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Plastic surgery in the 1920s: Why grow old? (1922)

by Ethel Lloyd Patterson – Ladies’ Home Journal (September 1922)

We are agreed, I assume, that the face of a woman who has passed her fortieth birthday betrays her age more than does all the rest of her physical make-up.

So it is her face — the clearness and color of her complexion, the hollows and potential wrinkles about her eyes and mouth, the condition of her hair, her eyebrows and eyelashes and her teeth — that naturally engrosses a large part of her attention when she seeks to lure on through life with her that youth which was so freely hers in girlhood.

So, primarily in the interests of the readers of this magazine, I took my face around with me during the last month, and submitted it to the inspection of a formidable array of specialists.

The tour was not at all dull for me. There was the doctor who almost pleaded with me: “Let your face alone.” And there was the surgeon who obligingly offered to carve the lines from beneath my eyes and restore to me “the expression of a girl of eighteen.”

Just here I may as well tell you the truth about myself: I have to confess that I am aware of the thoughts that come to a woman of forty when she looks in her mirror, because on one of these not-far-distant days I shall take that hurdle myself. Only I hope to go over with grace and agility.

I don’t expect to mind being forty any more than I expect to look or to feel my age. It seems to me that a woman literally ought to be at her best when she is about forty — that is, she should, unless in the preceding years, she has been busy forming a set of stupid and lazy habits.

As for myself, even before I talked with any authorities, I felt sure that it was no longer inevitable for a woman of forty-odd to be “middle-aged” — not in our days when the whole trend of science is towards youth and longevity.

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So, after having consulted some of the foremost specialists in the country, I am glad to tell the rest of the world that my amateur idea was right. In this case, since I myself am a woman standing with reluctant feet where thirty-nine and forty meet, my sensations at being correct are downright celestial. I have about made up my mind, too, that, with science going forward at its present rate, it soon will not be necessary for women to grow old at all — I mean shriveled or waddling old and all that.

Plastic surgery in the 1920s: A surgeon’s opinion on “face lifting”

The skin specialists and “beauty surgeons” I have consulted range in thought and practice from the very conservative all the way up to what even in these days is considered the extremely radical.

I have talked with the doctor who believes that “the woman who lets her face alone is better off in the long run,” meaning, I gathered, by “long run,” her eightieth or ninetieth birthday. And that specialist’s recipe for “letting her face alone” was ” pure soap and water and then more water.”

For myself, I think that man is a bit too careful. Still, I am not yet eighty or ninety years old, so I can’t be sure. He may be right. At the other extreme is the ultramodern surgeon, who blithely—and no wonder since his charges are fabulous! — offers to take a tuck here and a seam or two there until a woman’s face is as smooth and as undependable a record of the passage of time as the face of a beautiful clock that has stopped.

I believe that somewhere between these two points lies the truth for the average woman. I have plied my own face with many things besides “soap and water” — notably powder and cold cream — and I have as yet a perfectly good complexion; that, for the conservative whose slogan for the care of the skin is an uncompromising “back to nature.”

But in opposition to this, I want to say that, although I have the extravagant tastes of a passionate lover of the beautiful and can therefore assimilate a fortune with ease, nevertheless, no one has money enough to bribe me to allow a surgeon to cut away the wrinkles around my eyes. In the course of my investigations, I have seen several women who have had this operation successfully performed. All the same, I repeat my unqualified “No.”

But the story of this ultramodern face surgery is enthralling just the same. Whether or not you would allow one of these men to operate upon you, their work is extraordinarily interesting.

“Beauty surgery” or “cosmo-plastique surgery” or “plastic surgery’ or just plain “face lifting” are the names which have grown up over this new field; and to me, a peddler of words, the names rather give away the whole show. They suggest too much the “beauty parlor” and too little the honest-to-goodness operating room.

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So, before I interviewed a “face lifter,” it seemed to me the thing to consult a more conservative surgeon. I went to a man whose operations have been so exquisite in their skill that he is spoken of with something akin to reverence by his confreres. This man is unswervingly against the practice of cosmetic surgery. I give you his reasons.

“The technique,” he said, “of any operation upon the face is an intricate problem in geometry. Before the knife is applied that problem must be solved in diagram, on paper, to the last fraction of a degree.

“But I never heard of a ‘beauty surgeon’ who operates with this care. Instead, these men seem to cut and trust the rest to Providence. Yet every conscientious surgeon knows that each time he takes the knife in his hand to operate, he risks possible failure from two sources — his own fallibility as a human and the unknown quantity in the patient, which makes it impossible to forecast how a wound will heal — what kind of scar it will leave — until after the operation has been performed.

“Understand the seriousness of what I say, then ask yourself whether a conscientious surgeon would run such a risk unless there were true necessity. So for this reason alone — if for no other — surgeons of standing do not operate unless the condition of the patient is such that recovery from illness depends upon the operation.

“Notice that I say ‘surgeons of standing.’ There is the whole matter in a phrase. From it you may draw the inference that women who go to ‘face lifters’ to have ‘bags’ or wrinkles removed, in the very nature of things usually have placed themselves in the hands of operators without true standing in their profession.”

“Is there danger of death in this kind of work?” I asked.

“No — not often that,” the surgeon told me; “but there are dangers many people consider as bad. There is the risk of permanent disfigurement.”

“Is there,” I persisted, “always danger of disfigurement in the practice of the ‘cosmo-plastique’?”

“Let me answer you this way,” said the surgeon; “there is less danger in so-called ‘face lifting’ than in many other forms of beauty surgery. For a skillful surgeon to ‘lift’ a woman’s face — that is, to remove crescent-shaped pieces of skin, near the ears, and at the hairline, thus lifting the cheeks that have begun to sag and so removing the lines of age about the mouth — is actually a simple operation and practically without danger. But the difficulty is that really skillful surgeons are too legitimately busy to undertake such cases, not unless there is authentic reason for them. And so usually it is the unreliable men who perform these operations. Therein lies their danger.”

“What would you call an ‘authentic reason’?” I queried.

“Well,” he answered, “a moving-picture actor who had been in an automobile accident came to me. His ear and one side of his face were badly mutilated. Unless his face could be restored, and that practically without scar, he was deprived of his means of livelihood. I took his case. I would take any case, man or woman, under similar circumstances.”

Plastic surgery in the 1920s: Successful “beauty operations”

“But I would not touch any woman at any price who came to me and asked me to remove the legitimate trace of her years. There are too many people afflicted by real suffering, and who therefore need me, for me to be willing to throw away my time. The other surgeons, I know, feel the same way.

“And, I may add, as a man and as a human being, quite aside from the ethics of my profession, I am opposed to so-called ‘beauty surgery.’

“I am not now referring to those women, actresses and others in public life, whose face is their fortune. The risks these women run to keep a ‘youthful’ appearance are at least understandable.

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“But the average woman who seeks to have a ‘beauty operation’ performed upon her is to my mind — well, I have no words for her. A woman of forty years of age, or more, ought to be ashamed to have a face without a wrinkle. The comatose mentality implied by such a condition is a subject for sympathy.

“Since I myself am an intelligent human being, I love to watch the play of line and shadow across a face that mirrors a quick mind and a sensitive soul. My days are not long enough for me to waste the hours personally or in the practice of my profession upon these other doll women.

“I think my last word on this subject would be that if a woman is determined to have a ‘beauty operation’ performed upon her face — and, I can assure you, there are women so bent upon it that nothing will stop them — at least, when you write of this, implore them for their own sakes, to go to their family physician and consult him before they place their whole future in the hands of a surgeon who literally can make or mar their lives.

“Oh, the sad, sad cases that I have seen — too late! For, remember, if the operation is not ‘a success,’ it may then be beyond the power of any surgeon, however skillful, to repair the damage that has been done.”

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Plastic surgery in the 1920s: Cosmetic surgery expert

Then I went to interview a fashionable and well-known proponent of cosmetic surgery. I found him a man of opulent personality, although there was something about him, too, that suggested the utterly carefree.

He was occupying offices that were ” done” in black lacquer and peacock-green batik. I don’t wish to be flippant about this; I mean to be fair. After all, it is no laughing matter; it does create the wrong atmosphere when a surgeon sees his patients in rooms that resemble more than anything else a prima donna’s boudoir.

However, it should also be said of this exponent of cosmetic surgery that I saw women upon whom he had successfully operated.

I saw no unsuccessful ones. He would not admit that any such existed. The results of the successful operations that I saw were the outcome of that operation which I, personally, would not have performed upon me for love or money — I mean the operation in which the surgeon cuts away from around the eyes the superfluous flesh and wrinkles. Crescent-shaped pieces of skin above and below the eyes are removed.

Neither ether, chloroform or gas are used. Instead, cocaine is injected. When the pieces of skin have been taken out, the edges of the cuts are drawn together and sewn. This removes half an inch or more of bag and wrinkle. The stitches are left in place for about two days. They then are withdrawn.

The surgeons who do this work maintain that within three weeks practically no trace of the operation is left. The women I inspected, who had had the operation performed, certainly showed no scar to the casual glance.

Only when you stretched the skin with your fingers on both sides of where the cut had been you could see a very fine white line. I saw a blond woman who, I am sure, looks much younger for having undergone this operation.

Plastic surgery in the 1920s: Still fifty-odd years old

But I also saw a brunette, whose face evidently had been of the “baggy” type. Many women these days get the kind of face I mean from having been naturally plump and having reduced too quickly and too much.

The woman I am describing had been “lifted ” both above and below her eyes, at the upper sides of her cheeks and beneath her chin. She had been made almost entirely without wrinkles or “bags”; but she was one of the most uncanny-looking women I ever saw. Yet hers was “a successful operation.”

I would have known that she was fifty-odd years of age in spite of the surgery; and that knowledge, combined with her unnatural smoothness of contour, made my flesh creep. I found the tears smarting in my eyes and dared not meet her gaze, lest she should guess how pitiful she seemed to me. For she — poor soul! — was pleased with her appearance.

As I said, I did not find a woman who was the victim of an “unsuccessful” operation; but the surgeon of standing, with whom I first talked, explained that in most facial surgery the technique involves the crescent-shaped cut.

If you stop to think, you realize that the length of the curve on the inner side of a crescent is shorter than the length of the curve on the outer side. How then is the surgeon to draw together the two curves and reconcile them, without puckering the outer edge upon the inner?

That is but one of the “problems in geometry” mentioned by the first surgeon I saw; a problem that he explained to me in diagram worked out on paper.

Yet when I asked the “beauty surgeon” how he reconciled the edges of his crescent-shaped cuts, his answer to me was: “Oh, practice makes skill. Operating as often as I do develops intuition until I can gauge the thing by sort of feeling my way.”

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Remember, this is the verbatim answer to what I asked one of the foremost men specializing in his line of work!

If — please notice every “if” — if I had the type of face that with age sagged badly in the cheeks, making those sorry and discontented lines that drag on the faces of some women from nose to mouth, and my family physician would vouch for the surgeon whose name he gave me, and if this surgeon would himself perform the operation, then would I seriously consider having my checks “lifted.”

Never would I allow the skin around my eyes to be cut. The operation for the cheek lifting can be performed behind the lines of the hair. Therefore, if there were a scar, it would be comparatively easy to hide it. And the cutting would not be near the eyes, the nose, the mouth or the ears.

Consequently, I could be sure that, even though my face were pulled a bit out of shape, I still might continue to see the sunsets, to smell the flowers, to talk to my husband as much as I liked and to hear his answer to me, if ever I gave him an opportunity of making one.

But even after seeing the results of successful “lifting” around the eyes, the very thought of that operation still makes my blood run cold. Around the eyes, were the knife to slip ever so little, a woman might be made blind or forever hideously disfigured.

After weighing carefully the knowledge I have gleaned of the operations of this class, my personal verdict is this: In my opinion the practice of cosmetic surgery will one day take a legitimate place in the ranks of those branches of science that, as they progress, are pushing further and further from women the approach of old age.

But cosmetic surgery, except in rare instances, is not yet ready to occupy its legitimate place. Much of the trouble now is because women are far too gullible about such things. In consequence, the money to be made in this work is out of all proportion to the experience and skill that are used. Mark that I say “used,” not “required.” And”easy money” always attracts charlatans.

When I tell you that the average bill for a “beauty operation” is twenty-five hundred dollars; that, in the words of one of these surgeons himself, “I wouldn’t touch a woman to remove even one wrinkle for less than a thousand dollars”; that to operate upon both eyes requires not more than three-quarters of an hour, so that some surgeons can and do perform six or eight of these operations in a day, gives you some idea of the fortune that is there to be raked in.

But the get-rich-quick ideal has never yet appealed to the true doctor or surgeon. Therein is much of the danger to the woman upon whom the operation is performed. Also the true youth that is attainable, and that will last a woman to the grave, is something more than a tuck in the skin.

Incidentally, I believe that, whether or not they themselves realize it, many surgeons are prejudiced against face lifting largely because it is just now so easy to make money in that class of practice. Doubtless all this will adjust itself in the near future.

Meanwhile, at the behest of the famous surgeon with whom I talked, I do earnestly implore women not to consider a cosmetic operation unless a physician they know recommends the surgeon who is to perform it.

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Just common sense

So much then for surgery. The more a woman interviews skin specialists, the more she realizes that the principal ingredient in the recipe for a good skin is plenty of common sense.

Some of the skin specialists I saw told me rules that were so simple to follow and so natural that I felt silly because I never had thought of them. For example: If your skin is greasy, eat less meat and wash your face with plenty of good soap.

If your skin is too dry, eat more meats and fats generally and cleanse your skin with cold cream.

“But may not some women need meat to nourish them?” I asked a skin specialist. “No woman with a greasy skin needs much meat for her health,” he answered. “You never saw a tubercular woman with a greasy skin. Cut down the fats, and you cut down the grease. It’s as simple as that.”

Which is just another way of saying how dependent is a woman’s complexion upon her diet, or, I would better say, upon the normal condition of her digestive tract, which in its turn depends for health not only on diet but upon proper exercise as well. A woman should never forget that with health there is no real youth for anybody at any age…”

“I never think much about your kind of woman,” said one specialist to me. “You are one of the lucky ones. You have your own home in the country; you lead a healthy and happy life. If you are not still young and active at sixty years of age, it will be because you have not used your brains and your Heaven-sent opportunities.

“If a woman with your chances in life today does not remain young indefinitely, it is because she has sold her birthright for some kind of a mess of pottage, smoking, drinking, eating too much or indulging in physical irregularities. And such women get no sympathy from me.

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“I do what I can for their complexions, when they consult me; that’s all. The women of whom I think, and the women I would like most to reach and to help, are the women of forty and more who have to work in offices and in the cities, the women I see in subways and in crowded streetcars when I travel that way.

“Men in the cities, even men in very moderate circumstances, usually get out for a game of golf or some sort of outdoor exercise at the weekends.

“But how much chance for health and a clear, rosy skin has that same man’s stenographer, shut up, as she is, with him in his office all day, with the men with whom he does his business puffing tobacco smoke all over her?

It is uphill all the way for such women to remain young. The light in the wilderness, however, is that it can be done, if only they have enough determination.

“Tell such women for me that they must get out and exercise in the fresh air on every possible holiday and whenever they can. Pure oxygen is the only medicine that permanently puts color in the human face. These women must use their holidays for air and exercise, even though every tired nerve in their bodies cries out to remain in bed in the morning and to ‘do a show’ in the evening.

“If they can get themselves up to it, they ought to exercise every morning in front of an open window for ten minutes. Almost any exercise will do. What they need to keep their complexions fresh is to keep up a good circulation in their liver, kidneys and intestines. If they twist and move the muscles of their waists, it will go a long way towards turning the trick.”

Plastic surgery in the 1920s: Where “thank you” is true

“A good exercise for a woman is for her to just lean over and touch the floor with her fingers and without bending her knees; reach up and around with her arms, imagining herself a monkey swinging on the branches of trees.

“Only, if a woman is about forty years of age she ought not to tire herself too much. Let her take her exercises easily at first until she is used to them. A woman of even fifty or sixty may be in perfect physical condition, but she has to take everything more moderately than she did when she was a girl.”

All doctors apparently are agreed that, whenever it is possible, gymnasium work is the thing for women who work in cities.

Apparently, all doctors and surgeons I have interviewed feel that, because of the rapid advance of scientific knowledge, it is no longer necessary, unless there is constitutional ill health, for women to age when they are forty or for many years thereafter.

And they are all anxious to get to women that knowledge which shall preserve for them their youth and health and happiness. Every specialist, to a man, begrudges neither his time nor his labor, if by donating these precious commodities the good work is carried on.

So if there are women in our day who are ignorant of those fundamentals upon which their physical health depends, it is not the fault of those splendid men, who are waiting and anxious to pass on their knowledge. It seems to me that it is about time, therefore, for women to arise and say “Gentlemen, we thank you.”

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