Art vs Craft: The Eye Knows

Sabrina Fabi, MD, FAAD is a double board-certified dermatologist and dermatologic cosmetic surgeon, and is an assistant clinical professor at the University of California, San Diego. She is associate research director at Cosmetic Laser Dermatology in San Diego, where she practices, and is a frequent lecturer and author.

I recently read an article from a fragrance expert and renowned perfumer that talked about how a piece of art goes beyond its components. A Matisse painting or DaVinci sculpture is not about the materials it's made of, but the feeling it evokes. A symphony by Beethoven isn't valuable because of the individual notes or instruments it is played on. Similarly in aesthetic medicine, it is not about a syringe of filler but an aesthetically pleasing result that evokes a feeling in oneself and others of a person who looks “great” for their age, refreshed, beautiful or handsome, and most importantly natural. Yet, aesthetic medicine is all too often reduced to a vial of product, or a unit of neuromodulator, when in fact it is much more. It is still also the practice of medicine and, like any medicine, should be administered by a qualified and trained professional who can recognize an adverse event and have the tools and knowledge to manage it.

The article went on to talk about how in France perfume is a craft, and a serious one. Whether it is cosmetic dermatology, facial plastic surgery, oculoplastic surgery, or plastic surgery, aesthetic medicine in the US, as in many parts of the world, is, too. So much so that it takes four years of medical school training, one year of internship, three to five years of residency, and one to three years of Fellowship to not only learn the pathophysiologic changes occurring with age, but the underlying anatomy that needs to be respected when reversing the signs of aging so as to first “do no harm”—an oath only physicians take to practice this craft.

The myriad devices and drugs available are taught as well, each one with its own set of indications and side effects and unique interactions when applied to the face and body. As a Volunteer Assistant Clinical Professor at the University of California, San Diego, I share my passion and knowledge with residents, emphasizing that the most important part, which I believe differentiates craft from art, is facial assessment and techniques to apply and combine the modalities available to enhance the appearance of our patients safely and effectively.

Be an Artist

In the words of Yves Saint Laurent, “Fashion is not art, but to do it, you have to be an artist.” So it is with aesthetic medicine. If aesthetic medicine were an art, it would be the art of being able to assess and know the exact anatomic changes that account for the unique aging canvas that presents to us, so that we can treat the cause not the symptom. It would be the art of knowing how to use various chisels (fillers), paintbrushes (lasers), and colors (neuromodulators) in combination to enhance the appearance of our patients. It is having the eye for symmetry and proportion and the skill to create harmonious aesthetic results so that patients look natural. But most importantly, it is the art of recognizing the deeper impact that these procedures and we, as aesthetic physicians, have on the self-confidence and happiness of the patients we treat, and respecting and honoring that the impact is more profound than skin deep.