“Beauty is in the eye of the beholder.” This oft-quoted statement is attributed by some to Plato as a paraphrase of one of his writings. Shakespeare expressed a similar sentiment in “Love’s Labours Lost” which read, “Beauty is bought by judgment of the eye.” My favorite rendition, however, came from Miss Piggy who said, “Beauty is in the eye of the beholder, and it may be necessary from time to time to give a stupid or misinformed beholder a black eye!”
As a board certified plastic surgeon, I am quite familiar with the fundamental importance of involving the patient in surgical planning to make sure that the surgical result agrees with the patient’s idea of beauty. If the patient is not happy with the final appearance, then all is for naught! An article in the March 2012 edition of Plastic and Reconstructive Surgery explores this issue in those patients who are of Indian heritage (not the Native American kind) and who seek to have cosmetic nasal surgery. Often times these Indian patients wish to retain a bump over their nasal bridge. In a series of 316 patients, only 10 complained of their hump, far less than one would find in a similar series of American patients of Northern European heritage. An Indian surgeon explained, “In our country [India], a large hump may be well accepted but even a slight depression in the dorsum is a major concern. The stigmata of a depressed nose and leprosy is still deeply rooted in the minds of the general population.” Leprosy destroys the tissues that support the nasal bridge, resulting in a depressed “saddle-nose” deformity. Lepers are social outcasts because of the fear people have of contracting leprosy, and thus individuals considering nasal surgery wish to avoid the appearance of one who has the disease at all costs!
There are other reasons why ethnic patients seek to preserve certain aspects of their appearance that are common to members of their ethnic group but may not be considered attractive by most people. A prominent nasal hump is an excellent example. In my experience, the primary reason for this hesitation to remove the hump is that preservation of it allows the patient to look like and thus identify with other members of their ethnic group. What some may consider as an unattractive nasal hump is preserved to allow the Indian patient to continue to look Indian. Removing it may give the impression that the patient no longer wants to be thought of as having an Indian heritage. Even if the patient wishes to remove the hump, familial pressure often persuades them to retain it lest they look as though they are rejecting membership in the family and ultimately reap the ill will of their relatives. “Ill will” may become removal from the will!
To allow me to understand the patient’s desires, I will sometimes ask the patient to bring photographs or drawings to illustrate their desired changes. In the past I’ve often used what artistic talents I have to draw a picture of what I understand to be the desired result to make certain that the patient and I agree on our goal. The use of photographic imaging to morph the patient’s current photo into the desired result is a newer technique that makes use of imaging technology to accomplish the same outcome. I have made use of this technology for the past 15 years and find it to be invaluable in making certain that the patient and doctor agree on what is the surgical goal. As opposed to a patient bringing a photograph of a person whose nose they like, I alter their nasal photograph with the aid of the computer to allow them to make sure that what they are asking for looks good on their face. It’s a bit like trying on a dress to make sure it looks good before taking it home as opposed to seeing the dress on a mannequin and putting it in the bag without seeing how it fits! Imaging makes it much easier to insure that the final result is indeed, “Beautiful in the eye of the beholder!”
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