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Look Back to Move Forward

By: Steven H. Dayan, MD, FACS
Posted: May 3, 2010, from the May 2010 issue of
Physicians with hands in center

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I found this interesting, because the cheek scar looked much older. She then indicated her concern was elsewhere. She pointed to a small, two-millimeter red capillary lesion on her right temporal forehead, and said, “Doctor, can’t you see the blemish? Everybody sees it, and it’s killing me! You have to fix it!” The scar across her cheek from a dog bite at the age of two didn’t bother her at all. She didn’t even notice it. So I treated the blemish, and she left my office with a big smile and a satisfying experience.

The eye of the beholder

This scenario forces us to be reminded that it is about who we are treating. By making my patients happy, I have achieved the goal. It’s not about what I think is beautiful—it is about what the patient wants treated. Of course, within reason, except for the 7–10% of the population that suffers from body dysmorphic disorder (BDD), our job is to treat the psyche of our patients as much—if not more so—than the physical.

With this in mind, it is conceivable the most practical class we took in medical school was psychiatry. Somewhere along the way, cosmetic medicine got derailed. The physician achieving self-satisfying, heroic outcomes in an attempt to design the ideal human form became the rage, and a rash of unnatural, overdone Barbie dolls surfaced, misbranding the field of plastic surgery in particular, and aesthetic medicine in general. But treating the patient’s mental well-being has been at the core of the field from its inception, and a look back to the beginning of cosmetic medicine is warranted for all who practice it.

Changing through time

Cosmetic medicine originated not as a treatment to enhance the beauty of the elite, but more as a service trade allowing one to pass into society without discriminating characteristics. Beginning with the Romans and Greeks, plastic surgery allowed conquered nomadic populations to assimilate and hide evidence of a nefarious past or membership to an unacceptable cult. The first cosmetic surgeries were performed on early Hebrews, Egyptians and Phoenicians.

For 2,500 years, cosmetic medicine philosophy and techniques didn’t change much—that is, until the early 20th century. Following World War I, soldiers survived battlefield wounds and returned home with disfiguring facial wounds that prevented them from being visible in public. These disenchanted and disfigured veterans wanted to return to society and pass without being recognized. They desired form, function and assimilation.