Surgical Personalities: A Cultural History of Early 20^th Century American Plastic Surgery

This thesis explores the historical relationship between plastic surgery, theories of personality, and social hierarchy. Grounded in approaches from the history of science and medicine, disability studies, postmodernism, and feminist philosophy, this project examines the historical evolution of American plastic surgery during the interwar era.

Part I forms the core of historical research, critically interrogating the professionalization of American plastic surgery and public perceptions of the emerging surgical subspecialty. Chapter 1 details the cosmetic surgeon's pre-World War I technical arsenal, challenging the causal timeline for cosmetic surgery and investigating the persistent link between aesthetic interventions and the rehabilitation of injured veterans. The rising popularity of cosmetic surgery is reframed as a product of women's liberation, consumer culture, and the reconfiguration of American selfhood rather than an outgrowth of wartime expertise. Chapter 2 examines the cultural persona of the plastic surgeon, demonstrating how claims to artistic expertise helped shape the supposed social benefits of the nascent specialty in the context of interwar America. It argues that plastic surgeon’s claims to improve the socioeconomic prospects of its recipients relied on xenophobic and racist stereotypes and functioned to reinforce the national racial project of White America. Chapter 3 shows how tensions between practitioners of reconstructive and aesthetic surgery were central to the formation of early professional societies and regulatory bodies. In defining the strategies used by advocates for cosmetic procedures to justify their inclusion in the new surgical branch, this chapter demonstrates the lasting impact of the psychosocial rehabilitation model of plastic surgery in current practice and its ethical implications.

Part II applies the historical frameworks developed in Part I to address contemporary challenges in clinical plastic surgery. Chapter 4 uncovers the legacy of Black American plastic surgeons, delineating historical barriers to professional integration and emphasizing the role of Black surgeons in redefining racialized aesthetic paradigms. Chapter 5 problematizes standard clinical approaches to gender affirming facial surgery and criticizes the continued reliance on a binarized gender model. It introduces the surgical concept of intentional ambiguity to better address the diverse experiences of gender identity, particularly for nonbinary and gender nonconforming individuals. Chapter 6 advocates for recognition of the critical period after severe facial injury where the stigma of facelessness often leads to withdrawal of care. It argues that funding mechanisms for face transplantation must consider this patient population as key stakeholders in debates over quality of life and clinical benefit in resource allocation for facial vascular composite allografts.