For many decades, the US Prisons have been home to controversial programs for plastic surgery.
Face lifts were performed on inmates serving sentences for murder, sexual assault, and other drug offenses.
Between the beginning of the 20th century and the middle of the 90s, over 500,000 procedures were done in US jails. Many more took place under similar programs in the UK or Canada.
Most of the state-sanctioned and taxpayer-funded procedures were performed by highly qualified plastic surgeons.
Zara Stone presents Killer Looks: America’s Forgotten History of Plastic Surgery at Prisons. This book charts the history of plastic surgery in prisons and the shifts in political attitudes to crime, punishment and prison Reform.
They were eventually shut down due to public public outrage, the Supreme Court’s removal of ‘rehabilitation considerations’ in sentencing, ethical objections and the scandal surrounding experimentation on prisoners.
American Weekly, 2005, published mug shots taken before and after plastic surgery of Joliet Prison inmates. Zara Stone has written Killer Looks. This book traces the history of plastic surgery in prisons and the changing attitudes to crime, punishment, or prison reform.
Stone provides a thorough account of Dr Michael L. Lewin (a New York-based, plastic surgeon) who led a study over several years that included hundreds Rikers Island prison inmates.
Dr Lewin and a team of residents at Montefiore Medical Center, a 1,400-bed hospital in north-central Bronx, worked alongside psychiatrists, social workers and other government agencies to test whether plastic surgery could play a significant role in reducing the recidivism rate.
Stone states that Stone’s hypothesis was that improving the appearance and health of an inmate would result in a second effect.
“The idea was to increase the employment prospects and relationships of the traditionally beautiful, while the positive reaction to their appearance would improve their self-esteem as well as lower their rate of reoffense.
First, Dr Lewin started treating prisoners in another New York prison called Sing Sing. His patients included William Ricci (a former convict for first-degree manslaughter).
Ricci was a poor child born to poverty. He had a cleft palate and lip that severely affected his speech. Ricci was bullied relentlessly as a result.
Ricci killed a friend who was mocking him one night and’snapped’ another.
John Howard Crum, a mysterious convict, performs operations at the Hotel Pennsylvania in New York City, 1932. He was one the first to offer plastic surgery as a paid-for spectacle.
Stone wrote that Lewin had been told variations of the tale many times. Stone wrote, “The characters and circumstances changed but the story was timeless, a sad tale of disenfranchisement, alienation, lookism, poverty, and poor parenting.
“Lookism”, the discriminatory treatment given to people who are physically attractive, wasn’t considered the cause of the offender’s problems, but it was considered a contributing factor.
Dr Lewin believed that prisoners with perceived weaknesses would be more able to integrate back into society once they were released from prison.
After a rocky start, Ricci became a model patient. After his release, Ricci settled down in Manhattan, where he became a Longshoreman. He also rebuilt damaged family relationships, and fell in love.
To the surgeon, he said that this would not have been possible without you. ‘Thank you.’
Dr. John Pick performs plastic surgery on a convict aged twenty-two at Stateville Prison in Joliet. 1947
Dr Lewin was shocked at the disfigurements seen in prisoners during his visit to Sing Sing’s Hospital. He wanted to improve his treatment.
‘Men with jug ears, noses crooked, flattened, and twisted, faces scarred and burnt, and among that, an abundance of obscene tattoos: crude drawings of genitals and curse words scarred across inmates’ shoulders and backs,’ Stone writes. The prisoners suffered more trauma than the rest of society.
Dr Lewin started sending his team of plastic surgery to Sing Sing every week to do cosmetic procedures. He removed track marks from heroin users’ arms and noses, straightened their faces, and placed chin implants to give them a more powerful jaw.
Stone continues: ‘Due in part to Lewin’s work at Sing Sing, the American Correctional Association added a section on plastic surgery to the 1954 Manual of Correctional Standards, a hefty 451-page volume that had been distributed to every jail and prison in the United States since 1946.
‘Their revision highlighted the correctional association’s new approach to criminal reform. It stated that plastic and other elective surgeries to fix or reduce body disfigurements (especially repulsive facial disfigurements) have a place in rehabilitation. Such corrective actions tend to lower feelings of inequality, promote self-confidence, make it more easy to get and retain a job, and reduce the feeling that you are inferior.
One to two cosmetic surgery procedures were performed each week in the 1960s.
By then, Dr Lewin was at Montefiore Medical Center and wasn’t satisfied with the anecdotal evidence that he had about the success of his work. He needed empirical proof to prove that plastic surgery actually improved the chances of convicts once they were freed from prison.
Dr Lewin, after having been rejected at Sing Sing by the warden, decided to establish his Rikers Island study.
Randomly, four categories were assigned to inmates who had been accepted for the trial.
First received the largest package of benefits including plastic surgery, access to services, and assistance with housing, employment, and legal issues.
Only the second group received the plastic surgery and the third only received the support services. The control group, which received neither plastic surgery nor support services, was the fourth.
News article in Montefiore Tempo, Montefiore’s in-house newsletter, in spring 1965
In July 1964, after securing funding of $240,000, the study began.
Lewin, initially nervous that not enough people would be interested in his job, was overwhelmed by offers. He and his staff began screening candidates.
Stone wrote: “In Rikers Reception & Classification Center’s small, white, room, Lewin examined each inmate, one by one.
“Each assessment took at least thirty minutes, during which the doctor checked each patient’s medical history to make sure there were no other contraindicating issues.
The real assessment started: we had to confirm if they needed surgery. We also had to verify if their desired outcome was possible. Two metrics were used to score inmates: prognosis and severity. The severity levels of inmates were classified as either minimal, moderate or severe (one), two (two), three (three), and four (four).
He then rated them one through four, with four representing poor results and one being good. The minimum score on each axis was two. Candidates with potential unwelcome results or minor problems were turned down.
Over 9,150 screenings had taken place by the March 1965 end. 7.300 of them were accepted for surgery.
Before they were released, the psychologist team would interview the men and then assign a date for them to have their operation at Montefiore. The men’s progress would be monitored in follow-up interviews 6 months and 12 months after surgery.
The study was not without its challenges. They faced a lot of problems, such as a large turnover of prison staff and a dearth of support from other agencies. Prisoners also stopped turning up to check-up interviews or simply did not show up for the operations.
It was found that those with visible problems, such as broken facial scars or known injuries, are more likely than others to come for the operation.
It was possible that there was a correlation with education. The more educated prisoners were less likely not to attend court. Lewin suggested that this could be due to distrust in the experimental approach.
By May 1965, 17 ex convicts were undergoing operations.
Fred Marshall (a heroin addict of 280 lbs and who was dishonorably discharged by the army) was one of the first ex-prisoners treated.
Marshall was freed from prison two days later and was taken to Montefiore Hospital for liposuction.
Marshall relapsed after he failed to keep his initial six-month-long checkup. He was then readmitted back to Rikers Island. Others died from suicide, overdose, and murder.
A San Quentin inmate before and after nose surgery. Plastic surgery was believed to improve chances of getting a job and reduce the chance of reoffending.
The results of other research on plastic surgery’s effect on recidivism rates was promising in the late 1960s. Canada’s surgeon found that plastic surgery inmates had a lower recidivism rate than 75 percent.
But there was growing public disapproval of these schemes. It started with Frank Burdel Jr., an 16-year old juvenile delinquent from Cleveland, who murdered and raped his nurse after having his face reconstructed.
Michael Stratford (aged 19) sexually assaulted 13 female victims in England after he was convicted and had his nose chiseled. He admitted 12 additional offences while in police custody.
Stone says that Stone was more impressed by his nasal surgery than his ability to seduce victims.
Public began to wonder why prison inmates were allowed to have expensive cosmetic surgery without charge.
Lewin managed to complete the report despite all the obstacles. To address the particular problems faced by drug addicts, they had divided the group into addicts or nonaddicts.
Stone stated that the surgery had shown clear improvements in non-addict groups.
‘Those who’d received plastic surgery alone had a recidivism rate of 30 percent compared to 56 percent of the control group. Plastic surgery and vocational services had a 33 per cent recidivism rate.
California Institute for Women offers a cosmetology training program that teaches female inmates how to get jobs once they are released (California Department of Correction and Rehabilitation photo circa 1970s).
He said that there had been some unexpected results. For example, the only-services cohort had an 89% recidivism. The recidivism rate in plastic surgery was 32% compared with 65 percent in the nonsurgical group.
1968 saw the end of funding for SSR. The program was still seen as a template for future surgical work, and many more were authorized across the US.
There were totalling 23 state prisons, and seven federal prisons that offered comprehensive plastic surgery.
Killer Looks: The Forgotten History of Plastic Surgery In Prisons by Zara Stone is now available from Prometheus Books
Plastic surgery was included in the national youth service program. It covered psychological services as well as GED tutoring, job placements, and GED tutoring.
Stone notes: ‘This was far from the first time that doctors had targeted children’s bodies for treatment, but it was the first time it was fully adopted as national policy.’
However, in 1970s the numbers of prisoners taking legal action against prisons increased, leading to prisons shrinking and even scrapping some of their plastic surgery programs.
Along with specific concerns about inmate safety and medical care, questions were raised as to whether or not inmates felt pressured into undergoing plastic surgery.
The 1980s saw a shift in public opinion towards plastic surgery, especially regarding the high costs. While some programs relied heavily on trainee and volunteer surgeons in order to lower costs, others required fully-trained medical professionals.
A Texas hospital managed to treat almost 3000 inmates over a 1-year period at $16.4 million in taxpayer costs.
All of the surgical prison programs were closed by the middle of the 1990s.
‘Their closure can be attributed to a mix of factors: public outrage about inmates receiving “free” beauty benefits, the Supreme Court’s removal of “rehabilitation considerations” in sentencing, the scandals surrounding prisoner experimentation and the ethical violations of operating on a disenfranchised population, and a governmental directive that devalued rehabilitative solutions.’
Killer Looks: The Forgotten History of Plastic Surgery in Prisons, by Zara Stone, published by Prometheus Books, is out now