**4. Beauty, plastic surgeons: Are we unsettled?**

Plastic surgery symposiums offer learning opportunities in the form of oral and poster pre‐ sentations, as well as by interactions with other plastic surgeons. Some of these interactions have provided eye‐opening experiences during my training. Recently, while attending one of these events, the highlight of the night was listening to the introduction and speech given by the physician who had the honor of receiving the night's "Lifetime Achievement Award." It was fascinating to learn his story of success and multiple accomplishments, but undoubt‐ edly, what I found outstanding was the fact that he was able to use his cultural and ethnic background and apply his surgical knowledge to the analysis of his patients. His career path and his own race inspired him to study hundreds of black noses from different cultures and create a classification system to aid other surgeons to understand the differences on this type of patient. His interest was motivated by the erroneous assessments he witnessed during his career when other plastic surgeons continued to apply the same general techniques to every patient regardless of their different features and incompatibility of the procedures [12].

Assessments and technical approaches to aesthetic body changes, not necessarily for pure beautification, but in a broader sense for the transformation of the patient's image, should include patient age, ethnicity, characteristics, and flavor of desired type of attractiveness, fash‐ ion, etc. The assessment may require an isolated and comprehensive evaluation of "aesthetic units." For example, the analysis of anatomically defined parts of the face (subunits) helps to isolate different components of beauty (or loss of it) and provides the surgeon data which can be utilized for the development of software to image and morph imaginary outcomes to determine how the patient perceives his or her beauty features and propose changes [13].

If one considers that cosmetic medicine and surgery are scientifically based, then conse‐ quently, an evidence‐based approach to cosmetic surgery requires objective data based on which recommendations are formulated from the assessment. On the other hand, if beauty is defined as a subjective notion; perceptions of the patient and experience of a surgeon, less hard‐core scientific evidence is needed at for the decision‐making process. The reality is that both subjective and objective factors are needed for successful cosmetic interventions. Intermingling subjectivism with objectivism, in different proportions, depending on both patient's and surgeon's preferences are fundamental for the connection between both parties and a successful surgery. Unexpectedly, to a degree, differences in the perception of beauty (subjective) between seemingly similar ethnic groups may be rooted in variable approaches based on how they celebrate bodies, personal wellness, and achievements (objective). For instance, in China, the new‐style *qipao* (body hugging one‐piece dress) represented the sym‐ bol of changing attitudes and perceptions of beauty. The trend that started to dominate China in 1930s coincided with the abolition of foot binding and breast binding. These events marked a new era with displays of healthy and natural beauty and are an extreme historical example of diametrical change of the perception of beauty within the same ethnic population [14].

The need to mix subjectivism with objectivism brings relativism (the doctrine that knowl‐ edge, truth, and morality exist in relation to culture, society, or historical context, and are not absolute and constant) to cosmetic medicine and surgery. Standards of reasoning and justi‐ fication, translated into guidelines of practice, will depend on time and place. Good or bad (it is relative and subject to changes with time), these are products of differing conventions, i.e., plastic surgery and dermatology publications, fashion, and frameworks of assessment. Therefore, the authority of the norm is confined to the context giving rise to it (e.g., beautiful, morally good, epistemically justified). Debates about relativism permeate the whole spec‐ trum of philosophical sub‐disciplines: from ethics to epistemology, science to religion, politi‐ cal theory to ontology, theories of meaning and even logic, and now to the dilemma whether aesthetic surgery is a part of medical science. In the opening paragraph of this chapter an anecdotal example of inappropriate but unfortunately frequent subjectivism was brought up. The question whether cosmetic values and assessments are or are not part of medical science is of paramount importance and goes beyond the surgical locker room and certainly belongs in this chapter. For example, paradigm for body image stands behind "increasingly scien‐ tific" approaches to body dysmorphic disorder. Social perception and stereotyping have been important issues in social and cross‐cultural psychology over the centuries but plastic sur‐ gery pushed boundaries of concerns to an unprecedented level. Certainly, a plastic surgeon's perspective on stereotyping and perception of beauty goes well beyond the componential approach to interpersonal social perceptions. Therefore, standards of reasoning should be

**4. Beauty, plastic surgeons: Are we unsettled?**

184 Perception of Beauty

from Munich pursued also other beauty codifying projects (Photograph by the Author).

Plastic surgery symposiums offer learning opportunities in the form of oral and poster pre‐ sentations, as well as by interactions with other plastic surgeons. Some of these interactions have provided eye‐opening experiences during my training. Recently, while attending one of these events, the highlight of the night was listening to the introduction and speech given by the physician who had the honor of receiving the night's "Lifetime Achievement Award." It was fascinating to learn his story of success and multiple accomplishments, but undoubt‐ edly, what I found outstanding was the fact that he was able to use his cultural and ethnic background and apply his surgical knowledge to the analysis of his patients. His career path and his own race inspired him to study hundreds of black noses from different cultures and create a classification system to aid other surgeons to understand the differences on this type of patient. His interest was motivated by the erroneous assessments he witnessed during his career when other plastic surgeons continued to apply the same general techniques to every patient regardless of their different features and incompatibility of the procedures [12].

**Figure 6.** Surveys help to establish objective and sharable information for aesthetic surgeons and the public. Colleagues

studied, codified, and continuously adjusted. It is the author's opinion that aesthetic surgery is a science, however with continuously changing paradigms. Our focused studies appear to affirm this notion [15].

Coco Chanel remarked that fashion is always of the time in which we live and "is not some‐ thing that exists in dresses only". Social media technology has changed the world; consumers of both fashion and cosmetic surgery are savvier than ever before and more comfortable with exploring the range of fashion, aesthetic medicine, and surgical options available. Emerging from our diverse culture, the fashion industry projects a symbolic system of society pref‐ erences that speak about current society's personality. Beauty criteria and preferences although related to fashion—appear to be more timeless where the impact of local microcosm and beliefs are stronger and entrenched with local traditions. The future of plastic surgery will continue to build bridges between art, ethnography, and science.
