**3. Attractiveness then and now**

Beauty has evolved through history and has been delineated by different eras. Starting with the Renaissance period (14th to 17th century), where standards of female beauty seemed to be associated with the more voluptuous bodies. Iconic artists as Leonardo Da Vinci, Michelangelo Buonarrotti, and Raphaello Sanzio da Urbino gave us insight into the charac‐ teristics of perceived beauty from this time. Not only the unique "Mona Lisa" but also the nude forms of Michelangelo's Venus and Raphaello's 'The Three Graces" clearly depict the Renaissance' sense of beauty. Baroque and neoclassic times were followed by the Victorian era (18th to early 19th century) in which art demonstrates a change in perception with the female body emphasized with a smaller waist. Charles‐Edouard Boutibonne's work such as the painting for Queen Margherita of Savoy reflects this new perception. The roaring twen‐ ties (Post‐WW1) brought new awareness of beauty. Music, industrial growth, and the focus on movie stars transformed, yet again, what had previously seemed attractive. Beauty was now centered in less voluptuous bodies and a leaner boy look. Hollywood actresses and art‐ ist like Louise Brooks became an iconic symbol that influenced different aspects of beauty. In the Golden Age (1930s–1950s with the end of WW2) beauty standards transformed back to a more feminine look. Actresses Jean Harlow, Rita Hayworth, and Marlene Dietrich epitomize this trend. The mid‐twentieth century (1950s), brought in a new look with the hourglass fig‐ ure. Movie stars such as Marilyn Monroe and Grace Kelly completely depict this new take on beauty. In the 1960s, thin bodies became fashionable, and the first supermodels were revered. Model Jean Shrimpton characterized and led this new look. The 1970s perpetuated the very thin look with Farah Fawcett being a strong example of this trend. Undoubtedly, Madonna characterizes the views of the 1980s followed by stars like Kate Moss in the 1990s. This brings us to today with the new millennium, where it seems more than ever that the emergence and influence from the major beauty trends combined with athletic influences are captivating the world, women like Shakira, Beyoncé, and Jennifer Aniston, among others.

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,

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.

Beauty has evolved through history and has been delineated by different eras. Starting with the Renaissance period (14th to 17th century), where standards of female beauty seemed to be associated with the more voluptuous bodies. Iconic artists as Leonardo Da Vinci, Michelangelo Buonarrotti, and Raphaello Sanzio da Urbino gave us insight into the charac‐ teristics of perceived beauty from this time. Not only the unique "Mona Lisa" but also the nude forms of Michelangelo's Venus and Raphaello's 'The Three Graces" clearly depict the Renaissance' sense of beauty. Baroque and neoclassic times were followed by the Victorian era (18th to early 19th century) in which art demonstrates a change in perception with the female body emphasized with a smaller waist. Charles‐Edouard Boutibonne's work such as the painting for Queen Margherita of Savoy reflects this new perception. The roaring twen‐ ties (Post‐WW1) brought new awareness of beauty. Music, industrial growth, and the focus on movie stars transformed, yet again, what had previously seemed attractive. Beauty was now centered in less voluptuous bodies and a leaner boy look. Hollywood actresses and art‐ ist like Louise Brooks became an iconic symbol that influenced different aspects of beauty. In

guidance will be crippled.

176 Perception of Beauty

**3. Attractiveness then and now**

The perception of beauty has transformed through time and across the globe during specific events in history. In the late 1400s and early 1500s, after Christopher Columbus made landfall in the New World, Indians who had not been exposed to any eastern culture were found to have a completely different perception of beauty. For instance, The Mayan concept of beauty was influenced by many of their religious beliefs. "Yum Kaxx," the maize God, persuaded the Mayan's attraction for an elongated head and the implementation of primitive proce‐ dures to modify physical aspects of their newborns (**Figure 2**).Trepanning, for example, was a process used by parents to flatten their newborn babies' soft skull, facilitating their cranial transformation into elongated heads. Interestingly, cross‐eyed deformities have never been thought of as a particularly desirable trait in European culture but in ancient Mayan culture, being cross‐eyed was admired. In fact, like cranial shape modification, Mayans would also

**Figure 2.** Yum Kaxx, God of Maize. (Public domain; unknown Maya artist—Francis Robicsek: The Maya Book of the Dead. The Ceramic Codex, University of Virginia Art Museum (1981)).

go to great lengths to make their children cross‐eyed during infancy. This was accomplished by dangling objects in front of a baby's eyes until they were permanently crossed. Moreover, based on different sculptures and artifacts, it seems as if some of their ideal features included large noses, pointed teeth, and multiple piercings that completely contrasted from other influ‐ ences of the time.

Time‐related changes are yet another example that clearly reflects the strong influence that specific trends have toward the perception of beauty, even in heavily "regulated" environ‐ ments. Changes that occurred through time with the iconography of Joan d'Arc, who was supposed to be beautiful, exemplify, and support this opinion. With her canonization in 1920, religion‐dominated stereotypes of thinking build her image to be rather ascetic and far from attractive by today's standards, yet fitting the principles of Catholic propagated image of beauty. However, numerous movies, known paintings and posters from as early as 1851, confirm her changing appearance and exemplifies how symbols and characteristics of beauty followed the public perceptions of magnificence and femininity, even while being "censored" by the church. Early images made in her lifetime were destroyed upon her being condemned as a witch, rendering them dangerous devil's currency. However, two written sources on the life of Joan d'Arc remain. The first, "Process de Condemnation", was a record of her trial dur‐ ing her conviction that consisted of the events that took place during her interrogation. The second, "Process de Rehabilitation," was a record of her retrial that compiled testimonies of eyewitnesses who all had personally known Joan d'Arc. Interestingly, in these documents, she was described as a short, robust woman with black short hair who only wore men clothes. Contemporary portraits of her seem to contradict the written sources. In a few images, Joan d'Arc is portrayed as an average size woman with long red‐brown hair wearing armor. We may speculate that these images were created from the artist's imagination influenced by the perception of beauty of the time. Contemporary films similarly expose different takes on her appearance. The 1999 American movie "The Messenger: The Story of Joan of Arc" greatly differs from the popular TV miniseries "Joan of Arc" where beautiful yet completely differ‐ ent looking females Milla Jovovich and Leelee Sobieski portray this 15th century legendary warrior and saint (**Figure 3**).

In the current world, the fascination with the media and the capacity for globalization of cul‐ ture and fashion trends has allowed an evolving international concept of beauty between con‐ tinents. However, based on current experience from the practice of cosmetic surgery, it is clear that local preferences still remain strong. Is media powerful enough to influence perception of others? Can the use of specific products or brands make you feel and project a higher level of attractiveness? Well, hearing a 12‐year old girl in a Victoria's Secret store telling her mother that she wanted to carry the bag because it would make her look prettier was shocking. The comment initially made me laugh but then, I wondered if this statement could hold any truth. A recent study revealed that consumers often prefer and choose specific brands in an effort to affirm and enhance their sense of self and as a result to create a more positive self‐image [2]. Indisputably, we all recognize the effect that branding and media have in our minds. For example, hearing "Victoria's Secret" will most likely make you think about an attractive, thin, blond woman wearing sexy clothes. "Hugo Boss" will make us think about a tall, good‐looking elegant male. All over the world, a brand's goal is to build an appealing personality to attract

go to great lengths to make their children cross‐eyed during infancy. This was accomplished by dangling objects in front of a baby's eyes until they were permanently crossed. Moreover, based on different sculptures and artifacts, it seems as if some of their ideal features included large noses, pointed teeth, and multiple piercings that completely contrasted from other influ‐

Time‐related changes are yet another example that clearly reflects the strong influence that specific trends have toward the perception of beauty, even in heavily "regulated" environ‐ ments. Changes that occurred through time with the iconography of Joan d'Arc, who was supposed to be beautiful, exemplify, and support this opinion. With her canonization in 1920, religion‐dominated stereotypes of thinking build her image to be rather ascetic and far from attractive by today's standards, yet fitting the principles of Catholic propagated image of beauty. However, numerous movies, known paintings and posters from as early as 1851, confirm her changing appearance and exemplifies how symbols and characteristics of beauty followed the public perceptions of magnificence and femininity, even while being "censored" by the church. Early images made in her lifetime were destroyed upon her being condemned as a witch, rendering them dangerous devil's currency. However, two written sources on the life of Joan d'Arc remain. The first, "Process de Condemnation", was a record of her trial dur‐ ing her conviction that consisted of the events that took place during her interrogation. The second, "Process de Rehabilitation," was a record of her retrial that compiled testimonies of eyewitnesses who all had personally known Joan d'Arc. Interestingly, in these documents, she was described as a short, robust woman with black short hair who only wore men clothes. Contemporary portraits of her seem to contradict the written sources. In a few images, Joan d'Arc is portrayed as an average size woman with long red‐brown hair wearing armor. We may speculate that these images were created from the artist's imagination influenced by the perception of beauty of the time. Contemporary films similarly expose different takes on her appearance. The 1999 American movie "The Messenger: The Story of Joan of Arc" greatly differs from the popular TV miniseries "Joan of Arc" where beautiful yet completely differ‐ ent looking females Milla Jovovich and Leelee Sobieski portray this 15th century legendary

In the current world, the fascination with the media and the capacity for globalization of cul‐ ture and fashion trends has allowed an evolving international concept of beauty between con‐ tinents. However, based on current experience from the practice of cosmetic surgery, it is clear that local preferences still remain strong. Is media powerful enough to influence perception of others? Can the use of specific products or brands make you feel and project a higher level of attractiveness? Well, hearing a 12‐year old girl in a Victoria's Secret store telling her mother that she wanted to carry the bag because it would make her look prettier was shocking. The comment initially made me laugh but then, I wondered if this statement could hold any truth. A recent study revealed that consumers often prefer and choose specific brands in an effort to affirm and enhance their sense of self and as a result to create a more positive self‐image [2]. Indisputably, we all recognize the effect that branding and media have in our minds. For example, hearing "Victoria's Secret" will most likely make you think about an attractive, thin, blond woman wearing sexy clothes. "Hugo Boss" will make us think about a tall, good‐looking elegant male. All over the world, a brand's goal is to build an appealing personality to attract

ences of the time.

178 Perception of Beauty

warrior and saint (**Figure 3**).

**Figure 3.** Joan d'Arc: The only contemporaneous image created by a clerk of the Paris Court (Public domain; illustration credit National Archives, Paris, France).

consumers and enhance the way they view themselves. But not everyone gains the same things from a product. Two types of self‐theories were identified and described: the incremental and the entity theory [3]. Incremental theorists believe that their personal qualities can be improved or enhanced by their own efforts. Conversely, entity theorists do not believe they can improve their personal qualities on their own and adopt signals to project improved qualities to others. The former study concluded that implicit self‐theories carry a big influence on consumer self‐ perceptions, specifically the entity theorists. So can these same self‐theories apply to the world of plastic and cosmetic surgery? It all seems familiar and recognition of these clues may open insight into the individual goals', self‐perception and surgery expectations.

Many aesthetic research studies focus on finding characteristics that are considered attractive, but do they hold true? As we noted earlier, these same characteristics may eventually evolve into complete opposites. Other studies have focused on determining differences among "simi‐ lar groups". Answering the question—What does the patient find attractive?—can clearly pro‐ vide the plastic surgeon with information to minimize a generalization of their patients and improve surgeon‐patient interactions and outcomes. The question arises whether surgeons and patients are on the same page with what they consider "attractive". Do surgeons from different areas of the world have similar perceptions when it comes to different body parts? A study, which explored this matter, confirmed that the perception of beauty has multiple influences and revealed interdependence between variables such as country of residence, sex, age, occupa‐ tion, and aesthetic perception [4]. In this study, an online survey was distributed to both plastic surgeons and laypersons worldwide in an effort to assess lip attractiveness. The study gathered over 1000 responses from 35 different countries and concluded that surgeon's preferences on lip attractiveness varied depending on their practice location. Additionally, it revealed that layper‐ sons living in the same area as surgeons did not share the same aesthetic preferences.

In order to explore profiling of patients, our group conducted a study to test the hypoth‐ esis that there are meaningful differences in perception of beauty even between seemingly similar generations with the same ethnicity and culture. In this study, preferences for facial cosmetic surgery among Asian women were investigated [5]. It may have seemed based on geographical location that women of similar background would share the same views on beauty. However, significant differences in preferred beauty features were identified specifi‐ cally for the periorbital region.

To further survey these geographical influences, a similar study involving yet a different eth‐ nical group was undertaken. It was created to test the common stereotype that Latina women have similar opinions when it comes to buttock shape and its alteration or enhancement with cosmetic surgery. The interest in the topic evolved because it was noted that a growing num‐ ber of patients from all ethnic groups continue to request this type of cosmetic surgery in the United States. Specifically, increased interest in the ideal buttocks has led to higher demand and inquiry for these aesthetic procedures. Between 2002 and 2003, a reported increase of 533% of gluteal augmentation procedures was reported by the American Society for Aesthetic Plastic Surgery [6]. Latinas are the leading consumers of aesthetic surgery among US minority groups [7]. Media has a strong influence in creating a consistent prototype when it comes to Latina women and their aesthetic preferences.

Although beauty ideals are subjective among individuals and continue to change between cul‐ tures and ethnic backgrounds, different ways to evaluate the gluteal region have emerged. Examination of the current literature identified specific features that describe the ideal buttocks. The hourglass female figure appears to be the preferred and ideal shape. A waist‐to‐hip ratio (WHR) of 0.7 was established and described to support this idea [8]. Other defining features that stood out as consistent features of beauty include the anteroposterior projection, the length of infra‐gluteal fold, the presence of supra‐gluteal fossettes and the upper inner‐gluteal sacral junction "V‐zone" [9]. Similarly, it was recognized that there are two relationships formed by the infra‐gluteal to inner thigh and the sacral height to gluteal crease length as important con‐ touring zones [6]. Furthermore, four different body frame types have been widely described as critical features that dictate specific interventions when planning buttock aesthetic surgery. An extensive search for gluteal aesthetic improvements has occurred since 1960 and led to the evolution of more advanced techniques and products with improved aesthetic results.

Our study was created to test the hypothesis that generalizing all Latinas in the same category of aesthetic preferences is inappropriate [10]. The target group was Latinas born and raised in Central or South America but who were residing in the USA for at least 5 years at the time of survey. Three different countries were selected in a geographical manner to represent our study group. Three different zones were established: Central America, Eastern South America, and Western South America, which were represented by Mexico, Colombia, and Brazil, respectively. The investigation used a photomorph‐ based survey, which included 12 questions. Three of the questions were pertinent to age, nationality, and interest in plastic enhancement surgery. The remaining nine questions were composed of multiple photographs contrasting different features of the ideal but‐ tocks. The anonymized photographs were obtained from public files on the Internet and were edited to reveal a specific feature (**Figure 4**). None of these pictures resembled the original. The area of interest was isolated on each photograph to eliminate any bias from the overall appearance of the models. The nine features were identified in the literature to define anatomical details that contribute to attractive buttocks. These features are listed in **Table 1** and were found to be essential during evaluation and planning an approach to enhancement surgery.

patients are on the same page with what they consider "attractive". Do surgeons from different areas of the world have similar perceptions when it comes to different body parts? A study, which explored this matter, confirmed that the perception of beauty has multiple influences and revealed interdependence between variables such as country of residence, sex, age, occupa‐ tion, and aesthetic perception [4]. In this study, an online survey was distributed to both plastic surgeons and laypersons worldwide in an effort to assess lip attractiveness. The study gathered over 1000 responses from 35 different countries and concluded that surgeon's preferences on lip attractiveness varied depending on their practice location. Additionally, it revealed that layper‐

sons living in the same area as surgeons did not share the same aesthetic preferences.

cally for the periorbital region.

180 Perception of Beauty

Latina women and their aesthetic preferences.

In order to explore profiling of patients, our group conducted a study to test the hypoth‐ esis that there are meaningful differences in perception of beauty even between seemingly similar generations with the same ethnicity and culture. In this study, preferences for facial cosmetic surgery among Asian women were investigated [5]. It may have seemed based on geographical location that women of similar background would share the same views on beauty. However, significant differences in preferred beauty features were identified specifi‐

To further survey these geographical influences, a similar study involving yet a different eth‐ nical group was undertaken. It was created to test the common stereotype that Latina women have similar opinions when it comes to buttock shape and its alteration or enhancement with cosmetic surgery. The interest in the topic evolved because it was noted that a growing num‐ ber of patients from all ethnic groups continue to request this type of cosmetic surgery in the United States. Specifically, increased interest in the ideal buttocks has led to higher demand and inquiry for these aesthetic procedures. Between 2002 and 2003, a reported increase of 533% of gluteal augmentation procedures was reported by the American Society for Aesthetic Plastic Surgery [6]. Latinas are the leading consumers of aesthetic surgery among US minority groups [7]. Media has a strong influence in creating a consistent prototype when it comes to

Although beauty ideals are subjective among individuals and continue to change between cul‐ tures and ethnic backgrounds, different ways to evaluate the gluteal region have emerged. Examination of the current literature identified specific features that describe the ideal buttocks. The hourglass female figure appears to be the preferred and ideal shape. A waist‐to‐hip ratio (WHR) of 0.7 was established and described to support this idea [8]. Other defining features that stood out as consistent features of beauty include the anteroposterior projection, the length of infra‐gluteal fold, the presence of supra‐gluteal fossettes and the upper inner‐gluteal sacral junction "V‐zone" [9]. Similarly, it was recognized that there are two relationships formed by the infra‐gluteal to inner thigh and the sacral height to gluteal crease length as important con‐ touring zones [6]. Furthermore, four different body frame types have been widely described as critical features that dictate specific interventions when planning buttock aesthetic surgery. An extensive search for gluteal aesthetic improvements has occurred since 1960 and led to the

evolution of more advanced techniques and products with improved aesthetic results.

Our study was created to test the hypothesis that generalizing all Latinas in the same category of aesthetic preferences is inappropriate [10]. The target group was Latinas born

**Figure 4.** 1(A–B): Presence of supra gluteal fossettes; 2(A–C): Waist to hip ratio; 3(A–B): Length of infra gluteal crease; 4(A–B): Prone projection; 5(A–D): Square, A‐shaped, V‐shaped, Round; 6(A–C): Profile projection; 7(A–C): Sacral height to gluteal crease length; 8(A–B): Presence of diamond zone 9(A–B): Presence of V‐zone (Public domain).


**Table 1.** Features.

The survey was written in Spanish and Portuguese; it was distributed via social network and available for 5 days to female participants only. At the end of the 5 days, no additional surveys submitted were accepted. The identity of each participant was verified with the records form each personal profile in the social network. The study concluded that despite having similar backgrounds and influences, their buttock aesthetic preferences were not consistent. Even among women from the same country, differences were encountered. Regardless of national‐ ity, each patient is an individual with unique predilections that have been influenced from specific life experiences, cultures, education, economics, and social surroundings. This is what contributes in shaping their perception of beauty. Consequently, plastic surgeons should be sensitive to different ethnic concepts of beauty and appreciate a range of values rather than assume what a specific culture or ethnicity prefers.

Not only Latina but also black women are believed to prefer large buttocks. I erroneously at one point believed that statement. During a regular clinic day, a real example was in front of my eyes. This memorable patient had suffered from erroneous stereotyping based on her race. She had previously undergone an enhancement procedure for her buttocks. Specifically, she had fat injections to improve her shape. Soon after talking to her, she started crying from frustration with the results obtained from the procedure. She explained that she just wanted a slight increase of the projection of her buttocks. However, communication and discussion of expectations were not successful. The surgeon who performed the procedure assumed that because of her dark skin, she wanted large and voluptuous buttocks and performed what he "thought" the patient wanted. A thorough discussion prior to signing informed consents for cosmetic procedures should emphasize expected outcomes and ambitiously approximate the patient's goals for his or her appearance.

As one can imagine, buttock reshaping is not performed in the same manner for every‐ one. All surgical techniques are used in combination to achieve the desired results. Baseline exam of the patient and analysis of their buttocks are crucial prior to undertaking any inter‐ vention. Identification of physical features and the input from the patient will guide the plastic surgeon to the proper approach. It is important to recognize that physical features not only vary among females but also across gender and ages. For example, it has been dem‐ onstrated that male buttocks show fewer signs of atrophy and transformation with aging in comparison to females. The aging process is based on fat distribution, skin and tissue changes, volume and the effects of gravity [11]. Proper analysis applies to every part of the body (**Figure 5**).

Our studies on facial and gluteal features are random examples on how profiling and stereotyping can lead to inaccurate assumptions in cosmetic surgery. They denote that scientific analysis can assist the surgeon in preoperative counseling. It also influences in learning and managing patient expectations and helps to optimize the choice in tools for beautification. The use of evidence‐based medicine to approach the design and execu‐ tion of cosmetic surgery is practical and helpful in codification of technical guidelines (**Figure 6**).

The survey was written in Spanish and Portuguese; it was distributed via social network and available for 5 days to female participants only. At the end of the 5 days, no additional surveys submitted were accepted. The identity of each participant was verified with the records form each personal profile in the social network. The study concluded that despite having similar backgrounds and influences, their buttock aesthetic preferences were not consistent. Even among women from the same country, differences were encountered. Regardless of national‐ ity, each patient is an individual with unique predilections that have been influenced from specific life experiences, cultures, education, economics, and social surroundings. This is what contributes in shaping their perception of beauty. Consequently, plastic surgeons should be sensitive to different ethnic concepts of beauty and appreciate a range of values rather than

shaped; R: round)

1 Supra‐gluteal fossettes (SGF) 2 Waist‐to‐hip ratio (WTHR) 3 Infra‐gluteal fold (IGF)

4 Antero‐posterior projection (prone) (APP‐p) 5 Frame shape (A: A‐shaped; S: square shaped; V: V‐

6 Antero‐posterior projection (profile) (APP‐pr) 7 Upper‐inner glutal sacral junction (V‐zone)

9 Sacral height to gluteal crease ratio (SH‐GCR)

8 Infra‐gluteal fold inner thigh relationship (diamond

zone)

Not only Latina but also black women are believed to prefer large buttocks. I erroneously at one point believed that statement. During a regular clinic day, a real example was in front of my eyes. This memorable patient had suffered from erroneous stereotyping based on her race. She had previously undergone an enhancement procedure for her buttocks. Specifically, she had fat injections to improve her shape. Soon after talking to her, she started crying from frustration with the results obtained from the procedure. She explained that she just wanted a slight increase of the projection of her buttocks. However, communication and discussion of expectations were not successful. The surgeon who performed the procedure assumed that because of her dark skin, she wanted large and voluptuous buttocks and performed what he "thought" the patient wanted. A thorough discussion prior to signing informed consents for cosmetic procedures should emphasize expected outcomes and ambitiously approximate the

As one can imagine, buttock reshaping is not performed in the same manner for every‐ one. All surgical techniques are used in combination to achieve the desired results. Baseline

assume what a specific culture or ethnicity prefers.

**Features**

182 Perception of Beauty

**Table 1.** Features.

patient's goals for his or her appearance.

**Figure 5.** Fernando Botero's sculpture with exaggeration of curvy buttocks. Emphasis on the female buttocks as a sexual characteristic has recently increased, upper female torso (breast, shoulders) give way to the lower, perhaps perceived as more erotic, area of the body, specifically buttocks. The question arises whether the fashion (tight, accentuating hips, jeans) plays a role in this change (Old Town Cartagena, Colombia. Photograph by the Author).

**Figure 6.** Surveys help to establish objective and sharable information for aesthetic surgeons and the public. Colleagues from Munich pursued also other beauty codifying projects (Photograph by the Author).
