Aesthetics or Aesthetics? Part III

Mistakes in comprehension of artistic structure are easily made when an unaware practitioner judges his task within very narrow limits rather than taking into account the overall structure. The local situation may suggest one concept but the total context may demand another. In facial aesthetics the whole is almost always greater than the sum of its parts. The incapacity to grasp a pattern as a whole is a clinical condition called visual agnosisThe above applies most visibly in facial reconstruction from facelift through enhancements with dermal fillers to the effect of botulinum toxin. All through the process of  reconstruction, the able practitioner must bear in mind the structural skeleton he/she is shaping while at the same time must pay attention to the quite different contours, surfaces and volumes that are actually being made. The guiding image in the artist’s mind is not so much a faithful preview of what the completed work will look like, but mainly the structural skeleton, the configuration of visual forces that determines the character of the visual object.


The form of created object is a visible image and shape of the content.  Art itself aims at a graceful but deceitful illusion of reality, and any deviation from reality must be  either avoided, excused  or justified.  If the final outcome fails to fit this concept it is a result of one of the following:

–  the practitioner lacks the skill to accomplish the task,

–  the practitioner depicts what he knows rather than what he sees,

–  the practitioner blindly adopts the pictorial conventions of his peers,

–  the practitioner applies the correct principle from an abnormal point of view,

–  the practitioner perceives wrongly because of defects in his eyes or central nervous system defined as visual agnosis,

–  the practitioner deliberately violates the rules of correct representation

The inability to understand the perception, with results similar to naive realism style, assumes that there is no difference between the object and it’s image perceived by the mind so the mind sees the object itself. This simplified but erroneous concept is then introduced into creative process reducing it to a stiff template… a standardized plastic surgery based on physical data, measurements and ratios. This approach can not bring aesthetic results.

As a practical example a recent report revealed that 21% of all rhinoplasties (nose jobs) are…corrections of badly done nose jobs!

21%! 1 in 5 patients had their noses done by someone with defective aesthetic perception or poor skills. Would 21% failure be tolerated in any non-cosmetic surgical procedures, eg. open heart surgery, gallbladder surgery or removal of tonsils?  Similar results were recently reported on breast augmentation results. No need for comments here.

The major trend in most aesthetic procedures is a drive toward the least invasive procedures. More invasive procedures remain, and should remain, within surgical specialty. These require full surgical training and results are frequently more permanent.

Sadly, the completion of Plastic Surgery training does not depend on any comprehensive understanding of artistic/aesthetic perception or familiarity with the art form. The training should, at least, make them aware of any potential deficiencies that might be a source of aesthetic mistakes in real practice.

If Plastic Surgery training has minimal exposure to true aesthetics, other specialties have no exposure at all. From that point of view, in general terms, only Plastic Surgery training brings licensed physician a bit closer to the artistic understanding necessary in Aesthetic Medicine.

There are exceptions to this rule. I know personally a Plastic Surgeon who is an artist…a virtuoso of his trade. He works on many international celebrities without leaving a trace of enhancements and  remaining conservative in his approach.  Moreover, he is constantly perfecting a non-surgical and minimally invasive approach to many aesthetic problems creating masterpieces with various fillers and botulinum toxin.

I’m sure there are more Plastic Surgeons like him. I hope.

The non-invasive and minimally invasive procedures such as injectable dermal fillers, botulinum toxin, laser and light procedures are relatively uncomplicated in nature but require, like all human tasks, certain amount of knowledge, training and practice. They MUST, contain the same key ingredient: the aesthetic understanding of the art form. Without it, the optimal results are simply impossible regardless of the medical specialty, training, certifications or marketing claims. It is simple as that.

Sadly, the training courses teach a bare minimum necessary to…obtain a certificate allowing it’s holders to practice the “aesthetic medicine”.

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