This week’s Halakhah in Brief differs slightly from the usual in that the conclusion will come first— many important authorities permit all forms of cosmetic surgery. R. Ovadia Yosef, for example, allows a married woman to have plastic surgery on her nose if she believes that her husband will be more attracted to her if she does. Our goal here, then, is not to discuss whether one may have cosmetic surgery, but to make us aware of the issues that arise in pondering the question.

I came to this issue because I received an e-mail several weeks ago, asking me whether such surgery was permissible, and several members of our community were not even aware of anything questionable about the issue; I thought it would be productive, therefore, to at least raise the issues.

The first problem is the question of injuring oneself. While the matter is a dispute (in the Mishnah and among the rishonim), we rule that a Jew is not allowed to cause injury to him or herself. That rule, without qualification, would prohibit all unnecessary surgery (and the definition of necessity would be whether there was some medical need for that surgery). However, most authorities note that Rambam ruled only that a Jew must not cause injury in a negative way— if there is some positive value to the injury, they say, then it does not get included in this prohibition. Therefore, according to these authorities, as long as the procedure is being done with the intent to cause overall benefit rather than harm, it would be permissible.

I would note that Tsits Eliezer cites an opinion that distinguishes between naturally occurring deformations and ones that happened after birth, by virtue of some man-made circumstance. While surgery to correct the latter are permissible, this view believes that naturally occurring deformities are God’s Will and we should therefore not attempt to change them. The original poseq ruled that way even regarding infertility, a position Tsits Eliezer rejects, but he does accept that view regarding more cosmetic issues. Again, I note this position not to rule that way, but because the underlying assumption— that God creates us certain ways with a purpose in mind— strikes me as true, and as worth considering in our evaluation of the necessity of at least some cosmetic surgeries. While being attractive is very important (and R. Yosef permits men to have such surgeries as well, if their deformity causes them great embarrassment), I personally would have a harder time agreeing that (for example) a great-grandmother, who has had a full life in every way, could validly claim that she needed to fix the length or size of her nose. Other cases are more clear cut, but the principle is the same-- we are not allowed to lightly cause ourselves injury, and there must be some identifiably legitimate benefit to that injury before it is allowed.

The other issue that arises is whether we are allowed to incur the danger of surgery in such cases. Interestingly, in the late 19th century, Avnei Nezer ruled that all operations were inherently dangerous, and therefore prohibited all elective surgery. Nowadays, with the significant advances in medicine that we have seen, the reality has changed. Even so, the Hakham Ovadiah notes that anesthesia involves some inherent danger to life. He makes two claims about this: 1) The lighter anesthesia used for short operations, such as cosmetic surgery, is less risky than heavier anesthesia used for longer operations—a claim of medical fact that one would have to check with a doctor, 2) If an expert doctor says there is no meaningful risk to life in this operation, one is allowed to trust that doctor. I would note that he says an expert doctor; recent studies have shown that doctors who perform procedures more regularly are more expert at them, and there is less chance of something going wrong. That would suggest that one is required to use a doctor who is thoroughly familiar with the procedure being performed, and that only such a doctor can verify that there is no danger in this procedure.

Daf Yomi