I have recently been asked to serve as scientific course director for the first Dubai Rhinoplasty Symposium. Set for December 3-5, 2009, the Inaugural Symposium will serve as an opportunity for US plastic surgeons to teach and exchange ideas with rhinoplasty surgeons in the high demand countries of the Middle East. Along with four other US rhinoplasty experts, I will lead a three day comprehensive rhinoplasty symposium in Dubai to an audience of Middle Eastern, European, and Asian surgeons.

The Middle East represents one of the world’s hot beds for plastic surgery. Given the fact that many Muslin women have only their faces exposed to public view, it is not surprising that rhinoplasty is one of the most sought after procedures in many Middle Eastern countries. In fact, Iran, known as the nose job capitol of the world, was the subject of a critically acclaimed, award winning documentary film, “Nose, Iranian Style”. While there is a huge demand for cosmetic rhinoplasty in the Middle East, until now there have been few collaborative efforts between Middle Eastern surgeons and American rhinoplasty experts.

With an ever growing demographic of people seeking rhinoplasty, surgeons have had to broaden their aesthetic standards to serve a greater diversity of patients. Gone are the days when surgeons can give every patient the same cookie-cutter nose. With an expanding cosmetic market, we must now cater to cosmetic needs based on a variety of ethnic and familial preferences.

Refer to http://www.dubai-rhinoplasty.com/index.htm to learn more about the Dubai Symposium.

A Contemporary Assessment of Facial Aesthetic Preferences

To be published in the Archives of Facial Plastic Surgery (Mar/Apr 2009)

A variety of aesthetic “canons” have been long served as standardized measurements to guide plastic surgeons in facial cosmetic surgery. These metrics include various angles, proportions, and geometric relationships of the landmarks of the face which are supposed to define what is aesthetically ideal. For example, the angle formed between the upper lip and the base of the nose is supposed to be about 100 degrees for a female nose. Or, the apex (highest point) of the eyebrow is supposed to be directly above the outer edge of the iris of the eye. Sometimes termed “neoclassical canons” these measurements originate from a predominantly Western view of facial aesthetic beauty, spanning back to concepts espoused by the Ancient Greeks and Leonardo DaVinci.

What motivated this research was a nagging question in my mind: why should the same standards of beauty be applied to different people? It was clear to me that two individuals could look very different from one another yet both be very beautiful. Particularly in our diverse, multi-cultural world, it seemed that we ought to have broader views about facial aesthetic beauty.

The study set out to determine whether or not three common measurements traditionally viewed as aesthetically ideal by neoclassical canons would be viewed as favorable by a contemporary, ethnically diverse groups of individuals. Variations of these measurements were applied to both Caucasian and Asian models of both an older and younger age group. The three specific measurements examined were position of the apex of the eyebrow, width of the nasal tip, and rotation of the nasal tip (length of the nose). For each of these features, a range of measurements were applied to a baseline standardized digital photograph through a computer morphing program. For example, each model had 5 versions of her face with the nasal tip altered from narrow to wide, 6 versions with various degrees of rotation of the nasal tip, and 5 positions of the eyebrow apices.

These photographs were then shown to 171 study volunteers of various ages and ethnicities. The volunteers were asked to rank each picture in each series of photographs from most to least attractive. Consistent with our hypothesis, there were no clear preferences for aesthetically ideal metrics across all volunteers. Instead, preferences varied depending on age and ethnicity of both model as well as reviewer. For example, eyebrows with apices that were further outward (away from the center), were tended to be preferred in younger models and by younger reviewers. Asian reviewers tended toward a preference for a wider nasal tip as compared to Caucasian reviewers. Many of the other preferences did not follow clear cut patterns, signifying a widely variable range of facial aesthetic preferences.

Although there is some evidence that some of our sense of aesthetic facial beauty is innate and independent of culture, it is also clear that one’s aesthetic sense is influenced by age, gender, or ethnicity. This is important in the modern era with increasing globalization and a wider group of individuals of different backgrounds seeking cosmetic interventions. The research described suggests that we cannot adhere to rigid beauty guidelines when considering the faces of individuals from a variety of backgrounds. Rather, we should consider features based on each person’s unique composition that comes from their ethnic, familial, and individual backgrounds.

I was recently interviewed by the Marin Independent Journal regarding a documentary called America the Beautiful: Is America Obsessed with Beauty? You can check out the website at http://www.americathebeautifuldoc.com. Although the movie is not yet out, based on the press and trailer, it seems to be a thoughtful look at the impact of media and popular culture on our perceptions of beauty and self-image. The piece questions if we as a society have an obsession about beauty. I was asked several questions about my take on this idea, how it impacts my approach as a surgeon, and a variety of other related issues. I thought it might be interesting to paraphrase some of the discussion.

1) Has the media affected our perception of beauty?
Absolutely. For most people, the media affects our perceptions about many things, no matter how independently minded we may try to be. But I think that the media and our perception of beauty represents a “chicken and the egg” conundrum. Which came first? Does the media just reflect back to us our views or does it create them? Probably both. However, long before media existed there have been strong views about beauty going back to the ancient Egyptians, Greeks, and every civilization since. Beauty has been in the pot for a long time, though the media spices it up and gives it a good stir.
2) Is it shallow to be concerned about beauty?
To some degree we are all aware of our appearance. We all take measures to make ourselves look a certain way. This may range from basic grooming like combing our hair on one end of the spectrum to things that are more involved like cosmetic surgery. But to say that this concern is shallow for any given person is judgmental and a bit arbitrary. Every person has his or her own motivations. I can say though that there are numerous studies in sociology and anthropology, which confirms that appearance and beauty have a huge impact on life outcomes related to happiness, financial success and even longevity. So whether we like it or not, beauty is a pervasive and powerful influence on our individual consciousness and collective society.
3) Do we have an unhealthy obsession?
I think some of us do and some of us do not. I think the concern for appearance becomes an unhealthy obsession when it starts to interfere with our ability to maintain our life routines, our relationships with others, and damages our feelings about ourselves.
4) What else affects our perceptions about beauty besides the Media?
Lots of things. It is a nurture versus nature thing. On the nurture side there are our peers, our parents, family values, ethnic or nationality considerations. And then on the nature side there is growing evidence that much of our sense of beauty comes hard-wired into us…from our DNA! The theory goes that we are equipped with an innate sense of what is attractive because as a species, a sense of aesthetic beauty helps us find a suitable mate with whom we will have a greater likelihood of creating offspring and expanding the species. The scientists believe that beauty is a trait that signifies health and reproductive viability. But “what is beautiful” is different in each individual culture. This idea is supported by research I have conducted on modern preferences of facial beauty.