Cosmetic surgery may have come to be seen as merely another resource for those with too many already to fend off the great leveller, the grim reaper. But its story is far from being a tale of an absurdly dangerous liaison between quacks and rich ex-chicks. Faces, bosoms and our more private parts have been the object of surgical alteration for 400 years. Always the story seems to start with race and sex - indeed the history of aesthetic surgery could be interpreted as the history of these great themes. Certainly we are now learning that the story doesn't make sense without them. It reveals just how important the body remains as the last redoubt of both shame and pride. The body takes the blame - the body has been used to explain the conflicts associated with gender, generation and geography. But the body's triumphs and transgressions are always only in the eye of the beholder.
Far from the body representing immutable essences of beauty or horror, the history of aesthetic surgery confirms that the body bears witness to public ideologies of sexual and racial difference. And the body has its own invisible memories of tragedy from which, for some, aesthetic surgery offers the promise of transcendence.
We have been misled by the notion that cosmetic surgery is a fetish to be mocked as merely another example of women's pathetic self-indulgence and superstition, rather like their predilection for mink coats and astrology. Lip reduction, like bleaching and scrubbing the skin until it bleeds, is an effect of racial shame. Rhinoplasty, or nose jobs, likewise, have its origin in anti-Semitism and syphilis. It is race that explains the divergent ambitions and anxieties associated with breasts in Latin America.
Sander L Gilman's new history of aesthetic surgery, Creating Beauty to Cure the Soul, offers the startling evidence of how racism infuses the body strategies of prosperous women in Brazil. As an outpost of Portuguese colonialism, Brazilian demography is the child of slavery. While in neighbouring Argentina a million women have received surgical breast augmentation since 1970 (one for every 30 Argentines), in Brazil that fashion is matched among middle-class women by the opposite - breast reduction. Argentina's myth of powerful, big-bosomed Amazons is rivalled in Brazil by "white" women's determination to assert their difference from black women. Hence the Brazilian invention of the buttock lift in the Seventies, another attempt to Anglicise the South American shape. They'll do anything, apparently, to not look like their Afro-Caribbean sisters under the skin. Mexico is another country which attempts to shroud its racial heritage. Nose jobs have in recent years enjoyed an explosion in popularity with wealthy Mexicans, eager to hide their Indian heritage behind a European profile.
Western notions of beauty also dominate in Japan where there is a rampant trade in eyelid surgery, a technique first introduced in 1896. From this time to the present, according to Gilman, some 32 surgery techniques have been developed purely for the aesthetics of the eyes. It's a similar story in Vietnam and China. Indeed, Peking boasts one of the largest plastic surgery hospitals in the world with 400 beds.
Ironically, in the US it seems Eastern slightness is more the ideal. Male liposuction has increased by 200 per cent since 1992, and it is also the most popular procedure for American women. British women, while still opting mostly for breast enlargement and face lifts, are also increasingly drawn to liposuction.
Perhaps the most mysterious and public display of racial and sexual anxiety this century is manifested by Michael
Jackson. His profile is simultaneously one of the most visible yet most masked. Here is a boy, we are told, who wants to look like his mentor, Diana Ross. Here's a man who wants to be white, and if he can't be white he'll have white women and pale babies.
Vanity does not help us understand Jackson's reincarnation as a masked and mysterious icon. For good or ill, plastic surgery promised he could be someone other than himself. If Jackson's life and time synchronised with the rise of black pride, it seems his own experience was shrouded in shame. Friends and intimates have testified to Jackson's mania to wipe his father from his face. According to one of them, "with each operation he distances himself not only from his father but from his whole family. I'm afraid that's the sad, pathetic point of all the surgery."
As a man, Jackson is not alone - about 20 per cent of cosmetic surgery in the US is now performed on men. And 20th-century stardom is unthinkable without surgery. One of the more eccentric surgery stories belongs to a scarlet woman of film noir, who starred with Humphrey Bogart in In a Lonely Place, an elegant, cold study of violence. Gloria Grahame is the epitome of the plucky cracker, the brittle wit whose lisping wisecracks came out of a mouth that doesn't move a lot. Grahame took literally a Russian film theorist's belief in actors' facial immobility. She thought her own top lip was too deep. So she got it done. Gloria Grahame gave new meaning to the notion of stiff upper lip. The siren was notorious as a "difficult woman". Difficult because she would not be directed. She was powerful because her directors discovered when they saw the rushes that she was always right. What appeared to be sacrifice and self-hatred was the ultimate in self-control. No director or leading man would ever get those lips to move. The result - something prized for a woman in film noir - was, as someone once said, a mouth "poised somewhere between sadism and masochism".
But it is Fanny Brice whose body unites a couple of the defining imperatives of cosmetic surgery - race and sex. This Jewish star of the Ziegfeld Follies had her nose "bobbed" in the Twenties by plastic surgeon Junius Shireson, who came to be known as the "King of the Quacks". The spread of racism, scaffolded by the ideology of eugenics and racial purity in the 19th century, focused on assimilating and affluent Jews. Racial stereotyping stigmatised the Jewish nose - indeed given that only a tiny minority of Jews possess this particular phenomenon it could be said that anti-Semitism invented the idea of the Jewish nose. It therefore created the fashion for the nose job no less than racism drives the reduction of the Brazilian breast while elsewhere sexism creates the compulsion to make bigger and better breasts.
The science of breast enlargement brought its own catastrophic consequences. It was as if this form of beautification brought a new inflection to that poignantly feminine form of mutiny, self-harm. Whatever the dangers associated with implants, the operation itself produces additional risks that could have been predicted by any medical men. Scar tissue is the scourge of surgery and scar tissue had disastrous effects on breast surgery - stiffening all that squishy loveliness into a hard ball. Appearances are all. The best breasts are for looking at not touching, it seems.
The lessons are not lost on women, though. According to Elizabeth Haiken, author of Venus Envy, despite a steady surge in the numbers taking advantage of aesthetic surgery - operations increased in the US by 37 per cent between 1990 and 1993 - breast augmentations declined by 48 per cent. If plastic surgery can be seen as part of human beings' quest for perfection, its story is also a narrative of imperfection, or rather the pain that shadows the very notion of an ideal human type.
Before anti-Semitism came the plague of congenital syphilis, the bequest of an epidemic of sexually transmitted disease. The collapsed nose of congenital syphilis was the victim's marque of sex and scandal. The technology of nose jobs began, therefore, with sex, race and humiliation. The expanding science of cosmetic surgery was enlisted to rebuild the wrecked faces of soldiers during world wars so they could be restored, facially fit, to the killing fields. Perversely, in modern day Israel, penile aesthetic surgery is most prevalent in boys aged 16 to 18, at the time when they enter military service. "These boys are ashamed of the shape of their penises, and dread taking showers with other boys," explains Israeli surgeon Daniel Yachia. "They want to have `normal-looking' penises." Now we learn that school teachers are seeking cosmetic surgery to remove facial eccentricities that make them the butt of the school community.
All of this suggests that pious judgments about women - and men - who meet ageism by trying to mask the wear and tear of age, not by learning to love their wrinkles but by purging them, miss the point. The resort to aesthetic surgery comes not so much from trivial vanity than something more serious, the eternal effects of tragedy and transcendence.
`Making the Body Beautiful: A cultural History of Aesthetic Surgery', by Sander L Gilman, Princeton University Press, price pounds 18.99. `Creating Beauty to Cure the Soul: Race, Psychology in the Shaping of Aesthetic Surgery', also by Gilman, lished by Duke University Press, price pounds 14.95.