Julius Few, MD is founder of the Few Institute for Aesthetic Plastic Surgery in Chicago, IL.

As aesthetic physicians, we represent a unique breed in the medical field. On one hand, it takes years of education and training to learn the technical and scientific aspects of medicine—those foundational elements that all medical doctors must master in order to earn their credentials. On the other hand, most of us are drawn to cosmetic procedures because we also have an artistic side. We are visual artists—painters, sculptors, photographers— we have any one of dozens of outlets that foster our creative compulsions. Effectively merging medical expertise with an eye for beauty is a fundamental skill for success in the aesthetic medical field.

However, when it comes to our patients, the interpretation of “beauty” is not ours alone. It is a collaborative effort wherein the key to a successful outcome that pleases both ourselves and our patients is understanding their vision and desires as much as it is effectively communicating our skills and knowledge to help them make informed decisions.

In the growing multi-cultural milieu of the United States, this isn't always easy. But just as the cosmetic enhancement industry has evolved, so too have some key approaches that make this a more manageable process. From the ever-evolving techniques and trends at our fingertips, to race, culture, and media influences, fostering a successful practice and happy patient base means playing an active role in helping our patients to find a healthy balance of beauty and culture.


In the US, we were once all considered part of the “melting pot.” Assimilation was the predominant mindset for decades. Today, however, we live in what's been called a multicultural mosaic, where individual characteristics of various races and cultures are mixed together (think salad), but retain their form rather than becoming blended into a batter (think cake). We are a modern day mix of Middle Eastern, African, Classic South American, Asian, Hispanic, and more.

Still, in Hollywood, celebrities are both criticized and idolized for their homogeneous beauty. It's not surprising when we hear that patients want Megan Fox's eyes or Scarlett Johansson's lips. Celebrity culture is both a blessing and a curse for the aesthetic physician. While celebrities motivate and inspire patients to seek out treatment, they are also a homogeneous bunch. We all know that not everyone is going to look good with Kate Middleton's nose, but explaining that to a patient who is adamant about having one that looks just like hers is not always easy.

In general, we've seen society's pendulum swing from the desire to homogenize in past decades to where we are today: embracing those traits that make us different, yet beautiful. In fact, it's in these differences that we find beauty. Sure, the so-called all-American beauty still exists, but it is no longer the pervasive ideal it was back in the 1980s, when Carol Alt and Christie Brinkley were the faces everyone wanted to have. Today it would be hard to describe “standard” beauty. So while patients may think they want a particular feature or characteristic of their favorite A-Lister, it's important that we put some fundamental basics in perspective, and that begins with the science of beauty.


For centuries we've known that there's a science to beauty. The Fibonacci sequence, or pattern of perfection, measures beauty based on a numerical sequence that results in “ideal” proportions, regardless of race or culture. Taking a symmetrical approach to cosmetic enhancements produces natural and beautiful results that retain ethnic characteristics. We all know that sometimes it's not the nose that's out of proportion on the face, as the patient may believe, but the chin, and enhancing the chin balances out the nose and overall profile. Not every face is designed to have a button nose. This is one way to help minimize the risk of making major changes to appearance that could be met with regret down the road.

Of course we can't rely on science alone. There are also significant amounts of qualitative data we each gather during the evaluation process to make informed recommendations for treatment options:

  • We listen to the patient's own evaluation and desires.
  • We look at pictures of the patient during younger years to see how the face has aged.
  • We attend to cultural nuances so that we can help patients to see and understand what only hindsight can offer otherwise.

By this third point, I mean that it's easy for all of us—physicians and patients alike—to become enamored of celebrity culture. Unfortunately, it has the potential to lead to what has historically been a short-sighted desire for homogenized features. For instance, several years ago media headlines drew attention to demand for reverse rhinoplasties to reclaim ethnic features lost with surgery. These are the kinds of trends we strive to avoid. Patients today want natural-looking enhancements: To look like themselves, only better. In my practice, this is achieved by using what I call the continuum of beauty.


The continuum of beauty is a multi-cultural, multi-generational approach I designed to minimize the signs of aging while maintaining a natural appearance that includes retaining ethnic characteristics. A continuum, by definition, is a continuous sequence in which adjacent elements are not perceptibly different from each other. The idea is that we can avoid obscuring ethnic identity and deliver subtle enhancements by blending together less aggressive treatments over time to rejuvenate skin of color. This approach is both scientific and strategic and makes small changes that contribute to appearance in big ways, while maintaining identity and reducing risk.

This concept was inspired in my practice seven years ago in the treatment of skin of color where the traditional surgical approach came with the unwanted risks of scarring and pigmentation issues, as well as concerns of potentially obscuring ethnic traits and/or features. Using a combination of fillers, neurotoxins, non-surgical skin tightening treatments, and strategic periorbital techniques together resulted in a powerful rejuvenation process that delivered beautiful results without the risks and, notably, without significant change to features. Beyond overall facial enhancement, there are other benefits this approach offers: Fillers can be used strategically to simulate surgical results so that patients can actually experience what a result may look like before making a surgical commitment; non-surgical energy-powered skin tightening and laser treatment can correct irregularities in the soft tissue for a more natural result compared with surgery. Treatments can be “stacked” in the same day to maximize results and minimize recovery time.


Ours is an industry in constant flux. New technologies beget new techniques; beauty trends, largely generated by celebrity culture, trigger changing beauty “ideals.” Staying ahead of the curve in this ever-evolving industry demands a dedication that goes beyond what they teach us in medical school.

To be successful means to do more than simply deliver excellent cosmetic work; it is to have our patients happy with the process and outcome. To do so, we are responsible for helping our patients to see, understand, and make decisions about what only hindsight could offer them otherwise. We draw on what we know from popular culture, what we learn from our peers and educational outlets, and our own active research about our specific patient population's needs and desires. We are more than just adept surgeons; we are their consultants, guides, and sounding boards. This is arguably one of the most challenging aspects of what we do everyday. It is a qualitative process that we inform by listening to patient, attempting to see what s/he sees and what s/he wants. We evaluate pictures from previous years to identify the specific ways s/he has aged. We combine our evaluation with his/her expressed desires to agree on the best way to set and meet expectations.

It's not a simple process. It takes careful thought and attention, with an eye to both celebrity culture as well as the nuances of ethnic characteristics.