**2. Body**

For some, statements such as "beauty is in the eye of the beholder" and "perception of beauty that is in the eye of the beholder" are clichés. However, in plastic surgery, central to patient management, procedure planning, and execution is the recognition that everyone has a dif‐ ferent perception of beauty. Implications of this perception and related research range from practical everyday activities (e.g., ability to get a job) to the artistic, political, and philosophi‐ cal realms. For plastic surgeons, trends and perceptions of beauty characteristics (especially extreme) that become favored and those that tend to fade away provide challenging practice templates for daily work. The exact neural mechanisms of beauty perception are unclear; it is known that surroundings and one's mood (including professional) may have a direct effect on visual processing (**Figure 1**).

**Figure 1.** Behavioral studies indicate that emotion can have an effect on perception of surroundings, including visual processing. A positive mood enhances peripheral vision and increases the extent to which the brain encodes information encouraging positive, novel thoughts and actions (Commercially available plaque in author's collection).

Beauty? What is really beautiful? How do we determine beauty? Who decides if a specific fea‐ ture is beautiful? These age‐old questions in reality do not have an absolute answer. "Beauty is in the eye of the beholder"—it seems very precise. Beauty is an evolving term that is influ‐ enced by culture, geography, ethnicity, age, and art among others. What we today consider beautiful, would perhaps not be accepted somewhere else in the world or at a different time in history. In addition to opinion, different cultural stimuli further shape these judgments. The concept of beauty has never been definitive and will never reach an absolute. Beauty will continue to transform in similarity to fashion trends. Over the centuries, as the concept of beauty continues to evolve, the only fact that remains true is that society will continue to strive to conform to what their environment considers attractive.

of large breast implants to be available for an upcoming augmentation case. Nothing unusual, but it definitely caught my attention for a few minutes. The sales‐representative inquired if the surgeon would need any smaller size implants for the case; his response, while it may hold some truth, was shocking to me, "Only the bigger ones, she is Latina… they all want big breasts." Unfortunately, he as many other surgeons implement ethnic profiling and ste‐ reotypes to erroneously define their patient's preferences. This "template" type of approach to cosmetic surgery is a misconception, and may erroneously lead to imposition of surgeon's predilection and a surgical approach. Unlike society's submission to fashion trends, any sur‐ gical intervention for beautification is, by far, more than consequential. Anatomical altera‐ tions may be irreversible and therefore listening and acknowledging each patient's wishes as well as understanding their expectations is an integral part of the management of each case. We all have different tastes, likes and dislikes, which affect our definition and perception of beauty. This is one of the reasons why exploration of cultural profiling and its role in plastic

For some, statements such as "beauty is in the eye of the beholder" and "perception of beauty that is in the eye of the beholder" are clichés. However, in plastic surgery, central to patient management, procedure planning, and execution is the recognition that everyone has a dif‐ ferent perception of beauty. Implications of this perception and related research range from practical everyday activities (e.g., ability to get a job) to the artistic, political, and philosophi‐ cal realms. For plastic surgeons, trends and perceptions of beauty characteristics (especially extreme) that become favored and those that tend to fade away provide challenging practice templates for daily work. The exact neural mechanisms of beauty perception are unclear; it is known that surroundings and one's mood (including professional) may have a direct effect

**Figure 1.** Behavioral studies indicate that emotion can have an effect on perception of surroundings, including visual processing. A positive mood enhances peripheral vision and increases the extent to which the brain encodes information

encouraging positive, novel thoughts and actions (Commercially available plaque in author's collection).

surgery today is addressed in this chapter.

on visual processing (**Figure 1**).

**2. Body**

174 Perception of Beauty

Attractiveness affects our social perception and interactions in various ways. The fascination with beauty penetrates society worldwide. The desire to look and feel beautiful involves all races, ages, genders, and nationalities. It is believed that good‐looking individuals are more fortunate and given more opportunities. Some say that less effort is required from them com‐ pared to their less attractive counterparts to achieve the same goals (e.g., job promotions, salary increase, better schedules, etc.) This perception drives individuals of all backgrounds and ethnicities to try and fit into what society accepts as beautiful with the goal to merit more opportunities, be accepted and respected.

"Ugly Betty" exemplifies this concept. This television show takes place in the "superficial" word of fashion, where image is everything. An outcast, Betty, a smart mind but unattractive girl, reveals her struggles trying to fit in. This soap opera, which originated in Colombia, has been successfully adapted into many countries and languages around the world. International versions of the show have maintained the appearance of Betty with mild changes to local per‐ ceptions of attractiveness of each region (Colombia, Mexico, USA, Croatia, Dubai and Egypt). This show has inspired many people to deal with body imaging and raise awareness about the impact of discrimination that women face based on their looks.

As different cultures and ethnicities relocate to other parts of the world, plastic surgeons are encountering very diverse patients who have been exposed to different ideal standards of beauty with unique motivations for accentuation or elimination of features considered non‐ attractive (e.g., prominent ears). Clearly, each patient's definition of beauty is the result of individual's specific life experiences.

Even subtle details can interfere with patient interactions. Stereotyping is a mistake that we are all guilty of. Anyone involved in patient's care can make such mistakes. One of the nurses told a new patient "Where in Russia are you from?" The patient surprisingly to her responded, "I'm not Russian, I'm Polish." Well, she had assumed from her last name that the Russian connection was the case. No negative consequences resulted from that action; how‐ ever, like painting a canvas, start with a blank background. Eliminate all judgments and ask specific questions that will guide you into the creation of an individual piece of art. Plastic and cosmetic surgery allows you to transform and to an extent, recreate in the best possible manner the patient's wishes. As mentioned earlier, ethnicity plays an important role in defin‐ ing concepts of beauty; however, it is reckless to assume that belonging to a certain ethnic background is a definite indication for specific beauty ideals. "When a patient comes in from a certain background and of a certain age, we know what they're going to be looking for" [1]. Assuming this type of attitude as a plastic surgeon will lead to unhappy patients. However, the surgeon has to be capable to describe to a patient elements to consider and be sensi‐ tive and sophisticated enough to at least enlist suggestions and the rationale behind them. Without awareness of different demographic and culture that characterize specific patients, guidance will be crippled.

Knowing your patient well and establishing a relationship in which the patient feels com‐ fortable enough to express his or her wishes is the main key to success. I have been guilty of failing to recognize the broad diversity of beauty preferences. I remember a few years back meeting a young patient who had traveled from a different country to undergo breast reduction surgery. The size of her breasts had been affecting her social life and caused her to feel uncomfortable when interacting with other college kids. Meeting her provided me with new insights of a culture that I had not been familiar with before. This particular patient was beautiful with big black eyes, striking lashes, and gorgeous long black hair. She, however, did not feel comfortable and would camouflage her chest with oversized clothes. Her posture was also affected and she was constantly trying to cover her breast with her arms. Her body habitus was curvy with very large breasts that did not harmonize with the rest of her body. As I continued chatting with her, she mentioned that she wanted to be more active but felt restricted and embarrassed about her chest, which is a usual complaint of women with mac‐ romastia. I assumed that by decreasing her breast size, she would be able to participate in var‐ ious exercise activities that so far she had not been able to enjoy. When I asked her what sports she was interested in practicing, she stated that she did not want to do any sports because that could cause her to lose weight. I was curious to learn the reasoning of her statement. She then described that in her culture, being larger in size was a sign of wealth and that she would never want to look skinnier. Those words and the insight into her perception of beauty helped me become more aware of the role of socioeconomics and its influence on standards of beauty.
