Venus Envy: A History of Cosmetic Surgery by Elizabeth Haiken (Baltimore: Johns Hopkins University Press, 1997) pp. 370.

Most people in our culture would likely agree that surgery to correct physical deformity is an appropriate step in optimizing health and well being. The key difficulty however lies in defining what constitutes "deformity".

This thoughtful account of the history of cosmetic surgery in the United States highlights this dilemma without attempting to settle it. Haiken is a professor of History at the University of Tennessee and bring a non-medical approach to the troubling issues, which is quite refreshing to the regular reader of medically oriented books and papers.

Towards the end of the nineteenth century, surgeons began experimenting with techniques, which aimed not to just save lives, but also to improve them. Techniques to correct perceived social stigma, from the saddle nose deformity of syphilis to the crow's feet of aging, were developed. The sad aftermath of wounds received during World War I lead to a rapid acceleration in surgical capability as well as to a wide appreciation of the possibilities on the part of the public. "Feel-good" stories in the public press describing how soldiers with shattered faces were able, through the new surgical techniques, to return to normal lives were very popular, and fed the demand for procedures to modify features that while not induced by injury were none the less unacceptable to their owners.

From these early beginnings Haiken traces the development of cultural attitudes towards cosmetic surgery. Rather than use a medical perspective, which would refer to the development of medical knowledge, her approach is to look at the changing social context and how the surgical specialty was impacted by it. Making extensive use of medical archives, popular magazines and films, she examines the impact of fashion and style, the American zeal for self-improvement, and the universal need to "fit in" in the growth of cosmetic surgery.

Troubling questions such as the impact of racism, sexism and ageism are discussed thoughtfully and with insight. Haikim offers no facile answers but leaves readers to draw their own conclusions.

Fascinating drawings and photos from popular magazines as well as medical texts illustrate the work. Celebrities' use of cosmetic surgery (Fanny Brice, Michael Jackson, Cher) or not (Barbra Streisand) is used to exemplify many of the ideas in the text. The writing is generally lucid and clear, although her historian's use of run-on sentences could occasionally give the writers of medical texts (and perhaps book reviewers) a run for their money.

This book will appeal to not just medial historians and those interested in the interface between culture and medicine, but also to anyone with an interest in the human desire for physical beauty.

Allyn Walsh