The Responsa of Rav Moshe Feinstein in Choshen Mishpat 2:66 (In Volume 7 of Igros Moshe) can be found in the original Hebrew version
Here. The following is my translation with my comments.
66. Is a Young Woman Permitted To Beautify Herself Through The Use Of Surgery Which Causes a Wound To Her Body?
Rav Moshe's Responsa:
It was asked of me if, in order to get married, a young woman can beautify herself through a doctor using surgery which causes an injury to her body. Is it permitted with regards to the prohibition of "Injuring Oneself?"
It is [found] in Tosfos, Babba Kama 91b heading
Rather [this Tanna], that there is a prohibition to injure oneself even in a necessary situation. For example, [the case in the Mishna on 90b (
found here) of it being forbidden for] a woman to uncover her hair in order to place an isar (some amount) equivalent of oil on her head for a benefit (she was damaging herself, by uncovering her hair, for a benefit, but it was still deemed impermissible). If so, even here (by having plastic surgery in order to get married) which is considered a great need, apparently it would be forbidden because it is a stretch to [try] and separate between a small need (this case quoted from the Mishna) and a great need (our case of a woman wanting to get married) as long as we can not find an explanation [of the difference] (between a great need and a small need).
However, we can ask a question on this [understanding of Tosfos] from the conclusion that this Tanna is Rabbi Elazar Hakafar in the name of Rebbe. This Tanna holds that a Nazarite is a sinner because he causes himself grief [due to] wine and there is a fortiori argument (kal vichomer in the Gemara found
here) for the one that causes grief to himself with an injury (that he is also a sinner). [However,] it is clear that logic dictates if he (the Nazarite) had a monetary benefit or another type of benefit when he is causing himself grief by not drinking wine, this would not be forbidden. If this is so, then it also holds true by one who injures himself, which we learn from a fortiori argument [from the Nazarite,] that it should not be forbidden when there is a need (to cause the injury) for monetary gain or some other need. [Therefore,] how can Tosfos write that even if it is necessary (for some benefit) it is forbidden to injure yourself?
[To understand Tosfos] we need to say that [the case of] holding back from drinking wine for any beneficial reason is not considered to be causing grief since the beneficial gain (from not drinking the wine) is greater than the grief it causes. For, [if he were to] drink then he would not gain [anything] and this would cause even more grief [than not drinking in the first place] because he would lose [whatever beneficial] gain he would have attained if he did not drink the wine. [This means] all of the grief that occurs from withholding from drinking wine is only from the aspect of his desire to [drink wine] (meaning, a person only experiences suffering from withholding wine because he desires to drink it). [However,] by us he has a [greater] desire to [attain this beneficial] gain [he gets from not drinking] (Therefore, we see this guy is actually not suffering at the end of the day). However, injuring himself causes actual grief (physical, materialized injury) that is not from the aspect of [one's personal] desires, it is not interchangeable with the grief of not [attaining a beneficial] gain that is only [considered grief] from the aspect of a person's desire to profit. [In a situation] that a person wants to injure himself in order to profit, that he has a great desire to attain monetary gain and therefore is willing to suffer grief, this is [still] forbidden.
Furthermore, according to the [final] law we do not hold like Rabbi Elazar Hakafar in the name of Rebbe and, nevertheless, the Rambam decides in the beginning of Chapter 5 of
Injuries (Chovel) that it is forbidden to injure oneself, like it is stated in the GRA Yoreh De'ah Siman 236 Seif Katan 6. If this is so (that the GRA is right about the Rambam holding that injuring oneself is forbidden) he is learning it from somewhere else (and not Rabbi Elazar Hakafar in the name of Rebbe) that it is [forbidden] in every situation, even when there is a need.
However, in any case, if it is necessary according to Rabbi Elazar Hakafar in the name of Rebbe to say that when it is needed [to injure yourself] it is permitted, that would be a proof that everyone holds [when it is needed then it is permitted] because we don't find anyone who argues [on Rabbi Elzarar Hakafar in the name of Rebbe.] Also, concerning the Mishna that is dealing even with [a case of] there being a need and Rabbi Akiva says it is still forbidden the Gemara brings it from Rabbi Elazar Hakafar in the name of Rebbe saying that even according to Rabbi Elazar Hakafar in the name of Rebbe it is forbidden to injure yourself even when there is a need (This reveals that, according to everyone, injuring yourself is forbidden even if there is a need). Therefore, it is necessary to say like I answered (Basically, that an actual injury to yourself is not allowed even if done for some type of gain, but a denial of a desire that causes you non-physical pain would be allowed).
Still, the Rambam writes in the beginning of chapter 5 of
Injuries (Chovel) with regards to the prohibition of hitting an upright Jew, this [prohibition] is for hitting in the way of strife. According to another version it is referring to [hitting] in a derogatory fashion, see there (
English,
Hebrew). If so (that the injury is prohibited if it is done in the way of strife or degradation), with our situation (plastic surgery) that the injury is to beautify and there is no [injury] in the way of strife or degradation then the prohibition is not relevant. [Furhtermore,] if injuring a friend is only [prohibited] when done in the way of strife or a derogatory fashion then also with self inflicted injuries it is not forbidden when done to beautify because that [also] is not done in the way of strife or in a derogatory fashion.
This idea that my friend Rav Tuvia Goldstein SHLITA [learned] from the language of "And not just the injury itself, but all who injure upright Jews in the way of strife transgresses a negative commandment" that the condition of "the way of strife (that the Rambam says)" is only with regards to the blow and not the injury, does not make sense. For, whether it is [referring] to the injury or the blow, it is all learned from the one verse of (Devarim 25:3), "Do not add." This implies that, according to the Rambam, the adding of lashes is considered the way of strife and degradation and from this [verse] you are not able to learn about the blows that are not given in the way of strife or degradation. If so (that our logic is correct), then the injury is specifically included in the way of strife or degradation and this condition of "the way of strife" also applies to the injury (not just the blow) because it is irrelevant to try and separate a teaching in one verse (meaning, it is not the correct thing to do to separate the injury and the blow which are both learned from one verse).
A proof to the Rambam's opinion can be brought from that which was said in Babba Kama there (91b,
translation in Soncino), "R. Hisda, whenever he had to walk between thorns and thistles used to lift up his garments Saying that whereas for the body [if injured] nature will produce a healing, for garments [if torn] nature could bring up no cure." If every injury is liable (forbidden to be done) how was it permissible for him (Rav Chisda) to go between the thorns and thistles without clothing [protecting his feet]? This would [definitely] cause an injury to himself and would be a transgression of the prohibition of causing an injury to oneself even though it was not his intention, but it is a pesik Reisha (sure thing that it is going to injure him) since it is a stretch to say it was done in a way that it was not a pesik Reisha (not a sure thing to injure him). Therefore, we need to say that the prohibition of injuring only applies if it is done in the way of strife and since [Rav Chisda] needed to walk [through the thorns and thistles] this is not considered the way of strife and there is no prohibition [for what Rav Chisda did.]
We need to say that there are [situations] of need that are prohibited when they are done with the intention to cause grief. For example, someone who tears [their clothes] because of a dead person that it (this tearing) causes extra grief [in addition to] his grief over the deceased and he wants to destroy [something] (this is not allowed). However, according to this, with [regards to the issue of] injuring oneself, it should also be prohibited for a person to scratch [themselves] because of the deceased. For, the desire and need is to cause [more] grief from this [scratching] and this is done in the way of strife and degradation which is prohibited even if there is a need, because the desire to have [added] grief is considered a need to him (the one mourning over the deceased). [The reason this is prohibited is because] the Torah prohibited injuring yourself in any way [that was done within the boundaries of strife and degradation.]
[However,] we can ask from this [law] of scratching because of the deceased that it required a different verse [to prohibit] it (Vayikra 19:28). [This seems to imply] that scratching because of another distressing factor, like a house that collapsed, or a boat that sank in the sea, there [seems to be] no prohibition, like that which is seen in the Gemara in Makkos 20b. It is difficult to suggest that [the verse that says you can not scratch yourself because of the deceased] is an extra prohibition and the exception to this prohibition is that of when the house collapses [and it is permissible to scratch yourself. However, this] is only an exception to that verse, but it is still prohibited because of the law of injuring yourself. [The reason it is difficult to claim this] is because
Tosfos says in Sanhedrin 68a, with regards to the incident where Rabbi Akiva struck himself until blood flowed down upon the earth [after] the death of Rabbi Eliezer (
See Gemara in English here) says, "There [is no prohibition of] scratching oneself [here] because he did it because of Torah [learning], like [Rabbi Akiva exclaimed, "I have a many coins] but no money changer to accept them" (Meaning, I have many questions on Torah, but no one to answer them). (Tosfos seems to be saying that one is allowed to scratch themselves if they are scratching themselves for a reason other than grieving specifically for the deceased. In Rabbi Akiva's case, he scratched himself because of all the Torah learning he would miss out on and that seems to be allowed without any prohibitions.)
However, we can still ask because of the [prohibition of] injuring oneself [it should be forbidden (to cause yourself extra grief through scratching). In fact,] Rabbi Akiva in the Mishna (
Babba Kama 90b) holds that it is forbidden to injure yourself. And it is difficult to say (to give an answer to our question of it should still be prohibited under the law injuring yourself) that this (that one may scratch himself for any reason other than causing himself grief over the deceased) is like Rabbi Akiva of the Braisa (
91a) and not like Rava that holds according to Rabbi Akiva of the Braisa it [really] is forbidden to injure [oneself (just like the Mishna),] because then we could ask from the Braisa in Sanhedrin (68a, where Rabbi Akiva actually injures himself).
[Furthermore,] we can't say that scratching is considered giving honor to the deceased by [showing that one is] especially grief stricken because of him (or her) to the point that a person scratches and causes groups [of scratches] in their flesh and, therefore, this [would not be] considered the way of strife (thereby it would not be forbidden). [The reason is,] even for honoring the deceased [in this way,] this is considered the way of strife and degradation since the honor of the grief and degradation is because of [the deceased.]
We need to say [the reason this scratching is not prohibited under the law of injuring yourself is] that he is silencing his grief with this [scratching and it] is like that which is said in
Gemara Shabbos 105b.
Rashi explains the phrase in the Mishna (there) about he who tears in anger according to Rav Avin who says it is a reparation, for it calms him down because he forgets his anger (this guy that is angry and tears something is soothed because the ripping makes him forget his anger). So too, when someone injures themselves it [helps] him forget and silences his grief and anger that he has from the deceased. Therefore, this is not considered the way of strife and degradation, [therefore,] the aspect of the prohibition of injuring himself is not present. Only because of another prohibition, that of scratching because of the deceased [is present. However, scratching oneself] because of his collapsed house or boat that sank is not prohibited and, therefore, Rabbi Akiva's [case] was permitted because his grief was over the Torah [learning and the scratching was] to quiet his grief.
I saw in the Orech La'ner in
Yevamos at the bottom of 13b this question (about Rabbi Akiva saying it is prohibited to injure yourself, yet we see Rabbi Akiva injured himself) and his answer was [if you scratch yourself] because of honoring the Torah it is permitted, just like there is no [prohibition of] waste when mutilating [an animal] for a royal funeral (This is a transgression of wasting the animal, but since it is for the honor of royalty it is allowed because of the honor given). [However,] this does not appear to be correct at all because there is no honor for the Torah with this (scratching yourself). [In fact,] the Torah despises this kind of "honor." [Also,] in Tosfos it does not mention the word honor, rather [Tosfos explains that] he was grief stricken over the Torah [that he would miss out on] when it says "I do not have a money changer." Furthermore, this is found in the
Shach in Yoreh De'ah Siman 180 Seif katan 10.
Additionally, the answer that [Rabbi Akiva scratched himself] unintentionally and did not expect blood to come out with his blow, just like the [story] of
Rava in Gemara Shabbos 88a, "While the finger[s] of his hand were under his feet [and he ground them down, so that his fingers spurted blood,]" this is [also] not right at all. Over there[, by Rava,] his fingers were placed in a way that it was not a blow. Also, the grief (or pain) was minimal because the legs just happened to be [in a position] that crushed [the fingers] and he did not [even] think about it, that is why it is relevant to say that it was unintentional. However, where [Rabbi Akiva] hit himself with the intention to cause himself grief (pain) it should definitely enter his mind that [the blow could cause] blood to come out, so how is it relevant to consider that [Rabbi Akiva hit himself] without intention?
Also, we can not answer like that which the
Bais Yosef holds in Yoreh De'ah there (Siman 180) that if it is a different grief (other than a deceased person) it is permitted [to scratch yourself] (The reason this answer can not be accepted, in my opinion, is because it does not answer the question. First of all, why is a scratching other than for a deceased person allowed from the aspect of injuring yourself? Second, why is injuring yourself on account of the deceased not prohibited under the laws of injuring yourself? Why does it need a separate verse?). So too, the Ramah holds this there (
Siman 180 Seif Katan 6). Rather, we need to say as I have explained.
See the Shita Mikubetzet in Babba Kama 91b in the name of the Ramah that says that this [case] of Rav Chisda teaches us that a man is allowed to injure himself and we rule like him since he is a later [authority.] However, he asks on the Rambam why he says [injuring himself] is prohibited. But, [the Rambam] is as I have written that he only holds [injuring yourself] is prohibited if it is done in the way of strife.
However, it appears that we can ask from
Sanhedrin 84b that Rav would not permit his son to extract a thorn [from his flesh, since in drawing it out he would make a slight wound. And the Gemara] asks, if so (that this is prohibited because it makes a wound) then it applies by other [people] as well (even if they are not a son). However, this injury is not done in the way of strife and degradation since his intention is to extract the thorn and there is no prohibition of "do not add" (Devarim 25:3, with regard to lashes). Also, this is not similar to a son [causing an injury to] his father which [the son is then liable] to [die by] strangling even if the wound is not in the way of strife or degradation, where the only exception is for healing (the son is not put to death if he causes an injury to the father while trying to heal, but he is put to death in other situations even if the injury was not caused in the way of strife or degradation).
And we need to say that there is a fear (in the case of Rav and there is a good question from this Gemara) that perhaps [the son] will injure [the father] more than what is considered the way of healing, like is found in the Nimukei Yosef in the name of the Ramban (19a on the pages of the Rif). The intention is that this (act of healing by the son for the father) should be done in a way that [the son] is able to be careful that he does not injure [the father] more than necessary. But, if he can not be appropriately careful because of the bother and this injury is larger [than necessary] it is considered [to be done] in the way of strife and degradation since it (the injury) was not needed for healing. [Also,] this warning, for a man is always considered forewarned, is like he did not think about the prohibition (for a son to injure a father) due to his laziness to [heed] the warning. Therefore, we find that he transgressed the prohibition of injuring through negligence. [Hence,] this is a good question (what we originally asked, that it should apply by other people as well) and it should be prohibited [for everyone] if there is this concern with a son to his father (that the son pulling out the thorn may damage his father more than necessary).
In fact, from the [idea] that the Gemara explains, that it is permitted to let blood from a friend, and we ask if it is permitted for a son to [let blood] from his father, this is a proof that the prohibition to injure, that we learn from (Devarim 25:3, with regard to lashes) "do not add," is specifically in the way of strife and degradation and not when an injury occurs during healing. However, with regard to injuring your father, that it simply says (Exodus 21:15) "Strike," there is room to say that even in the case of healing [the son] will be liable [for punishment] when there is no danger, for the law of saving a life pushes off [this law (but when there is no danger, healing does not push off any laws).] If so (that you are allowed to let blood from anyone and there is no prohibition of injuring because it is not in the way of strife and degradation), you can learn from this that also in a case that is not for healing, if the injury is in a way that is for his (the person receiving the injury's) good and it is not in the way of strife and degradation it is permitted, like the Rambam holds.
[Therefore,] we are forced to say that this question of it should also be forbidden for another (not just a son to a father) when removing a thorn is because there is a warning from injuring more than what is necessary [and if an injury does occur then it] is considered the way of strife and degradation, like I have answered.
Additionally, there is a proof from the story in
Sanhedrin 89b of where Micah says to his friend, "Please, smite me," that the one who refused to smite [Micah] was punished by being stricken by a lion. The Gemara asks, "From where did he (the one who refused to smite Micah) know he should be punished?" The Gemara answers, "Where [the prophet is] well established (as a prophet) it is different" (Even though Micah did not give a sign that he was a prophet, since he was an established prophet, this "friend" should have listened to him. See the Gemara there for a better understanding). [The Gemara] needs to prove this [idea] from Avraham at Mount Moriah and Eliyahu at Mount Carmel (that they were listened to even though they had not performed signs because they were established prophets) and [the Gemara] does not prove [its point] from this [case of Micah] itself. If you don't say this (that Micah is an established prophet and, therefore, you believe he is speaking the word of G-D) it would be forbidden to listen to him (Micah) because of the prohibition of (Devarim 25:3, with regard to lashes) "Do not add." We see that from the aspect of the prohibition of "do not add" it was permitted [for the "friend" to hit Micah] since [Micah] said to him that it was the word of G-D that he should be hit and that [makes it] not the way of strife and degradation.
[Furthermore,] even if [Micah] was not yet established as a prophet and it was not permitted to trust him to transgress a prohibition, nevertheless, since he did not say that he should be hit because he wanted to injure himself, but rather because it was the word of G-D, and he believed this was [the word of G-D], in no way is this considered the way of strife and degradation. Also, [this friend of Micah was] permitted to believe [Micah] since he is a great and wise man and it would be appropriate for him to receive prophecy. [This is true since] even if there is no obligation to believe [a prophet] until he performs a sign and wonder,
like the Rambam says at the end of Chapter 7 of Yisodei HaTorah. Nevertheless, [the Rambam holds] it is permitted to believe him when he is fit for prophecy since if the truth is like his words, then there is no prohibition at all. (Therefore, since the injury would not be in the way of strife or degradation it is allowed)
[Plus,] you can not push off the prohibition (of injuring) from the aspect that it is a command of a prophet because he is only permitted to be believed [to give a command] if he gives a sign or is an established prophet. However, if the prohibition of injuring applied in every situation (even if the injury would not be in the way of strife and degradation) and it was only because of the commandment of the prophet (that Micah was telling the friend to hit him), he would be obligated to transgress the prohibition of injuring and [the Gemara] would have proved this idea that a prophet who is established is different and does not need a sign from this case [of Micah] itself (and it would not have needed to bring Avraham or Eliyahu to prove this idea). If this is so (this explanation of the Gemara in 89b), then it would be a proof to the Rambam (that the prohibition of injuring only applies when it is done in the way of strife and degradation).
Accordingly, it appears from this [reasoning] that it is permitted for a young girl to beautify herself even if it is through causing an injury [to herself] since [the injury] is not done in the way of strife and degradation, but rather the opposite, [it is done] for her benefit.
See
Sanhedrin 84b that Rav Masna says a son is allowed to let blood for his father because of the verse (Vayikra 19:18), " Love your neighbor like yourself," and Rashi explains Jews are warned not to do things to their friends that they do not want done to themselves. It is obvious that the intention is not for a person who does not care to do something to himself that he can then do that [action] to his friend, rather anything that is not for his [neighbors] benefit [is no allowed.] For example, a person who wants to cause himself affliction or injuries, this is definitely forbidden to do to your friend even according to the one that holds injuring yourself is permitted. Not only with regards to injuries [does this idea apply,] but even by a man that does not care about his shame. [This is] not only to uphold the Mishna in Avos Chapter 4 Mishna 4 that says, "Rabbi Levitas, a man of Yavneh, said be extremely humble," see over there the Rambam's commentary on the Mishna with the occurrence with "that" righteous [person.]
Rather, even if it is a person's nature not to care that it is forbidden for him to mock his friend, on the contrary he is obligated to honor his friend, and [he does not care that] it is a great sin to whiten the face of your friend (embarrass your friend) from the prohibition of "you shall not bear a sin on his account" (
Rashi says this means "
[in the course of your rebuking your fellow,] do not embarrass him in public"). [and] if [the embarrassment] occurs in public the punishment is [the one who embarrasses] loses his share in the World-to-Come, like is explained in the
Rambam in Chapter 6 of De'ot halacha 8 (
Hebrew here) that the prohibition to embarrass a [fellow] Jew is even in private and [the Rambam] does not mention a difference to say that a humble person (who does not mind being embarrassed) is permitted to embarrass other people. If this [reasoning is correct then] also a man that wants to torture himself with afflictions and injuries, it is forbidden for him to afflict and injure his friend.
However, the intention of Rashi (in Sanhedrin 84b) that an injury like this, that is for benefit, like blood letting, that every man wants and desires to do this to themselves from the aspect of a person's love for themselves, it is not relevant to forbid him from doing this [beneficial] action to his friend and you do not need a verse to allow this [action.] Consequently, even for his father that the explanation does not say the liability for striking him is specifically when it is done in the way of strife and degradation and there is no verse to exempt healing, still it is impossible to forbid [this beneficial action of causing an injury] when it is for the good of the father, like the [case of] blood letting to heal even if there is no fear of danger or loss of life.
It is logical to say that even Rav Dimi bar Chinina (Sanhedrin 84b) that requires a verse to permit blood letting to heal his father and he makes a connection between injuring a man to injuring an animal, he is only referring to injuring his father [that requires a verse] that perhaps there is a loss of fear that comes with the injury and this levity occurs even when blood letting for healing purposes (but no verse is necessary to allow a person to heal a friend). Also, perhaps a verse is necessary if the father does not want an injury, even though it is for healing purposes, that [the son] is also exempt and permitted to do this like the law states in the Minchas Chinuch commandment 48 (the son is exempt from injuring his father against his will if it is for the purpose of healing). [Over there,] he holds that this is not known from "Love your neighbor as yourself" because we find a minority of people that do not want to be caused pain with an injury, even if they know this will heal them, in a case that there is no danger. Therefore, there is room [to claim] that we need to go according to the will of this [type] of person, even though he is from the minority, and we need a verse that connects [injuring a man] to injuring an animal that it is exempt when it is for the sake of healing even if it is against the will of the owners. Since [the healer] did not cause damage in [the animal], on the contrary he increased its worth, and it is not relevant to be liable to give anything for increasing value to a man even if it was against the will [of the owner,] so too it writes by injuring a man, dealing with his father, if it is to heal him [the healer] is exempt even if it is against [the] will [of the father. However,] Rav Masna holds (Sanhedrin 84b) that the verse is not needed because it is logical to follow after the majority of people [and not worry about the minority.]
[On the other hand] perhaps Rav Masna argues on this and holds that letting blood for the father against his will is forbidden when there is no danger and [Rav Masna] is not like the Minchas Chinuch. So too, it is possible that the Rambam decides [this way], according to what he writes in the
5th chapter of the laws of Mamrim halacha 7 (Hebrew
here), that "If, however, there is no one else there capable of doing this but him
and they are suffering, he may let blood or amputate according to the
license that they grant him." This language implies that without the "license" of the father it would be forbidden for the son to let blood for [his father] for healing purposes because he (Rambam) decides [the law is] in accordance with Rav Masna.
The Minchas Chinuch takes this language of the Rambam and learns that his language is not specific. However, it is possible that it is specific and [Rambam holds] that it is forbidden to [heal your father] by force because he (the Rambam) is holding there is an argument with this between Rav Masna and Rav Dimi bar Chanina and [the Rambam] decides like Rav Masna. In any situation, the verse that Rav Dimi bar Chanina requires [is only for] one injuring his father [for healing,] but blood letting for a friend [in order] to heal him, that it is permitted even when it is not necessary, does not require a verse according to the Rambam. For, when [the injury is done] not in the way of strife and degradation (like an injury to heal) there is no prohibition. [Therefore,] even if we do not hold like the Rambam in this case since it (the injury inflicted for healing) is for his benefit, it is permitted in its simple understanding without a separate verse, [because it is included in] "Love your neighbor like you love yourself" that Rav Masna says.
But, perhaps what I wrote in the second explanation that Rav Dimi bar Chanina needs a verse for [a situation of] injuring his father against his will, perhaps he also needs a verse for injuring a friend for healing against his will. And, we know this from an "all the more so" [situation] that since injuring his father is permitted through a connection (to another verse), all the more so [injuring] his friend should be permitted. If we say that Rav Masna argues and [holds] that it is forbidden [to injure] his father against his will [in order to heal him,] perhaps he also holds that it is forbidden [to injure] his friend against his will [in order to heal him.] This requires further looking into. According to the law of the Minchas Chinuch it is obvious to him that it is permitted to [injure] his father [against his will for the purpose of healing him] and all the more so with [regards to] his friend.
However, if it is the will of his friend [to be injured in order to be healed] then everyone holds that it is permitted even without a verse. Also, even if we do not hold like the Rambam and we say that it is forbidden to injure in any way (not just specifically in the way of strife or degradation) since [this injuring] is for his benefit and according to his will [it is permitted] from the verse of "Love your neighbor as yourself."
If this is so, then by a young woman that wants to beautify herself, that it is for her benefit and according to her will, we can simply permit it even if we do not hold like the Rambam in his innovation that [injuring someone is only forbidden if done] in the way of strife and degradation.
There is a further slight proof that can be brought from
Bechoros 45a that we learned if [the kohain] had something extra [on his body] and he cut it off, if it was forbidden to cut it off then the Mishna should have added in [the phrase] even though it is not permitted, like we learn in the first Mishna of the first (
found here) and second chapter (
found here) over there (in Bechoros) by someone who sells the [embryo of ] his donkey and [the embryo of] his cow to a non-Jew that we learn [the phrase] even though it is not permitted. [However,] here we do not say this, which implies that it is permitted [for the kohain to cut off extra parts of the body.] It is a stretch to say that these Mishnas argue on Rabbi Akiva of the Mishna in Babba Kama (90b) and hold that [really] a man can injure himself, for the Mishna does not bring this [case from Bechoros] according to the Tanna that argues [on Rabbi Akiva.] Rather, we need to say that since it (this cutting off an extra appendage) is for beautification [of the kohain] and is, therefore, for his benefit and he wants this, there is no prohibition of injuring involved.
From this there is a real proof for our case, that even more so by a young girl that good looks are very necessary and good for her, much more so than a man, for it is seen in
Kesubos 59b, Rav Chiyya taught, "A wife [should be taken] mainly for the sake of her beauty." That it is certainly considered for her benefit [to have surgery to improve her looks] and it is permitted to be injured in order to beautify herself.
End of Rav Moshe's Responsa
I would just like to add that, for a man, this Responsa seems to say that he is allowed to have plastic surgery as well. The main reason I believe this is because of his last point with the Kohanim cutting off extra appendages. For a further look into this idea, see Rav Moshe's Responsa on a man caring about his appearance (found here).
