Rethinking the Approach to Beauty in Medicine

Abstract

IN 1907 A SURGEON NAMED CHARLES C. MILLER DESCRIBED WHAT HE SAW as a growing preoccupation with physical beauty in society. “For years,” he warned, “the newspapers and magazines have been devoting many pages to ‘Beauty Chats,’ . . . and the people have gradually developed a desire for knowledge of those means which will enable them to appear to the best advantage.” While his colleagues ridiculed patients seeking correction of cosmetic defects, Miller was anxious for them to be seen by responsible surgeons: “Every practitioner who laughs at the patient who questions him regarding an operation, takes the chance of seeing that patient return . . . disfigured for life.” Nearly a century later, the American public is arguably just as concerned about physical attractiveness as it was in the early days of cosmetic surgery. In a recent survey asking whether “physical beauty” or “inner beauty” “counts more in the real world,” for example, more than a third of participants over the age of 18 said that they thought physical beauty “counts” more. Nearly a quarter of women said they considered maintaining an attractive physical appearance “essential,” and more than half of women said that they considered it at least “important.” At the same time, public demand for more diverse and sophisticated ways of enhancing appearance continues to arouse conflicting feelings in the medical profession. On the one hand, clinicians specializing in fields such as dermatology, plastic and reconstructive surgery, and cosmetic dentistry have seen an explosion in the demand for their services. According to the American Academy of Cosmetic Surgery, the number of cosmetic procedures performed annually in the United States has more than tripled in the past decade. On the other hand, clinicians from all medical fields may worry that patients’ concerns about their appearance may distract them from issues that are more critical to their health. While it is clear that a person’s appearance can affect his or her social and economic success, it is not obvious that beauty is “medically necessary” for well-being. Furthermore, psychiatric conditions associated with body image distress point to ways in which patients’ anxieties about their appearance can cause them to adopt behaviors damaging to their health. This issue of MSJAMA examines themes surrounding cosmesis in medicine. Is it possible to distinguish between normative and pathological body image distress? Can clinicians use patients’ dissatisfaction with their appearance to motivate them to change their behavior? How has the medical profession helped to shape stereotypes about beauty? Can physicians, patients, and insurers agree on what distinguishes “cosmetic” and “therapeutic” procedures? Today, concerns about appearance and concerns about health continue to overlap.