Once upon a time, in the 1980s there were 8 cosmetic surgery procedures: facelift, blepharoplasty, rhinoplasty, browlift, liposuction, abdominoplasty, breast lift and breast augmentation. While there were always a few techniques or variations to each operation, most surgeons used a single technique each and every time with only minimal variation. This cookie cutter approach has been transformed over the past few decades, bringing us to a wholly different plastic surgery world.
First, there are many more procedures and variations. The big impetus for this was the desire to do something minimal if that was adequate and save bigger variations of the procedure for later in the aging process or for bigger aesthetic issues. Also options are often selected based on how much recovery time the patient can afford. Having many options creates a new task –the need to pick the right procedure for the stage of aging.
The end result is light to heavy treatments in a very gradable fashion. Not one size fits all. Little treatments to do early and more extensive procedures for later. This broad range is a very powerful thing.
The depth of understanding of aesthetic features and aging changes continues to expand. We are now treating many features of aging that were previously ignored. Not just lifting skin with a facelift but improving skin itself, and many small aging features not addressed by the facelift.
View of beauty
Historically, plastic surgery in the United States relied on classic Greco-Roman principles of facial harmony and beauty that dated back centuries. Every human loves youth and beauty but the vision of beauty is different person to person. The Barbie doll serves as a metaphor for a classic iconic image of beauty –stylized, not real and a universal single image. Now Barbie dolls are more ethnically diverse in how facial and body features are represented and they look more real like actual human body shapes.
Similarly, plastic surgery has incorporated a broader view of what’s beautiful. In addition, the patient population seeking plastic surgery has changed. For the past 20 years there has been so much about plastic surgery in the media. Whether this is due to a major increase in public interest about plastic surgery or that interest was fueled by this media coverage, a much broader portion of the public is seeking and obtaining plastic surgery. That broader participation means a broad range of national origins, ethnicities and views of beauty.
Just as most industries now work on the international stage, plastic surgery teaching and education takes place on a global playing field and considers the differences in appearance and beauty goals of people around the world. Locally, plastic surgeons have developed techniques to produce much more variation in appearance and apply that based not on their vision of beauty but that of their patients. This is also done to maintain ethnic diversity or blunt it at the preference of the patient. The results are natural and varied, not stylized and monolithic.
Rather than assuming the patient’s aesthetic goals , more detailed communication is taking place between patients and plastic surgeons to accurately identify and target the desired endpoints. Imaging systems have helped insure that patients and plastic surgeons hold the same picture in their minds. Media’s increasing representation of varied appearance in just the last few years has also fostered a broader view of beauty. Plastic surgery cannot create an exact appearance or guarantee a result but techniques constantly improve to serve our enhanced understanding of the nuances of beauty.
Why is this change good for patients and plastic surgeons? Options mean more precision, more scalability than ever before. Non-invasive treatments have transformed plastic surgery from a more traditional surgical model with a short-term physician patient relationship to a long-term relationship driving anti-aging and beauty care over time. Patients are in the driver’s seat controlling frequency and amount of services but both the doctor and patient improve at anticipating needs, increasing the precision of results based on mutual learning over time.
Important Takeaways:
- Not stylized, iconic or monolithic
- Patient centered focus
- Greater level of detail in how appearance is modified.
- Better communication taking place
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Transcript
Doreen Wu (00:00):
Welcome back to the Park Avenue Plastic Surgery Class. I’m your co-host Doreen Wu. And I’m here with Dr. Lauren Bass Park Avenue, plastic surgeon, educator, and technology innovator. Together. In every episode, we will explore various controversies and breaking issues in the world of plastic surgery. The title of this episode is “Barbie Versus Star Wars Part Two: Customization and Ethnic Diversity in Plastic Surgery.” So Dr. Bass, continuing on conversation from the previous episode, how has plastic surgery strayed away from the traditional cookie cutter approach?
Dr. Lawrence Bass (00:44):
Well, there are two big ways in my thinking. One is we have many, many more procedures if we go back to the 1980s and again that the history lesson about lasers started in the 1980s. And so the second factor, the Barbie factor started then also there were probably about seven or eight procedures in all of aesthetic plastic surgery. There was facelift, eyelidplasty, brow lift, breast lift, breast augmentation, tummy tuck, liposuction, rhinoplasty. That was it. Now all of those procedures have many more variations and many versions, and there are all kinds of noninvasive and minimally invasive treatments. So that’s a really big change at the same time. These procedures are increasingly being done in a way that’s customized for each patient. So rather than just giving everybody the same nose, putting the same nose on a hundred different faces, we’re putting a hundred different noses on a hundred different faces based on the other features on that face. Um, that’s where it started. But from there it’s really moved on to taking a broader view of what’s beautiful and applying that based on patient preferences.
Doreen Wu (02:12):
It sounds like this changing view of beauty has really affected how plastic surgeons are now approaching their practice. So I’m really curious and I wanted to ask you has the group of people requesting plastic surgery changed in the last 20 or so years?
Dr. Lawrence Bass (02:33):
So, yes. Before, before I address that, you know, we’ve really been able to, because because of these changes to go from very light to very heavy treatments in a much more gradable fashion, depending on where you are in the aging spectrum, for example, with a rejuvenation treatment before it was one size fits all. And now if you’re on the younger side, but seeing a few things you don’t like, there are little things that can be done. And if a lot of things are going on, then something much more extensive can be done and anywhere in between. And that great ability is really, really powerful and important for people because you want to get the results you need, but you don’t want to have to go through or invest in time or effort anymore than is necessary to get what you need at that point in time.
Dr. Lawrence Bass (03:31):
Um, because of all of those extra treatments, we’re also able to come in and address all kinds of features that were simply ignored before in the 1980s. Well, if you picked the skin up and took away the laxity, you, you were as young again, as you were going to look, and now we’re going to do that. We’re going to restore volume. We’re going to address the appearance of the skin surface itself, all of those things to get you to a more complete endpoint. So that’s affected, you know, that powerful capability has been very well expressed in all forms of media, TV, radio, newspapers have really taken up the banner for plastic surgery and featured what it’s able to create. That’s fueled tremendous interest in the public, and I’m not sure whether, you know, it’s like the chicken and the egg. I’m not sure whether the public’s interest induced the media to cover plastic surgery more and more or media covering it, got the public interested. But what in the old days was said to be an undertaking for socialites and starlets is now something that almost everybody pursues to whatever degree it bothers them. You know, it’s very permissive, but that’s brought in a little bit of everybody. And of course in the United States, everybody is literally a little bit of everybody from around the world. So that means we’re now looking at people who are very ethnically diverse compared to the average patient walked in a plastic surgeon’s office in 1985 or even 1995.
Doreen Wu (05:22):
That’s really interesting. And I, I was thinking when you were talking about the term mommy makeover, so it seems like a lot of women in their late thirties, once they’ve had their children, they come into a plastic surgeon’s office and they’re interested in getting this so-called mommy makeover. Can you talk a little bit about how you kind of customize the treatment to get every patient where they want to be?
Dr. Lawrence Bass (05:51):
So, you know, that’s, that’s a good example on the body, uh, of some of the variations. So mommy makeover in broad terms describes a combination of some treatment for the tummy area, like an abdominoplasty or tummy tuck and some treatment for the breast area, like a breast lift or a breast augmentation. But again, some patients lost volume. Some patients got droopier in the breast area after pregnancy and breastfeeding and others didn’t have as big a change there, uh, or have a different size preference. And all of that has to be taken in consideration. Some people in the tummy area have a fair amount of extra fat. They may have had difficulty getting rid of some weight gain after pregnancy and others may be very slim, but they’ve had a lot of change in their abdominal wall, muscle stretching, or a lot of change in the skin envelope. And so you’re going to adjust which components of the procedure you put in as part of the mommy makeover, depending on what you find when you examine someone. And depending on what they’re telling you is bugging them, because remember this is about the patient’s preference for what bothers them enough to be worth going through some kind of treatment.
Doreen Wu (07:22):
Exactly. That makes a lot of sense. Um, I also wanted to kind of touch on another point that you brought up earlier. You mentioned how the patients that are seeking plastic surgery have really changed in the last 20 or so years. So how has the field of plastic surgery responded to these changes in patients?
Dr. Lawrence Bass (07:45):
So everybody just as a human characteristic, I believe loves youth and beauty. We find that appealing. It’s probably biological programming, but everyone’s view of beauty is different. And this goes to the, again, the Barbie component in Barbie versus star wars, you know, Barbie used to be this iconic image of what was supposed to be beautiful in the way the way girls or women were supposed to look. And Barbie now is ethnically more diverse and has a more real human appearance. And in that same way, I think plastic surgery, as we see a little bit of everybody coming in to get treated really needs not only to customize to patient preference, but customize to ethnicity and made those two concerns because it’s really, it’s really doing something that harmonizes with the rest of the patient’s beauty, rather than creating a stylized iconic monolithic image of beauty.
Dr. Lawrence Bass (09:05):
So that customization also addresses ethnic diversity as well as just preference. But there’s an intersection there cuz some patients are looking to blunt or change the ethnicity of their appearance or amplify an ethnic look that they, they weren’t born with and other patients want to preserve their ethnicity, but just harmonize their features. And you know, this is about freedom. It’s really their choice, which direction their treatment should go, not a standard plastic surgery view. So I think in the 21st century, there is not a standard plastic surgery view anymore of what beauty is. It’s a patient driven view of what beauty is and that’s as it should be.
Doreen Wu (09:55):
Right. I think the, the patient centered focus and really listening and understanding their preferences and what they want prevents a lot of misunderstandings and miscommunication down the road, especially when it comes to something like plastic surgery.
Dr. Lawrence Bass (10:11):
I, I, I think that’s right. And you know, it’s really about looking at details. Uh, you know, we have to address the big picture issues in any given procedure that may not vary in huge amounts from one patient to another. But details of what you’re trying to do is very specific to each individual. And it’s important to take the time and discuss those things so that what the plastic surgeon walks into the operating room or the treatment room as a picture in his or her head and what the patient’s walking in as a picture in his or her head is as close to the same thing as possible.
Doreen Wu (10:52):
Exactly that congruency. You want to be on the same page. So before we wrap all of this up, I want to close with one final question. Why are all of these changes in the world of plastic surgery, a positive thing for both patients and plastic surgeons?
Dr. Lawrence Bass (11:14):
I think there are a couple of things here. I’m not a believer that change is inherently good, but having all of these options, I think gives us a great deal. More precision, more scalability for patient needs than anything we had before. And the nature of a lot of these noninvasive treatments has really transformed plastic surgery from a field that was solely about performing operations, where you would see the patient a few times to make sure they healed and then maybe never see them again to a mutual planning process between the doctor and the patient to care for appearance beauty over time. So I see patients several times a year, the patients in the driver’s seat, how often they get seen, but we have a long term relationship and that allows more precision. And it allows you to come closer to hitting the nail on the head when it comes to customization because you learn and learn and learn what in the individual’s preferences and goals are much better over time than you can in a single encounter.
Doreen Wu (12:39):
I think that’s a really important point that you bring up being able to truly understand your patient and what their goals, their motivations, and all of that are. So thank you so much for providing all this information. I definitely learned a lot all about, um, the Barbie versus star wars and the two big factors that really transformed plastic surgery stay tuned and join us for the next episode of the Park avenue Plastic Surgery Class with Dr. Bass.
Speaker 3 (13:11):
Thank you for joining us in this episode of the Park Avenue Plastic Surgery Class podcast with Dr. Lawrence Bass Park Avenue plastic surgeon, educator, and technology innovator. The commentary in this podcast represents opinion. This podcast does not present medical advice, but rather general information about plastic surgery that does not necessarily relate to the specific conditions of any individual patient. No doctor patient relationship is established by listening to or participating in this podcast, consult your physician to advise you about your individual healthcare. If you enjoyed this episode, please share it with your friends and be sure to subscribe to our podcast on Apple Podcasts, Google, Spotify, Stitcher, or wherever you listen to podcasts.
