Do You Choose Your Patients? Or Do They Choose You?

Beauty is not only the universal language connecting all humans across all cultures but also the universal language connecting all living species. It is the vehicle that allows a banana to message a primate it is ripe as well as a daffodil to solicit a bee for pollination. And as a primal force, it exerts itself at a very primitive and evolutionarily preserved level. The human act of perceiving beauty takes place in the deepest corners of an archaic portion of our brains where we appreciate, recognize, and value beauty. Three centuries before Christ, enlightened Greek philosopher Plato equated beauty with all that is good, realizing that it is a coveted treasure. Beauty is the lubricant leading to procreation and it very well may be the rawest of energies fueling evolution.

But don't mistake beauty with attractiveness. While related, they are two distinct entities. Beautiful can be unattractive, and attractive can be ugly. Consider 1985's sexiest man (according to People magazine) Mel Gibson's distasteful tirades, Picasso's engaging but disturbing Guernica, or Joshua Bell's melodic violin sonnets unappreciated in the Washington subway. All can be perceived beautiful or reprehensible, depending on the relative environment. To be attractive requires two parts: a form to project beauty and a second being to receive it as beautiful. But in the cognitively complex human, unlike lesser developed species, the manner in which the beauty is projected is highly dependent on the projector feeling beautiful. Herein lies the challenge: To feel beautiful and thus to project beauty takes effort and work, it is not a given—even for the physically advantaged. True to all forms of human advancement, feeling beautiful requires energy and ATPs to be expended in order to achieve a higher level or meaningful accomplishment.

Thinking, exercise, communication—all require purposeful work and effort, but we struggle with our primitive nature to seek out the path of least resistance. While we are designed to conserve ATPs and preferentially ration them for activities dedicated to survival, our ability to purposefully work toward a goal provides us with our most valuable rewards. And it is through creative muscle, reasoning, and ingenuity that human advancement individually and collectively occurs. However paradoxically in our post-modern world where food and shelter is readily available for most, modern advancement seems to be focused on increasing measures to take away the privilege and subsequent rewards gained by those who work hard for something:

• Stories once read in books progressed to being heard on the radio and now to video screens, reducing our ability to imagine scenarios
• Egyptian math abacuses transitioning to calculators to computers, limiting our ability to rapidly problem solve.
• Walking giving way to moving sidewalks and now personal scooters reducing exercise for our muscles.
• Poetic letter writing yielding to abbreviated emails to texting acronyms, mutating our ability to communicate.

Is beauty following the same path of “Do it for me?” In multiple TV, radio, and print advertisements, beauty is portrayed as an effortless quick fix—a magic pill, potion, or procedure away. If we take away the ability to conquer, achieve, or taste victory no matter how small, are we destined to have a generation of patients who are going to assume we can deliver them to beauty?

Unlike a moving sidewalk we can't just automatically transport someone from being beautiful to feeling beautiful. The positive, healthy psyche is as much a part of being beautiful as the somatic form. And this takes work on the patient part as much as our part. Just like a teacher can provide information and a student can either choose to study with or without purpose and learn, we can give someone a balanced nose, defined eyes, or more proportionally sized chin but not succeed in making them attractive. And while physically beautiful, perhaps they still do not project an attractive image. Projecting beauty is so much more than just the physical. It requires an acceptance and commitment to improving the self, which necessitates effort and expending of energy.

In a society where it is easier to quit than to communicate, to numbly absorb instead of participate, or conjure excuses rather than execute, how does this bode for the next generation of patients considering plastic surgery?

As medicine strays from paternalistic overtones of yesteryear we must admit and recognize in our post-modern world that our role has evolved toward partners in the process and not the manufacturers of health and beauty. As aesthetic physicians it would behoove us to abandon previously held notions that we are gods granting beauty for the vanity challenged. Instead, today we are more akin to talented stewards that help our patients achieve attractiveness. But for this relationship to be successful takes equal commitment from both the doctor and the patient. We cannot make people beautiful unless they work at it as well. And patients who are committed to enhancing their attractiveness are more likely to achieve success as are the doctors who choose them.

In an evolving world perhaps we should evaluate human nature within a modern context attempting to better understand the motivations, desires, and commitment of our patients. Perhaps our training should not only focus on the latest techniques and products but also make a concerted effort to teach what makes someone feel beautiful and why. The future of our field may depend on it.