– Author: Rav Yehoshua Asulin

From the sources discussed in the shiur on the subject, it seems that the major halachic challenge with cosmetic surgery is the prohibition of injuring someone (chavala). In this essay, we will explore some of the points made in the shiur regarding causing injury a bit further – the source of the prohibition, the definition, and other considerations to take into account when issuing a ruling on the matter.

The Source of the Prohibition of Chavala

Although many commentaries view any kind of injury as “chavala,” when we examine each one of the potential sources mentioned in Chazal for the prohibition individually, this conclusion does not seem to be entirely clear. There are two main sugyot that address the issue and four possible sources for the prohibition in total.

The first sugya, a baraita in Masechet Sanhedrin,[1] derives the prohibition of causing injury through a logical deduction known as a kal v’chomer. The pasuk says:[2] “לא יוסיף… להכותו” — “Do not continue… to flog him.” When a person is liable to receive lashes for the violation of a prohibition, there is a mitzva to strike him, but yet the Torah warns that one must not strike the guilty person even one extra lash more than is required. If this is true concerning a person whom the Torah permitted to strike, how much more so is it prohibited to strike an innocent person. The Gemara here clearly refers to striking someone in order to cause pain, just as in the case of the lashes given by the beit din. Accordingly, this Gemara appears to limit the prohibition to a case where one injures another.

The second sugya is found in the Gemara in Bava Kamma,[3] which cites a machloket Tanna’im whether one is allowed to injure oneself. The Gemara, in search for a source for those who forbid it, initially suggests two possibilities: The first is the verse[4] “ואך את דמכם לנפשותיכם אדרוש” – stating the punishment for one who kills oneself. The second is couched in the prohibition to destroy (bal tashchit), derived through a kal v’chomer: If one is not allowed to destroy one’s clothes, how much more so is one forbidden to destroy one’s own body.

These two sources in Bava Kamma are fundamentally different from each other. The former (killing) is a prohibition specific to hurting people, while the latter (bal tashchit) is a general prohibition of destroying anything, clothes and man alike. The Gemara though ultimately rejects both sources. The first (killing) is rejected as it may only forbid killing, which is more severe, and not just injuring, while the second is rejected because perhaps bal tashchit of clothing is forbidden as clothes never heal, but the human body heals, and injuring it might be treated less severely. The Gemara then suggests a third source – nazir. The concept of a nazir, concerning whom the Torah refers as a sinner, teaches us that anyone who afflicts oneself is called a sinner. This seems to be the source for injuring oneself that remains at the conclusion of the sugya.

If this is indeed the source for the prohibition of injuring oneself, then it would seem that injuring would only be forbidden as part of a broader prohibition to cause anguish to one’s self, and only injuries caused in a manner of affliction would be forbidden. This could lead to the following two potential nafka minot (practical applications):

  1. Cosmetic surgery under anesthesia doesn’t cause pain, and since the pain can be avoided, it might not be considered affliction.
  2. Waxing hair removal can cause serious pain (and occasionally bleeding) and could be an issue (though it is not usually assumed to be forbidden under the prohibition of chavala).

Despite the fact that the sugya appears to conclude in accordance with this opinion, one may question whether the notion of nazir indeed can serve as the source for the prohibition to injure, as the pasuk does not formulate a clear prohibition and the derivation appears to be more in the realm of aggada than halacha.[5] Consequently, the institution of nazir does not seem to be the primary source for the prohibition to injure oneself. Indeed, the Meiri[6] states clearly that it is not the primary source. He explains that once the Gemara concludes that causing affliction to oneself is considered a sin (as in the case of nazir), we can return to the first source[7] (that one who kills oneself will be punished) and suggest that it serves as a source for a prohibition to injure oneself even without killing in a case where the injury is considered an affliction. This approach is supported by the Tosefta,[8] which states that the source for the prohibition of self-inflicted injury is the pasuk “ואך את דמכם לנפשותיכם אדרוש”.

The Rambam also seems to have understood that the concluding source in Bava Kamma, i.e., nazir, is not the primary source for the prohibition of causing self-injury, as he says:[9]

Anyone who strikes an upright Jewish person in an attacking manner… violates a negative commandment, as it is stated: “Do not continue… to flog him.”

The Rambam here does not mention any of the pesukim quoted in the sugya in Bava Kamma at all. Rather, he mentions the source from Sanhedrin that only refers to one person injuring another. Perhaps he understood that since one who afflicts oneself is called a sinner, we can derive that self-injury is a subcategory of the general prohibition of injury referred to by the Gemara in Sanhedrin.

Chavala – The Definition of the Prohibition

If we consider the nature of all the above sources (one in Sanhedrin and all three in Bava Kamma), it seems that they all discuss cases in which actual damage or affliction is caused, and it is done solely for the sake of causing damage. On the other hand, cosmetic surgery is performed in order to help someone to ease their suffering. This difference may already suggest that there is room to permit cosmetic surgery in some cases and not consider it to be a standard case of injury.

The Rambam clearly follows this understanding in his pesak, as he states that one is only punished if he inflicts injury in a manner of nitzayon:[10] “But anyone who strikes  an upright Jewish person in an attacking manner…” Indeed, it is based on this interpretation that Rav Moshe Feinstein deduces that cosmetic surgery is not considered chavala at all.[11]

The same conclusion can be achieved when analyzing the source of bal tashchit in the context of clothes. In that case, everyone agrees that one is allowed to cut a piece of garment in order to fix or improve it, and this is not considered hashchata in the first place. Even in the case of the nazir, where the affliction is undertaken for the sake of affliction, if he does so temporarily in order to elevate himself spiritually, he is not considered a sinner, as most commentators on the Torah explain. This might explain, then, why the majority of poskim permit cosmetic surgery in certain cases, as we will see.[12]

Rav Ovadia Yosef[13] permits cosmetic surgery for a woman who wanted surgery on her nose and mentions two additional important arguments to support his ruling:

His first argument is that even according to those who forbid chavala for a purpose, a distinction should be made between different types of needs, as in this case, the affliction and pain is minor (as we use an anesthetic) and the long-term benefit of the woman is quite significant.

Rav Ovadia’s second argument is that Rav Menashe Klein[14] allowed a woman with a big nose to have surgery in order that people would want to marry her. Rav Klein opined that that case did not qualify as injuring (chovel), but rather as healing (merappei).

Although both reasons given by Rav Ovadia yield a lenient ruling, it should be noted that there is a fundamental difference between them. According to the former, cosmetic surgery is still considered injuring and would generally be prohibited, yet it was permitted in that case due to a great need that justified the chavala. However, according to the latter reason, the action itself is defined as one of healing and is permitted by its nature.

Whether we combine the two sevarot (explanations) or not, I think his logic points in the same direction we suggested to differentiate between the cases mentioned in the Gemara and cosmetic surgery. In all the cases mentioned by the Gemara, someone causes damage to another or to an object in a manner that eases his anger or grieving in the short term, but results in long-term damage. The total cost-value evaluation dictates that the action is one of damage. However, if the proportion is reversed, with little damage caused in the short term but resulting in a condition better than the original – by definition this is not damaging, but healing.[15]

Intervening in Hashem’s Creation: “There is no Creator Like Our God”

Although as we have seen many poskim today relate to cosmetic surgery as a form of healing, based on the fact that many individuals feel it is necessary at times, one of the prominent poskim who addressed this issue, Rav Eliezer Waldenberg,[16] disagrees, saying: “And there is good reason to claim that this is not the case where the Torah gave permission to a doctor to cure [even if we call such a procedure a treatment] …” In his opinion, it clearly does not matter how people view it.

Rav Waldenberg invokes another argument to support his view as well:

And one should know and believe that there is no Creator like our God, and He, may His name be blessed, creates and imprints His image and form on every one of His creatures in a manner that is appropriate for it. And one should not add to it, nor should one take away from it.

It is unclear whether this notion is the basis for his ruling or merely the consolation he offers to those wishing to undergo cosmetic surgery but are not allowed to do so (in his opinion). Either way, we may ask: Is this reasoning correct? Is Hashem’s creation always flawless in a manner that dictates that we should not intervene to improve and perfect it?

Without a doubt, “there is no Creator like our God” – that is clear to all. Every scientist knows that there is no substitute for the wonders of nature, and that the biological “machines” Hashem created are incomparably better than any manmade counterpart we could hope to create.

However, that itself does not dictate that we should never try to improve Hashem’s creation.[17] On the contrary, everyone knows that some people are born unhealthy or with defects. Clearly, the machine known as the human body is quite amazing, but often contains flaws, which we strive to fix and heal on a constant basis. The best example is medicine. All agree that we intervene in God’s creation to heal, and no one suggests that it detracts from Hashem’s greatness and divinity. It is clear that some parts of creation contain defects or are imperfect intentionally, not God-forbid due to Hashem’s lack of ability, but perhaps by design, in order to allow us to try and help.

Furthermore, we find that aesthetic defects are recognized in halacha as significant to the point where a kohen who has a defect (mum) is excluded from service in the Beit HaMikdash.[18] When explaining the reason for the disqualification, the Rambam[19] and Sefer HaChinuch[20] state that the masses would dismiss such people as their leaders, and the Holy Temple should be a place of splendor in the eyes of all.

We see here how aesthetic imperfection that is Hashem’s creation is nevertheless considered a defect that prevents a kohen from serving in the Mikdash. The Torah thus acknowledges severe deformities as a problem. Why, then, would we not consider fixing the problem as healing rather than injuring?[21]

The question is where do we draw the line? At what point do we stop trying to improve Hashem’s raw creation and say that the “defects” are not in fact defects?

I’d like to suggest that the answer may differ depending upon the world view of each posek. Times have changed and as a result we invariably see things differently today than some may have viewed the same treatment or phenomenon a generation earlier. For example, there are some medical conditions that are not particularly severe, but were untreatable one hundred years ago, and people were forced to live with them. At that time, perhaps we would say: This is how Hashem created you, and you should accept it. But today, if that condition can be easily cured, then we would certainly treat it. Although there is no danger to life, and not much pain, just some inconvenience, we will nevertheless still treat it to improve one’s quality of life. Perhaps this argument should hold true for cosmetic treatments as well, at least in situations where the “deformity” that the person wishes to change is somewhat noticeable by others. If so, perhaps even if one would have forbidden the procedure in the previous generation, today it might still be permitted.

Let’s explore Rav Waldenberg’s idea further. We can ask ourselves: Why is makeup allowed? If Hashem wanted a woman to have a specific appearance, how dare she change it? How can she conceal anything or add make up to her face if it’s already perfectly fit to God’s will? Why do we allow jewelry if God’s creations are beautiful as they already are? Once again, where do we draw the line?

Perhaps one will argue that we draw the line where a prohibition exists, and a woman would not be allowed to injure herself simply in order to create a more beautiful appearance. If so, then why is it so obvious that little girls may pierce their ears in order to wear earrings (which is accepted as permissible by all)? Rav Ovadia Yosef[22] uses this idea as a proof for his permission of cosmetic surgery: “Go out and see how the nation acts, where all have the custom to pierce their girls ears in order that they can adorn themselves with earrings, and no one is concerned about the prohibition of injuring oneself or injuring another since this is for their benefit and beauty.” Alternatively, perhaps it can be argued that Rav Waldenberg forbids an act that alters the person’s actual body (where there is no identifiable prior illness), as opposed to adding an exterior substance to improve one’s appearance.

Is Mental Anguish Sufficient Reason to Permit Cosmetic Surgery?

Another aspect of this question that must be considered is the need for the procedure in the eyes of the patient. The vast majority of poskim would allow even a male to undergo cosmetic surgery or treatment if they have a deformity of which they are ashamed and feel embarrassed to walk in public as a result. The reason is that such feelings may be considered an “illness,” and to treat the act of improving it as “healing.”[23]

What if someone doesn’t like the shape of their nose? Would the same aforementioned leniencies apply in this case as well? It isn’t an obvious deformity and does not qualify as a defect in a kohen, but the person is very unhappy and conscious of it. They are not ashamed to walk around in public, and do not necessarily believe that it will lower their chances of finding a spouse. Yet, they are still troubled by its appearance and struggle with a problem of self-esteem as a result. Although some poskim would not allow cosmetic surgery in this case, as this is the way Hashem created that person, I’d like to suggest that mental anguish should not be ignored, and it affects different individuals in different ways. If one will have to pay a psychologist for ongoing therapy to teach one to love one’s self as it is, can that not be considered an “illness” or a sufficient need? The fact that people are willing to pay a lot of money to undergo the procedure could serve as an accurate indicator as to how much they need it.

Of course, no surgery or change in one’s appearance can guarantee happiness. However, it can often ease the pain and allow the person to live their life normally, a point that is worthwhile to consider.[24]

In Summary

There is no question that we should educate and guide people to focus on their character and inner beauty rather than outer appearance. Furthermore, we shouldn’t encourage or allow cosmetic surgery performed for no reason other than to satisfy a person’s desire to beautify their appearance. Yet, in the complex reality in which we live, some people may feel very unhappy with their appearance. Not everything can be changed; after all, Hashem is the one and only Creator, and our abilities are limited. However, steps we can take to help people feel better about themselves should perhaps be permitted as part of the mitzvah of “ואהבת לרעך כמוך”[25] – loving our fellow like ourselves.  If it causes great mental anguish and shame, cosmetic surgery may very well be permitted. In such grey areas, it is best to consult with a posek.

[1] 85a

[2] Devarim 25:3

[3] 91b, quoted in the Tzurba shiur.

[4] Bereishit 9:5

[5] While the previous two sources refer to a punishment or a clear prohibition (according to Tosafot, s.v. hachovel, the exemption is from lashes), the pasuk concerning the nazir only calls him a sinner. In addition, the Gemara (Nedarim 10a) relates to it as a matter of guidance rather than a clear black and white prohibition.

[6] Bava Kamma 91b

[7] One could ask why we do not now derive the prohibition of injury from the second source of bal tashchit. Perhaps the reason is that bal tashchit is the “odd one out,” as the other two (punishment for killing oneself and self-affliction) both refer to a form of affliction of the body.

[8] Bava Kamma 9:31

[9] Rambam, Hilchot Chovel Umazik 5:1 (source 4 in the shiur)

[10] Rambam, Hilchot Chovel Umazik 5:1

[11] Igrot Moshe, Choshen Mishpat 2:66

[12] Note that Tosafot, Bava Kamma 91b, s.v. ela, does not permit injury even when caused for a significant need.

[14] Mishneh Halachot 4:246

[15] This is similar to the accepted business practice that when one makes a good deal, one doesn’t consider the expenses to be “monetary damage.”

[16] Responsa Tzitz Eliezer 11:41

[17] That is certainly the case with regard to brit mila, which symbolizes our partnership with Hashem, where we take the raw material he created and improve it (see the words of the Sefer HaChinuch, cited in the English Tzurba M’rabanan, volume 2, p.250, and Midrash Tanchuma, Tazria 5, concerning the argument between Rabbi Akiva and Turnus Rufus).

[18] Rambam, Hilchot Biat Mikdash Chapter 8

[19] Moreh Nevuchim 3:45

[20] Parashat Emor, Mitzvot 275-277

[21] We will not address the question of whether a kohen whose defect was “cured” by plastic surgery may serve in the Beit HaMikdash in this context.

[22] Responsa Yabia Omer, Vol.8, Choshen Mishpat 12

[23] As stated by Rav Ovadia Yosef cited previously. See also responsa Chelkat Yaakov, Choshen Mishpat 31 (source 9 in the shiur).

[24] On the other hand, one must also consider the possibility that the  self-esteem issue is much greater than the desire to simply alter the shape of one’s nose, and that it may manifest itself in other ways even following the procedure. If so, then perhaps other types of therapy may be necessary, and cosmetic surgery should not be permitted.

[25] See Igrot Moshe, Choshen Mishpat 2:66.

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