Psychology, Physiology, and Philosophy of Aesthetic Medicine

The question of why we practice aesthetic medicine always intrigues me. Is it just because we want to make a lot of money? I’d say no because we know that beauty itself has its own currency; that hypothesis came about in the late 1990s. Who wouldn’t want to look their very best?

From a young age, women are exposed to society’s standard of beauty. There’s a fascination with beauty pageants, Disney princesses, models, and other celebrities; we look at them and think, “They’re so amazing.” But why do we encourage young girls to fantasize over this idea of beauty? The Mister World pageant tried to exploit women’s attraction to men, but it didn’t work. Women weren’t thinking these attractive men would make great life partners; rather, they would make excellent shopping partners.

Industry experts say we’re trying to promote the survival of the group with our genes, but most of my patients are postmenopausal. They are not interested in attracting men to have more children. Why do patients accept risk from cosmetic procedures, such as blindness, swelling, pain, asymmetry, high costs, and even death from procedures such as the Brazilian butt lift (BBL)?

Researchers found women who use Botulinum toxin and other aesthetic procedures increase self-confidence and self-esteem.1

Psychologists in the early 1900’s thought that women that cared about their appearance had a neglected form of insanity. Now, we realize that cosmetic procedures grant empowerment to control over how our body ages. Similarly, having an aesthetic procedure is like getting a tattoo. A study found tattoos are a form of self-expression, and that people feel it’s necessary to get the tattoo to relieve a sense of anxiety. Most people contemplated their tattoo for 8 to 9 years prior, whereas 6% were young, drunk, and spontaneous.2

As we age, we want to maintain our relevance. This is important for having some control. Research shows self-esteem has improved with procedures like blepharoplasty.3 Studies have shown that some cosmetic treatments and procedures could be equivalent to taking an antidepressant. Both taking the antidepressant and receiving an aesthetic procedure showed improved mental health and emotional scales, but not physical health.4

Aesthetic medicine connects to physiology and the red lip theory is a perfect example. Humans are unique; they are the only species with red lips. Women notably enhance the color of the lips with shades of lipstick. A study in France highlighted this by timing how long it took a woman to have a man approach her depending on the color of lipstick she wore. When a woman walks into a bar wearing red lipstick, it takes about 20 minutes for people to flirt with her. If she’s wearing a pink shade, it takes about 24 minutes, brown lipstick takes about 25 minutes, and if woman is wearing no lipstick at all, it takes about 27 minutes for people to flirt with her.5

Functional MRIs have shown four key areas of the brain that light up when viewing female faces: orbitofrontal cortex (Gob), nucleus accumbens (NAc)/ventral striatum, sublenticular extended amygdala (SLEA) of the basal, and forebrain.⁷

Red is symbolic for power, passion, and purpose. Another study found wearing red in internet personal ads enhanced a man’s attraction to it. Wearing red in a dating profile is linked to a 20% higher chance of getting asked out.6 Country flags tend to have more red in them because it represents power, passion, and purpose.

A woman feels the most beautiful during the first three months of a sexual relationship. She is slightly disinhibited. She feels good. It only takes 0.2 seconds for hormones in the brain to act when seeing a beautiful person. The brain physiology of falling in love is when dopamine and oxytocin rise, and serotonin is low. This seems counterintuitive because serotonin reuptake inhibitors are common anti-depressant drugs and you begin to feel obsessed. We prescribe selective serotonin reuptake inhibitors (SSRIs) and antidepressants to people who are depressed because it increases serotonin. Falling in love allows you to obsess about your partner a bit more.

Functional MRIs have shown four key areas of the brain that light up when viewing female faces: orbitofrontal cortex (Gob), nucleus accumbens (NAc)/ventral striatum, sublenticular extended amygdala (SLEA) of the basal, and forebrain.7 Faces that are beautiful tend to receive more viewing time than any other kind of face. Social beauty is very different from moral or other kinds of beauty, such as a Claude Monet painting. There’s something about a face that lights up key areas of the brain differently than anything else.

When a beautiful couple walks into a bar, the women in the bar look at the woman. They examine her hair, cellulite on her backside, her shoes, and even the bag she is carrying. Studies show women look at men and women equally, whereas a man cuts out looking at the man to focus on the woman.

Humans are somewhat chasing a hormonal high and aesthetics is the fifth key area of philosophy. It allows us to dream about how we can improve our lives and our patients’ lives. Plato thought it was dangerous and should be censored, which told us that it’s actually very powerful. If you look at all these reasons, we practice aesthetic medicine for money, currency, power, purpose, passion, self-esteem, confidence, relevance, and empowerment.

A 103-year-old patient of mine said his key to longevity is not having peer pressure. His sense of humor as a centenarian is how we should all aspire to age.

1. Singh C, Dulku A, Haq A, Bhatti T, Bhatti A. Why Do Females Use Botulinum Toxin Injections? J Cutan Aesthet Surg. 2015;8(4):236-238. doi:10.4103/0974-2077.172201

2. Dimitropoulos V, Brown CW Jr, Ressa NA, Newman M. Reasons behind the ink. Cutis. 2016;98(5):320-322.

3. Papadopulos NA, Hodbod M, Henrich G, et al. The Effect of Blepharoplasty on Our Patient’s Quality of Life, Emotional Stability, and Self-Esteem. J Craniofac Surg. 2019;30(2):377-383. doi:10.1097/SCS.0000000000005057

4. Rudolph C, Hladik C, Stroup DF, et al. Are Cosmetic Procedures Comparable to Antidepressive Medication for Quality-of-Life Improvements? A Systematic Review and Controlled Meta-Analysis. Facial Plast Surg. 2019;35(5):549-558. doi:10.1055/s-0039-1697030

5. Guéguen N. Does Red Lipstick Really Attract Men? An Evaluation in a Bar. International Journal of Psychological Studies. 2012;4:206-209. doi:10.5539/ijps.v4n2p206.

6. Gueguen, Jacob C. Color and cyber-attractiveness: Red enhances men’s attraction to women’s internet personal ads. Color Research & Application. 2013;38:309-312. doi:10.1002/col.21718.

7. Martín-Loeches M, Hernández-Tamames JA, Martín A, Urrutia M. Beauty and ugliness in the bodies and faces of others: an fMRI study of person esthetic judgement. Neuroscience. 2014;277:486-497. doi:10.1016/j.neuroscience.2014.07.040