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In 2016, 1.7 million elective cosmetic surgeries were performed in the United States. Of these 1.7 million, over 200,000 were rhinoplasties, or nose jobs. Women underwent 75 percent of these nasal surgeries, the vast majority of which were performed by men.
Men make up 85 percent of board-certified plastic surgeons. If, in 2016, you selected one of those surgeons at random, you would have been nearly six times more likely to wind up with a man than with a woman.
Finding a plastic surgeon is not exactly like drawing blindly from a hat. There are online directories and annual rankings, like Super Doctors and America’s Top Doctors. A search on that second database, for plastic surgeons within 50 miles of my Massachusetts hometown, returned 61 “Top Doctors.” Eight of them were women.
In 2014, when the gender gap was even greater, Eden Strong got a rhinoplasty. Her husband had broken her nose, leaving her dissatisfied with her appearance and reminding her constantly of the violence she’d endured.
Strong is a writer based outside of Chicago. She writes under a pen name to protect her and her young children’s identities: Her blog, “It Is Not My Shame To Bear,” exposes her as a victim of domestic abuse and rape. I’d found her, and then her blog, by way of a post she’d written for Thought Catalog.
“I’d be looking in the mirror at my face. I’d look at myself and say, ‘You look really good today except for your really ugly fucking nose,’” she told me when we spoke over the phone.
“One day I got all ready, did my hair, my lipstick. And then I stopped and was like ‘Why do you have to feel this way?’” she said.
With her counselor, she came to the conclusion that she didn’t, which is when she booked a consultation with a local surgeon who could see her as soon as possible. She’d made her decision, and didn’t want to wait.
The first doctor she saw — a man — seemed confident he could fix Strong’s nose. The trouble arose for her when she began to ask questions. She wanted to know not just if he could perform the operation, but how he would do it.
“He got annoyed. He got out a mirror and started pointing to the bump and the crooked part. I was like ‘That’s it?’ ‘That’s the entire consultation?’” she said.
“It felt like a drive-thru, like you’re another female cut out. There was no one asking me what I wanted to look at, what I wanted to accomplish. I remember he said, ‘Don’t worry. We’ll make your nose real sexy.’ And I thought, ‘I’m not coming to you to be sexy.’”
Women decide to get elective aesthetic surgeries for all sorts of reasons, some of which, like Strong’s, are easier for everyone to understand than others.
I’d gotten one, too: a nose job I didn’t need in January of my 25th year. When I say I didn’t need this operation, I’m referring to medical necessity. I could breathe and smell just fine. I’d never been beaten up, hadn’t broken my nose before I paid a doctor to.
I want to put aside the politics of my choice to have surgery. For now, I’m not interested in why I did this to myself, but in who did it with me. I found Dr. Melissa Doft on the internet. I didn’t Google “Best Plastic Surgeon in NYC” because I knew what that would return: a Facebook of smiling man-faces, most white, some not, many balding, and apparently unaware that all headshots are creepy. I wanted, and sought out, a woman doctor.
Pretty much everyone I knew — which, granted, is an insular and homogenous Manhattan group — advised me to see these other doctors, those man-faces, the ones who had been called “the best” because they’d fixed the imperfections of celebrities, who charged twice as much as my doctor, having branded bespoke body parts like expensive bags. But I began a search with “woman” in the key words. When I found her, I called her up.
The gap between male and female cosmetic surgeons is also true of surgery overall, but the disparity is more startling in plastics because it is so unlike the one among patients. Ninety-two percent of cosmetic surgeries are performed on women, and women make up only 15 percent of the doctors available to patients. Wander New York’s Upper East Side and you’ll see this statistic IRL: Dr. Adam, Dr. Brad, Dr. Craig on every corner.
You’ll also find Dr. Doft, who is soft-spoken, pretty like your favorite teacher, the sort of person I could imagine trading lives with. That comforted me. I didn’t want an old man reorganizing my face, just like I don’t want to read David McCullough, no matter how many times my dad suggests I should.
The underrepresentation of female surgeons is generally attributed to one of two connected beliefs: that surgery is and has always been an old boys club, and that women’s domestic responsibilities interfere with the practice’s long hours and physical demands. This latter tenet may be botched. A 2011 survey of nearly 8,000 surgeons (12 percent of whom were in plastics) showed that 91.8 percent of respondents who identified as men had children, whereas 40.5 percent of those who identified as women did not. The survey also showed that women surgeons overall were less likely to be married or divorced, but also less likely to feel that their schedules contained enough personal time.
As for the boys’ club, it may be getting less clubby. The percentage of general surgeons who are women rose from 3.6 percent to 19.3 percent between 1980 and 2015. Nevertheless, the barrier to entry remains high, and the opportunity for woman-to-woman mentorship low. A 2013-2014 survey of women in academic medicine showed that only 38 percent of surgery residents are women, and surgery ranks among the med school departments with the lowest proportion of full-time women faculty.
During our consultations for my rhinoplasty, Dr. Doft and I had discussed the fratty nature of surgery, and plastic surgery in particular. While she peered into my nasal hollows, I asked her why she thought my parents’ friends had steered me elsewhere, even though she’d graduated No. 1 from NYU’s medical school and had a list of accomplishments longer than my senior thesis.
Some 18 months later, I called her to ask more. “When I was going to my interviews, other surgeons or people I was doing research with in the lab said, ‘You come across as very feminine, Melissa. No one wants a feminine surgeon,’” Dr. Doft told me. Obviously, this was not entirely true. I am a woman, and I wanted her, chit-chat and all. But it’s not entirely untrue either. Just like doctors are trained to behave professionally, patients are trained to seek professional doctors. The world is changing slowly, but for the most part, the arbiters of professionalism continue to be men.
Like Melissa Doft, Lara Devgan is a multitalented NYC surgeon — her CV runs on for pages, citing numerous awards and publications. Dr. Devgan recently performed a “Vampire Facial” on Kim Kardashian; she’s been a talking head in an animation on nonsurgical cosmetic procedures for the website Betches; she manages her own Instagram account. Dr. Devgan also went to Yale, where she was a debate star, and then to Johns Hopkins Medical School and top residency programs.
“I do have patients who seek me out because I’m a woman,” she said. "I’m very comfortable with that. But as with all things, you don’t want to be the best woman, you want to be the best.” Understanding the context of this article — Dr. Devgan is shrewd — she added: “It’s a more feminist and more egalitarian tenet to put forth that being good is what matters most.”
In our conversation, Dr. Devgan lauded her male colleagues for their professionalism and the empathy they displayed for their patients. She resisted my attempts to differentiate her because of her gender identity, or for being a person of color. When I asked if she ever felt at odds with her colleagues, she recounted the first time she’d had to gaze on a projection of female breasts in a room full of men in blue suits. The experience had made her “feel weird,” but she’d gotten used to it. She is a top doctor — her professional tenacity predominates.
“You can’t be having a hallmark epiphany every day of your job. You need to be a steady, reasonable, calm, well-adjusted person,” Dr. Devgan said. These adjectives have loaded antonyms, however, which all too frequently populate today’s political discourse: unstable, irrational, hysterical, ill-fit.
A thousand miles south of Dr. Devgan’s office, in Miami, Dr. Jeremy White helms the Aesthetic Reconstructive Center. “Where Art and Skill Meet,” the website welcomes prospective patients: “Your New Life Starts Here.” A photo banner at the top of the homepage flashes between an image of Dr. White — who is handsome, with a Hollywood smile — and another of his all-women team. His RN, who is also an aesthetician, wears a lab coat embroidered with her title. The award-winning surgeon is in a suit and tie. It’s a Charlie’s Angels shot; the award-winning surgeon is both hands-on and omniscient.
“We’re taught the same ideals or techniques and I think that we probably have the same ideas of what is beautiful,” Dr. White tells me when I ask him about the flip side — whether as a man, he feels uncomfortable evaluating and redefining women’s appearances.
“We study proportions. A lot of what we learn harkens back to the Renaissance. But these are just frameworks upon which we then build our our own ideals of beauty, because not everyone wants a fine tip. Some people like their button nose, and that’s okay.”
Presumably, this capacity for improvisation, for repeated redefinition of the norm, or redirection to it, is the mixture of art and skill that Dr. White’s practice advertises.
He is not alone in making this connection. Artistry and technical difficulty were critical factors for all three of the surgeons with whom I spoke. Dexterity attracted them to their professions, and acted as a sort of gatekeeper in rising to the top.
“Plastic surgery, from the surgeon’s standpoint at least, is a serious intellectual field with a heavy dose of art and science,” Dr. Devgan wrote in a 2016 op-ed for Kevin MD, an online resource for physicians and patients.
The website of the renowned New York plastic surgeon David Hidalgo — the Wall Street Journal has deemed him “The Man of a Thousand Facelifts” — boasts sections for both his surgical and fine art. He works in graphite, oil, and charcoal, and draws preoperative sketches himself, where other surgeons only use computers.
A French artist, Malika Favre, designed the cover of The New Yorker’s April Health, Medicine & the Body issue. Rendered in cool, aquatic blues, the illustration is a trapezoidal portrait of four surgeons, from the patient’s prone perspective. The corners of the surgeons’ eyes tick upwards; we see one set of hands, which is slender, like the shoulders above it. In a fun subversion of the age-old “the doctor was a woman,” joke, we are made to assume these surgeons are women. At the very least, they are womanly.
When endocrine surgeon Susan Pitt saw Favre’s illustration, it gave her an idea. She and three of her colleagues snapped a selfie from the same upward-facing angle that Favre had designed, tagged it #ILookLikeASurgeon (The hashtag is an offshoot of the #ILookLikeAnEngineer movement in 2015), and challenged others to do the same.
Marissa Boeck, a senior resident at Columbia Presbyterian, was the first to respond to Dr. Pitt’s challenge from an actual operating room, where she and three other surgical students posed in scrubs, an iPhone on the vacant table. Her Twitter profile says she loves yoga and barre; her handle is @KickAsana. At work, she specializes in trauma.
“Looking like a surgeon isn’t really a viable concept anymore,” she says. “That doesn’t mean anything — anyone can be a surgeon as long as you have the proper training and skill set. I’ve never tried to be somebody that I wasn’t. For better or for worse, our work is our lives.”
In one of our conversations, Dr. Doft spoke of a “special advantage” she found in blending her social and professional worlds, when nursery school meetings turned to moms’ nights out, and then to impromptu information sessions on cosmetic procedures.
“We’d spend over an hour going over different possibilities and impossibilities. There’s always a portion of time where people will ask, ‘What do you use on your face? What do you think about lipo?’” she said.
She told me about friendships developing with her patients. At first, I found this perplexing; it seemed to brush against the boundaries our culture expects to exist between doctors and patients. We don’t get lunch with our therapists. We call our dentists by their titles and last names, a formality that goes just one way.
“It’s valuable that girl talk can morph into an informed conversation,” Dr. Devgan told me when I asked if she spoke with prospective patients in social settings as well. “I try not to be on the clock all the time, but I do think that if an acquaintance or a social contact of mine has a burning question, I would much rather they get accurate information from me rather than turning to a potentially less-reputable source.”
To imagine a situation in which a woman might, before visiting the examination room where a male surgeon waits, answer her more sensitive questions via Google, is not so difficult. The real questions might be easier to spill over a glass or two of rosé.
Had Eden Strong been able to keep the nose she was born with, she might never have considered changing it. Hers is the kind of case that makes it difficult to call cosmetic surgery optional. The operation felt like it could be another step in the long and painful process of restoring her life, motivated by survival, not vanity. Once hopeful, she left her first doctor’s office dejected. Gratefully, her second experience was not so bad. She found another doctor, a man affiliated with a Chicago hospital, who referred to himself as the “Cadillac of plastic surgeons.” Having coaxed her story out of her, he offered to perform the surgery for free.
Strong is happy with the way her nose came out, but she’s unable to divorce her story from the luck that facilitated it. She never would have been able to afford this second doctor on her own, and wouldn’t have returned to the first one, so turned off was she by his demeanor.
“You’re taking women that already have these male-driven insecurities,” she tells me. “They’re going to a male doctor saying, ‘What’s wrong with me? Fix it.’ And I don’t know if these male doctors are aware that anything they say is really going to stick in these women's heads.”
“It’s not a mean thing; it’s just the way men are wired. They don’t want to get to the bottom of your issues. They’re like, ‘You have a problem? Where? Let’s fix it,’” she adds. “Think about husbands. They just want the quick, simple solution.”
While she speaks, she laughs. She’s kidding around: Not every husband is this way, just like not every woman just wants to “talk about it,” and Strong knows that. Surgery may be gendered, but humans on both sides of the profession want solutions as much as they want to be understood.
“Everybody wants to help people,” she says.
Correction: This post was updated August 17th, 2017 to reflect that Dr. Devgan updates her own Instagram but not her own Twitter, and has worked with Kim Kardashian but never appeared on Keeping Up with the Kardashians.