The following article appeared in Civilization magazine in April 1996

The Price of Perfection
By Robin Marantz Henig

Il faut souffrir pour etre belle;
one must suffer to be beautiful. Anonymous

Before 1992, when they were taken off the market because of questions about long-term health risks, silicone implants had been inserted into the chests of more than two million American women. A small minority of these were cancer patients undergoing breast reconstruction after mastectomy. But the vast majority were perfectly healthy women who just wanted to be bustier. In an age that presumed equal rights for everyone, why were these women so willing to mutilate themselves, undergo risky surgery, and endanger their well-being for the sake of a bigger bra size? How had they succumbed to the idea that they had to be beautiful in order to succeed, and that there was only one way to be beautiful?

These women were part of a long line of women -- and, on occasion, men -- who for centuries have undergone mutilating or dangerous procedures in the quest for beauty. Their methods have changed as the prevailing ideal of the female form has changed; the constant has been the obsession to shift, stretch, and rearrange bodies in imitation of that changing ideal.

The long history of beauty-by-manipulation makes us re-think today's frenzied search for the body that rates a perfect 10. We tend to think that the current epidemic of anorexia, face lifts, and liposuction is unique to the 1990s. So we blame uniquely modern institutions for these trends, particularly the fashion industry and Hollywood. Fashion magazines tout a single image of beauty, that of a dewy-faced, slim-hipped 14-year-old dressed to look like a grownup. Movies and TV shows feature actresses who, with the exception of an occasional Roseanne, all look the same. When Madonna goes from curvy to sinewy, when Cher undergoes dozens of cosmetic surgeries (including one that removed two perfectly healthy ribs to accentuate her tiny waist), women tend to assume that they should try to look that way, too. And with the price of many of the most brutal operations now set at about the cost of a 10-day Caribbean cruise, the search for physical perfection has moved from the salons of Hollywood to the living rooms of Middle America.

But we would be short-sighted if we thought the beauty quest was a uniquely contemporary obsession. Over the centuries, women have mauled and manipulated just about every body part -- lips, eyes, ears, waists, skulls, foreheads, feet -- that did not quite fit into the cookie-cutter ideal of a particular era's fashion. During the Renaissance, well-born European women plucked out hairs, one by one, from their natural hairline all the way back to the crowns of their heads, to give them the high, rounded foreheads thought beautiful at the time. Those who didn't want to resort to plucking used poultices of vinegar mixed with cat dung or of quick-lime -- though the latter often removed some of the skin as well as the hair. In China, right up until World War II, upper-class girls had their feet bound, crippling them for life but ensuring the three- or four-inch long feet that were prized as exquisitely feminine. In Central Africa, the Mangbettu tightly wrapped the heads of female infants in pieces of giraffe hide, to attain the elongated cone-shaped heads that were taken to be a sign of beauty and intelligence.

Indeed, the dogged pursuit of female beauty, however it was defined and to whatever lengths women went to achieve it, has been with us for so long that it makes one wonder whether there is some evolutionary advantage to being vain. In the struggle for a male's attention, the woman who dominates may be the one who preens in the right way. She knows that in the state of nature, a male will mate with the female who seems as if she would make the best mother, one who looks youthful, healthy, and well-rounded. So in evolutionary terms, perhaps women who come closest to this nubile ideal are the ones who will have the most reproductive success.

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The crazed quest for beauty at any cost has led to some bizarre detours along the way. Consider, for instance, the highs and lows of fashions regarding a woman's breasts. In ancient Greece and again in 14th century Europe, breasts were hidden and tightly bound. The ideal torso was a flat torso, the same ideal that re-emerged for the flappers of the 1920s and the mod models, like Twiggy, of the 1960s. Among the Circassian women of Eurasia -- reputed to be the most beautiful women in the world because of their symmetrical features and their lily-white skin -- a young girl was sheathed tightly in leather garments from before puberty until the day she was married.On her wedding night, the bridegroom ritualistically cut apart the leather with his hunting knife. "After that, the breasts were allowed to grow -- if, indeed, they were still disposed to," note Arline and John Liggett in The Tyranny of Beauty. "What was cheerfully ignored was that many women became anemic, frequently consumptive, and that a great many died."

By the mid-1800s, Dolly Parton-style curves were back. A well-rounded bosom was something to be proud of -- and something to be artfully created with some clever undergarments. Breasts were powdered, perfumed, and painted to appear as fair as the face and neck. Middle-aged women even etched delicate blue veins on their breasts to make their skin look as translucent as a maiden's.

At around this time came the world's first falsies. Originally they were made of wax or stuffed cotton, but these stiff shapes just lay on the chest and failed to move when a woman did. Within a few years, more natural-looking falsies came on the market, made of wire or inflatable rubber, which, according to one French firm's advertisements, were capable of "following the movements of respiration with mathematical and perfect precision."

In 1903, an iconoclastic Chicago surgeon named Charles Miller opened a cosmetic surgery practice in which he experimented with new methods of surgical breast enlargement. Miller opened up women's chests and inserted, according to his own account, "braided silk, bits of silk floss, particles of celluloid, vegetable ivory and several other foreign materials." There is no record of how his patients reacted, physically or emotionally, to these stuffed breasts.

Just when women had grown adept at highlighting their natural -- or amplified -- endowments, breasts again became passe. In the 1920s, stylish women put their breasts under cover, with constricting devices like the one from the Boyish Form Brassiere Company of New York, guaranteed to "give you that boy-like flat appearance." Some women actually folded their breasts, squashing them as close as possible against the ribcage and holding them there with tight elastic binding.

Then the pendulum swung once again. By the 1950s, breasts were back. And this time, 20th century technological know-how was able to provide far more sophisticated solutions to the perennial quest for physical perfection.

At first, the only women who surgically enlarged their breasts were professional entertainers. Carol Doda, a topless cocktail waitress from San Francisco, was one of the pioneers. In the late 1950s, she became an instant celebrity when she boosted her bosom to a size 44-DD with twenty shots of liquid silicone.

After they tried silicone, women injected other plumping substances directly into their breasts, such as collagen, paraffin, or their own fat cells taken from the hips or rump. "Enthusiasm for this method waned," notes Kathy Davis in Reshaping the Female Body: The Dilemma of Cosmetic Surgery, "when it was discovered that paraffin or silicone injected directly tended to migrate to other parts of the body, causing cysts and necrosis [death] of the skin. Sponges made of terylene wool, polyvinyl or polyethylene were then introduced to replace the injections. These new materials were an improvement, but they often hardened, protruded or caused fluid to accumulate in the breasts, which then had to be drained."

Despite the vagaries of vanity that changed the ideal notion of breast size every few decades, one factor has held relatively constant: most cultures, through the centuries, have wanted their women to be slim. Anorexia may seem to be a uniquely late-20th century disease, but the sad truth is that going to great lengths to be thin is nothing new.

In ancient Greece, mothers wrapped their baby daughters tightly in bands of wool or linen for the first six months or more, in hopes of elongating their proportions to the willowy, slim ideal of the time.

In England in 1665, a health pamphlet entitled "To Reduce the body that is too fat to a mean and handsome proportion" noted that one handy technique for losing weight was bloodletting. Overweight women, according to this pamphlet, should be bled "largely, twice a year, the right arm in the spring, the left in the autumn" -- an eerie precursor to today's binging-and-purging syndrome known as bulimia. And for the nether regions that still bulged too much, the 17th-century pamphlet advised using "ligaments to bind those passages where the member is supplied with nourishment." In the 1930s, women actually swallowed tapeworms to lose weight; the opera diva Maria Callas is said to have been one such desperate reducer.

For those who could not drop all the pounds they wanted to, undergarments came to the rescue. Of these, the most notorious was the corset. In one form or another, women subjected themselves to wearing corsets for nearly 600 years, from their first introduction during Chaucer's time until far into the Victorian age.

The first corset, or cotte (from the French word cote, meaning side), was made of two pieces of linen fabric stiffened and held together with paste. Later, corsets became far more cumbersome, involving two-inch-wide wooden boards and even heavy lead breastplates. By the 19th century, the corset had become a portable torture chamber made of rubber and strips of whalebone, pieces of which might easily protrude from their casings and pierce a woman's skin. It was designed to be worn so tightly that women tended to faint, unable to take breaths deep enough to get sufficient oxygen to their brains.

It was obvious to many observers that corsets were foolhardy and potentially dangerous. In the British medical journal The Lancet, an 1868 article stated quite flatly that "The mischief produced by [a corset] can hardly be over-estimated. It tends gradually to displace all the most important organs of the body while by compressing them it must, from the first, interfere with their functions."

Yet the feminine ideal at the time remained a slender "wasp-waisted" figure with an 18-inch waist -- a size that virtually no woman past puberty could attain without some heavy-duty assistance. This involved not only corsetting, but its sadistic extension, tightlacing. This extreme form of compression is how the servant Prissy squeezed Scarlett O'Hara into her ballgown in "Gone With the Wind," pulling and straining at the criss-crossing ribbons that held the corset closed at the back.

No woman could tightlace herself alone, not only because the laces tied up in the back, but also because the woman's natural instinct for self-preservation would likely prevent her from applying the kind of pressure needed to attain that 18-inch ideal. Most required the assistance of their maids (tightlacing was mostly the madness of the upper classes), their mothers, or at the very least their bedposts. Sometimes the recalcitrant flesh fought back so mightily that it required two helpers, one to tighten the laces while the other held the subject in place with her foot.

Modern observers have tried to assess the damage that this pinching and straining did to a woman's internal organs. Tightlacing "caused headaches and fainting spells," writes Lois W. Banner in American Beauty, "and may have been a primary cause of the uterine and spinal disorders widespread among 19th-century women."

Grave physical problems also resulted from fooling around with the complexion. In the Elizabethan age many women, in search of skin that looked like porcelain, whitened their faces using ceruse, a potentially lethal combination of vinegar and lead. Queen Elizabeth herself used ceruse so consistently that it ultimately ate pits into her skin, causing her to pile the paint on in thicker and thicker layers in hopes of camouflaging her growing imperfections. This, in turn, only led to more corrosion, and the Virgin Queen's face was ultimately so ravaged that she ordered all mirrors banned from the castle. (In The Tyranny of Beauty, Arline and John Liggett write that Elizabeth's servants exploited the ban on mirrors in a wickedly mischievous way: Every morning they painted the Queen's face white with ceruse, but they painted her nose "a cruel crimson.")

By the mid-1800s, face paint was thought to be cheap and tawdry, so ladies who wanted to achieve the porcelain look "naturally" took to swallowing whitening potions made of vinegar, chalk, or arsenic, the latter of which is poisonous even in tiny amounts. Arsenic was also the base for Fowler's Solution, a topical cream prescribed for teenaged acne in that same period. But like Retin-A a century later, Fowler's not only dried up pimples, but also gave a translucent tone to the skin, so some fashionable women used it as a facial cosmetic.

Women unwittingly courted blindness, too, in their beauty quest. The ancient Egyptians, Romans, and Persians tried to make their eyes glitter by using drops of antimony sulphide. The drops often dried up the tear ducts, though, and eventually destroyed vision. In the 16th and 17th centuries, women used eyedrops made of belladonna (also known as deadly nightshade) to dilate their pupils. But while it had the desired effect of making their eyes look dewy, interested, and excited, the drops also robbed these women of the normal pupil-shrinking reflex that keeps bright light away from the delicate retina. Modern experts believe that by continuously dilating their pupils, these women might have predisposed themselves to the potentially blinding eye condition of glaucoma.

Chemicals used to make blondes out of brunettes also proved far more dangerous than their users first suspected. In the 19th century, British women used a solution made of potentially lethal oxalic acid to change their hair color. They believed that dark hair was caused by an excess of iron in the system, and the acid was thought to neutralize iron. They mixed an ounce of oxalic acid in a pint of water, soaked their hair thoroughly, and went out into the sunshine to let it dry. This procedure was to be repeated, according to one pamphlet of the day, "until it begins to affect the skin when it must be discontinued, otherwise the hair will fall out."

In Venice, the recipe for hair lightening involved a mixture of lime and bisulphate of magnesia. A paste made of these ingredients could be "very effectual in bleaching the hair," wrote one Venetian in an early demonstration of tongue-in-cheek humor, "and also for burning it away entirely, together with the skin and brains, if there are any, beneath it."

Manipulations of the skeleton proved to be every bit as disfiguring as some of the chemicals applied to the skin and hair. The most nefarious, and most long-lasting, practice of bodily mutilation for the sake of beauty was, of course, the foot binding of Chinese girls, which was thought to have begun in the tk dynasty and persisted for more than one thousand years.

Foot binding went far beyond putting tight bandages on the feet and hoping they did not grow. It was something more akin to Cinderella's stepsisters cutting off their own heels and toes to fit into the dainty glass slipper. Beginning at about the age of five, a girl's foot was virtually folded in two, and a 10-foot long bandage was wrapped tightly around it to force the toes down toward the heel as far as possible. The child could not move without doubling over in a graceless and largely futile effort to walk without putting any weight on her feet. In order to keep the girls from tearing off the maddening bandages, many families kept their daughter's hands tied to a pole. Eventually, the feet lost all blood supply, turning the skin blue; portions of the soles and toes sometimes actually dropped off. If the girl was lucky, her feet became deadened to any sensation at all.

Every two weeks, the child's bound feet were squeezed into a new pair of shoes, one-fifth of an inch smaller than the pair before. After several years of this, the bones were sufficiently crippled and deformed to keep her feet stunted at the desired four-inch length.

"My foot felt very painful at the start," recalls one woman, whose account was recorded in The Tyranny of Beauty. "The heel of my foot became odiferous and deteriorated. Because of the pain in my foot, my whole body became emaciated. My face color changed and I couldn't sleep at night." But this woman put up with the agony, because she was convinced that "no one wanted to marry a woman with big feet."

Western cultures, while not going to quite the same extreme as the Chinese, also revered a small female foot over a large one; indeed, that is what the Cinderella story is all about. Even today, women wear shoes that are tight, pointy-toed, and high-heeled because they make feet look good, even though they also hurt. High heels especially are bad not only for the feet, but also for the entire body. The woman's torso is not designed to hobble about on its toes; stiletto heels can lead to abnormally lengthened calf muscles, stretched spines, and chronic back pain.

Just as painful as stunting the growth of one part of the body is exaggerating the growth of another, a practice that has been widespread in Asia and Africa. Many African tribes have inserted plates into young women's lips to enlarge them, or weigh down their earlobes with heavy hoops so that the lobes eventually brush the shoulders. Some contemporary observers think this practice began as a way to make African women less appealing to the slave traders from the New World, but it gradually became a standard of beauty for other members of the tribe.

Among the Padaung people of Burma earlier this century, the ideal of female beauty was a greatly elongated neck, preferably 15 inches or more. This was accomplished by fitting girls with a series of brass neck rings. At a very young age, girls began with five rings; by the time they were full grown, they were wearing as many as 24, piled one on top of another. Even today, Burmese refugees in northern Thailand continue to stretch their daughters' necks, since the bizarre stretching has become something of a tourist attraction. The weight of the rings leads to crushed collarbones and broken ribs, and the vertebrae in the neck become stretched and floppy. Indeed, these women are forced to wear their neck rings, all 24 of them, around the clock, since without them their necks are too weak to support their own heads.

What many of these beauty trends have in common is that they have forced women into positions of frailty, with their impossibly long necks, impossibly tiny feet, impossibly small waists. And the highest-achieving women tended to be those most susceptible to the lure of the ideal; their perfectionist streak made them want to attain every goal society deemed worthy, no matter how ludicrous it might be. This might explain why Queen Elizabeth I, whose comprehensive classical education was rare in a girl in her day, fretted over her hair and her complexion like a teenager preparing for a ball. And it might explain why Hillary Rodham Clinton, arguably one of the most powerful women in the United States, was willing to jazz up her looks in the 1970s with contact lenses and peroxide for the sake of her husband's political career -- and why she still careens through hairdos the way other women go through pantyhose.

One question, of course, is why women respond to these media images in a way that is different from men. How many men take Arnold Schwarzenegger's body personally? While cosmetic surgery is increasing among American males, it is still primarily the province of women, as is the self-loathing that often results in women who fail to look the way they believe they are supposed to look. In every survey that asks men and women, or boys and girls, questions like "What do you think about your body?" females reveal a distorted and inferior body image far more commonly than do males.

There might be an evolutionary explanation for this gender difference. Sex researchers Master and Johnson found that while men are highly susceptible to visual cues in their sexual arousal, women respond more to other senses. Evolutionary biologists tell us that men are attracted to women because of the way they look, while what attracts a woman are not so much a man's looks as evidence of his wealth, status, and power. So maybe it follows that women would be more susceptible to the prevailing idea of what it means to look desirable -- they have more at stake in looking good.

Feminist writer Susan Faludi offers a more political interpretation. She writes in Backlash: The Undeclared War Against American Women that as women achieve greater professional power, the prevailing ideal of female beauty becomes more and more passive and child-like. "The beauty standard converges with the social campaign against wayward women," she writes, "allying itself with `traditional' morality; porcelain and unblemished exterior becomes proof of a woman's internal purity, obedience, and restraint." To Faludi, a change in the prevailing standard of beauty toward a more girlish look -- as happened in the 1960s and again in the 1990s -- is a sure sign that, politically, women have become too threatening.

A more sociological explanation is that women have always been in competition with each other, casting sidelong glances to see how they look in relation to the other females in the cave, the harem, the secretarial pool, or the executive boardroom. From this perspective, face lifts and tummy tucks are just another way to keep up with the competition, no more significant than a move from long skirts to short ones.

Whatever the explanation, it's been this way for a long, long time. Since before Cleopatra's day, women have been judged by the way they look, and have struggled mightily to make themselves look the way they want to be judged. To expect this to change as women become more powerful is simply naive. Gloria Steinhem -- a highly accomplished author and publisher, a noted feminist leader, and not incidentally a very attractive woman -- confessed in her recent autobiography to harboring profound self-doubt about the way she looks. If Gloria Steinhem can feel that way, why not more ordinary mortals? Perhaps Elizabeth I was on to something after all. Maybe the only way for women to get on with things is to banish all mirrors from the castle.

Detailing the folly of cosmetic surgery has been something of a mission for contributor Robin Marantz Henig, "maybe because those `before' pictures in the ads for liposuction and breast implants always look so much like me," she says. "I believe I have an obligation to my two adolescent daughters to show them that women's faces and bodies are just fine, whether or not they conform to some arbitrary definition of beauty." She has written articles about the hidden costs of body alteration for The New York Times Magazine, The Washington Post, Vogue, Self, and Mirabella, as well as in her book, How a Woman Ages.