Going Under the Knife, Behind Bars


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From the 1920s to the mid-1990s, nearly half a million prisoners across America, Canada, and the U.K chose to go under the knife—and their bill was paid for by the government. In Killer Looks (Prometheus Books), author Zara Stone explores how the emergence of plastic surgery in prisons underscores society’s obsession with beauty. Read an excerpt below.

For inmate 203981—a.k.a. Nancy Willeford, to her dwindling number of friends—January 30, 1989, began like every other day inside the Texas Department of Corrections prison system. The fluorescent lights winked on at 4:00 a.m., their electric hum a gentle backdrop to daily head count and the single-line shuffle to the showers. By 5:00 a.m.—breakfast—their whirring had faded to a distant annoyance, drowned out by the mess hall chatter.

After breakfast—half a pint of milk for coffee, one egg, two cold biscuits, and a slop of gray oatmeal—the women trudged back to the dorms for another count, and then it was on to their work assignments, where they’d fold laundry, mop floors, or, if they were lucky, take a spin in the woodshop or beauty school. Assignments like the auto shop, the print shop, the license plate factory, and pretty much everything else were reserved for the male inmates; Texas detained 44,022 inmates, of which 1,000 were women.

Instead of directing her to her work assignment, a guard conveyed Willeford to a cold white room in the medical wing. Here a white-coated doctor held a hand mirror up to her face. Willeford’s watery blue eyes narrowed as she examined her reflection. Her pale skin had a gray leathery sheen to it, each line and crease exacerbated by the harsh overhead light, creating valleys and furrows in her reflection. Even her hair looked dull, its auburn tones somehow muted to mousy brown. Her hand traced the contours of her face, resting on the puffy folds under her eyes. When had these become permanent? she wondered. She couldn’t remember. She looked down. In the mirror, she was old, so old. How had this happened to her? She was only forty-three.

The doctor was speaking but there was a roaring in her ears. He’d told her his name when she walked in, but she’d instantly forgotten it. She hadn’t even tried to remember it—the prison doctors were all the same, after all, wide-eyed medical students shipped in from Baylor College of Medicine in Houston or the University of Texas Medical Branch in Galveston for a quick residency stint. They’d stay a while, until the thrill of prison dissipated, or their course credits were completed, or both, and then they’d leave, immediately replaced by another batch of fresh-faced students. “We could tighten that, get rid of this…” The doctor gently tugged at the loose skin on her face, pulling the flesh back so the years faded away. “What do you think?” Held taut, time shrunk.

Willeford frowned. What was the catch? She wasn’t some credulous fish who trusted the Department of Corrections to do the right thing. The days when she could be lured by a kind smile and shiny promises were long gone, vanished within weeks of her first go-round in 1968, on a two-year charge for murder without malice. Faces came and went, the do-gooder social workers burned out, the programs cancelled, the changes reversed—the one thing you could be certain of was that the prison always would put itself first. She was not a sucker to blindly participate in one of its games. It had enough control as it was.

Nervously, she pinched the corner of her shirt, the worn seam beginning to fray. Well, its shirt, really. Everything she wore was courtesy of the state, her shapeless white pullover and pants, the cheap cloth smoothed by the many bodies who wore it before her. The previous occupants of her clothes had been larger than she was; they’d stretched the elastic waistband so thin that she often had to hike up her pants to keep them from sliding down her hips. The cotton polyester blend was freezing in winter and scratchy in summer, when temperatures reached 150 degrees inside the cells. Texas prison summers were the worst; every few years there was a riot after one or more inmates slowly had baked to death inside the concrete blocks.

killer looks by zara stone

Dr. John Howard Crum operates on an ex-convict inside the Hotel Pennsylvania in New York City.

Courtesy of Blue Ribbon Books

Willeford had grown old inside these walls. This was her third sentence; so far, she’d served time for murder, forgery, and possession of a firearm. Currently, she was on year four of a fifteen-year sentence for attempted murder; a heist gone wrong, she’d told her lawyer. Almost half her life had been spent behind these walls. It wasn’t how she’d wanted her life to go. Not that her life had ever been easy.

She’d grown up in a single-parent home in Diamond Hill, Texas. Her mom never had much money, but they’d gotten by. Everything changed when she was seven years old, and her Mom moved in with Bill. Bill was loud, rude, and drank too much, and Mom always took his side. She couldn’t remember when the rapes started. At sixteen, he got her pregnant, but her Mom blamed her for what happened and refused to leave Bill. They sent her to a “wayward girls” home for the birth. Her Mom reappeared when baby Sherry was a few weeks old; “You’re coming home with me, and Bill and I will raise Sherry as our own,” she told her. Broke and alone, Willeford returned home with her Mom. Bill’s abuse continued. Sometimes she’d fight him, and sometimes she just shut her eyes and waited for it to be over. She drank whatever she could get her hands on, shot up anything that was offered to her—whatever made the pain go away.

Things were never going to change unless she did something drastic, she realized. To get free, she needed funds. It was tough to find work without an education—she’d dropped out of school due to the stress—but she was slim, charming when she wanted to be, and her glossy red-gold mane reached almost to her knees. She outlined her eyes in thick, dark kohl, mascaraed her lashes, and donned a low-cut top and her tight Wranglers; looking like this, it was easy to swing a job in the local saloon or diner. She loved getting a paycheck, but after the initial rush wore off, it became clear that this was never going to cut it. You couldn’t make real money doing waitressing or shopgirl work, she realized, not the kind of money that could get her out and keep her safe. She started small; a forged check now and then, a few items pocketed at the store. Sometimes she’d exchange a blowie or more for some bills.

Then, late one Tuesday night at the Buena Vista Courts, a seedy motel in downtown Fort Worth, she was cornered by an overly handsy trucker. She panicked and shot him in the head with a 44-caliber pistol she kept in her purse.

She fled. It took two months for the police to track her down and charge her. Paroled at twenty-six years old, she found that her winning smiles didn’t work as well with a criminal record hanging over her. Then she met Lathan; he was nine years older than she, with thick dark hair and a roguish smile. His family had relations to the mob, he told her, and they ran most of the scams in town. Soon enough, her mother and Bill were a horrible memory; she married Lathan, owned multiple cars, and could buy all the nice clothes and fancy dinners she desired. She wore jewelry with everything, hanging strings of glittering diamonds—certified by her jeweler—from her earlobes and neck. She basked in the appreciative stares she got around town. She liked looking good, feeling their admiring eyes on her. Her two-packs-a-day habit—and her heroin addiction—kept her slim.

But then she forged a check and was found with a gun (a big no-no as a felon), and things had escalated quickly. In prison, survival, rather than appearance, was the focus. How she looked became less and less important. Willeford felt disconnected from her body, her friends, her “real” life. But there were benefits to being good-looking inside the compound; attractive inmates received more leeway from the guards, better work assignments, and were paroled earlier. It was hard to maintain a beauty routine with so few resources.

killer looks by zara stone

A news story in Montefiore Tempo, Montefiore’s in-house newsletter, from spring 1965.

Courtesy of the Archives at Montefiore Medical Center

The commissary sold lipstick and mascara and handle-less hairbrushes, but most inmates preferred saving their meager funds for food luxuries. Instead, they used colored pencils to line their eyes and hard candy to color their lips. Contingent on the guards, of course; break a rule or cross some invisible line, and their cells would get swept, their little palettes of humanity confiscated.

How about eye bag removal surgery? the surgeon asked her. That would really open up your face.

She silently considered his offer. She’d been vaguely aware that plastic surgery was happening inside the prison—it was around during her first go-round in 1968—but it wasn’t something she’d thought very hard about. It was mostly for the men, she’d thought; there had been little outreach at the female prison. That was due, in part, to the general disregard for women in prisons, and because the surgeons were wary about accusations of improper behavior and how the women might respond to a discussion about their defects.

The majority of female prisoners in Texas was housed in women-only units in Gatesville, a small town in northeast Texas so saturated with prisoners that more than 60 percent of its residents sported state-mandated attire. Female inmates mostly had been an afterthought within the system. But during the last decade, the number of women behind bars had skyrocketed across America, from 13,258 women in state and federal prisons in 1980 to some 42,000 in 1988.5 This spike lit a fire under the corrections board, which ordered the department to be more inclusive, and that’s why Willeford was here, drumming her feet on the plastic spindle of her severe-looking folding chair.

Cosmetic surgery seemed so extreme—but then, she wouldn’t be in prison forever. She couldn’t be. The very idea made something deep inside of her choke up. She couldn’t blame her crimes on her fading looks, but… wouldn’t it be nice if she left looking better than when she came in? She didn’t trust the prison, but the doctor came from the outside. If he was willing to fix her face for free, well, she’d never been one to turn down free things. She told the doctor yes.

Zara Stone is an award-winning journalist and author of Killer Looks (Prometheus Books), from which this is excerpted.

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