Terry’s nose was bigger than his rap sheet.
He was only 18, in a B.C. prison for crimes that “had the characteristics of a naughty child, rather than an adult criminal.”
He said his nose didn’t bother him all that much, but his friends sometimes called him Pinocchio. When he applied for the nose job, he told prison officials what he was really worried about was breathing difficulties.
But Dr. Edward Lewison noted in his report: “In fact it is quite clear he would like to be better looking.”
Lewison wanted to improve Terry’s chances of success outside the walls of the prison, so under local anesthetic in the jail’s operating room, he reshaped the cartilage.
Terry’s attitude toward prison staff improved. He completed long-distance courses, and when he was discharged he worked at a gas station, with dreams of becoming a photographer.
“This is the type of individual who could have become a chronic offender,” Lewison wrote in a 1974 paper. “The improvement in his self-image was certainly a major factor in his personality change and readjustment.” He gave equal credit for the changes to counselling from a social worker and educational assistance.
By 1974, Lewison, had been volunteering at the Oakalla provincial prison in Burnaby, B.C., for more than 20 years, fascinated by the relationship between “physical disability and crime.”
The ear, nose and throat specialist once noted that comic book heroes were usually handsome fellows like Dick Tracy, but villains were “ugly characters at whom everyone laughs.”
Lewison was part of a little-known movement in North America that hoped to answer one question: If you change a man’s face, can you change his prospects?
There was no national policy for plastic surgery in prisons, and very little institutional memory exists in Canada. The movement was spurred by individual doctors volunteering their services at places like Kingston Penitentiary and Oakalla, in addition to many American facilities.
“I always cursed this face of mine,” an inmate in Kansas State penitentiary told a reporter in 1965. “It bugged me every time I shaved. It bugged me when I tried to talk to a girl. I couldn’t stop thinking about it.”
The inmate was serving time for grand larceny when a plastic surgeon removed his pockmarks and tightened the loose skin on his face. He planned to become a salesman when he was released.
In the Kingston Prison for Women, inmates wanted to remove the tattooed names of old boyfriends. At Kingston Pen, one man wanted his bashed-up nose fixed so he’d have an easier time finding work. These were not surgeries for vanity: “All they wanted was to look normal — not glamorous,” Dr. Lorne Burdett said in a 1965 Maclean’s article, referring to the 10 inmates he operated on.
By the 1960s, stories of successful work on upside-down ears and double thumbs had attracted some media attention, but then they receded into the world of academia.
Rod Williams, a creative director with Thinking Violets, a production company in Britain, came across an article about the programs last year. Intrigued, he pitched the idea to the BBC as a documentary. Producers are now trying to track down plastic surgeons, nurses, inmates — anyone who may have taken part. In Canada, they’ve been able to determine that programs existed in Kingston and Oakalla.
Nobody really knows how it began or why it was stopped. There is some speculation that it was stopped in Texas when the public felt it was unfair that inmates were receiving free surgery.
“No one knows about it,” associate producer Harriet Mathams says from her office in Britain. “That’s why it’s so fascinating.”
Anyone who practises a craft tends to see the subtle flaws that others miss. Anne Lewison remembers how her father — a balding man of average height — saw the mistakes of human face renovation.
“You see that woman over there? She’s had a nose job,” Anne Lewison remembers her father telling her once. “They’ve taken a little too much out of the tip. If you look at her you just see nostrils.”
He wasn’t being cruel, just thinking aloud, as a carpenter might opine on a poorly hung door.
Anne, an architect, splits her time between Toronto, where her husband lives, and Manhattan. She was the Snohetta architectural firm’s project director for the World Trade Center museum pavilion.
On a sunny day in Yorkville, she talks about her father’s early years in Toronto, when he changed his name from Levinson. It was the Great Depression, and it was tough to find work as a Jewish doctor.
After he graduated from the University of Toronto, he practised medicine in British Columbia and then served overseas during the war as a doctor, later using his education grant to become an ear, nose and throat specialist and plastic surgeon.
He was back on the west coast in the 1950s when he approached Oakalla prison to volunteer his services.
Lewison wanted to do some research, “to discover if correction of disfigurements, especially of the nose, might contribute toward the rehabilitation of the offender,” Guy Richmond, a former doctor at Oakalla, writes in his book Prison Doctor.
Oakalla Prison Farm, as it was officially known, was built in the early 1900s. By the time Lewison arrived, it was usually overcrowded with “chronic offenders who keep returning, usually for minor offences.”
Richmond was a progressive who didn’t believe in capital punishment, and helped set up Vancouver’s first methadone clinic. “A man ahead of his time,” says his daughter Gillian Kydd. She remembers that her father and Lewison — “Lewie” — became good friends who worked on the project together, with the support of warden Hugh Christie.
In between his regular office hours and surgeries at local hospitals, Lewison would spend two mornings a week at the prison, fixing a couple of noses each day before leaving for a game of golf in the afternoon.
When they were children, Anne and her sister joined their father on rounds. At Oakalla they sat in the prison guard’s hut instead of the waiting room. “For us, it was just another hospital,” she says. “It was one way of being with Dad.”
It was mostly fractured noses, but occasionally deformed ears and receding chins and scars. Inmates were assessed before the procedure. People who believed the surgery would be a miracle cure for all of their problems were not ideal. The most suitable people, were under the age of 20, with fewer than five convictions, and reasonable expectations. There was always a waiting list.
Lewison saw changes in behaviour post-surgery. Hostility and incorrigibility gave way to graciousness and polite behaviour. “There was a marked inclination to co-operate with those in authority and to participate in prison activities,” he wrote.
“He wanted to see if that kind of behaviour continued — you know, what did it to do to their sense of themselves?” his daughter says.
By 1965, he had given 450 patients new noses, ears and chins, and 42 per cent had returned to the criminal justice system, compared to the prison’s recidivism rate of 75 per cent.
But Lewison had been selective in the candidates chosen for surgery; in later years, they might have stayed away from prison regardless. In a 1966 study, he would aim for a better methodology. This time, he studied 200 inmates at two B.C. prisons, Oakalla and Haney Correctional Institute. All 200 were approved for surgery, but only 100 received it. In his 1974 paper, he wrote that fewer than half of the people who had surgery returned to prison, while 69 per cent of the men without surgery returned.
Lewison wrote that perhaps the inmates changed because their disfigurement, now erased, had contributed to their delinquency. Or maybe an inmate was so grateful to the surgeon for the “unusual favour” that he felt obliged to “reciprocate” through better behaviour. There were many possible explanations, he wrote.
“Modern research has shown that there are no perfect individuals and few unreformable, but simply people who can be influenced to be better or worse,” the doctor wrote.
Lewison died in 1993. He hated the spotlight and never sought acknowledgment. He was just motivated by a strong sense of what was right, says his daughter.
He is mentioned several times in the annual report of B.C.’s “Inspector of Gaols” as someone who gave his services free, boosted morale and helped grateful inmates, “however slow their progress.”
Still, there were some who boosted their confidence in a way that was not exactly a credit to the project.
Lewison called it an interesting “sidelight” — that these inmates with improved faces had given up on ordinary crime for more subtle, sophisticated techniques, and careers as confidence men and cheque artists.
Does plastic surgery really help inmates?
In 2015, “the notion that you just correct a facial deformity in someone and they’re going to change their behaviour” is not taken very seriously, says Kevin Thompson, criminal justice professor at North Dakota State University.
“Today we’re much more into trying to find deficiencies at an early age and correcting them with a lot of skill building,” he says. Thompson lists examples such as education, self-control, impulse regulation and social skills.
In 1990, Thompson looked at nine plastic surgery programs in mostly U.S. prisons and noted that six indicated that surgery lowered the likelihood of recidivism, two found no difference, and one showed an increase in return visits to prison. The problem was that most studies used the recidivism rate of the general prison population, or statewide statistics, as their control group, which made it difficult to eliminate “alternative interpretations of the data.”
“They were just too sloppily done, most of them, to be able to arrive at some definitive conclusion whether plastic surgery works or not,” he says.
Thompson explains that in the 19th century, early criminologists such as Cesare Lombroso believed that hardened criminals were physically flawed people. The idea was later discredited, but the notion of physical abnormalities being a barrier evolved in the 1950s and 1960s with “strain theory.”
“That would be the impetus behind a lot of this that these guys claimed their disfigurements were holding them back, they weren’t able to have decent relationships or get decent employment,” Thompson says of the inmates.
In his 1990 study, Thompson noted that it wasn’t clear whether disfigurements were a cause or effect of antisocial behaviour. Sure, there was research from the 1970s that showed that unattractive people were treated unfairly in many ways. That bolstered the theory that unattractive people who face rejection can develop a poor self-image, which can create problems with employment, friendship and academic success. These people may be driven to a deviant group “because they are stymied in their attempts to fit in” with conventional society, he writes in his paper.
But Thompson wondered about causation. What if people who break the rules are rejected by society, and because of that, they’re perceived as unattractive? He pointed to research that shows more than half the deformities in prison are traumatic (broken noses, knife scars) or acquired (needle marks, tattoos). “This suggests that a host of physical deformities succeed rather than precede anti-social tendencies.”
Thompson doesn’t know how common the plastic surgery programs were in the U.S., but believes thousands of inmates likely had the procedures.
If you have any information about plastic surgery in prisons, contact firstname.lastname@example.org.