Medicine: On the Nose

Britain’s famed 18th century plastic surgeon John Hunter once summed up his professional philosophy in a single curt phrase: “Why not try?” Today’s reputable plastic surgeon is less impetuous. Aware that he often operates within surgery’s twilight zone—past the point of obvious physical need—he is inclined to weigh his would-be patients’ motives. For advice in sticky cases, he may turn to a psychiatrist. Members of the American Society of Plastic and Reconstructive Surgery recently did just that when they invited Dr. Wayne E. Jacobson of the University of California at Los Angeles to discuss motives for the commonest cosmetic operation of them all: rhinoplasty, or “nose-bobbing.”

Basing his report on a painstaking study of 120 patients at Baltimore’s Johns Hopkins Hospital, Psychiatrist Jacobson said that women are generally better risks than men for rhinoplasty. His reason: male motives are usually more complex, reflect a larger degree of psychiatric disorder.

Identifying with Papa. Among women patients, Jacobson found a standard pattern: when children, they had rejected femininity as their mothers inadequately personified it, embraced masculinity as their amiable fathers represented it. Sometime during adolescence, they decided they wanted to be women after all. The resultant conflict, said Jacobson, was expressed by a sense of nasal deformity (even if a serious deformity did not exist), because the women identified their noses with those of their fathers, felt that they were distastefully masculine. Women patients often told Jacobson that their noses “would look better on a man’s face”; a few went to considerable lengths to hide their profiles from view. Even among married women, Psychiatrist Jacobson found, success of the nose-bobbing operation depended a great deal on whether the patient’s mother approved the result.

Women patients divided neatly into three groups, according to age. Those under 20 were nearly all Jewish, but their desire for nose-bobbing, said Jacobson, was motivated by a desire to avoid social stereotyping—not a denial of their religion. Patients between 21 and 30, on the other hand, were almost all Protestants; many had achieved professional success. Said Jacobson: “They came at a time when success in their chosen work highlighted a sense of frustration and block in their emotional capacity for dealing with courtship and marriage.” Women over 30 also had a common motive: marital strain. “Correction of a longstanding sense of nasal deformity,” said Jacobson, “is felt by these patients as a necessary preliminary to coping with the threat of depression evoked by their interpersonal difficulties.”

Rage Toward Mamma. The men were more difficult to type. Explained Jacobson: “Although their physical health had been good, the incidence of severe psychopathology was high.” Most of them had an “unmastered, unconscious rage toward the mother” and were deprived of close companionship with their fathers. Their relations with women were characterized “by anxiety, inhibition and avoidance.” Like the nose-bobbing woman, said Psychiatrist Jacobson, the man who seeks rhinoplasty hopes to look handsome. But he is less eager to change his own psychological outlook than to change that of others toward him.

Jacobson’s conclusion: women’s noses can be bobbed without much fear of psychic harm, even if their relatively minor psychological problems are overlooked. But men are prone to “put all their eggs in one basket”—the operation—and are likely to be disappointed, angered and even vindictive toward the doctor at the results.