Defining beauty with preconceived dimensions and measurements flies in the face of what Steven Dayan, M.D., says is the formula for successful cosmetic surgery outcomes.
Beauty isn’t defined by what we see; it’s what we don’t see, according to the facial plastic surgeon. Dr. Dayan’s approach, called “subliminal difference,” is based on a concept that what makes someone beautiful and why is subconscious. It’s not something you have to think about.
“Perhaps, we’ve gone off on a tangent in plastic surgery, and we make people look unnatural,” he says. “How do you make people look natural, when consumers are demanding to look natural? We’ve yet to respond. The philosophy that I employ results in a face that projects a more favorable first impression with an elevated quality of life and others are not quite certain what was done.”
Dr. Dayan says aesthetic surgeons should approach surgical and nonsurgical procedures by making small changes in the right places versus dramatic change.
“We’ve never been taught that. All through medical school, residency, fellowship and even when you go to medical meetings, we’re taught how to make a facelift more perfect; how to lift it further; how to make the eyes more open. But, the reality is we’re are allowing for an outcome that may make people look strange,” he says. “There’s a bias in plastic surgery. We want to make a difference. But the reality is if we can see the changes then we failed. You shouldn’t be able to recognize a difference. It should be so subtle that it hits you subconsciously.”
Dr. Dayan’s concept is more than theory. His studies on first impressions and quality of life as it relates to cosmetic surgery are widely published. He’s speaking at many of today’s most important plastic and aesthetic surgery meetings (including a recent presentation on the subliminal difference at American Academy of Facial Plastic and Reconstructive Surgery’s fall meeting) and he has authored books on the topic, including The New York Times and USA Today best seller, Subliminally Exposed: Shocking Truths about Your Hidden Desires in Mating, Dating and Communicating. Use Cautiously, which came out in 2014.
In This Article
The Beginning of a Theory
Dr. Dayan, who practices in Chicago, recognized years ago that what he had learned in school to be a facial plastic surgeon wasn’t necessarily consistent with making patients look natural. Piqued by his interest in evolutionary biology in college and a passion for sculpting, Dr. Dayan began to ask questions and conduct research studies. About seven years ago, he started teaching an undergraduate course at DePaul University on the science of beauty and its impact on culture and business in America. Today, he not only practices making subliminal differences but also teaches the concept. His book, Thrive, resulted in a national series of training seminars educating physicians about how to optimize minimally invasive office-based procedures, according to Dr. Dayan’s website [www.DrDayan.com].
“Plastic surgery is very primary, very primordial, very basic,” Dr. Dayan says. “Because we have big egos, we think, yes, we can make a difference. But we don’t want to make a big difference. We want to make small differences. With a slight change at the corner of the eye; a small change at the corner of the mouth can absolutely alter your first impression of someone. You think they’re smiling when the corners of their mouth are elevated. You don’t know why you think they’re smiling, but they are. And you think they look happy.”
Dr. Dayan argues that aesthetics make people feel better about themselves, in part, by projecting better first impressions.
“The minute we make someone look unnatural, then we’ve failed them. Because we made them look unnatural, they make a worst first impression,” he says.
He has studied what makes a person seem beautiful and found, for example, that what’s infantile is subliminally beautiful. So, botulinum neuromodulators, such as Botox [Allergan], Dysport [Galderma] and Xeomin [Merz Aesthetics], work not because they remove wrinkles, but rather because they help to open the eyes.
“Making the eyes look bigger makes a person look more infantile. We all like infantile eyes. We make the eyes look further apart with botulinum neuromodulators because we spread the muscles and that is a more infantile look. Similar to other species, wide eyes are nonthreatening. Narrow eyes, is a very aggressive look— like a wolf. So, that’s, in part, what we’re doing with our neuromodulators,” Dr. Dayan says.
In a study published earlier this year, Dr. Dayan and colleagues analyzed the impact of onabotulinumtoxinA treatment for crow's feet on patients’ self-perception and satisfaction. Some patients were also treated for their glabellar lines. The researchers found that compared to untreated individuals, neurotoxin-treated patients experienced notable improvements in perceived appearance, tiredness, age, attractiveness and satisfaction. Those psychological variables improved even more when patients were treated for both crow’s feet and glabellar lines.1
In other research, Dr. Dayan and colleagues conducted a double-blind, randomized, placebo-controlled health outcomes survey of how botulinum toxin type A treatment affected quality of life and self-esteem.2 Among the 100 subjects who received either neurotoxin treatment or placebo, patients in the active group reported significantly greater improvements in physical health, mood, household activities, overall life satisfaction, body satisfaction, self-consciousness, intellect, self-worth, appearance, comprehension, weight satisfaction, attractiveness and sense of well-being. They also reported increases in overall self-esteem and appearance-, social-, and performance-related self-esteem, according to the study.
In fact, his studies have shown that small changes resulting from treatment with not only neuromodulators, but also fillers or makeup improve people’s first impressions significantly compared to people who haven’t had treatment. Makeup had the biggest impact on first impression.
In a study published in Drugs in Dermatology in April 2015, Dr. Dayan was among the researchers to evaluate cosmetic makeup’s impact on women’s appearance and confidence. They recruited 27 women who share their first impressions after looking at photographs of women wearing control cosmetics, their own makeup and no makeup.
“Subjects wearing cosmetic makeup appeared four years younger than those wearing no makeup. And the control cosmetic makeup subjects on average projected a 37% better first impression than subjects wearing no makeup,” according to the study.3
Small Details, Big Results
Less is not just more. Less is more if in the right places, according to Dr. Dayan.
“…in other words, a little around the corner of the eyes, a little between the eyebrows. Not doing heavy doses. Doing small doses in the most appropriate location,” he says.
That’s hard to teach, according to Dr. Dayan. Every face is different, so there’s no formula. And while doctors tend to like specifics, Dr. Dayan says there are none.
“It’s more important to understand the philosophy of how it’s taught, than to understand technique,” Dr. Dayan says.
Where does that leave the “big” surgeries?
Facelifts and other more invasive surgeries remain in the cosmetic surgery picture, according to Dr. Dayan. The key is for surgeons to better understand what patients really want. For example, someone may come in and say she wants a facelift, when all she really wants is a little more fullness in her cheeks or prejowls — not a complete lifting procedure. Performing a “massive surgical procedure” on someone who just wants to look refreshed and happier isn’t going to be remedied by a facelift, says Dr. Dayan.
“I think we have to be more sensitive to that, and that it may not mean doing a four-hour, very aggressive facelift, where you restructure the face, because your risk of making them look strange is high. And it may not be what they want,” he says.
Treating Mind and Mood
Dr. Dayan’s work on how cosmetic surgery impacts people’s lives is far from over. His focus now is on how what cosmetic and plastic surgeons do impact patients’ happiness.
“If you smile, people around you start to smile. If you frown, people around you start to frown. Happiness is contagious. One of the things that happens when we treat someone, when we use Botulinum neuromodulators, we’re taking away the frown, which makes them happier. Then, people around them become happier,” Dr. Dayan says.
The facial plastic surgeon surmises (but has yet to prove in studies) that if the doctor who is treating a patient smiles while treating that person, the likelihood of it positively effecting the outcome is high.
“And if we can make patients happier, that happiness is contagious and the patient will continue to more positively engage others,” he says.
“This is theoretical, but I think how we interact with the patient can affect the outcome. That’s where my research is now,” he says.
“I think our treatments have much more impact. And if you believe in this concept, the market of people who are eligible to get cosmetic medicine is going to grow 20 times, because we’re evolving past treating just form and function. Now, we’re about treating mind and mood. And that is a message not of vanity but of empowerment.” Dr. Dayan says.
1. Dayan S, Coleman WP 3rd, Dover JS, De Boulle K, Street J, Romagnano L, Daniels S, Kowalski JW, Lei X, Lee E. Effects of OnabotulinumtoxinA treatment for crow's feet lines on patient-reported outcomes. Dermatol Surg. 2015 Jan;41 Suppl 1:S67-74. http://www.ncbi.nlm.nih.gov/pubmed/25548848
2. Dayan SH, Arkins JP, Patel AB, Gal TJ. A double-blind, randomized, placebo-controlled health-outcomes survey of the effect of botulinum toxin type a injections on quality of life and self-esteem. Dermatol Surg. 2010 Dec;36 Suppl 4:2088-97. http://www.ncbi.nlm.nih.gov/pubmed/21070456.
3. Dayan SH, Cho K, Siracusa M, Gutierrez-Borst S. Quantifying the impact cosmetic make-up has on age perception and the first impression projected. J Drugs Dermatol. 2015 Apr;14(4):366-74.
Read More of Dr. Dayan’s Research
Dayan SH. Mind, Mood, and Aesthetics. Aesthet Surg J. 2015 Aug;35(6):759-61.http://www.ncbi.nlm.nih.gov/pubmed/26044342
Dayan SH. The pain truth: recognizing the influence of pain on cosmetic outcomes. Facial Plast Surg. 2014 Apr;30(2):152-6. Epub 2014 May 8. http://www.ncbi.nlm.nih.gov/pubmed/24810126
Dayan SH. Coming face to face with our own bias. JAMA Facial Plast Surg. 2013 Mar 1;15(2):78-9.http://www.ncbi.nlm.nih.gov/pubmed/24810126
Dayan SH, Arkins JP. The subliminal difference: treating from an evolutionary perspective. Plast Reconstr Surg. 2012 Jan;129(1):189e-190e. http://www.ncbi.nlm.nih.gov/pubmed/22186557
Dayan SH. What is beauty, and why do we care so much about it? Arch Facial Plast Surg. 2011 Jan-Feb;13(1):66-7. http://www.ncbi.nlm.nih.gov/pubmed/21242436