Joan Rivers, who became a comedic star with an act that was a mélange of insult, insecurity, over-the-top cattiness and a nothing-is-sacred philosophy, died at the age of 81, her daughter Melissa Rivers said.

Rivers, an outspoken advocate of the plastic surgery that gave her a preternaturally preserved appearance, died after suffering cardiac arrest during an outpatient procedure on her vocal cords on August 28 at a clinic in New York that had left her on life support for several days.

“My mother’s greatest joy in life was to make people laugh. Although that is difficult to do right now, I know her final wish would be that we return to laughing soon,” Melissa Rivers said in a statement announcing her passing.

Rivers found fame as a stand-up comedian and TV host. Onstage, she came across as acidic and manic – sort of Don Rickles in diamonds and a Chanel dress. “Can we talk?” she would ask her audience in a husky New York accent before delivering a brutal put-down line, such as “Elizabeth Taylor’s so fat she puts mayonnaise on her aspirin”.

When it came to getting a laugh or just being provocative, no topic was taboo for Rivers.

“If you laugh at it, you can deal with it – and if you don’t, you can’t deal with it,” she told a TV interviewer in 2010. “And don’t start telling me that I shouldn’t be saying it. ... I would have been laughing at Auschwitz.”

Rivers, who was Jewish, said she was only saying what everyone else was thinking and if someone found it mean or inappropriate – too bad.

She did not always like criticism, however, and stormed out of a CNN interview in July when asked how she could be an animal rights activist and still pose in fur on the cover of her book Diary of a Mad Diva.

Rivers also drew fire when she said that relatives of the victims of the September 11, 2001, attacks should have been thrilled to get a financial settlement for their loss. Despite complaints, Rivers steadfastly refused to apologise for such comment.

Joan Alexandra Molinsky was born on June 8, 1933, in Brooklyn and grew up there and a nearby town, the daughter of a doctor and a housewife. She graduated Phi Beta Kappa from Barnard College and had a six-month marriage that was annulled before she began pursuing an entertainment career with the last name Rivers, which she borrowed from her agent.

Rivers first wanted to be an actress but veered into comedy and wrote sketches for Topo Gigio, a talking mouse character on The Ed Sullivan Show in the 1960s after a friend turned down the $500 job.

“For $500, I’ll write for Hitler,” she said in an interview with National Public Radio.She also worked on the seminal reality TV show Candid Camera as a writer and in sketches with unknowing members of the public. She wrote jokes for comedians Phyllis Diller and Bob Newhart before concentrating on her own stand-up act.

Rivers’s peers in the comedy club scene of New York’s Greenwich Village at the time included Bill Cosby, Richard Pryor, Woody Allen and George Carlin, but she said she never felt like she was part of their clique.

Her career got a boost in 1965 when Johnny Carson, the undisputed king of late-night TV in the US, had Rivers on his Tonight show and declared she was a star in the making.

By the 1980s, she had well-paying stand-up work, regular TV appearances, an Emmy-nominated album and a bestselling book, The Life and Hard Times of Heidi Abramowitz, based on one of her characters.

Rivers reached a pinnacle in 1983 when Carson crowned her as his regular guest host on the popular NBC television show. But their relationship imploded three years later when she left to start her own late-night talk show on the fledgling Fox network. The two never spoke again and the move to Fox turned out to be the start of a downward spiral for Rivers, both personally and professionally.

The Fox show lasted only seven months. It was cancelled amid low ratings and much enmity between Rivers’s husband-manager, Edgar Rosenberg, and network executives. A few months later, Rosenberg committed suicide.

Rivers fell into depression, fought bulimia and endured suicidal thoughts. Her relationship with daughter Melissa fell apart at the time because Melissa blamed her for Rosenberg’s death.

Rivers had to pull out of a financial trough because Rosenberg’s bad investments left her several million dollars in debt. She accepted an offer from a television shopping network to hawk her own line of jewellery and it became a success.

From 1989 to 1993 she hosted The Joan Rivers Show, which in 1990 won a Daytime Emmy for outstanding talk show.

As she aged, Rivers was a carefully constructed testament to her belief that looks matter a great deal, especially to a woman in show business. She was slim and always well dressed, her hair was immaculately styled and her skin taut and seemingly wrinkle- free.

I’d rather look younger and feel happy than look older and be depressed

“Looking good equals feeling good,” Rivers said in her 2008 book Men are Stupid... And They Like Big Boobs: A Woman’s Guide to Beauty Through Plastic Surgery. “I’d rather look younger and feel happy than look older and be depressed.”

Rivers said she had undergone full face lifts, nose jobs, chin tucks, liposuction, breast reduction, an eye job and botox injections.

In recent years, Rivers found a career niche commenting on celebrity fashion. She was seen along the red carpet at televised award ceremonies asking stars “who are you wearing?”. She also hosted the cable TV show Fashion Police where she mercilessly skewered celebrities’ wardrobe choices.

Rivers and Melissa also starred in Joan & Melissa: Joan Knows Best? with Rivers living with her daughter. She was the winner on Donald Trump’s The Celebrity Apprentice show in 2009.

Tributes flow in

• Statement from TV network E!, which aired Rivers’s Fashion Police show, and parent company NBC Universal: “For decades Joan has made people laugh, shattered glass ceilings and revolutionised comedy. She was unapologetic and fiercely dedicated to entertaining all of us and has left an indelible mark on the people that worked with her and on her legions of fans.”

• Israeli Prime Minister Benjamin Netanyahu said in a statement: “Joan Rivers brought laughter to millions around the world and was proud of her Jewish heritage and a vocal supporter of the State of Israel. We will miss her deeply and we send our heartfelt condolences to her family.”

• Actress and singer Liza Minnelli said on Facebook: “Joan Rivers was my dear friend and I will miss her but I will always remember the laughter and friendship she brought into my life.”

• David Letterman, from Thursday’s taping of his CBS Late Night talk show: “Here’s a woman, a real pioneer for other women looking for careers in stand-up comedy. And talk about guts – she would come out here and sit in this chair and say some things that were unbelievable, just where you would have to swallow pretty hard but it was hilarious the force of her comedy was overpowering.”

• Real estate mogul Donald Trump, whose Celebrity Apprentice reality TV show Rivers won in 2009, on Twitter said Rivers “was an amazing woman and a great friend. Her energy and talent were boundless. She will be greatly missed”.

• Comedian and talk show host Ellen DeGeneres said on Twitter: “Joan Rivers will always be a pioneer. She paved the way for a lot of comedians. I’m very sad she’s gone.”

• Kelly Osbourne, Fashion Police co-host, on Facebook: “I’m completely heartbroken by the loss of my beloved Joan. Not only was she my boss, she was and will always be my teacher, therapist, closest friend, inspiration and the only grandmother I ever knew ... I will miss you deeply and will always hear your voice in my head saying ‘my darling get out there and be you!’”

• Actress and singer Bette Midler said on Twitter: “Joan Rivers has died. What a sad ending to a brilliant and tragi-comic life; one of the bravest, and funniest of all.”