Dr. Bryan Mendelson, a prominent plastic surgeon in Toorak, Australia, does not believe the modern-day adage “you can always tell if someone has had surgery.” In fact, good surgery, by definition, should be undetectable. For over twenty-five years, Dr. Mendelson has done research on facial anatomy and facial aging, and has further advanced the techniques of aesthetic surgery to provide natural and long-lasting rejuvenation for patients. Dr. Mendelson has recently written a book called In Your Face, where he discusses the real reasons why patients undergo aesthetic surgery. It is, he says, “About enhanced self esteem and self confidence, not about changing looks to impress people.” He currently maintains a private practice at The Centre for Facial Plastic Surgery in Victoria, Australia, and was past president of ISAPS.
As an aesthetic plastic surgeon, what inspired you write In Your Face, a book about the physical and psychological importance of the face?
Writing In Your Face became almost an imperative for me because of the complete difference in what patients were telling me about the benefits of their surgery compared to what you read in the media. It is about enhanced self esteem and self confidence, not about changing looks to impress people. For this reason, in the book I included 12 stories, written by 12 patients, explaining why they decided to have surgery and how it impacted their lives.
When you think about it, this is the only real information available about why people undergo aesthetic surgery. While we can be critical of the media for the sensationalist perspective they give in what they publish about cosmetic surgery: the bizarre, the ridiculous and extreme—the reality is that normal people who undergo surgery are intensely private about it. They do not wish it to be known. Although this may be more so in some communities than others, it is certainly the attitude of plastic surgery patients in Australia, as it is in more traditional parts of the United States and elsewhere. The real market is not Los Angeles, Dallas, and Miami.
So what exactly drives us to go under the knife? Is it purely cosmetic or is it part of an inherent drive for survival?
The “need” that motivates patients to undergo surgery is inherent in the human makeup. People have a need to feel satisfied about their life and particularly their appearance. In fact, what is portrayed in the media tends to confuse people and discourages them from undergoing surgery. This is because of the media expectation that people who have surgery always look ridiculous. This has lead to a widespread misunderstanding about aesthetic facial surgery that “you can always tell if someone has had surgery.” Of course, this is simply not correct—as plastic surgeons know and people who have had good surgery know. Good surgery is, by definition, undetectable.
What do you think the future holds for the field of plastic surgery–in terms of patient expectations and medical/surgical advancements?
Aesthetic facial surgery faces many challenges, largely because of increasingly high and unrealistic patient expectations. Gen Yers have grown up with plastic surgery always being available, which was not the case for previous generations who are more appreciative of what can be done for them. The challenge for surgeons is to refine the surgery to be more predictable. But the desire for predictability often comes with compromise in obtaining the highest quality. I hope that through presenting this perspective in the book, patients will be better informed. Aesthetic facial surgery is, after all, surgery with inherent, although small, risks.
The development of an aesthetic sense in the surgeon is a real concern for the specialty. Most trainees go into surgery on account of their aptitude for the technical—not artistic aspects. But we all know that good surgery requires good aesthetic judgment as well as good surgical technique. Surgeons are taught various formulas that help explain good appearance. However, given the complexity and multidimensional nature of facial aesthetics, these are a rather simplistic starting point. Following these formulas alone does not take into account the minutiae of variations that exist in the face and is one of the major reasons for “obvious celebrity surgery.”
What is physiognomy and why is it important for successful surgical outcomes?
Physiognomy is basically “judging a book by its cover.” In other words, judging a persons’ character based on their appearance. This was taken seriously right from the time of the Ancient Greeks, who idealized beauty, and it reached its nadir with the work of Lavater who wrote at length on the subject in the late 1700s.
Lavater defined physiognomy as “a science or knowledge of the correspondence between the external and invisible man.” The difficulty with this is the relationship between looks and judging a person’s morality, as if the face truly reflected the person’s inner being.
In its simplest form, attractive people are automatically regarded as being good people, whereas unattractive people as bad. It is a form of discrimination based on the lottery of life. There is no doubt that many people are born with the “wrong face” or with aging, the wrong face develops, which does not reflect the person within. This is the main reason people undergo facial rejuvenation surgery. What they see in the mirror and the way they are treated because of their appearance is different to who they have always been and who they really are.
Does knowing the history of plastic surgery make you a better surgeon? Have technological advancements paralleled patients’ expectations of a more natural look?
The history of plastic surgery is a fascinating subject on two grounds. First is the extraordinary ability of ancient surgeons to repair defects on the face using tissue from nearby or from remote places such as the arm. This was being practiced in biblical times by a few practitioners, particularly in India, and then later in Italy and Sicily. The deformity that arose from, for example, the loss of the tip of a nose was so hideous that people would go to extraordinary lengths to try to regain a sense of normalcy.
The other aspect is the fact that people from time immemorial would go to great lengths for their appearance. Not out of a 21st century fashion sense but because it is fundamental to who we are and the way we are treated.
It was only late in the twentieth century that the quality of surgery had advanced to the point that it became possible to rejuvenate a person’s appearance and let it be completely undetectable. This requires anatomical-based surgery to tighten laxity of the support layer beneath the skin, rather than the conventional simple skin pulling. This requires real training of the surgeon, which is beyond cosmetic practitioners.
Unfortunately, with the recent explosion of cosmetic procedures, particularly with camouflage fillers and neurotoxins, there are more and more practitioners coming into the field with less and less training. For the public, it is becoming a matter of being informed as to how to select a surgeon with an aesthetic eye, technical ability, and experience to deliver natural looking results. These surgeons are the quiet minority and are not found by reading advertisements in profile publications or in tourist destinations.