2. Aesthetic Surgery
Jacques Joseph
Nasenplastik und sonstige Gesichtplastik
1931
3. Aesthetic Surgery
âWe restore, repair and make whole,
those parts which nature has given but
which fortune has taken away, not so
much that they may delight the eye, but
that they buoy up the spirit and help the
mind of the afflicted.â
Jasper Tagliacozzi 1597
Father of Plastic Surgery
4. Aesthetic Surgery
(Reconstructive Surgery is) âan attempt
to return to normal,
Aesthetic surgery is an attempt to surpass
the normal.â
Harold Delf Gillies 1882-1960
5. Aesthetic Surgery
Surgeons were concerned about aesthetic results:
âą careful suturing of edges of facial wounds
âą nasal fractures reduced and splinted
Papyrus (3,000 BCE)
7. Aesthetic Surgery
â(Billroth performed) plastic operations with artistic
ability to correct defects of beauty...one could see his
joy when he was able to successfully improve the
appearance of a damaged person, so that that
person was no longer the object of pity or horror.â
Theodore Billroth (1829-1894)
8. Aesthetic Surgery
âBeauty is the outward and visible sign of
health - perfection - virtueâŠ.â
Jules Hericourt (1850-?)
9. Aesthetic Surgery
Beauty Myth
âThe accepted wisdom is that if you
understand your body as âuglyâ, you bound
to be âunhappyââ
10. Aesthetic Surgery
Mens Sana in corpore sano
The mark of the healthy body is the happy soul
Mens non sana in copore insano
The mark of the unhealthy body is the sick soul
11. Aesthetic Surgery
âą Modern society - attempt to change our
body - diet, cosmetics, fashion and surgeons
âą Pursuit of âBody Beautifulâ/âHappy Soulâ.
12. Aesthetic Surgery
âPlastic surgery with the aesthetic as well
as the reparative objective, will be
commonplace in another five years, as
neatness and cleanliness are todayâ
Henry Schireson (1881-1949)
13. Aesthetic Surgery
Widespread Acceptance
No longer limited to âRichâ
Status symbol in South America
14. Aesthetic Surgery
Increased number of procedures performed
liposuction - #1
breast enlargement - #2
eyelid correction - #3
chemical peels - #4
facelift - #6
(breast reduction - reconstructive - #5)
16. Aesthetic Surgery
Benefit psychologically
âself consciousâ
âsocial acceptanceâ
âpositiveâ change in appearance
improve professional chances
increased admiration
17. Aesthetic Surgery
This artistic branch of surgery has long
been perceived as âfrivolousâ and not
âseriousâ medicine.
18. Aesthetic Surgery
Performed nose jobs on three members of
same family in âvaudevilleâ manner
People in audience fainted
Reinforcing the tasteless aspect of advertising
J. Howard Crum (1888-c.1970)
?performed first facelift
19. Aesthetic Surgery
Core of the Psychological theory of
Aesthetic Surgery:
Curing the Physically Anomalous is curing the
Psychologically Unhappy.
20. Aesthetic Surgery
ââŠ.did not claim only to cure the âpug
noseâ; he claimed also to be curing his
patientâs unhappinessâ
John Orlando Roe (1849-1915)
Rochester, New York
22. Aesthetic Surgery
Prozac nicknamed Cosmetic surgery of
the Brain
Decline in stigma associated with Aesthetic Surgery
parallels the change in stigma of mental illness.
23. Aesthetic Surgery
âPeople have the feeling they canât control
their own future; that working hard and
being a good citizen wonât get you
anywhere, Thatâs why beauty has
become the main value in the market.â
Marcelo Hernandez
Argentinean psychiatrist
24. Aesthetic Surgery
âoftenâŠcompared cathartic
psychotherapy with surgical
intervention.â
âconvinced that the patients would benefit
if we were more often to hand over the
treatment of these affections to the
rhinological surgeons.â
Sigmund Freud (1856-1939)
Studies of Hysteria (1895)
25. Aesthetic Surgery
Reversal of Traditional Medical Model
âą Classic model - the patient comes to the physician
who makes a diagnosis and then provides the
treatment.
âą New model - the patient tells the doctor the diagnosis
and how they want it treated.
26. Aesthetic Surgery
Reversal of Traditional Model
Classic model - operation is performed on a deformed
patient to make them look normal
New model - operation is performed on a healthy patient
to enhance the way they look
27. Aesthetic Surgery
ââŠthe idea that we get a permit to
operate on someone who is totally
normal is an unbelievable privilege. In
a way itâs the ultimate surgery.â
Joseph M. Rosen MD
Dartmouth-Hitchcock Medical Center
28. Aesthetic Surgery
Definition of heath - âa state of complete
physical, mental and social well-being.â
World Health Organization
29. Aesthetic Surgery
Cosmetics -adjunct of treatment (disguise) of
illness
Origin of âcosmetic surgeryâ - late 19th
century subspecialty of âmedical cosmeticsâ
- disguise of syphiliticâs symptoms (i.e.
missing nose or ulcerated lesion )
30. Aesthetic Surgery
Medicamenti faciei
make up as a form of medication for the soul
Ovid (43 BCE - 17/18 CE)
31. Aesthetic Surgery
The study of the ugly is to the
examination of beauty what the study of
pathology is to illness.
Karl Rosenkranz (1805-1879)
32. Aesthetic Surgery
Caveat: One cultureâs ânormalâ is another
cultureâs ugly.
Rod Sterling (1924-1975)
The Twilight Zone 11/11/60
Eye of the Beholder
33. Aesthetic Surgery
âCharumâ
Men who are âflat-nosedâ or
snub-nosed are forbidden
from becoming priests.
Aimed against those with leprosy who were seen as
ritually unclean. The unclean is also the ugly, and the
unhappy.
Leviticus 21:18
34. Aesthetic Surgery
âabsence of the nose is a horrible thing to
look at.â
Erik, the Phantom
Phantom of the Opera (1911)
Gaston Leroux (1868-1927)
35. Aesthetic Surgery
All lost noses, in the age of syphilophobia,
were signs of sin. Syphilis marked the
face of the naĂŻve and the innocent as
well as the lecher and hypocrite.
37. Aesthetic Surgery
The Jewish Visage
The âunmanlyâ âbodily infirmityâ
The tubercular Jewish woman
THE JEWISH NOSE
38. Aesthetic Surgery
Nostrility
The anatomy of the Jew in which the âhooked noseâ
represents the first visual representation of the
âPrimitiveness of the Semitic raceâ
âDr. Celticusâ
Anti-Semitic Pamphleteer
39. Aesthetic Surgery
The Nose was a Sign of the Jewâs Nature.
A sign that does not vanish when the Jew is
acculturated.
Being seen as a Jew meant being persecuted, attacked,
and harassed.
Alteration of the body through surgery was seen as the
âcureâ.
40. Aesthetic Surgery
Tradition of the Sweet Sixteen Nosejob
Aesthetic Surgery comes to be understood as
âSomatopsychic Therapyâ
41. Aesthetic Surgery
The Deformity affects the Conscious Mind
through the Patientâs Reception in
Society.
The Operation alters the Perception of the
Body in others and thus alters the
Patientâs Consciousness.
42. Aesthetic Surgery
The focus of the patientâs unhappiness is
on their fixed (racial) physiognomy
Image of the African Face: low forehead, flat wide nose
Enrico Morselli (1852-1929)
43. Aesthetic Surgery
âWe, belonging to the higher races,
regard as ugly all noses which
approach that of the apeâŠâ
Paolo Mantegazza (1831-1910)
45. Aesthetic Surgery
PLUMPNESS - Double Edged Sword
âNormalâ women can be plump and are therefore
âhealthyâ.
âCriminalâ women, such as prostitutes are plump, a sign
of their ânaturalâ tendency to their craft.â
Cesare Lombroso (1835-1909)
46. Aesthetic Surgery
Micromastia
? Real Diagnosis
? American Culture
âFeel less of a Womanâ
Desire the fullness of pregnancy
47. Aesthetic Surgery
âIdeal patient is someone who, in the
aesthetic sense, is less than optimal,
but who otherwise is well adjusted.â
Jim Pietraszek, MD , La Jolla, CA
48. Aesthetic Surgery
Ability of the patient to tell a complete
narrative is a predictor of positive
outcome.
Inability to narrate is a sign of
psychological instability.
49. Aesthetic Surgery
âUnhappinessâ is a problem of your fictive life, rather
than your ill organs.
âYou are what you imagine yourself to be.â
Hans Vaihinger (1852-1933)
50. Aesthetic Surgery
âThe anomaly of the unhappy patientâŠ.is
explained as a too heightened
sensitivity to beautyâ
Jacques Joseph (1865-1934)
51. Aesthetic Surgery
Josephâs Psychological Scale
Hypo-aesthetic - unfazed even by gross deformities
Ortho-aesthetic - normals who can âobjectivelyâ evaluate their
deformities
Hyper-aesthetic - âextremely unhappyâ with strongly developed
sense of beauty such as painters, sculptors, and others with artistic
nature
Para-aesthetic - pathologic aesthetic sensibility focus on âimagined
deformitiesâ. Have normal or even beautiful features that do not need
change.
52. Aesthetic Surgery
âBadâ Patient Qualities
male, unmarried, twenty to thirty-five. low self esteem,
grandiose ambitions, hyposexual with no long term
relationships, extremely obsessive yet passive with
surgeon, aggressive when not accommodated, anxious,
vague about goals of surgery, dissatisfied following
initial postop enthusiasm, minimized problem
Knorr, Edgerton, and Hoopes
John Hopkins University
53. Aesthetic Surgery
Dependent and Controlling Females who
Hate the Aging Process
Any violation of the body engenders exacerbation of
neurosis even with the normal patient.
Evidence of depressive symptoms preoperatively will
be intensified in the immediate postoperative period
Erich Lindermann (1900-1974)
54. Aesthetic Surgery
Negative Result of Surgical Intervention
Exacerbation of unhappiness through the patientâs
experience of trauma awaken existent psychic
patterns.
Helene Deutsch (1884-1982)
55. Aesthetic Surgery
âMonomaniaâ
Male patients requested multiple nasal procedures
The ânormalâ nose still made the patient unhappy
1892 paper
Robert F. Weir (1838-1894)
56. Aesthetic Surgery
Polysurgery
The demand for repeated surgery
A sign of psychopathology
57. Aesthetic Surgery
Dysmorphophobia
Compulsive disorder
Anxiety about having something âobvious or comicalâ
about oneâs body
(i.e. unusually formed nose, knock-knees, disgusting
odor)
58. Aesthetic Surgery
Dysmorphophobia
Preoccupation with some imagined defect in
appearance in a ânormalâ-appearing persons or the
exaggeration of a slight physical anomaly
(i.e. bald head, nose (male), ears, breast (women)
59. Aesthetic Surgery
Nasal Neurosis
male obsession
three qualities (big, ugly, asymmetrical)
Phallic Nature of the Nose (Ex Naso Viris Hastam)
Nose reveals the âCastratedâ/Circumcised nature of the
man with the long nose, where you are a Jew or not
60. Aesthetic Surgery
Freudâs Little Hans
âif - says the child - I can be circumcised and made into
a Jew, can I not also be castrated and made into a
woman?â
61. Aesthetic Surgery
Nasal interventions
One cure for sexual dysfunction and hysteria was to
operate on the nose
Shared relationship embryologically between the tissue
of the nose and that of the genitalia
Male menstruation - âoccasional bloody nasal
secretionâ
Wilhelm Fliess (1858-1928)
62. Aesthetic Surgery
âThe âsurgical quackâ is the surgeon who
does harm, (and) who almost kills the
patient. â
Sigmund Freud
Psychoanalysis and Quackery
63. Aesthetic Surgery
Breast Obsession
Female Equivalent of Nasal Neurosis
Large Pendulous Breasts - Mark of the Primitive
Caucasian breast - hemispherical shape
African breast - pointed breast shape
64. Aesthetic Surgery
Thersites- Complex
Compulsive sense of being seen as ugly because of a
specific quality of the body
named after ugliest man in Greek army at Troy
Homerâs Iliad - most vicious warrior, not aware of his
ugliness
Hermann Stutte (1909-)
65. Aesthetic Surgery
Body Dysmorphia Syndrome
1980 - excessive concern with an âimaginaryâ defect
Patients believe themselves to be âquite uglyâ and are
convinced that they âcould be very attractive if some
changes were made surgicallyâ
1994 - preoccupation with a defect in appearance
which either âexcessiveâ or âimaginedâ
66. Aesthetic Surgery
DMV IV - preoccupation with an
imagined defect, causing clinically
significant stress or impairment of
social, occupational, or other important
areas of functioning, not accounted for
by another mental disorder.
67. Aesthetic Surgery
BDD
Obsessive compulsive disorder
Late 20s or early 30s
Affects both men and women
Avoid describing their defects in detail
Their preoccupations are self-described as âintensely
painfulâ âtormentingâ or âdevastatingâ
Requires psychopharmacological intervention
?Michael Jackson - 30 operations
68. Aesthetic Surgery
Dysmorphophobia is not necessarily an
indicator to the surgeon not to operate -
but you may put your own life at risk
M Tavis MD
69. Aesthetic Surgery
Polysurgical Addiction
A compulsive need for surgical interventions
Whose search for perfection/(in)visibility, means they
will never be satisfied
âCastration anxietyâ center of male desire for repetitive
surgery
Women undertake surgery to âfulfill an ungratified
infantile wish for a childâ
Karl A. Menninger (1893-1990)
70. Aesthetic Surgery
âSurgeonâs intuitive responseâ
knowing a difficult or dangerous or unhappy patient
when one sees one
71. Aesthetic Surgery
âRecommend a Simple Interview
Question Method of Counseling
designed to Identify Underlying
Psychological Manifestations and to
control the Problem Patient.â
MR Wright and WK Wright
72. Aesthetic Surgery
Psychological Testing
Minnesota Multiphasic Personality Inventory
Patient Attitude Scale
Expectation for Plastic Surgery Scale
Esthetic Analysis Form (dentistry)
73. Aesthetic Surgery
The act of narration is one of the marks of a healthy
psyche.
âThe patientâs inability to state accurately and succinctly
the thing that displeases him.â
âThe more pronounced the deformity of loss, the more
apt is a reasonably good result likely to be
acceptable.â
74. Aesthetic Surgery
âCosmetic surgery appeals to vain people.
There many idle men and women who have
nothing to do but study themselvesâŠ.learn
to avoid these psychopaths.â
Charles Conrad Miller (1880-1950)
75. Aesthetic Surgery
The problem patients are dangerous and
difficult, they are never happy with the
results and they sue!
76. Aesthetic Surgery
âAnything that attracts notice to a child in
an unpleasant way is, as a rule, bad for
the child.â
Vilray Papin Blair (1871-1955)
77. Aesthetic Surgery
â..a nasal defect may produce such an
inferiority complex as genuinely to
hinder the patientâs happiness and
progress.â
Harold Delf Gillies
New Zealand reconstructive surgeon
78. Aesthetic Surgery
âThesurgeon seeks to ease the mind by
remolding theâŠfeatures to a conformity
with the normal.â
Maxwell Maltz, MD
Chicago aesthetic surgeon
New Faces, New Futures (1936)
79. Aesthetic Surgery
âThe result of aesthetic surgery can be
â..an infusion of confidence, and a
losing of sensitiveness which
sometimes amounts to an inferiority
complex.â
George Warren Pierce, MD
San Francisco surgeon
80. Aesthetic Surgery
âprejudice and discrimination - real or
imagined - and the desire to âlook
Americanâ played a substantial role in
the motivation for surgeryâ
Francis Cooke Macgregor 1989
81. Aesthetic Surgery
âPassingâ remains a major goal of aesthetic surgery
âDisfigurement becomes the last bastion
of discriminationâ
Angus McGroughter
British Aesthetic Surgeon
82. Aesthetic Surgery
Body sculpture and Psychic Surgery may
be closely related.
Passing is either acquiring âhealthâ and âhappinessâ or
being seen as âill or âpsychopathologicalâ. Both are
attributed to the individual who wishes to âpassâ
unnoticed.
83. Aesthetic Surgery
Tagliacozzi Myth
Condemned after his death for his âattempt to improve
upon the work of the Almightyâ
Chastised for his practice of plastic surgery
This was a religious problem not exclusively a Jewish
problem
Gaspare Tagliacozzi (1545-1599)
Father of Plastic Surgery
84. Aesthetic Surgery
âChavalahâ (Wounding)
Traditional Judaism rejects surgical alteration of the
body except for reconstructive surgery
Halachic tradition would permit alteration of the shape of
the nose for men and women for psychological
reasons
85. Aesthetic Surgery
âCosmetic Surgeryâ is justified if
the defect:
1/prevents a woman from finding a marriage partner
2/prevents a happy relationship with her husband
3/prevents a person from fulfilling a constructive
function in society - this applies especially to men
who without such improvement could not earn
enough to support their families
Secular Reposa
86. Aesthetic Surgery
Aesthetic surgery can be sanctioned if it
ameliorates âgrave psychological
effectâŠsuch as a sense of inferiorityâ.
At this point it is not âonly permissible but also a
necessityâ
Father Charles G. OâLeary
Principle of Totality
87. Aesthetic Surgery
âAesthetic surgery is not in contradiction
to the will of God, in that it restores the
perfection of the greatest work of
creation, man.â
Pope Pius XII
88. Aesthetic Surgery
Women and Plastic Surgery
Aesthetic surgery is seen as a means of placing the
woman in a Position of Power concerning her own
body or is seen as making her complicit with
Patriarchal Standards of Beauty.
89. Aesthetic Surgery
âThe purpose of cosmetic surgery is to
improve a personâs psychological
functioning by modifying their body
image.â
Gregory Borah, MD
90. Aesthetic Surgery
Aesthetic Surgery makes patients truly happy by
restoring the ideal state that already exists in the
patientâs imagination.
Aesthetic surgery does not remove psychological
symptoms because there are none.
Aesthetic surgery does not manufacture patients
because there is no patient role and the individual
retains a sense of autonomy.
91. Aesthetic Surgery
âThe surgeon, however is not a psychologist or
psychotherapist, who wants to create mental health
but rather an artist, whose âartistic ability to createâ
along with âthe patientâs willingness to be molded,â
assures the happiness of both. Happiness is defined
as the ability âto offer external changes which are
more compatible with the vision of the inner self.â
Sander L. Gilman
Creating Beauty to Cure the Soul