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"Beauty Is In The Eyes Of The Beholder": How Plastic And Reconstructive Surgery Patient Narratives Alter The Interpretation Of Beauty
Helen Xun1, Erica Lee, BS1, Pooja Yesantharao, BS, MA1, Leen el Eter, BS2, Mya Abousy, BA1, Myan Bhoopalam, BS1, Justin Sacks, MBA, MD, FACS1.
1Johns Hopkins School of Medicine, Baltimore, MD, USA, 2St George's University of London, London, United Kingdom.

PURPOSE: The proverb "beauty is in the eyes of the beholder" highlights the subjective interpretations of aesthetics. In Persichetti et al., 2019 the authors explored how plastic surgeons must objectively view beauty to comply with evidence-based medicine, yet beauty is viewed subjectively. While the bridge from objective cosmetic surgery practice to the subjective universal appreciation of beauty is wide, we hope to better characterize subjective contexts of beauty. In our study, we analyze how the patient's individual narratives, experiences, and motivation for either a cosmetic or a reconstructive procedure effects public interpretation of his or her beauty.
METHODS: Surveys were administered through mTurks and an IRB exempt study. Demographic information was self-reported. Surveyors were then presented with before and after pictures of procedures with patient narratives that served as cosmetic or reconstructive cues. They were then asked if they would classify the procedure as cosmetic or reconstructive, attractiveness after procedure, change in attractiveness, impact of surgery on self-esteem, and insurance coverage. All statistical analyses were completed using Stata v. 13 (StataCorp, College Station, TX). Patient-level variables and survey responses were analyzed using two-tailed Student's t-tests and chi-squared analyses
RESULTS: Average age of the 459 surveyors was 38.5 (SD 12.1), and 48.4% female. Of this population, 15.7% have previously undergone cosmetic surgery, and 10.4 % report a personal history of reconstructive surgery. Breast reconstructions were seen as more attractive (p<0.0005) and more likely to have a high impact on self-esteem (p<0.001) than breast augmentations. Nose reconstruction due to trauma was classified as cosmetic, and was ranked as more attractive, more likely to be pursued, and had a higher impact on self-esteem when compared to rhinoplasty for cosmetic reasons (all p<0.0001). Similarly, compared to blepharoplasty, ptosis correction was more often classified as very improved (p<0.01), more likely to be pursued, and higher impact on self-esteem (p<0.01). Surprisingly, for gynecomastia reductions, cosmetic cues resulted in higher rated mean attractiveness than reconstructive cues (Table 1).
CONCLUSION: Our findings indicate that for most plastic surgery procedures (with the exception of gynecomastia reduction), reconstructive procedures were seen as more attractive, with higher impact on self-esteem than cosmetic ones. This data supports the hypothesis that beauty is seen subjectively, and the patient narrative plays a large role in judgement. Furthermore, reconstructive surgery is viewed more favorably, and reconstructive patients should be counseled on the importance of expressing their narratives during recovery. Alternatively, patients undergoing cosmetic procedures are more likely to be classified as "moderately improved", and should be counseled for realistic expectations. In order to bridge objective practice to subjective reality, we recommend surgeons post patient narratives along with pre and post-operative pictures on their websites and social media accounts. As one of the first studies combining aesthetic plastic surgery and narrative medicine, we hope to further develop this field promoting psychological dimensions of plastic surgery patients to improve experience and satisfaction.


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