quoted in B. Rogers, 1971, p. 269; Haiken,1997, p. 25) . He also ran foul of the law for il-legal ownership of quack drug stores in Chi-cago and selling narcotics without a prescrip-tions. Nevertheless, medical historians stillrefer to Miller as ‘something of a surgical vi-sionary years ahead of his more academic col-leagues’ (B. Rogers, 1971, p. 266) or give himcredit for acknowledging the social forceswhich drove many women to the surgeon’s of-fice and for convincing his colleagues not tolaugh off their patients’ desire to improve theirappearance (Haiken, 1997, pp. 25–29). A sur-geon’s faults seem to fade in the light of hiscontribution to the development of a profes-sion—a profession which apparently demandsa certain amount of arrogance and audacity.

With her characteristic views on the profes-sion and practice of cosmetic surgery, MadameNoël represents a radical departure from bothher contemporaries and her successors. She

stands in sharp contrast to the archetypal sur-geon described by Cassell (1991)—that invin-cible hero imbued with all the ‘right stuff’ re-quired to get the job done. Noël was not only awoman working in a man’s world, but she dis-played an ethos which did not fit the valuesand behavior which have historically been re-garded as the

sine qua non

of surgery.Like the other pioneers of cosmetic surgery,

Noël was interested in promoting and develop-ing her field. Like them, she was also involvedin experimenting with new techniques andprocedures. However, she was also cautious,going to great lengths to avoid taking unneces-sary risks. She was enthusiastic about her pro-fession, but never arrogant and invariably pre-pared to admit that she made mistakes. Shesituated herself as a craftswoman rather than amagician with mysterious powers to transformthe human body. Her goal was to teach andcommunicate rather than to stake out her ter-ritory and set herself apart from other sur-geons. She did not describe her operations as apublic spectacle where the surgeon has to cutfirst and think later. Instead she depicted sur-gery as a rather mundane event, not unlikecooking a meal or sewing a seam, requiring pa-tience, experience, and a ‘good eye’. Noël wasless obsessed with the incision as the surgeon’smoment of glory than with the operation as awhole—a process which began before the pa-tient arrived in her office for the first time andended months or even years after the first in-tervention. For her, the immediate result of theoperation was less important than the long termsconsequences for the patient who also mightneed time to reconsider her options or decidethat she was too busy for further surgery.

Noël does not appear as a lonely discoverer,exploring the secrets of the human body. In-stead she seems to be engaged in an ongoingand highly collaborative interaction with thepatient—from giving the prospective candi-date patterns to try out at home to the gentlehand resting on her patient’s shoulder (as de-picted in photographs of the operations) to herunflagging interest in the patient’s successesand misfortunes during the years that fol-lowed. Noël was not only respectful of her pa-tient’s wishes, but had no qualms about con-ceding that a patient might know better thanthe surgeon what was required. And, last butnot least, Noël was especially sympathetic toher women patients. She took a personal inter-

Fig. 7. Before and after eye surgery.

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est in their problems and understood their rea-sons for wanting cosmetic surgery. She situatedtheir desire to have their faces rejuvenated ortheir bodies improved in the difficulties whichwomen of her day had in obtaining and hold-ing onto paid employment. For Noël, cosmeticsurgery was just as much a right for women astheir right to work or even to vote.

In short, Madame Noël provides a glimpseof another kind of professionality and profes-sional practice. If the ethos of surgery is typi-cally ‘masculine’, then Noël’s surgical ethoscould be viewed as drawing upon values whichhave often been associated with femininity:empathy, patience, a concern for the particu-larities of each case, and a modesty about heraccomplishments which allowed her to shareher success with her colleagues and entertainself-doubt (Keller, 1983). As such, her casemight be regarded as an example of cosmeticsurgery in a different voice.

CAN A FEMINIST BE A COSMETIC SURGEON?

At the outset of this article, I raised the ques-tion of whether a feminist could possibly be acosmetic surgeon or, more generally, whetherpracticing cosmetic surgery would, by defini-tion, be antithetical to the values of feminism.Feminists are fairly unanimous in their critiqueof cosmetic surgery as a practice which is dan-gerous and demeaning for women (Bordo,1993; Morgan, 1991; Wolf, 1991). In additionto the side-effects which accompany many op-erations, cosmetic surgery is problematic forideological reasons. Although it may empowerindividual women, it remains, at best, an indi-vidual solution. At worst, cosmetic surgeryrepresents a capitulation to the cultural normswhich victimize women in the name of beauty.As such, cosmetic surgery is viewed as ‘unal-terably opposed’ to the goals of liberation andemancipation which are the bread and butterof feminism (Haiken, 1997, p. 275).

Madame Noël practiced at a time when cos-metic surgery was a marginal and slightly dis-reputable medical specialty, which was valiantlytrying to gain acceptance in the mainstream ofmedicine. ‘First-wave’ feminism in France andelsewhere was primarily concerned with issueslike suffrage, access to education, women’sright to paid employment, or the protection of

poor women from prostitution or deplorableconditions in factories and sweatshops (Boxer,1982). Beauty was not a major issue for femi-nists of the first-wave, with the notable andsomewhat eccentric exception of AmeliaBloomer and the clothing reformers who cam-paigned against the constricting corset and un-wieldy skirts dictated by high fashion in favorof loosely-fitting clothing.

12

It would be anach-ronistic to dismiss Noël because she did notsubscribe to the present critique of cosmeticsurgery as put forth by feminists in response tothe current proliferation of technologies forbody improvement and the cultural pressureson women to meet the ideals of femininebeauty. In order to assess Noël’s contributionas a cosmetic surgeon and the relevance of herwork for a feminist critique of cosmetic sur-gery, we need to situate both her feminism andher medical practice in the context in whichshe practiced.

As feminist, Noël belonged to a woman’sorganization which was concerned, first andforemost, with gaining access to work, particu-larly work in the professions. Although Noëlwas sensitive to the economic pressures affect-ing women of all classes (she claimed, for ex-ample, that she was prepared to operate freeof charge for her less affluent patients), she didnot question the norms which made agingwomen seem unfit for employment or legiti-mated men abandoning their wives in favor ofyounger women. She poked fun at men for ob-structing their wives’ desire to improve them-selves, but advised her patients to employ the‘feminine’ strategies of manipulation or deceitrather than direct confrontation. While Noëlmight have adopted the stance of some of herfeminist contemporaries that beauty—particu-larly fashion—was trivial compared to themore pressing issues of emancipation, it is un-likely that this would have changed her beliefin women’s right to improve their appearance.She was convinced that cosmetic surgery alle-viated suffering and was a useful tool for help-ing women–to be sure, affluent, professionalwomen–to achieve financial independence andsocial recognition.

As such, Noël’s vision of cosmetic surgerymight seem to have little relevance for presentfeminist critiques of the feminine beauty sys-tem and the role cosmetic surgery plays in dis-ciplining and normalizing women throughtheir bodies. We might conclude that advocat-

Cosmetic Surgery in a Different Voice 487

ing a woman’s right to a youthful face does lit-tle to dismantle the inequities of a societywhich treats older women as unfit for work.Noël’s uncritical belief in cosmetic surgery as asolution to women’s professional problemsmight seem to represent a feminism of compli-ance and accommodation rather than a femi-nism of rebellion and resistance.

It is my contention, however, that such con-clusions would be short-sighted, particularly ifwe situate Noël’s work in the context of medi-cine. It is here that her views on cosmetic sur-gery, the techniques and procedures she devel-oped, as well as her ideas about how operationsshould be performed, can be seen as a radicaldeparture from medical practice, both in herown day and at present. Her approach to cos-metic surgery provides a dramatic antidote tothe masculine ethos of surgery with its prefer-ence for the ‘heroic’ intervention, its lack ofconcern for embodied realities of their pa-tients’ circumstances, and, last but not least, itsreticence to be critical of its own practices. Inview of the current expansion of medical tech-nologies for altering the body and the medicalprofession’s willingness to act first and thinkabout the consequences later, Noël’s approachto cosmetic surgery is a timely reminder of thecontinuing importance of combining ‘sympa-thy with science’ (Morantz-Sanchez, 1985).She provides a vision of a different kind ofmedical practice—a practice which is respect-ful, responsible and reflexive.

It is here that we should look for MadameNoël’s feminist contribution—not in her at-tempts to empower individual women throughface-lifts, but rather in the kind of profession-ality which she represented. While this maynot be enough for a feminist cosmetic surgery,it is an ingredient which a feminist critique ofcosmetic surgery should not ignore.

ENDNOTES

1. The number of women surgeons grew from 485 in 1970to 4754 in 1993 in the United States. The proportion ofwomen surgeons, however, increased from less than 1%in 1970 to 5% in 1993. In 1994, the percentage of womenresidents in surgical specialties was 13.9% (C. Rogers,1995; Sheldon, 1996).

2. ‘Masculine’ is not the same as gender-specific. Cassell(1991) observes that many male surgeons do not displaythe ‘right stuff’ which epitomizes the ethos of surgery,while some women will. Culturally, however, the valuesand behavior which exemplify the ideal surgeon are per-

ceived as masculine, just as the protoypical patient isassociated with stereotypical ‘feminine’ qualities likedependency or frailty.

3. I borrow this term from Carol Gilligan’s (1982) well-known

In A Different Voice

about gender differences inmorality and women’s great propensity to adopt an ethicof care.

4. Regnault (1971) describes meeting the—by then—64-year-old Noël in 1942 as follows:

She was sitting at a desk in a consulting room at theClinque des Bleuets and wearing a black feather hatand black coat. She looked exactly as she appears in thepicture reproduced here (see Figure 2). She had asmooth and oval face without a wrinkle—having herselfhad multiple face lifts and blepharoplasties. . . . I wasimpressed by her dignity. She gave, at once, the impres-sion of being a grand lady—although she was no morethan 5 feet 4 inches high . . . her words were simple anddirect. They revealed a clear mind . . . wisdom, calm-ness, and self-confidence emerged from her appearanceand manner. (pp. 133–134)

5. The term Soroptimist combines ‘soeur’ (‘sister/woman)with ‘optima’ to mean, literally, the ‘best for women’.See, Haywood (1985) for a history of the internationalsoroptimist movement.

6. Among the early pioneers of cosmetic surgery areCharles C. Miller, Frederick Strange Kolle, Eugen Hol-lander, Erich Lexer, Raymond Passot, Adalbert G.Bettman, Julien Bourguet, Jacques Joseph, HaroldNapier Lyons Hunt, and Suzanne Noël. See, Stephenson(1970); B. Rogers (1971); Regnault (1971); González-Ulloa, (1985a).

7. The first medical article on a cosmetic operation isthought to be written by John Roe of Rochester, NewYork in 1887. It was called ‘The deformity termed “pugnose” and its correction by a simply operation.’ Papersappeared in the early 1900s on nose corrections, eye-lidsurgery and face-lifting. The first full-length medical his-tory of cosmetic surgery was written by Charles ConradMiller from Chicago in 1907 and a slightly expandedversion appeared in 1908. Frederick Strange Kolle, aGerman-born American, was the second to write a med-ical history of cosmetic surgery in 1911 and his book wasmuch more extensive—‘a large tome consisting of 511pages and 522 illustations’ (B. Rogers, 1971).

8. All further references in this section are indicated bypage number only and are taken from the Germantranslation.

9. Take, for example, Julien Bourguet’s (1928) populartreatise on the correction of ‘baggy eyelids’ which isdescribed at length in Stephenson (1985, pp. 32–37). Heuses language like ‘herniated intraorbital fat’ and‘mucosa of the conjunctival cul-de-sac’, speaks in the‘we’ (‘If we examine Figure 1 we realize that there aresome emptinesses in certain places . . .’) and, generally,positions himself as someone viewing the patient’s body,ready to dissect it and uncover its secrets.

10. The ‘mini-lift’ has been the subject of some contro-versy among cosmetic surgeons. Stephenson (1970)traces the history, showing how Noël’s intervention wasreplicated in the ‘fifteen minute tuck’ which was popularin the late 1960s. The controversy continues to be wagedover the best method for face-lifting. Given the fact thateven extensive face-lifts usually have to be re-done, it

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seems likely that the final word has yet to be said on thesubject of the face-lift.

11. This has not changed. It was not until 1972 that RobertGoldwyn (1972) compiled the first collection of papersdevoted to the ‘unfortunate result’ in cosmetic surgeryand attempted to explain practitioners’ reluctance todeal with their mistakes.

12. Not all feminists were in favor of clothing reform asthey found new fashions like bloomers unfitting forrespectable women. Moreover, arguments for morecomfortable clothing were framed in terms of healthrather than beauty and, indeed, considerable attentionwas directed at devising fashionable reform clothing.See Newton (1974).

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