Einleitung: Is Beauty Only Skin Deep?

Sander L. Gilman

Recently Nigel E. Drury of the University of Southampton University Hospital published a paper summarizing the evolutionary biological claims for the existence of beauty. [1] At the center of his claim is the notion that symmetry lies at the very heart of the beautiful, from Phidas to the present. Our brains and especially our visual cortex are pro- grammed, Drury argues, to see symmetrical things and to respond to them with a favorable affect. This is what underlies the desire to reproduce with those who are symmetrical. Sex is the result of symmetry and beauty is indeed skin deep, but this skin is read as enclosing one who is a better mate. Drury ends his piece with the assumption that the only symmetry that exists is in the female figure and thus signifies the choice of mate for the male: Beauty „has become a principally male concept of favourable female appearance, not through social conventions but via evolution.“ [2] He does not deny that women can experience beauty but comments that „women do not innately possess the same allure to the female form as do men.“ [3] Now, giving some credence that radical asymmetry is often associated with the misperception of the nature of the body, as when bodily or facial disfigurement is read as indicating some type of mental deficiency, there is a sense that cultures often do confuse the inside and the outside of people. But to assume that symmetry is a universal ideal and that only men that are hard-wired respond to it, makes light of two rather striking aspects of our modern world: first, the idea that the „male“ and the „female“ are radically different in their sense of the beautiful and that second, beauty is somehow only rooted in its biological ends.
In the past hundred years the globalized world of modern medicine has developed modern aesthetic surgery. [4] Its purpose is to make human beings happier through the surgical alteration of their bodies. Its initial patient population was gender balanced. The first nose jobs were undertaken on men; the first face lifts on women; the first breast reductions on men; the first breast enlargements on women. It is the case that over the course of the twentieth century aesthetic surgery attracted more and more women to its procedures. It is also very clear that the pattern of the last two decades of the twentieth century saw a growing parity between men and women undertaking aesthetic procedures. All wanted to enhance their appearance and become happier. All sought this for a wide range of different motivations from the improvement of the social life to the improvement of the economic status.
It is true that the first aesthetic surgeons, especially those in Germany, truly did adapt the Greek notion of symmetry as their model. Classical models of the body were available such as those provided by the Viennese anatomist and physiologist, Ernst Brücke (1819-1892). Brücke, later one of Sigmund Freud’s favorite teachers, published his handbook of the anatomical „beauty“ of the body in 1891. As lecturer in anatomy at the Berlin Academy of Arts, he presented a normative body based on classic aesthetics. Brücke used Michelangelo’s sculptures of the female breast as the model for the perfect breast and the classical Greek sculpture known as the Diadumenos for the perfect male torso. The perfect female body is pubescent, unmarked by childbirth, but prepared for it; the perfect male body is also unmarked, here by circumcision. The Greek body is the German body in its classical perfection. J. J. Winckelmann had developed the ideology of Greekness as the ideal body form in the late eighteenth century. The identification became more and more radical in the course of the nineteenth century as „Greece“ (both classical and modern) came to serve many ideological purposes in German culture. And one of those functions was to distinguish Hebrew from Hellene, Jew from German.
Brücke’s image of the beautiful draws on Kantian notions of „clas- sical“ perfection, but uses them to stress the values of his contemporary society. The aesthetics of high art were, according to Brücke’s assumption, rooted in an idea of art as imitation. Works of art imitated the most beautiful human beings, rather than creating ideal types. Brücke’s ideal body is that of Greek sculpture. He imagines the body as symmetrical, according to the guidelines extrapolated from classical models by nineteenth-century art history. These are themselves idealized models which stress a perfect, symmetrical physique for men and women. Brücke presents the „real“ image of the beautiful foot and leg. The beautiful foot is not the flat foot, at least according to Brücke. [5] The flat foot, as I have shown in detail elsewhere, is the foot of the black and the Jew in fin-de-siècle European medicine, a foot that disqualifies the possessor from ever being fully a citizen of the modern European state. [6] The idealized image of the beautiful also represents the healthy and the good.

The first German aesthetic surgeons, such as Jacques Joseph (1865-1934), a highly acculturated young German Jewish surgeon prac-ticing in fin-de-siècle Berlin, based their sense of the ideal body on images taken from the cutting edge of the racial aesthetics of these days. [7] Joseph finds his mathematical formulae for beauty and deformity in Albrecht Dürer (1471-1528). The beautiful is the symmetrical, the regular, and the proportioned. Beginning in the latter half of the nineteenth century, German nationalist advocates of a true German art used Dürer as the essential creator of „Germanic“ types. [8] Dürer’s visions of the people of his time were made into modern national symbols of beauty and ugliness during the late nineteenth century. Whether in the nose or the breast, balance and proportion are the hallmarks of the beautiful and therefore healthy „German“ body. The unhealthy, ugly bodies are those of the syphilitic and the Jew.
Joseph’s ideal female face has a „greco-roman profile with a 33° facial angle.“ [9] What is striking is that his choice of an image is a portrait of his (Jewish) wife. His „proof“ for her beauty is the similarity of her profile (and nasal angle) to a drawing he reproduces by Leonardo da Vinci (1452-1519). The international universal of the Renaissance represented by da Vinci is thus grafted onto the national local as a model for beauty, as sanctioned by the aesthetic politics of the turn of the century. The norms for Joseph’s ideal beauty are taken from high art, with all of its status for the educated German of the age. Thus he reproduces an image of the Venus de Milo’s profile [10] and notes that „when the correction of an abnormal (ugly) profile is desired, a Greek nose is usually requested since it is well recognized as being normal and beautiful.“ [11]

Joseph’s models animate more than elite academic notions of „art.“ They also illustrate the handbooks on the „beautiful“ that typified the libraries of educated German middle class readers. These handbooks provided a canon of the beautiful through the merger of reproductions of „classical“ works of art with contemporary (often erotic) photographs presented as modern parallels to the classical world. [12] Such books cemented the relationship between social status and the beautiful. You can acquire a new nose just as you can acquire objects such as the illustrated book. Joseph’s wife is beautiful because she resembles a work of high art reproduced in the illustrated book. [13] High art becomes his and his patients’ ideal of the healthy. Such art is, however, an ideal, which can be purchased: It is available as a commodity on the market either in the bookstore or on the surgeon’s table. It is infinitely reproducible, like the images in the book. There are no longer any „authentic“ works of art or noses that cannot be copied. Jews who do not look like the aesthetic norms of European artistic „beauty“ are thus sick. But they can remedy this – and become like the cultural ideal. However, there is a double bind for Jewish consumers of aesthetic surgery. In purchasing the new nose and healthy (read: [in]visible) visage they are acting „just like Jews,“ purchasing a false mask of honor through material means.
To answer this charge, and repudiate the accusation of contemporary thinkers such as Otto Weininger (1880-1903) that the Jewish physician was simply mired in the material world, Joseph and his fellow Jewish aesthetic surgeons saw that they must become artists. As Joseph put it, the aesthetic surgeon must

possess a certain degree of artistic aptitude in order that he may fashion with certainty the exact form determined for the specific case […] and also that he may know the shapes of individual facial parts, and their harmonious grouping. In a word, the plastic surgeon must have something of the artist in him. [14]

Now, this is on the one hand a commonplace of nineteenth and early twentieth century medicine. It echoes the influential Canadian early twentieth-century physician Sir William Osler’s claim that medicine is an art rather than a science. Yet there is a concrete sense here that is lacking in the metaphoric world of the physician-philosopher of the time. For Joseph the aesthetic surgeon is really a sculptor: He uses hammers and chisels and shapes an object – just like an artist. This also answers the charges of materialism against the surgeon. If he is an artist in terms of post-Romantic imagery, he is an honorable man of the „spirit“ rather than of the material world. The surgeon has become „a ‘creator,’ a magical word that can be used once one has defined the artistic operation as a magical, that is, typically social operation,“ to quote Pierre Bourdieu. [15] Thus the choice of models and the self-definition of the surgeon complement one another and enable the physician to become one with the culture in which he lives.

The surgeon as sculptor, a theme omnipresent in the reflections of the aesthetic surgeons before and after Joseph, also implies the problem of period and style. Harold Delf Gillies stated in 1934 that this was a problem of reconstructive as well as aesthetic surgery.

For it is [the aesthetic surgeon’s] aim and object in life not only to restore beauty to the human form, but also to change for the better such portions of human bodies that are now considered in the present trend of thought to be of an ugly or non-aesthetic character. Still further do some of us go, and whole groups of people are turned out through the plastic mill, bearing the unmistakable stamp of the hand that molded them. Even in the early days of the Great War, when there were ten of us making new faces to replace those that had been left behind in the trenches in Flanders, it was possible to say, „Oh, that one is so-and-so’s nose […] that’s another’s lip […]. There goes a typical so-and-so’s eyelid,“ mentioning the names of individual surgeons. The same habit of style that in an artist enables the expert to say that a certain picture is that of a Rembrandt or Constable, is at work in the plastic surgeon’s make-up and his results tend to run to type. There is even a certain element of impressionism that is justifiable, and there is also, unfortunately, in our poor results an element of cubism. [16]

Gillies’ awareness becomes part of the complex response to the role that the aesthetic and the notion of the surgeon as artist come to play throughout the history of aesthetic surgery
Much of the „correction“ for ethnic difference dealt with Western notions of aesthetic symmetry and balance. While it is clear that certain ideas of symmetry may be universal and therefore „biological“ (such as the recognition of a crudely drawn „smiley face“ by infants in all cultures), the ideology which defines the beautiful and healthy as symmetrical is espoused by European, post-Enlightenment aesthetics.

Here again notions of an aesthetic ideal are imposed on images of difference. It is all right to look „ethnic“ (defined clearly by the culture in which one lives) but there must be balance and symmetry within that notion of difference. Thus in a late twentieth century study of the appropriate nose, investigators measured „the noses of 34 attractive young North American Caucasian women.“ [17] The measurements echoed those of Oken and Joseph, but were even more extensive, using „19 nasal measurements (6 single and 7 paired linear measurements, 3 angles, and 3 inclinations) and 15 craniofacial measurements (10 linear measurements and 5 inclinations).“ The more detailed the measurement, according to such views, the more „scientific“ the findings. These „beautiful“ faces (or „happy“ people?) were compared to „21 women with below-average faces.“ The investigators located their subjective response (which constructed the contrast between „beautiful and ugly“) in the absence of symmetry in the faces of the „below-average“ faces:

Two types of facial harmony disruption were identified: disharmony, a normal index with a visually apparent failure of proportionality, and disproportion, an index value outside of the normal range. The percentage of disharmonies and disproportions was sig- nificantly higher in the group of 21 women with below-average faces.
What the investigators labeled as „symmetrical“ and „disharmonious“ came to be the criteria for ideal beauty. In these distinctions the nose carried disproportionate weight.

The greatest disproportion in the attractive face was the moderately short columella in relation to the tip protrusion and in the below-average face the long nasal bridge related to the upper-lip height.
Or to translate – Irish noses are cute; Jewish noses aren’t and a cute nose makes a cute face. Indeed the study showed that an „analysis of ethnic and racial differences showed the […] nose as the main feature of the most characteristic differences. The study revealed that the key to the restoration of facial harmony was the renewal of the uniformity of proportion index qualities by eliminating disharmonies and/or disproportionate relationships.“ [18] The emphasis on proportion is readings of ideal types. How does one want to pass? Well, art does provide idealizations which one can imagine as one’s own body, but these idealizations are based on mathematical and structural principals, perhaps better suited for architecture than aesthetic surgery.
For we are confronted with François Xavier Bichat’s (1771-1802) paradox, as paraphrased by Charles Darwin:

If every one were cast in the same mould, there would be no such thing as beauty. If all our women were to become as beautiful as the Venus de’ Medici [sic], we should for a time be charmed; but we should soon wish for variety; and as soon as we had obtained variety, we should wish to see certain characters a little exaggerated beyond the then existing common standard. [19]

If we all look like works of art, will the works of art still be our idealized type?

Joseph’s fantasy about high art as the appropriate model for aesthetic surgery never truly vanishes. In 1988 Xavier de Callatay, then the Director of Studies at the New York Academy of Art, spoke to a „Symposium on Beauty“ sponsored by the American Academy of Cosmetic Surgery:

They are making too many cute, bland faces, with small turned-up noses, like the women on soap operas […] The prototype should be the Greek gods, like Aphrodite and Apollo, whose faces in sculpture had a classical structure, characterized by a prominent forehead and a straight nose. […] The Greeks were beautiful, healthy and youthful – and that’s exactly what people want to look like today. [20]Symmetry is equal to beauty is equal to health is equal to happiness. But this is a very different notion than that espoused by Dr. Nigel E. Drury of the University of Southampton University Hospital. It is not evolu-tionary nor is it biological. It is clearly an ideology of aesthetics that equates the symmetrical with the beautiful with the moral with the healthy. Here the need to evoke the symmetrical, the beautiful and its cultural values reflects, as it did in nineteenth century Germany, the desire for a body beyond the confines of the world in which we live. It is a world beyond disease, ugliness, and difference, a world in which all can become beautiful, good, and healthy.

[1] Drury (2000).

[2] Drury (2000), 92.

[3] Drury (2000), 92.

[4] See Gilman (1998) and Gilman (1999).

[5] Brücke (1891), 141-144.

[6] See Gilman (1992), 38-59.

[7] Joseph (1931), 21-24.

[8] Bialostocki (1986).

[9] Joseph (1931), 23.

[10] Joseph (1931), 23.

[11] Joseph (1931), 24.

[12] Thus Jacques Joseph (1931), 26, cites and reproduces images from Carl Heinrich Stratz (1914).

[13] See D’Alessandro (1997).

[14] Joseph (1931), 30.

[15] Bourdieu (1993), 109.

[16] Gillies (1935), 1.

[17] No definition of what „attractive“ is said to mean is offered in the study!

[18] Farkas/Kolar/ Munro (1986), 191.

[19] Darwin (1897), 585. See also Pichstone (1981) as well as Heywood (1979).

[20] Hirsch (June 20, 1988). This is not a view yet lost in the training of aesthetic surgeons. See A. D. Morani (1992).


o Bialostocki, Jan (1986): Dürer And His Critics, 1500-1971: Chapters in the History of Ideas, Including a Collection of Texts. Baden-Baden: V. Koerner. o Bourdieu, Pierre (1993): Sociology in Question. Trans.: Richard Nice. London: Sage. o Brücke, Ernst (1891): Schönheit und Fehler der menschlichen Gestalt. Wien: Braumüller.
o D’Alessandro, Stephanie (1997): „Über alles die Liebe:“ The History of Sexual Imagery in the Art and Culture in the Weimar Republic. Diss. Ms., University of Chicago.
o Darwin, Charles (1897): The Descent of Man and Selection in Relation to Sex. New York: D. Appelton. o Drury, Nigel E. (2000): „Beauty Is Only Skin Deep.“ In: Journal of the Royal Society of Medicine 93, 89-92. o Farkas, L. G./Kolar, J. C./Munro, I. R. (1986): „Geography of the Nose: A Morphometric Study.“ In: Aesthetic and Plastic Surgery 10, 191-223. o Gillies, Harold (1935): The Development and Scope of Plastic Surgery. The Charles H. Mayo Lecture for 1934. Chicago: Northwestern University.
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o Gilman, L. Sander (1999): Making the Body Beautiful: A Cultural History of Aesthetic Surgery. Princeton: Princeton University Press.
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o Stratz, Carl Heinrich (1914): Die Darstellung des menschlichen Körpers in der Kunst. Berlin: J. Springer.

In the male the trajectory from beauty to ugliness follows the degeneration of alcohol and is mirrored on the face as well as in the unseen internal organs. Anna Fischer-Duckelmann (1901): Die Frau als Hausärztin: Ein ärztliches Nachschlagebuch der Gesundheitspflege und Heilkunde in der Familie. Stuttgart: Süddeutsches Verlags-Institut, 1905.
The image of the healthy and therefore beautiful female face as well as the ill and therefore ugly face. Anna Fischer-Duckelmann (1901): Die Frau als Hausärztin: Ein ärztliches Nachschlagebuch der Gesundheitspflege und Heilkunde in der Familie. Stuttgart: Süddeutsches Verlags-Institut, 1905.
Bild 4
Anna Fischer-Duckelmann (1901): Die Frau als Hausärztin: Ein ärztliches Nachschlagebuch der Gesundheitspflege und Heilkunde in der Familie. Stuttgart: Süddeutsches Verlags-Institut, 1905.