Killer Looks

Killer looks is the definitive story about the long-forgotten practice of providing free nose jobs, facelifts and other physical alterations to prisoners, the idea being that by remodelling the face you remake the man. From the 1920s up to the 1990s, half a million inmates willingly went under the knife, their tab picked up by the government. The following is an introduction from Zara Stone’s fascinating new book on the strange history of prison plastic surgery in America.

Early Wednesday morning on December 6, 1967, the daily frost still glistening on the trees as the city’s homeless dismantled their cardboard shelters to a chorus of sirens, the doors to the Montefiore Hospital and Medical Center conference center in the North Bronx swung open.

In ones and twos and threes, braving the six-to-twelve-mile-per-hour gusts of wind sweeping through the Bronx, seventy-odd besuited professionals, a mix of sociologists, psychologists, corrections workers, and plastic surgeons, trickled in. One of the first to arrive, heavily bundled against the chill, was Ellis McDougall, the director of corrections for South Carolina, followed by the assistant surgeon general, Dr. Ernest Siegfried, fresh off the Washington, D.C., commuter train. Attendees came as far afield as California and Washington State and as close as a ten-block radius.

These white men—only two of those gathered were women and all were white-presenting—had gone to this effort for one reason only: the inaugural Montefiore Conference on Correctional Plastic Surgery. This three-day event was the world’s first scientific conference about utilizing prisoner cosmetic surgery as a recidivism tool. People respond better to the beautiful, the attendees reasoned; would remaking inmates’ faces curb future criminal tendencies? In strode the answer to their questions, Dr. Michael L. Lewin, a sturdy, striking man with thick brown hair that was just beginning to gray at his temples, who headed up Montefiore Hospital and Medical Center’s plastic surgery division.

For the last three years, Lewin had codirected the Surgical and Social Rehabilitation (SSR) project, an experimental study conducted with Rikers Island inmates. Funded with $254,000 from the U.S. Department of Health, Education, and Welfare, the SSR investigation was rigorously designed and included a control group, work training, and counseling in addition to free cosmetic surgery.

The reason for the governmental go-ahead for Lewin’s surprising surgeries was born of necessity; during the last decade, the U.S. prison and jail population had skyrocketed, with prisons so flooded that convicts often slept three or four to a one-person cell. In New York, 68 percent of ex-cons re-offended within three years of release.¹ The city’s jails were brutal; deaths were common, with violence and abuse a daily occurrence. What little medical care existed was shoddy, its personnel understaffed, and few programs offered inmates the chance to find a new path upon release, which contributed to inmates returning to prison multiple times. This revolving door of crime was untenable. Hence, the administration’s exploration of preventative pathways.

Lewin stepped onto the stage and the room hushed. He smiled at the audience, cleared his throat, and assumed the lecturing tone he used with his residents for his address. “We live in an era when social medicine assumes increasing importance,” he said. “Plastic surgery services offer the promise of becoming an important adjunct in the social rehabilitation of the public offender.” I’m not talking about functional plastic surgery such as reconstructive breast surgeries or cleft palate treatment, which fall under medically necessary plastic surgeries, he clarified. What was up for discussion here was face-lifts, liposuctions, nose jobs, chin implants, scar removal, and more—the majority of operations falling squarely in the cosmetic sphere.

The hypothesis was that improving an inmate’s appearance would have a twofold effect, Lewin explained. The hope was that the societal benefits awarded the conventionally beautiful would increase their employment and relationship prospects, and the positive response to their appearance would increase their self-esteem and lower the rate of re-offense.

Inmates who were interested in receiving plastic surgery volunteered by filling out an application slip and dropping it in one of the submission boxes placed inside Rikers Island’s jails. Volunteers had to clear a number of physical and psychological tests to enter the study. We vastly underestimated prisoner interest, Lewin admitted. He’d thought that a few hundred might apply, but so far, they’d screened more than 9,300 men. He flipped his glasses down onto his nose. “So. Our findings.”

The Rikers Island experiment was not the first time that American prisoners had received free plastic surgery as a recidivism treatment. The practice of remodeling the physical features of criminals—or assumed criminals—dates back to the turn of the twentieth century.

Most of these early surgeries stemmed from the burgeoning concept of racial science, which conflated certain physical traits with low intelligence, poor health, and criminality. Here, surgeons carved up the faces of Black, brown, and Jewish people, reshaping ears, noses, and breasts in an attempt to correct the so-called disease of “ugliness of nonwhite races.”² Over time, these operations evolved from deracializing features to focusing on improving an individual’s attractiveness.

In January 1910, Henry Solomon, New York’s prison commissioner, published a report that advocated providing free plastic surgery for the state’s criminals. “Often a man’s physical condition makes it easier for him to steal a dollar than to earn one,” he told the New York Tribune.³ “The relationship of physical defects to crime is generally not appreciated. We readily see how physical distress might conduce to crime.” The press took Solomon at his word. “Surgery on Criminals: New York Official’s Plan to Remove Bad Streaks” was front page news in the Chattanooga Daily Times.⁴ “Surgery to Help Convicts” reported the Baltimore Sun.⁵ The headlines were inflammatory, but their contents were sympathetic; wanting to appear socially acceptable was easy to understand.

This outlook wasn’t an anomaly; historically and to the present day, people have instinctively understood the societal benefits of conventional beauty. Even the word “beauty” is studded with emotional landmines, the term so deeply commingled with the language of our culture. A scroll though the synonyms and related words listed in the Merriam-Webster dictionary exemplifies this; “beautiful” receives “fair,” “good,” “lovely,” “elegant,” “flawless,” “personable,” “charming,” and “lovesome,” whereas “ugly” is paired with “monstrous,” “grotesque,” “hideous,” “homely,” “vile,” “repellant,” “revolting,” “awful,” “disgusting,” “sickening,” and “nauseating.” The correlations between appearance and personality traits, and the de facto assumptions inherent in those terms, are reflective of how the beauty bias permeates today’s social and cultural mores.

Correlations between criminality and appearance have persisted over centuries— and society’s insidious, instinctive response to beauty, and the lack of it, harms some of its most vulnerable. Beauty is a valuable currency in society.

The benefits the conventionally good-looking receive include higher salaries at work, better service in bars, and shorter sentences in court. They’re fined 174.8 percent less for serious misdemeanors, and they’re convicted less. The beauty premium begins at birth. Attractive preschoolers get more one-on-one time with their teachers, attractive middle schoolers get more flexibility with their grades, and when they act out, they’re more likely to be called “high spirited” than badly behaved. Overall, attractive students score higher on tests, all the way through university.⁶ “I like to think that eventually people won’t care anymore about looks, but I don’t think this will happen in my lifetime or yours,” Daniel Hamermesh, a beauty economist and global research director of the IZA Institute of Labor Economics, informed me. It’s more than a social construction; studies show that that babies as young as nine hours old will track the most attractive person in the room.7 Beauty privilege is real, and it’s real uncomfortable.

There are many signifiers of one’s attractiveness beyond the attributes that are distributed at birth. Well-cut clothes, gleaming hair, glowing skin, and straight teeth—even eyelash length!—all play a part in the impression of someone’s overall attractiveness. Generally, these are socioeconomic privileges, available only if one can access health care, hairdressers, cosmetics, and unguents.

Privileges—thanks to historic discriminatory practices against Black and marginalized communities—have created an unbreachable wealth gap.

What we think of beauty, then, is a combination of genetic luck and economic and social status, which perpetuate a circular economy of beauty privilege. This works in reverse as well; less access to health care and retinols can result in rotting teeth and age-spotted, wrinkled skin. Without care, easily treatable wounds can leave scars and broken noses may set crookedly. Taken to the extreme, one may have a scarred, wart-filled face with blackened teeth and a crooked nose, the eponymous bogeyman or witch from children’s stories, the archetypal bad guy.

Small wonder, then, that the cosmetic surgery space is booming—people recognize the benefits of the beauty premium and are angling to get some of that special sauce for themselves. In 2019, the American Society of Plastic Surgeons reported that they performed some 18.1 million cosmetic surgery procedures.

Americans spent approximately $16.7 billion on self-beautification, their surgeries ranging from face-lifts to nose jobs, calf implants, and nonsurgical fillers, a 77 percent increase since 2005.

In the age of the influencer, the emphasis on physical attractiveness is heightened more than ever. The relationship between the way a person looks and his or her bank balance has never been clearer. By seeking improvement, one is seeking to raise one’s status. However, the ability to successfully self-improve surgically directly corresponds to one’s place on the socioeconomic ladder.

Cutting costs can have horrific consequences, from bursting breast implants to death; a 2019 investigation from the Center for Health Journalism reported that fourteen women died in Florida after receiving Brazilian butt lifts.⁸ The majority of surgical improvements and the benefits that go in hand with them are reserved for those with disposable income. In 2019, Black and Hispanic Americans (who generally earn less than white Americans), accounted for 20 percent of all cosmetic surgeries in America.⁹ At the bottom of the socioeconomic ladder falls prisoners, with approximately 30 percent of all inmates growing up below the poverty level, according to a 2018 report by the Brookings Institution.¹⁰ The poverty-to-prison pipeline encompasses education; 70 percent of all state prisoners lack high school diplomas.¹¹ The wealth gap continues once incarcerated; don’t expect the American prison system to exact a high level of medical care or compassion. In 2016, Texas State prisons provided seventy-one dentures, total, to its 149,000 inmates— chewing wasn’t considered a “medical necessity” by officials.12 In 2017 an Arizona inmate with skin cancer was given Tylenol and taken to a dermatologist but not to an oncologist. He was refused sunscreen and did not receive radiation therapy. He died shortly thereafter.¹³ Incarceration itself is famously hard on the body. The incarcerated experience almost five times as many head injuries as civilians. An analysis of intentionally caused facial fractures inside Louisiana penitentiaries found that injuries via “slock” (a padlock in a sock) had doubled between 2011 and 2019. A 2017 study of inmate health care in New York City found that facial trauma accounted for 33 percent of all inmate emergency room visits,¹⁴ compared to 0.7 percent of the general population.¹⁵ When released, many ex-cons struggle to gain employment due to hiring biases against former felons and find their criminal records preclude them from many positions. “Uglier” ex-cons have an even harder time of things, their physical appearance adding to the prejudices stacked against them.

Which brings us to the current 68 percent recidivism rate¹⁶ within three years of release, according to a 2018 Bureau of Justice Statistics report.

A lot of attention has been given to the problem of recidivism and the benefits of being beautiful, but these have rarely been addressed at the same time. For many, the combination of the two produces confusion; the history of prison plastic surgery has been heavily buried, so much so that few of the (unaffiliated) plastic surgeons, criminologists, or prison historians I consulted were aware of its history. Its existence is America’s dirty little secret.

Starting in the early 1920s and lasting well into the mid-1990s, more than five hundred thousand face-lifts, chin implants, nose jobs, breast implants, liposuction, and other cosmetic surgeries took place in jails and prisons across America, with thousands more occurring in lockups across Canada and Britain.

For the most part, these surgeries weren’t experimental or residency training programs; they were bona fide cosmetic surgeries.

Prisons welcomed these programs, viewing the face-lifts, nose jobs, chin implants, and so forth as rehabilitative, acknowledging the benefits inherent with perceived “pretty privilege.” This was a surprising move, given the racial and social turmoil of the mid-twentieth century, as the battle for equality and civil rights swept America, and Black bodies were shunted into cells. As ideas about crime became more racialized, a deeper emphasis was placed on imparting long-lasting social change. The correctional investment in inmate beautification was seen as a recidivism treatment, akin to the investment in prisoner education and reentry programs.

No one is more disenfranchised than criminals, reasoned the officials—and likely no one could benefit more from these programs. This state-sanctioned, taxpayer-covered mass beautification was part of a larger push for prisoner rehabilitation by President Lyndon Johnson, spurred by the civil rights movement and postwar rehabilitative ideals, alongside the growing acceptance of using psychology and sociology to treat people.

: But starting with President Nixon’s administration and continuing deep into the Carter, Reagan, and Bush years, there was a major overhaul in policy. The administration moved away from the medical model of crime, whereby it was a disease that could be treated, to viewing offenders as “incurable” and necessary to lock away for the public good. The rehabilitative ethos was replaced by punitive sanctions, and the government passed hard-line edicts that discriminated against minorities. Cosmetic surgery was slowly phased out as money was diverted from educational and reentry programs into building more cells, leaving few options for inmate improvement. Pell grants for prisoners were eradicated.

By 2001, approximately $57 billion was spent on incarcerating Americans,¹⁷ a 493 percent increase since 1982.18 The political “tough on crime” approach birthed our “incarceration nation”—today, America houses approximately 22 percent of the world’s prisoners.

It was seven more years before President Obama was elected, and prison reform finally returned to the political and social agenda. When he left office, there were concerns that President Trump wouldn’t continue his work. The answer to this is complex; in 2018, President Trump signed the First Step Act to reduce the number of federal prisoners and prepare them for reentry. He also supported prisoner education initiatives. However, President Trump’s push for stronger border sanctions and funneling money into private prisons has mitigated that impact.¹⁹ Even so, these changes add to the slow but steady shift back toward the rehabilitative-minded ideals of yesteryear, and President Joe Biden’s campaign promises, if followed through, could result in significant changes. Biden vowed to fully support the Safe Justice Act, a criminal justice reform bill, to develop a $20 billion grant program for state prevention programs, to cancel incarceration for drug use alone, to decriminalize cannabis, to eliminate private prisons, and to “end the criminalization of poverty” by removing cash bail. His campaign page declares he has a “national goal of ensuring 100 percent of formerly incarcerated individuals have housing upon reentry.”²⁰ On October 17, 2019, the city council of New York approved plans to close Rikers Island. Of all the city’s jails, Rikers Island in particular has acquired a reputation for brutality and human rights abuses. Inmates sleep in rat-infested cells and are regularly served rotten food and tortured with solitary confinement.

The idea, today, that the prison ever offered its residents free cosmetic surgery is laughable. Here, inmates are lucky if they receive access to showers, menstrual products, and sewage-free cells.²¹ Still, the symbolism of abolishing the jail and its abusive systems is indicative of a new wave of reforms sweeping America as people seek to address the historic inequalities and racist laws that have criminalized addicts and Black and brown people. COVID-19 related crises have put the closure of Rikers Island on hold, but the promise to close remains.

There are still too many people in prisons. In 2017, the number of people imprisoned for drug-related charges was 1,007 percent higher than in 1980.22 In 2020, America housed approximately 1.4 million men, women, and children in correctional institutions.

To make real progress, the country needs to address its troubled history, a reeducation that will prevent the problems of the past from reoccurring. A cosmetic excision will not create the change necessary for progress.

The socioeconomic gap between the haves and the have-nots has never been more prominent, with the world sharply segregated on religious opinion, political discourse, and personal liberties. It’s time to reevaluate the contribution of appearance bias in today’s criminal justice system and how it intersects with race, economic privilege, structural inequalities, and the prison industrial complex.

Through the narratives of plastic surgeon Dr. Michael Lewin and other pivotal characters involved in the prison plastic surgery programs, this book spans the myriad surgical programs available in the twentieth century.

Through the lens of identity, beauty, and privilege, I examine the benefits and pitfalls of these programs and the ethics of performing medical work on a disenfranchised population.

At its heart, this is a story about the power the prison system wields over those in their care, but it’s also about the socioeconomic power the beautiful wield—and how this problematic power has shaped society today. AMP

1. Anna Kross, Progress through Crisis (New York: New York City Department of Correction, 1955–1963).
2. Sander L. Gilman, Making the Body Beautiful: A Cultural History of Aesthetic Surgery (Princeton, NJ: Princeton University Press, 1999), 16.
3. Henry Solomon, “Sing Sing Report: For Better Surgery,” New York Tribune, January 10, 1910.
4. Newswire, “Surgery on Criminals: New York Official’s Plan to Remove Bad Streaks,” Chattanooga (TN) Daily Times, January 10, 1910.
5. Newswire, “Surgery to Help Convicts,” Baltimore Sun, January 10, 1910.
6. Naci Mocan and Erdal Tekin, “Ugly Criminals,” National Bureau of Economic Research, 2006; B. W. Darby and D. Jeffers, “The Effects of Defendant and Juror Attractiveness on Simulated Courtroom Trial Decisions,” Social Behavior and Personality: An International Journal 16, no. 1 (1988): 39–50; Rachel A. Gordon, Robert Crosnoe, Xue Wang, and Patricia J. Bauer, “Physical Attractiveness and the Accumulation of Social and Human Capital in Adolescents and Young Adulthood: Assets and Distractions,” Monographs of the Society for Research in Child Development 78, no. 6 (2013): I–137, accessed February 3, 2021, www.jstor.org/stable/43772912; Ray Bull, “Physical Appearance and Criminality,” Current Psychological Reviews 2 (1982): 262–81; A. Chris Down and Phillip M. Lyons, “Natural Observations of the Links between Attractiveness and Initial Legal Judgments,” Personality and Social Psychology Bulletin 17, no. 5 (1991): 541–47.
7. Alan Slater, Gavin Bremner, Scott P. Johnson, Penny Sherwood, Rachel Hayes, and Elizabeth Brown, “Newborn Infants’ Preference for Attractive Faces: The Role of Internal and External Facial Features,” Psychology, Medicine Infancy (2000): 265–74.
8. Maria Sosa and Erika Carillo, “A Dangerous Cosmetic Surgery Killed 14 Women in Five Years,” USC Annenberg, Center for Health Journalism, 2019; and American Society of Plastic Surgeons, “Press Release: Plastic Surgery Societies Issue Urgent Warning about the Risks Associated with Brazilian Butt Lifts,” plasticsurgery.org, August 6, 2018.
9. American Society of Plastic Surgeons, “2019 Plastic Surgery Statistics Report,” ASPS National Clearinghouse of Plastic Surgery Procedural Statistics, 2019. For the salary disparities, see Stephen Miller, “Black Workers Still Earn Less Than Their White Counterparts,” Shrm.org, June 11, 2020.
10. Adam Looney and Nicholas Turner, “Work and Opportunity before and after Incarceration,” The Brookings Institution, March 14, 2018.
11. Authors Bruce Western and Becky Pettit, “Incarceration and Social Inequality,” American Academy of Arts and Sciences, June 2010, www.amacad.org/publication/incarceration- social-inequality.
12. Keri Blakinger, “Toothless Texas Inmates Denied Dentures in State Prison,” Houston Chronicle, September 23, 2018, www.chron.com/news/houston-texas/houston/article/Toothless-Texas-inmates-denied-dentures-in-state-13245169.php.
13. Josh Saul, “An Inmate Had Skin Cancer and Needed Radiation. This Prison Gave Him Tylenol,” Newsweek, December 21, 2017.
14. Mark Siegler and Selwyn O. Rogers Jr., Violence, Trauma, and Trauma Surgery: Ethical Issues, Interventions, and Innovations, (Cham, Switzerland: Springer, 2020).
15. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, “National Hospital Ambulatory Medical Care Survey: 2017 Emergency Department Summary Tables,” 2017, www.cdc.gov/nchs/data/nhamcs/ web_tables/2017_ed_web_tables-508.pdf and www.cdc.gov/nchs/hus/contents2018.htm?search=Emergency_department_visits; Charles Dodge Rees, Adam Blancher, Paige Bundrick, Mickie Hamiter, Tara Moore-Medlin, and Cherie-Ann O. Nathan, “Assessment of Facial Injury by ‘Slock’ in Incarcerated Patients,” Otorhinolaryngology Hypersensitivity Treatment 1, no. 2 (2020): 1–4, DOI: 10.31038/ OHT.2020121.
16. Mariel Alper, Matthew R. Durose, and Joshua Markman, “2018 Update on Prisoner Recidivism: A 9-Year Follow-Up Period,” Bureau of Justice Statistics, 2018, www .bjs. gov/index.cfm?ty=pbdetail&iid=6266.
17. Douglas C. McDonald, “Medical Care in Prisons,” Crime and Justice 26 (1999): 427–78, DOI: 10.1086/449301.
18. Melvin Delgado and Denise Humm- Delgado, Health and Health Care in the Nation’s Prisons (Lanham, MD: Rowman & Littlefield, 2008), 4–24.
19. Ames Grawer, “What Is the First Step Act—And What’s Happening with It?” Brennan Center for Justice, June 23, 2020; and Federal Bureau of Prisons, “An Overview of the First Step Act,” n.d., www.bop.gov/inmates/fsa/overview.jsp.
20. Joe Biden, “The Biden Plan for Strengthening America’s Commitment to Justice,” n.d., joebiden.com/justice.
21. Dave Davies, “Former Physician at Rikers Island Exposes Health Risks of Incarceration,” NPR Radio, March 18, 2019.
22. The Sentencing Project, “Criminal Justice Facts,” n.d., www.sentencingproject.org/criminal-justice-facts.