Aesthetics or Aesthetics?

The time has come to look at Aesthetic Medicine from a different point of view.

Let’s discuss the meaning of aesthetics, what has become of it, what it should be and what it could be. I begin with my views on facial aesthetics since this is the key element of the most common misconceptions.

Later in this series of comments, I will try address the endless and ever-changing list of aesthetic procedures, particularly those with claims that do not meet promised results.


Aesthetic Medicine in the US is beginning to transform. It is a painfully slow process that is, to no surprise, not very enthusiastically welcome by some.

Thankfully, the strong winds of change come from the most important source – the patients!

To me it is a clear signal that the “old school” of facial aesthetics is on the way out; permanently, I hope.  If this is true, it will allow us to join the rest of the world of aesthetics, a world that has been light years ahead of us in using medical aesthetic procedures responsibly.

   The issue of monumental importance in Aesthetic Medicine is the perception, understanding and implementation of true aesthetics – an art form that governs any artistic creation. I am not unique in observing, that too many facial aesthetic procedures have been unsuccessful …they are aesthetic failures. I stress the word “aesthetic” since this is the main ingredient that makes the final result of ANY artistic creation, a great success or miserable failure.

The word “aesthetic” means, in general, the art; the nature of art, it’s philosophy, theory and practice. In contains both, the strict rules and their liberal applications as we hear in music and see in visual arts. Tracing these elements from ancient times until present, all original and revolutionary styles that were breakthroughs of their times, share the basics of the art form. The same must be expected from Aesthetic Medicine if we insist on using this name.

  Aesthetic Medicine has its roots in antiquity with a simple human desire to maintain and improve ones appearance. It evolved into Plastic Surgery which has become almost synonymous with the most sophisticated methods of aesthetic improvements.

   Organized Aesthetic Medicine was born in early 80’s in France and quickly spread over Europe, South and North America and Asia. In the last decade it expanded to contain various aspects of health maintenance, overall wellness, prevention of illness and correction of the aging process withenhancement of features and improvement of visible deficiencies.

   Unfortunately, the “enhancement” and “improvement” have spiraled out of control replacing natural beauty with an amateur concept of over-improvement that resulted in antithesis of aesthetics. The abundant examples are all around us: oversized breasts, shapeless and disproportionate lips, protruding cheeks, pencil – shaped noses with upturned, “pinched” tips or a “shrink-wrapped” immobile foreheads with hyper-arched eyebrows.

  It is impossible to say what or who triggered this sub-culture that lingers on like a nightmare. What isknown, is that the rest of the world has followed more difficult trends, shifting their aesthetic forces into natural and artistic enhancements.

  The need for aesthetic services is constantly growing,  reflecting ones natural desire to look as good as possible. Unfortunately, the prevailing trends of facial aesthetics are being defined too frequently by those who have marginal understanding of true aesthetics.

    The physical ability to hold a pencil, brush, chisel, syringe, or laser hand-piece is a minor accomplishment in the scheme of aesthetic creation. However, the very next step, the ability to understand and properly assess the spatial relationships of target area, is what opens…….or shuts the door to the successful project.

  An “Artistic sense” is almost impossible to learn in full….. it is either a part of our perceptive process or not. If it is, the work is inspired and the job is well done….if it is not, one should think of it as notnecessarily a fault of the aesthetic practitioner per se  but  his/her failure to recognize it.

    But what if the practitioner doesn’t want to admit that his/her left brain dominates thus giving the aesthetic doctor all the gifts of scientific brilliancy but making him a poor artist?

   Nothing could better illustrate the point than an event that I witnessed during the 6th Anti-Aging Medicine World Congress in Paris in 2008.  This grand annual event is attended mostly by physicians from countries in Europe, South America and Asia, countries that have been well ahead in implementation of true aesthetics.

   As a part of the Congress, there are live presentations of the newest concepts, from laser procedures to implants and injection techniques.

One of the workshops, a non-surgical cheek augmentation with dermal fillers turned out, unexpectedly, to be one of the most educational and memorable presentations of the Congress.

The injector was a guest expert from the East Coast city in the US; the patient – model, a Frenchman in his early 40’s.

 After a brief introduction the expert began injecting the right cheek of the model.

 Two syringes later, before proceeding to left side, the presenter asked the audience for any questions regarding the injection technique.

  To his surprise several eager hands shot up into the air and the floor was given to an older gentleman, a French plastic surgeon. In his heavy accent, he asked the expert: “Doctor, could you please ask your model to smile?” The request was translated and the patient obliged with a suspicious , almost clownish smile.

  The audience gasped, some laughed, some murmured and the rest contemplated results in silence. The model smiled no more.

   The author of the question continued…:  “This is an unacceptable result for many of us; it’s unnatural, with disregard to proportions and any artistic or aesthetic values. I am sad to say but you would be banned from injecting this way in many countries”.

It was a tense moment to say the least, an embarrassing and humbling  moment for the patient AND the physician. It brought to realization the enormous divide of artistic perception between us here in the US and the rest of the world practicing Medical Aesthetics.

The event was suddenly amplified by the motto of the Congress:

                                                “LESS is MORE”.

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