Passing: Fred Korematsu and the Wartime Reconfiguration of Plastic Surgery

Abstract

Plastic surgery has long reflected and reshaped prevailing societal ideals of beauty, identity, and belonging. This historical review explores the lesser-known intersection of racial identity and reconstructive surgery through the life of Fred Korematsu, a Japanese American who resisted internment during World War II. Korematsu’s attempt to alter his appearance—reportedly through rhinoplasty and possibly a “double eyelid” procedure—to evade capture reveals the fraught ways plastic surgery was employed not just for healing but for survival. Set against the backdrop of Executive Order 9066 and the internment of over 100 000 Japanese Americans, this paper juxtaposes Korematsu’s story with wartime advancements in plastic surgery that served injured Allied soldiers and covert operatives in Europe. Surgeons like Harold Gillies and Archibald McIndoe advanced techniques to restore identity and dignity to disfigured soldiers, while others modified facial features to facilitate espionage or assimilation. The paper critically examines how reconstructive surgery became both a tool of liberation and a reflection of beauty standards. It also traces the use of surgical assimilation beyond WWII, including in postwar Asia and during eras of segregation and colonialism. By framing Korematsu’s experience within this broader historical and ethical context, the review interrogates how surgical practices, even when evidence-based, are vulnerable to sociopolitical pressures. Ultimately, it challenges modern plastic surgery to move beyond aesthetic norms rooted in assimilation, advocating instead for identity-preserving, patient-centered approaches.

Introduction and Historical Vignette

In its early stages, reconstructive surgery served as a lifeline for individuals injured in World Wars I and II. ¹ As such, plastic surgery advancements during wartime became a beacon of hope for those with socially stigmatized features, allowing them to escape discrimination, hate crimes, and even death.^1,2 Amid the commendable strides in techniques developed by surgical pioneers such Harold Gilles, the “father of modern plastic surgery,” in response to wartime injuries, a parallel narrative emerges—one that gains poignancy when contextualized against the backdrop of the Japanese Internment Camps in the Western United States at the conclusion of the Second World War. The story of an Asian-American named Fred Korematsu shows how war reconfigured the role, possibilities, and expectations for surgery of the face in less recognized, albeit indelible ways.

Fred Korematsu was born on January 30, 1919, in Oakland, California, to two Japanese immigrant plant nursery owners. In his early 20s, anti-Asian prejudice culminated with the passing of Executive Order 9066 in 1942. ³ Korematsu refused to relocate to the nearest internment camp with his family as required by this order; and instead, he adopted an alias named Clyde Sarah, claiming Spanish-Hawaiian ethnicity. ⁴ Soon after, he was arrested by the FBI and federally convicted for violating the executive order. ⁴ While early news reports claimed Korematsu underwent a ‘double-lid’ surgery, his later recollections denied this, stating he only had a nasal repair procedure. ⁵ Regardless of the exact intervention, the suggestion itself underscores a cultural moment where plastic surgery was seen as a viable tool for racial passing. We propose that Korematsu’s decision to alter his identity through surgery or other means was not made in isolation, but rather reflected the heightened animosity that defined America’s wartime home front—an atmosphere in which appearance alone could determine one’s freedom, safety, or persecution.

Increasing Wartime Prejudice

Reconstructive surgery for head and neck injuries incurred at war remained in high demand through the eve of the Second World War as a tripartite alliance formed between Italy, Germany, and Japan. Years before, California had been home to an estimated 97 000 Japanese Americans due to a post-railroad and gold mine wave of immigration to sustain the labor market on the West Coast. ⁶ Like their Chinese counterparts, Japanese Americans were the brunt of institutionalized discrimination before WWII but thrived as the prominent labor force in major Western American cities, including Sacramento and Los Angeles. ⁷ However, at the top of the 1940s, Japanese expansion moved eastward from the mainland to overtake islands dominated mainly by United States and United Kingdom naval forces. This expansion as well as the attack on Pearl Harbor exacerbated the already present tensions in the U.S. against the Japanese and Japanese Americans. It became clear that America had identified its enemies abroad and at home.^7,8

The Japanese attack on Pearl Harbor on December 7, 1941, initiated the official involvement of the U.S. in World War II. On February 19, 1942, just 2 months after the Pearl Harbor attack, President Franklin D. Roosevelt enacted Executive Order 9066, directing the Secretary of War to

“prescribe military areas in such places” [. . .to ensure] “protection against espionage and against sabotage to national defense material, national defense premises, and national defense utilities.” ⁹

This order did not specify who would be retained in these “places.” However, as the ink dried from Roosevelt’s pen, Lieutenant General John L. DeWitt of the Western Defense Command issued Public Proclamation Number 4, which specifically targeted Japanese Americans. ¹⁰ This proclamation led to the forceful evacuation of hundreds of thousands of families from military zones, relocation to internment camps, and subjection to curfews and other social restrictions. ⁶ Those who did not comply paid hefty fines and or faced criminal prosecution.

Wartime Development of Plastic Surgery

With Pearl Harbor marking America’s involvement in the war, American surgeons naturally adapted European wartime advancements in plastic and reconstructive surgery. During this time innovations like Dr. James Barrett Brown’s split-thickness graft, Dr. Joseph Murray’s bridge graft, and Dr. Bradford Cannon’s xeroform-like wound dressings were developed.^11–13 Sir Archibald McIndoe, younger cousin to Gillies, refined flap techniques for wounded soldiers with severe facial wounds and burns. At Valley Forge Medical Center, McIndoe treated 647 members of the “Guinea Pig Club”— a haven of camaraderie and identity restoration for soldiers recovering from horrific facial injuries. ¹⁴

Plastic surgery’s strategic uses spanned both sides of the globe both before and after the war. Across the Atlantic, British Special Operations Executive (SOE) utilized plastic surgery as part of its covert operations to support espionage in enemy territory during World War II.^15–17 In his memoir, That Drug Danger, Dr. James Hutchison described his work with other SOE surgeons, Dr. George Bankoff and Dr. Arthur Rainford Mowlem, who co-led the camouflage section in the 1940s and 50s, projecting more European facial features on agents to aid their missions in France and England. ¹⁵

Just as the Allies used facial modification for strategic wartime concealment, others across Asia and the U.S. began to employ surgery for social and cultural concealment—particularly as American occupation developed alongside shifting beauty standards on the Asian continent. Similarly, after Japan’s surrender in 1945 and leading up to the Korean War, American surgeons Dr. Ralph Millard and Dr. Howard Rusk popularized procedures that modified Korean facial features, aiming to align their appearances with western standards of beauty.^18-20 Millard and his mentor Harold Gillies documented these techniques in their book, noting patients’ desires to undergo surgery to assimilate into American culture. ²¹

It was against this backdrop that Korematsu resorted to a means of identity alteration to live in peace and freedom. In 1976, 31 years after Japan surrendered, the U.S. government finally acknowledged the egregious social repercussions of the executive orders and proclamations affecting the Japanese during WWII and overturned Executive Order 9066. ²² Years later, Korematsu’s case was reopened on the grounds of Ex parte Mitsuye Endo and, this time, closed in his favor in 1983. ²³ Fred Korematsu Day is celebrated yearly as U.S. holiday on January 30 (his birthday) to commemorate his activism.

Broader Applications

Since its inception, reconstructive surgery of the face has been inextricable from its profound influence on and reflection of society. Despite the recent application of evidence-based methods, this craft remains vulnerable to our biases, strikingly reflecting humanity’s normative standards of health, personhood, and justice. Yet, amidst the complex narrative of reconstructive surgery, it emerged as a lifeline for survival during WWII that simultaneously shed light on prejudice that permeated the world. ²⁴ Moreover, it exposed a system of inadvertently legalized and systematic injustice. However, we know this pattern is not exclusive to this era or the United States, and echoes throughout history in other parts of the world.

The surgical impact on identity was consistent between Korematsu and Gilles’ patients. This struggle for identity finds echoes in a nation that, during the Jim Crow era a few years later, encouraged the sale of skin-bleaching and hair-straightening products to African Americans—who, if appearing more Caucasian, were less likely to be targets of discrimination. Similarly, this genealogical shame is mirrored by the Hutus in their prosecution of the Tutsi tribe during the Rwandan Genocide. Recently, more thoughtful research and commentary is aimed at correcting racialization of facial features, as techniques and their descriptors are revised to become more patient-centered.^24-27 Yet, the field must be further safeguarded against implicitly enabling and promoting assimilation. ²⁸

Conclusion

The lives of Fred Korematsu, countless other Japanese Americans incarcerated during World War II, and soldiers sustaining horrific facial injuries at the front lines reflected a world confused about identity. Individuals who had spent most of their lives shaping an identity were abruptly compelled to redefine it, and the advent of facial reconstruction techniques provided them with the means to do so; and underwent these procedures to heal wounds inflicted by their enemies. This historical and political milieu uniquely reshaped the relationship between identity and the face during and after times of conflict.

As the innovative front of plastic surgery advances, it oscillates between innovation and conformity to social norms before realigning with a broader acceptance of diverse beauty ideals. So, as some continue to scrutinize plastic surgery for merely fostering vanity, they would be remiss to ask themselves, “What parts of one’s identity are going under the knife? Why? And, how does this reflect our world?”