Many years ago I conducted a study on models from the international modeling agency Ford Models. In an attempt to better understand, from a mathematical and geometric perspective, facial proportions and symmetry, I incorporated the work of Dr. Leslie Farkas, laboriously measuring minute differences in the facial alignments of these "attractive" women. But after all the spreadsheets were tabulated and the regression lines drawn, what truly constitutes facial beauty? In other cultures and times, people enhanced their physical appeal through body piercings, scarification, lip rings and earrings. In our culture today, what is the ideal of beauty? Who is our Venus de Milo? Our Mona Lisa?
FACE OF THE FUTURE One weekend I took a break from the office and took a walk to a nearby magazine store. I picked up as many international fashion magazines as I could carry. Flipping through the glossy pages of editorials, advertisements and layouts, there was a universality to these images. Whether from Asia, Europe, Eastern Europe or South America, the women featured in these pages had similar looks. Was this evidence of a multicultural melding? As our world grows smaller and our disparate cultures continue to mix, are our standards of beauty cross-fertilizing beyond geographic boundaries? Will the beautiful face of the future be a true combination of vast cultures and varied peoples? Or perhaps an amalgamation is not what we are witnessing. Maybe the homogeneity of beauty is a westernization of beauty that colonizes and replaces other long-standing traditions and values. Maybe the beautiful face of the future will be a white woman with decidedly western features.
INDUSTRY INFLUENCE It is a contested cultural debate. And what is the plastic surgeon's involvement in the evolution of facial beauty? It is not enough for an ethically minded, socially responsible plastic surgeon to absolve himself in this discourse by saying, "I am simply providing a service that people demand in an open marketplace." As an industry, I feel it is important for us to engage in this social dialogue. Some have argued that plastic surgery is a modern democratic solution to the fickle way in which Mother Nature dispenses beauty. In this light, cosmetic surgery endorses free market, personal fulfillment, self-actualization and free choice. It is liberating that we can take our physical appearance into our own hands and transform ourselves in an act of reinvention. It is a very American notion! Others have criticized the industry, claiming that plastic surgery has added to the image-driven culture we find ourselves in. Some have said that as cosmetic procedures become more and more commonplace, a standardization of beauty, particularly female beauty, has developed. Globally, this homogenization of beauty, they contend, is strikingly Western and white.With the expansion of media, via television, magazines, movies and the Internet, what constitutes beauty in our world today is becoming more and more narrow. These critics have also linked plastic surgery to a pathologization of the natural course of aging. When a consult walks into a plastic surgeon's office, the doctor discusses "treatment options" for sagging jowls. The very vocabulary used by these physicians equates aging with other diseases. Growing old, critics contend, is no longer an opportunity for growth and enrichment. It has become a maligned process of deterioration and loss.
ENGAGE AND EXCHANGE Plastic and reconstructive surgery first made its mark in the medical field during the first World War. When malicious trench warfare injured and damaged countless young men and women, our field found ways of surgically healing the wounds. We devised techniques to restore their physical appearance, to mask the disfigurement. Now the field of plastic and reconstructive surgery encompasses the medical response of everything from the emergencies of warfare to the pursuit of beauty and physical perfection. This scope is incredible and singular in medicine.
The motivations for seeking plastic surgery are as varied as the procedures themselves. With all the possibilities, our profession must be vigilant in the practice of ethical, moral medicine. We must celebrate the good and positive things, but we must not shy away from asking the difficult questions. There are no simple answers as we explore the social and cultural significance of cosmetic surgery and the beauty industry. I encourage all of us to engage in the exchange of ideas: Can we personally define for ourselves our moral and ethical viewpoints in this debate? And how do we, as a profession, navigate the many fault lines of this extremely important discussion?
Darrick E. Antell, M.D., F.A.C.S. , received his general surgery training at Stanford University Medical Center and went on to specialize in plastic/reconstructive surgery at the New York Hospital/Cornell Medical Center and the Memorial Sloan-Kettering Cancer Center. He has been in practice for over 20 years at his Park Avenue office in New York City.