Motivations of patients seeking aesthetic surgery of the face

Motivation for patients seeking aesthetic surgery of the face

The motivation for someone to seek out an aesthetic surgical or nonsurgical procedure on their face is complex and multifactorial. This chapter will examine the social value systems and the cultural, racial, and gender issues that contribute in various ways to the decision to seek out change, enhancement, or rejuvenation of the facial mosaic. Cultures differ from nation to nation and are formed by a long history of religious and moral boundaries, institutions, followed by government influence, and finally art, literature, and philosophies, all of which underscore the fact that motivations, for surgery differs from nation to nation and race to race.

History of aesthetic facial surgery

Modern aesthetic facial surgery was really born in the late nineteenth century and owes much to the ravages of syphilis and to the rebuilding of jaws and noses of soldiers surviving shrapnel facial injuries on the Western front in the trench warfare of World War I. From the experience gained from treating over 250,000 facially-injured soldiers, the founding fathers of plastic surgery emerged, including Harold Gillies, Jacques Joseph, Erich Lexer, and Hans Esser. The results of the efforts to reconstruct mangled faces were occasionally very rewarding to patients allowing them to reenter society. However, the majority of the facially-mutilated remained permanently disfigured either because they did not receive the reconstruction or the reconstructive efforts fell short of them being able to participate in gainful employment or meaningful social interaction. In reality most of the facially-mutilated became either charity cases or wards of the state or were employed in workplaces that did not expose them to the scrutiny of the wider population. Yet our specialty was born from these efforts to rehabilitate the facially-mutilated victims of conflict.

Nonsurgical aesthetic procedures such as paraffin injections to the nose and face existed before World War I, and there were fledgling aesthetic surgical practices especially in Germany by Jacques Joseph, Eric Lexer, and Eugene Von Hollander, who were performing facelifts and rhinoplasties.

The performance of aesthetic surgery at the turn of the twentieth century was not endorsed by the general surgical community, and the subspecialty of plastic surgery did not emerge from the control of general surgery until after World War 1. Aesthetic surgery was in the exclusive realm of the wealthy, the privileged, and the elite of Europe at that time.

One hundred years later the American Society of Plastic Surgeons in 2015 reported that there were 15.9 million surgical and nonsurgical aesthetic procedures performed in the United States representing a 115% increase since the year 2000. The enormous growth in the number of patients having aesthetic enhancement needs to be evaluated in the light of what has influenced the public to endorse aesthetic procedures so avidly. The patients themselves can be evaluated by the internal or psychologic state that brings them to seek aesthetic surgery and the external factors, such as the market place and medical environment, which offer the patient a better life through surgical and nonsurgical procedures. The psychologic issues related to aesthetic surgery are dealt with in this book by other authors. This chapter will deal with the nonpsychologic motivating factors.

Ethnocentricity (fitting in)

In large multicultural cities, where immigration expands the population and workforce the availability of rhinoplasty procedure deemphasizing an ethnic facial feature such as a prominent nose has been a strong motivator for immigrants to seek out surgery.

The stigmatization of “the Jewish nose” as a racial stereotype, a large curving nose hanging down like the number six, was a source of antisemitism characterizing a race rather than a religion, and this stigmata was carried by the immigrants into large urban centers such as New York City in the early twentieth century. In the era of antiimmigration in New York in the early twentieth century, Ashkenazi Jews fleeing from the ever-increasing antisemitism of Europe sought out removal of the prominent hump of their nose. European surgeons who acquired the techniques of rhinoplasty from Jacques Joseph included Gustave Aufricht and Jacques Maliniac, who performed thousands of rhinoplasties on Jewish immigrants. Rhinoplasty became the norm for the “Jewish nose,” and a “nose job” up until recent times was given to most Jewish girls by their parents if their parents could afford it.

Recently responding to the pressure of Purim, a Miami plastic surgeon offered free nose jobs to assist in the dating and marriage market. Melvin Kenner, an ex-anthropologist from Emory University, in his book The Jewish Body , says that the need for Jews to blend in was why “rhinoplasty was invented.”

More recently, middle European Jews are not really regarded as “new” immigrants to major American cities. However, wars in the Middle East have continued unabated, and this has caused a new surge of immigration since the 1970s whereby Western cities now have large populations of Lebanese, Syrians, Iranians, and Iraqis. These new immigrants are now highly motivated to fit into the WASP (White Anglo-Saxon Protestant) majority, and a rhinoplasty is considered a priority for young immigrants or the children of first generation immigrants.

Jewish identity has been reinforced by pride of Jewishness as is exemplified by the Jewish actress Barbara Streisand who stood alone in the 1970s, resisting the temptation of a rhinoplasty. Rhinoplasty is one of the most popular procedures globally, and within Turkey and Iran it is almost a rite of passage. The motivation for aesthetic rhinoplasty is strongly influenced by pressure from the family unit and is not discouraged by the Islamic faith. Saudi women are influenced to seek aesthetic surgery by the need to attract a husband or to prevent a husband from seeking another wife. Wearing a veil is not an impediment to seeking surgery.

Male surgery

The proportion of men seeking rhinoplasty has increased; men have always been consumers of aesthetic procedures especially hair transplantations and cosmetic dentistry. Their motivation for seeking surgery is more clearly related to identity, work, relationship, and life events. Holliday noted that the desire for aesthetic surgery in men was to be a “new man” to combat insecurity and “date younger women” enhancing their sexual self-identity. For men, aesthetic surgery has become commonsense rather than effeminate vanity.

The eurasian nose

The rapid growth of commerce in Asia and a burgeoning middle class in China, Korea, Japan, and Thailand has led to a population of mainly females seeking aesthetic facial procedures, particularly the procedure of dorsal nasal augmentation; deepening of the upper eyelid fold, called the “double eyelid operation”; and topical skin treatments to achieve a lighter skin tone. It is recognized by the mass media beauty model industry that the Eurasian features are highly desirable, both to Asian and Western aesthetic sensibilities. The Eurasian nose is more sought after in Western cities by immigrants who take permanent residence in large cities. What is sought after is different from what they might be able to attain in their own homeland. Choe et al. and Hodgkinson have noted respectively that Koreans in New York and Asians in Sydney are looking for enhancement with the Eurasian image in mind. The dorsum should be slightly higher and the supratarsal fold of the eyelid slightly deeper than might be sought by Asians in their cities or countries of origin.