Beyond Formula and Into Feeling : How to Optimize Cosmetic Surgery

How Art is Everywhere – And Hard to Explain

When I was in college, one of my good friends was an artist. Not only did he paint and draw, but he had spent a good amount of time studying art and learning the principles of design and aesthetics. Being the product of a regimented French school system, and having been on target for a life in the sciences, I had none of that exposure. When I looked at art, I expected it to represent literally what it showed. An apple is an apple. Does it look like one in this painting?

As I ventured through my first year of PreMed education, I realized that I had been studying science for so long that I had no idea what anything else really was. I browsed the list of offered courses and found 2700 classes that I could take. Most of which were not in science. Was there really that much you could do that was not science? Well, there was. And I wanted to do it all.

I changed my major to psychology to allow for the most flexible program. I then decided to dip my toe into design, and I took a class on contemporary artists. For weeks I sat there, watching them project images of colorblock paintings: one red rectangle on top of a blue square, four dots in a line, two lines down the painting, not quite centered. I couldn’t wrap my head around this. What was this nonsense? Who decided that these people were amazing artists? How were there entire books written about these works? Then I saw the ultimate offender: a solid white canvas. Just white. Um. What.

I decided to discuss this with my artist friend, beginning the conversation with a full-on accusation about the entire concept of design. He didn’t try to explain. Instead, he got some tickets to an art show and brought me to the exhibit. We walked around a little bit, observing some more traditional works and things that looked like themselves. And then there it was. A blank screen with some smudges on it. Nothing more, just smudges. I braced myself. I’m not going to get angry I said in my head.

“Okay. Please explain that to me,” I gently suggested. “It’s three smudges.”

He smiled patiently, stared at it some more, smiled wider.

“Yes,” he said. “But they are all in exactly the right spots.”

In the decades since that visit, I have come to understand the point of design, as well as the profound impact that it has on everything around us. The way that things are laid out and distributed not only determines what we consider attractive, but it can also affect our moods, our fears, and our spending patterns. We can become more productive in a less cluttered room, feel safer with symmetry, be attracted to someone who seems healthy and strong, and be confident when we feel balanced and in shape. The psychological impact of design makes the world turn, and despite being subjective, there are constants that hit us all the same way.

One of the most critical parts of a cosmetic breast surgery is the positioning and shaping of the nipple. For this portion, the patient is sat up to see how the breast falls, and then the nipple and areola are placed exactly in the right position. The surgeon often stands at the foot of the bed, and compares both sides, with the nurses and scrub technician confirming that they agree things are where they should be. For this, you don’t need much formal training. Things either look right or they don’t- you just know it when you see it.

This is the same thing that I try to explain to the medical students and residents that I train. While there are many aesthetic principles of which you must be aware in order to design things the right way, the bottom line is that proper designs just feel right. There is an instinct about it that lets you know that you have done things well. This is the principle that I use in all of my work.

Beauty Is Instinctive

It happens regularly that a patient will come in and say, “I hate my nose. I’m not sure why. I just hate it.”

At that point, the surgery training and the design training kick in. I can pick apart and analyze the issues, and help the patient realize why they are not happy with the shapes that they see. This helps with surgical planning and guides the process for what needs to be done. But ultimately, on the operating table, the work must continue until the overall design just looks RIGHT. This starts with the original plan based on aesthetic principles, and then gets modified to fit that patient’s face. The nose you draw in isolation is not the nose that will look best on that person. It is a version of the nose you drew that will optimize to this situation. Finding that version goes beyond formula and into feeling.

Plastic Surgery As An Art Form

In the decades since I renounced PreMed and became an artist/designer, then later returned to my first love of science and ultimately blended the two, I keep going back to the same art show exhibit. And every time I perform a surgery I think to myself: “Is that exactly the right place for that? Does that just look like it BELONGS there?” If the answer is not yes, then you’re not done.

There is a golden rule for aesthetics that dictates how to proportion things. It states that things look best when they are divided in thirds, and one part is one third, with the rest being two thirds. This is especially true for photography, where things looks good when the photo can be sectioned into 1/3 and 2/3 sections. If the bridge pictured here were in the middle of the frame, the photograph would look amateurish. I have always marveled at the fact that the human body is completely proportioned this way, throughout; and even more amazing is the fact that I learned that at Parsons and not in plastic surgery training.

One of my greatest joys in my work is improving or restoring my patients’ life or function. As a person who needs to be creative, I find tremendous satisfaction in the fact that every case is different, and every outcome can be customized. I have never made two noses look the same, or two sets of breasts fall the same way; because there is no one beauty standard. Not only do trends change and people evolve, but sometimes even the same person needs different things at different times in their lives. But the one thing that never changes is the total satisfaction of making it look and work just right, and seeing the beaming smile in someone’s eyes when they take a look in the mirror, then look up at you, and simply say, “Nailed it.”


How Do I Know What Balance Is?

To some degree, balance is instinctive. You know it when you see it. But getting there requires training, and there are scientific principles in play. For example, the golden ratio dictates how we like things to be divided. This applies to photographs and faces equally. The rule is two thirds/ one third.

Is There a Perfect Shape For My Nose Or Breasts?

While there are design principles that guide our goals, it is crucial to remember that everyone is different, and needs a different result. Individual genetics and cultural difference should always be taken into consideration, because the same nose that looks perfect on one person may be completely out of place on another. There is a range of target shapes for every patient, and the goal should be to choose one that meets their aesthetic and functional goals, while respecting the principle of balance as a guide rather than an outline.

Cookie-Cutter Cosmetic Surgery

As with anything else, guidelines need to be applied to be optimized. The measurements and concepts are standardized to some degree, but they have to be personalized by patient in order to truly shine. This is the key to success: toeing the line between fitting in enough to not be obviously “done,” and looking good enough to stand out in the crowd. Balance is a delicate thing indeed.


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