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Beauty & Body

“It is better to be beautiful than good, but it is better to be good than ugly”
-Oscar Wilde

Let’s face it. The human obsession of beauty is prevalent in virtually every society. Interestingly, recent studies by Cunninghman et al, 1995 suggest that the constituents of beauty are neither arbitrary nor culture bound. That is, the consenseus on which a woman is considered to be physically attractive or not is actually high across four cultures (Asian, Hispanic, Black, and White.) We will get to the bottom of beauty in a moment. But for now, take a brief step back in time…

Prior to the Age of Enlightenment (an eighteenth-century movement in European and American philosophy), beauty had been closely linked to truth and moral goodness. Beautiful people, for instance, were seen as virtuous and trustful. Ugly people on the other hand, were often equated with unreliability and dishonesty. Taboos, prejudices, and religious views dominated the conception of beauty, and physical attractiveness. Implicit in this era, however, was that the beauty ideal was to the core an inner, or personal beauty. When one talks about beauty today, it often refers to physical attraction. And physical attraction in the modern era stands as a value and function in society totally independent of it’s ‘‘inner’’ terms. That is, beauty to many really is only skin deep. People appreciate it for what it is, such as a tall, petite woman with round perky breasts, small hips, and firm buttock, or a tall fit man, with broad shoulders, and ‘‘nice arms’’. Beauty, or physical attractiveness is intimately connected to ones idea of self and identity and in many ways, defines who we are as a person. The philosopher Medard Hilhorst in 2002 described physical beauty as a construct of several features including: a. physical looks (body, face, figure) b. Artistic looks (clothes, make-up, perfume, hair) c. Personal looks (appearance, impression, aura) d. Performance (voice, attitude, behavior) e. Personality (charm, charisma, appeal, allure) f. Rational capacities (contactual skills, communicational competence) g. Friendship abilities (reliable, nice, offbeat, loveable, companionable). According to Hilhorst, judgements are made at each level. For instance a physically stunning woman could be a bad dresser or a poor friend. An obese man could be charming and trustworthy. Indeed this is how we evaluate people day to day on a subconscious level. However, an ugly, reliable woman with a beautiful Prada gown, charming personality, sexy voice, and wonderful friend is still ugly, at least in the physical sense. In January 2001, a survey asking the American public whether ‘‘physical beauty’’ or ‘‘inner beauty’’ ‘‘counts more in the real world’’ revealed that over 1/3 of participants over the age of 18 said that they thought physical beauty ‘‘counts more’’. Nearly a quarter of women said they considered maintaining an attractive physical appearance ‘‘essential’’, and more than half of women said that they considered it at least ‘‘important’’. It is no wonder that plastic surgeons, dermatologists, and cosmetic dentists have seen an explosion in the demand for beautification procedures. And I doubt anyone would argue that personal appearance and physical beauty are becoming increasingly important in American culture. As a consequence, plastic surgeons have seen a boom in many body procedures, including abdominoplasty, liposuction, brachioplasty, and thighplasty. The numbers don’t lie. In fact, nearly 14.6 million cosmetic plastic surgery procedures were performed in the United States in 2012, up 5 percent from 2011, according to statistics released by the American Society of Plastic Surgeons (ASPS).

While minimally-invasive cosmetic procedures continue to see an increase among all age groups including injectables and fillers, baby boomers are adding skin and body lift procedures in increasing numbers, according to ASPS statistics.

So why are many baby boomers, those 76 million Americans born between 1946 and 1964 choosing to combat aging skin, sagging breasts, pudgy tummies? Well, why should one age gracefully when one can in some way take control of the ageing process? The fact is many adults don’t feel old yet. Many adults are at the top of their career in their mid-life and don’t plan on slowing down anytime soon! And in some if not all careers, an attractive body equals success. More than ever adults are extremely fitness conscious. So it follows that big premiums on youthful bodies just makes sense.

It is interesting that despite all people being ‘legally equal’ in life, beauty does indeed have Its advantages. Beautiful people are treated differently. It’s a fact. Differential treatment actually starts early in life. For instance, three month old children gaze longer at attractive faces than at unattractive faces. Attractive children receive less punishment than unattractive children for similar acts of misbehavior. Indeed, this differential treatment continues through school, college, and post-college. For instance, attractive students receive better grades. And there is some evidence to suggest even that physical attractiveness may dominates job qualifications. And what about really good looking criminals? Well, they’re more likely to receive better treatment and easier convictions based on study by Hatfield & Sprecher in 1986.

So you might be saying, ‘but what if I have a great personality and I’m really successful?’. Sure, it helps, particularly if you’re a guy. Appreciate this: Across 37 cultures looking at ‘mate selection’, men attach the greatest value to women’s physical attractiveness, healthiness, and youth (since these are all markers for reproductive success); Women tend to value a man’s socioeconomic status, social position, prestige, and wealth (markers for protecting offspring.

A Harris Interactive consumer survey conducted for ASPS in 2006 found interesting trends. In this ASPS survey of 800 women ages 35 to 69, it was found that the majority would prefer their face to look 13 years younger. The survey also found women were most likely to be extremely or very concerned about wrinkles and sagging skin. The majority (81 percent) of respondents were 40 to 64 years old (3).

Not all of these patients are the “mommy-make-overs”, either. ASPS statistics tells us that males had more than a million cosmetic plastic surgery procedures in 2012.
Male thigh lifts increased, male breast reductions (usually from gynecomastia), and abdominoplasty continue to grow in popularity among men.

What is the beautiful body, anyway? Good question. There are several attractive facial features that have been studied and reproduced, particularly in the woman. For instance, a small size of the lower 1/3 or the face in women is attractive, as well as ‘high and prominent cheekbones’. Some authors (Rensch, Cunninghman, Johnston & Franklin) found that high forehead, large eyes, small nose, and small chin are considered beautiful traits in women and correlate with ‘babiness’ features. There has been only one consistent male facial feature that has correlated positively with male beauty and that is ‘wide jaws’ and ‘big chins’. If we look at the ‘body’, there really has been less defined reproduced studies. In women, a positive pelvic tilt, and breast size appear important. And with men? Male ‘bellies’ and overall fatness are considered unattractive. Waist to hip ratio (WHR) has been considered a good marker for beauty in many (but not all) cultures. Interestingly, low waist to hip ratios appears to correlate even with fertility! In fact, women with optimal waist to hip ratios become more often pregnant and more quickly pregnant through artificial insemination. This of course is not to say that abdominoplasty and liposuction might improve your fertility rate. But it does tell us one thing: There is a reason why men like a beautiful curve in their lover. It’s programmed in our head!

Aesthetic plastic surgery is unlike any other field of medicine. It is intimately connected with psychology, and the plastic surgeon finds him or herself dealing with people’s emotions, psychological, and social needs and aspirations on a daily basis. Many times, our goal is to alter physical appearance to boost body image. The interesting (and challenging) component to this type of care, is that the true ‘outcome’ is measured not by the technical wizardry of the surgeon, but the satisfaction of the patient. Indeed, one of the most frustrating situations is when I perform a technically perfect abdominoplasty or liposuction and obtain a marvelous result in my eyes, but the patient is not satisfied over some minor asymmetry or virtually invisible imperfection. This brings me to two topics. One, body image. And two, body dysmorphia.

Body Image

“Beauty comes in all sizes —— not just size 5.”
-Roseanne

Roseanne may have a point. Many of my patients want to be a size 3!
Body image is a person’s perception of his or her own physical appearance.
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Dr. Sarwer suggested the assessment of four central elements that contribute to the conceptual construct of body image when studying the effects of aesthetic surgery: (1) the physical reality of appearance, (2) perceptions of appearance, (3) the importance of appearance, and (4) the degree of satisfaction with appearance. It is a totally subjective phenomenon related to one’s own evaluation of oneself

Likewise a person with a poor body image will see his or her own body as being unattractive or even repulsive to others, while a person with a good or healthy body image will see him or herself as physically attractive to others, or will at least accept their body in its current shape. Important to this idea is that perceived body image is not necessarily related to any objective measurement. It is also not related to the opinions of other people; So, a person who has a poor or unhealthy body image may be rated as beautiful by others, and a person with a good body image may be rated as ugly by others. Many of us know people that fit into these two extremes. As you can imagine, persons with poor body image may develop feelings of inadequacy, and poor self esteem. In more extreme cases, eating disorders such as bulimia, binge eating, and anorexia can manifest. Body dysmorphia as we’ll see in a bit, is a form of poor body image without characteristics of eating disorders. On the other spectrum, those that are obsessed, fixated, or constantly preoccupied with their appearance of their positive body image might have narcissistic features or vanity issues.

Body image is most strongly affected during puberty. Over the last several years, there has been more media attention devoted to plastic surgery of the teenager. Of course, the impetus behind many adolescents to pursue aesthetic surgery is psychological in nature and involves body image. The teenage years are sensitive years for the developing person and it is during this heightened time of ‘self awareness’ and integration into social arenas. The adolescent is most vulnerable during this time of development and appropriately planned plastic surgery interventions have documented therapeutic aid in the reorganization of body image into a more healthy self-perception. The result can be positive changes in behavior and interpersonal relationships with a total impact of well-being and improvement in conduct of his or her life.