Beauty reimagined: 500 years of Botticelli

When we have a consultation with a patient, it’s not always that they want to look “beautiful” as such. Ultimately we are trying to work out what the patient finds unpleasant about themselves. They might have a bend in their nose, or some other “imperfection” that they are quite happy with, but they don’t like some other thing, like the lines on their face.

I think it’s deeply inherent: we know what beauty is when we look at it, but there are lots of other factors putting pressure on it, too. Beauty is something that makes you feel good: when you look at a beautiful face you feel optimistic, positive, happy and so on. Otherwise it’s hard to categorise, because there are so many variables. There are various classical ideas, about symmetry, high foreheads, the shape of the eye, etc, but then you have to think about race, sex, age and cultural influences. It gets very complicated. Recently there has been a shift towards a leaner, more sporty look. And even the supermodels now, like Kate Moss or Cara Delevingne, have “interesting” features rather than being classically beautiful, like someone like Christy Turlington.

Sometimes patients want something that just doesn’t suit their face: fuller lips is a common example. Some patients want to conform to an ideal even if it’s not going to suit them. You tell them that you won’t do it, but they don’t listen, and they find a doctor that will do what they think they need. You’ll always be able to find someone willing to do what you want. Perhaps a third of the patients I see do exactly that.

Working as a plastic surgeon probably does make me think harder about my own appearance. I’m vain, and I would like to look well groomed. But I think that it’s a cycle: if you feel good, you look good, and if you look in the mirror and look good then you feel better. I used to do a lot of work with HIV patients: the early medications could cause significant disfigurement, and there was a stigma associated with the skeletal look they got. People might argue that the surgery was “cosmetic”, but it drastically improved their quality of life. It wasn’t an added extra, it was central to their character.