Madame X

Madame X“Madame X” is a painting by the famous 19th Century American portrait artist John Singer Sargent. This painting has always struck me as an unabashed celebration of the nose. I have enjoyed this painting long before I became a rhinoplasty surgeon, and seeing it again through the eyes of a surgeon, gave me pause. This was painted in a time before cosmetic rhinoplasty. In fact, I think that if Madame X walked in to a plastic surgeon’s office today, they may well tried to persuade her to have rhinoplasty as, according to the modern aesthetic, her nose is prominent.


To be more precise, most rhinoplasty surgeon’s critiques would likely include descriptive terms such as an “overprojected tip,” “too much columellar or nostril show”, or “tension nose deformity.” To my eye, I can see all these “deformities,” but I am still struck with her beauty, as Sargent clearly was. Her nose is prominent, but each feature is beautiful: the undulation of her nasal bridge, the slight visual depression of the profile separating the nasal tip from the bridge, the delicate tip, the forward pointing of the nostril shadow, and the second angle or double break under the tip as the nasal profile returns to the face.


What makes her nose beautiful is how well suited it is to her face: distinctive, detailed and bold. It is prominent, but it is well balanced with her strong chin. It is complex in detail as one might imagine her real life personality might have been. Sargent’s bold and dark strokes of background outlining the fair and delicate contour of her nose declare his confidence in her beauty and suggest that Madame X is fully self-aware and confident of her appearance and uniqueness. She seems to have turned away from the artist in a bit of defiance, while simultaneously and self-consciously highlighting her profile for the artist’s enjoyment.


If Madame X walked into my office today, I would not touch her. Certainly my instinctive critique and analysis of her nose might lead me toward an attempt at some vain, generic perfection. As I tell young surgeons, “Just because you can do something, does not mean you should.” Judgment and appreciation of the multiplicity and complexity of beauty should make us all stop and appreciate how beauty is about cohesiveness and harmony rather than its dissected elements. What “MadameX” reminds me of is the intellectual space between the artist and medical scientist that I live in every day.