June 3, 2025 • 24 mins
Living in a diverse, multicultural society, your idea of beauty is shaped by the variety of people around you.
In the U.S., what we find attractive has shifted over time, from the narrow ideals of the 1950s to a broader, more inclusive standard influenced by global cultures.
Dr. Steven Dayan joins Dr. Bass to talk about how beauty is defined differently across cultures, and why today’s aesthetic providers need to understand those differences to deliver truly personalized care.
From the evolutionary roots of attraction to real-world examples of how cultural preferences impact aesthetic choices, get a fascinating look into the intersection of beauty, identity, and modern medicine.
About Dr. Steven Dayan
Dr. Steven Dayan is a renowned facial plastic surgeon, author, and entrepreneur. He’s known for his insightful speeches and groundbreaking research on the science of beauty. With a passion for innovation, Dr. Dayan has founded multiple successful companies and is a recipient of the AMA Foundation’s Leadership Award.
Learn more about Chicago facial plastic surgeon Dr. Steven Dayan
Follow Dr. Dayan on Instagram @drstevendayan
About Dr. Lawrence Bass
Innovator. Industry veteran. In-demand Park Avenue board certified plastic surgeon, Dr. Lawrence Bass is a true master of his craft, not only in the OR but as an industry pioneer in the development and evaluation of new aesthetic technologies. With locations in both Manhattan (on Park Avenue between 62nd and 63rd Streets) and in Great Neck, Long Island, Dr. Bass has earned his reputation as the plastic surgeon for the most discerning patients in NYC and beyond.
To learn more, visit the Bass Plastic Surgery website or follow the team on Instagram @drbassnyc
Subscribe to the Park Avenue Plastic Surgery Class newsletter to be notified of new episodes & receive exclusive invitations, offers, and information from Dr. Bass.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:01):
Welcome to Park AvenuePlastic Surgery Class,
the podcast where we explore controversiesand breaking issues in plastic
surgery. I'm your co-host, Summer Hardy,
a clinical assistant at BassPlastic Surgery in New York City.
I'm excited to be here with Dr. LawrenceBass, Park Avenue plastic surgeon,
educator and technology innovator.
The title of today's episode isCulture and Diversity in Aesthetics.
(00:24):
This seems like a verytimely topic, Dr. Bass,
what is the scope of whatyou're hoping to discuss today?
The desire for beauty isuniversal and not new.
How beauty is defined inpopular culture is somewhat to
very different in different culturesin different parts of the world.
(00:46):
From there, how that beauty issupported by beauty industries,
including medical beauty services,is part of our discussion today.
I've asked my colleague, Dr. Steve Dayan,
to join us again on the podcastto discuss this topic in detail.
Dr. Dayan is a facialplastic surgeon in Chicago.
(01:09):
He is a New York Times and USA
today bestselling author,
and he's been an exceptionallyprolific speaker and writer. His book,
Subliminally Exposed springs fromhis popular undergraduate course,
the Science of Beauty.
He's known for his dynamic keynotespeeches and deep understanding of human
(01:33):
behavior. In addition,
he's an entrepreneur havingfounded and run a medical
research company, amedical marketing company,
a skincare training center, anda medical education company.
His ventures placed him at theforefront of aesthetic innovation and
(01:53):
product development.
He's the recipient of the AMAFoundation's Leadership Award showing
recognition of his tirelesswork in advancing our
understanding of this fieldin medicine. Dr. Dayan,
welcome back to the podcast.
Thank you so much, Dr.Bass. It's nice to be here.
Summer's nice to be here as well.
(02:15):
I enjoyed it so much last time that Ithought I'd come back for another serving.
Welcome back to the podcast.
So can we start by hearing about thehistory of culture representation in
aesthetic medicine?
Every culture has adesire to be beautiful.
That's nothing new and that'sbeen going on for millennium,
but since the evenbefore recorded history.
So that's nothing new andthat's part of our DNA.
(02:38):
Now there are different styles and there'sdifferent things that happen within
our culture over time that varyslightly, but it always goes back,
in my opinion, to the primal
necessities to survive.
And that means to find someone that'sbeautiful so that we can ultimately mate
and have the perfect offspring. I thinkthat we're for that subconsciously.
(03:04):
That makes sense. Soyou kind of mentioned,
but exactly what kinds of distinctionsare you considering and are you
talking about?
Well, all cultures desire beautiful,
but how they manifest that isdifferent. So I'll give you an example.
(03:24):
In Africa, if you go tothe Mercy Tribes of Africa,
they put a 14 centimeterplate in their lips.
If I showed you that, you'd belike, oh, that's a little strange.
Why would they put a 14 centimeterplate? Their lip is expanded,
it looks distorted to us. Itwouldn't look very natural.
They think that's beautiful andattractive. We don't. But in our culture,
we may put collagen in someone'slips and we think that's attractive,
(03:46):
and they would say, why wouldyou do that? That's unattractive.
So we both have different waysof approaching the same concept.
What we're both doing iswe're highlighting a secondary sexual characteristic,
which is the lips. Lips areassociated with fertility,
lips are associated withyouthfulness. The bigger the lip,
the more prominent the lip,
the more attractive someone is. So weboth see it as a beautifying feature.
(04:06):
We both recognize it as a secondary sexualcharacteristic trait that's directive
in nature for females more so than men.
And we both have different ways ofhighlighting that within our cultures.
So that's kind of what thedifference between the cultures.
I'll give you another example.
If you look at bodies, if you go to Brazil
(04:27):
or even certain partsof Sub-Saharan Africa,
a large behind or a large buttocksis really attractive and that also
associated with fertility.
We may find that a little bit too curvyand unattractive to us because that
seems inappropriate in the us.
But you go to Cameroon andthere's cultures and there's tribes there that place
pillows into their clothing to highlighttheir butt to make it look bigger
(04:50):
because that in theory attracts a manbecause they look more fertile and they're
both doing the same thing.
We're highlighting the secondarysexual characteristics,
but we just may do it differently herein Western society than they do in some
of those other African societiesor South American societies.
So do you think it'sall about fertility and
(05:10):
attracting a mate or is it a sense of
self appreciation or how
you are representing yourselfto the outside world? I mean,
is there more than one reasonjust mating that we style
ourselves or does italways come down to that?
(05:33):
So great question Larry. I am areductiveness. So I think yes,
it comes down ultimately toour inherent desire to mate,
just like we have a desireto eat food and breathe air,
there's certain things that we can't helpthat are ingrained within us that are
subconscious, that are based on oursurvival, and two things in particular,
fear and procreation orfinding the ultimate mate to
(05:57):
have an offspring with. So everythingI think comes down to that. Now,
having said that,
we get self-esteem when wefeel pretty about ourselves.
We get self-esteem or handsome or weget self-esteem when others give us
positive feedback. So we feel goodabout ourselves and we seek self-esteem,
we seek feeling confidence justlike we seek any other type of
(06:18):
drug or anything else thatincreases our mood, our appetite.
So I think yes,
we want self-esteem and then we representit with the way we address the way we
present ourselves to the external world.
But ultimately I think the reason whywe do that is because we're pre-wired to
try to find a mate.
Traditionally the beauty industryin the US has been dominated
(06:39):
by certain kinds of ethnic looks that draw
from America's Eurocentric heritage
and certain parts of thebody that are getting styled.
Are we still in that vein orare we doing that the same
(07:01):
way,
or are we doing it a little morebroadly or a little more variably at
this point in time, butstill the same things?
Or are we just broadeningout in every way what we're
chasing,
what beauty features we're modifyingand what acceptable standards for
their modification may be?
(07:25):
Well,
this is where the cultural appropriationor the diversity and a culture really
has impact and influence. Ifyou look at the US population,
which today is very multicultural, butif you look at it in 1950s, it wasn't,
it was highly Caucasian at that time.
What was attractive wassomeone like a Twiggy.
I'm not sure if many people whoare listening know what Twiggy is,
but she was a cultural beautyicon in the 1950s. Big eyes,
(07:49):
very small nose and chin, and she wasvery infantile looking. Today, however,
beauty is somewhat with aheavier eyebrow, a wider nose,
bigger lips, strongerjawline, that's more feminine,
that's more attractive today.
But that's also based on the fact thatwe have a culture that's comprised of
many races and many ethnicitiesand many backgrounds.
(08:11):
So as more and morepeople come into the US,
we shift what becomes more attractiveto the average. And this goes for all of
us too.
If you live in a small community of justa group of people that look like you
and you don't extend outsidethat group very much,
then you find attractivewhat's in your community.
But if you live in a society that'svery multicultural and very diverse,
(08:32):
then what you find attractive tendsto move over a little bit to something
that's the average of all thepeople within your reference range.
And you can see that in our advertising.You can see that in our marketing.
You see that in our social media.
So the US has moved now to a moremulticultural beauty that we all find
attractive somewhere in between what itwas in the 1950s to what it is like now
(08:53):
in maybe a South African country,which may be all just one ethnicity.
So it varies distinctly,
but it's all based on our referencerange as a society and as an individual.
And it goes beyond beauty ifyou really think about it.
It goes to the same thing withideas, thoughts, politics, religion.
The more you expose yourself to morecultures, more ideas, more thoughts,
(09:14):
more disciplines,
the more your reference range changesto go towards the middle of that.
Okay, that makes a lot of sense actually.You've kind of touched on it a bit,
but
how do these diverse beauty standardsreally translate into differences in the
care that's sought and thecare that's then delivered?
(09:37):
It changes a lot. And that'sa great question, Summer,
because if you're a physician and youlive in a small town and you're just used
to one type of look,then that's all you do.
That's what you may make thatscooped out nose or you may make a
strong chin and that may not be somethingthat the people are coming to you if
they're from a different ethnicitywant. Last year or two years ago now,
(09:59):
I did a whole program on diversityin aesthetics. I traveled the world.
I went to five continents,seven different countries,
and we studied beauty inall different cultures.
And we went to Africa and we studiedbeauty in Africa with doctors in Africa
treating African patients.
And then we compared and contrast thatto doctors in the US who are treating
African-American patients,
the patients who are culturally fromAfrica or are black or dark-skinned in
(10:21):
color. We did the same thing with LatinAmerica, the same thing with Asia.
So we compared and contrast, it wasso unique to see the differences.
So when we were in Africa andwe were treating patients there,
the patients would come in,
they wanted their templestreated or their lips treated.
And I was thinking to myself, really,
that's not how it's donehere in the US so much,
or that's not what we wouldthink they would want treated.
(10:42):
Because if you look at them skeletallyand you look at them morphologically,
they seem to have a small chincompared to our Eurocentric standards,
and you think they want their chin bigger,
their lips are large by standardsthat we have in our rating scales,
which go up to five points.And you look at their lips,
there are four out of five youwould say they're already augmented,
(11:02):
they're already large, they don'tneed their lips bigger. But no,
they wanted their lips bigger.It wasn't so much bigger.
They wanted them treated,
they wanted them with a filler becausethey thought it gave 'em better shape.
But in the US you mightthink that's not necessary.
So you start to see that in these Africancommunities that was different than
the US population, theywere treated differently.
Now a US doctor has to understand this,
(11:22):
if they're going to treat those patientswho are coming over from that country,
and as they start to come to this country,
some of those desires then start toinfiltrate and become part of our
norms and customs. So last year Idid a paper I presented already.
It has not published this, but it'sbeen accepted for publication in
Facial Plastic Surgery & AestheticMedicine. So it should be coming out soon.
(11:44):
We did a study in African-Americanpatients and lips,
and it is a very interesting studybecause if you look at the clinical trials
that were originally done on lips,
there weren't African-Americanpatients in the lip studies,
and these are the pivotal trials to getapproval for filling in their lips. The
reason why is because for apatient to get fill in their lips,
they had to be deficient in theirlips. They had to emphasize one,
(12:04):
two on a scale of five in orderto qualify to get lip fill.
Well,
African-American patients wouldn'tqualify for that because natively they had
three, four, and five size lips. So astudy was done, the product gets approved,
but it didn't include African-Americanpatients and the FDA and others thought
that that wasn't appropriate.So the scale got modified,
(12:25):
but still there was no clinical trialsto look at these patients with larger
lips and say, do they want theirlips augmented and are they happy?
So we did a clinical trial two yearsago now we took patients who are
African-American who desiredhaving their lips treated,
and then we measured them on a scale andthey mostly came in at 3.4 to 3.5 and
what size lips they wanted, and theywant lips that were size four on a scale,
(12:48):
on a five point scale, four to 4.5.
And we were able to get them prettyclose to what they wanted and they were
happy with it.
And we were able to show that thesepatients desire their lips treated,
they want their lips a little bit bigger,
and that us as physicians areunderestimating undervaluing that those patients
may need those treatmentsand want those treatments.
So it's very interesting way to look atit from the patient's perspective and
(13:11):
what they desire and how it differentiatesfrom what the Eurocentric version of
lips are and what wewere taught in school.
So I'm curious to lookback at this issue of how
different cultural groupsinfluence each other. I mean,
I'm in New York City andif you get on the subway,
(13:32):
you're going to be in the subwaycar with a lot of different cultural
groups and seeing how people
look not only from the culturalgroup you're accustomed to,
but from many others influencesyour perception of what's normal or beautiful or
desirable, but not onlyin-person exposure,
(13:55):
but we're heavily exposed by media.
And we've talked about the impact ofmedia on self-image the last time you were
on the podcast,
but how does media expose usand how is that influencing our
perception of what's beautifulmaybe drawing from other
cultures?
(14:17):
This is a great question. This is,
I think one of the most beautiful thingsabout America is that we are a melting
pod or a salad, if you want to call itthat, of many cultures that come in here.
And if you're in New York,you're driving on the subway,
you're going to see a whole smorgasbordof different types of people from
different cultures.
And isn't that great that you lookacross the train and you're like,
(14:38):
I want to look like, I think that'sreally pretty. And it may be a tattoo,
it may be a piercing,
maybe a hairstyle or maybe the way theirlips are done or the way their eyebrows
are done. But gee, I think that's great.It's just like I love Italian food.
I love Middle Easternfood, I love Indian food,
and I take from that and I developcertain spices and I certain tastes for
certain spices after tasting it. The samething with beauty and the same thing.
(15:01):
When we all come together, we tendto find other things more attractive.
At first, they're unique and atfirst we're scared. We fear them.
We don't like them becausewe're not familiar with it.
But the more you see something,
the more you become attractedto it no matter what it is.
And the more you see a certain typeof look, you become more attracted it,
and eventually you start to adoptsome of those desires or needs or
characteristics.
(15:21):
So that's what I think is happeningwith beauty and media is just a way to
amplify that, especiallywith social media today,
because you're seeing all different typesof cultures come across your feeds and
you're going to find itattractive and it's great.
It's not just what's going on in theUS but you have what's going on in
different culture in different countries.
So you see what they're doing in Japanor Korea or wherever that may be that
(15:42):
you're following and you mightsay, Hey, I want to do that here.
I think it unifies usall as we move forward
into what we find beautiful.
This has been a really interestingdiscussion. I'm wondering though,
is aesthetic medicine and surgery doinga better job today of adjusting for the
(16:03):
cultural and diversity inthe patient population?
So I think that medicinetoday is definitely doing a better job because it has
to. It's got to meet thedemand of our patients.
When I was coming through training,
we were given the canons of beautyand the mathematical five formula,
which has proven itself over and overagain to not necessarily work for all
(16:24):
cultures the same, andit's very Eurocentric,
and that probably was abias training. Now today,
we look at people very differentlyand we look at them as what's
beautiful within their ownculture. I think that's important,
but we're also looking at the waypeople feel about themselves too.
We're looking at the psychosocialaspect of it as well.
I think as our students comethrough today and as we train,
(16:46):
that's part of the curriculum is makingsure everyone's more sensitive to these
other cultural desires. So yes,
I think we're doing a much betterjob say than we were in the past.
I think our clinical trials are makingsure to have a diverse population in
them,
and we're making sure our studies andour designs and our questions and our
patient reported outcomes are allasking questions that are necessarily
(17:06):
capturing the needs and desires ofdifferent genders and different cultures.
And then just to playdevil's advocate a bit,
are all of these kind ofmore like stereotypes and the care should just strive
to provide custom options to eachindividual patient based on the individual
preferences instead? I knowyou've talked about it a bit,
(17:27):
but I just wanted to throw that out there.
So of course, I think we shouldtreat people as individuals,
and I think when we get to cookiecutter treatments, we get in trouble.
And I don't think aesthetics struggleswhen we go to cookie cutter treatments.
And I think that's where aestheticsfalls apart and everyone tries to make us
cookie cutters,
but it just doesn't work in aestheticsbecause we're dealing with people's
emotions and we're dealing with culturesand societies and expectations that are
(17:50):
very different than someone who's hasgallstones and needs their gallbladder
taken out. It's not that simple.And when we try to simplify it,
I think we get into trouble. So yes, Ithink everyone should be individualized.
I had a patient come to me recentlywho wanted a hump put on her nose.
She was Italian. She goes, Iwant a hump on my nose. I'm like,
do you want to a hump on your nose?
She wanted a hump on her nose becauseshe thought that was elegant and
attractive and fitwithin her culture. Now,
(18:13):
I wasn't going to give her something thatI thought was inappropriate that would
make her look strange, but to give hera little bit of convexity to her nose,
okay, I can do that. But I thoughtthat was an unusual request,
but that was her desire.
So I think that we have to be sensitiveto what the desires is of that person
that's culturally appropriate for them.
That's interesting becauseI think historically a lot of patients sought plastic
(18:34):
surgery to try to blunt certain ethnic
identity so that theywouldn't look stereotypically
part of the ethnic group theycame from. And increasingly,
patients come in and want to modify,
harmonize, beautify,
but retain or amplifytheir ethnic identity.
(18:57):
And it's great that they canfeel comfortable and proud,
but either request is a fair request.
It's really just important to understandwhere the patient is hoping to go,
so you don't make a misstep in takingthem in a direction different from what
they're asking for.
So I think this is a great point,
(19:18):
and I want to emphasize this a littlebit more because if you look at patients
in the fifties and sixties,
when plastic surgery first cameinto the US and became part
of what we do to enhance our beauty,everyone wanted to be American.
They wanted to look American,they wanted to blend in.
They did not want to be different.They were hiding their ethnicity.
(19:39):
So you see a lot of these people comingin and getting a little scooped out
noses because that was the lookand that was the American look.
So you see a lot of thosepatients, they're now in their seventies and eighties,
but I'm sure you see them inyour office. I see them too.
There's a little scooped outnoses that doesn't work so well.
But that's what they wanted.And sometimes they come in,
now I see 'em with their grandkids,
but I saw 'em with their kids.Now I see 'em with their grandkids and the
(20:01):
grandkid comes in andsays, I want a nice nose,
but not like my mom's or my grandma's.And the mom or grandma's like, wait,
what's wrong with my nose?They love their noses,
but that's not what theywant say. So what I find,
and tell me if you seeit differently, Larry,
because this is a unique observation Imade, is that people who are first gener,
people come over on theboat, people who come in,
they just move to this country.They want to look American.
They want the scooped out noses.
(20:22):
They didn't want their identityto be so noticeable on their face.
The first and second generation that Iget, especially the second generation,
is so proud of their ethnicity, isthat they don't want any loss of it.
I want to maintain my ethnicity.
I want to make sure peopleknow that I'm Syrian,
or they want to make sure peopleknow that I'm Asian, Chinese,
whatever it may be. They don'twant to lose that ethnicity.
Whereas the people who come overright away from the other countries,
(20:44):
they want to look different. Theywant to look more Americanized.
Yeah, I think that'ssomething I've seen. And
I think people are lookingfor much more nuanced things.
People who are here are nottrying to stamp a certain
identity into their look.
They're just trying to createtheir own unique enhanced look.
(21:08):
That's who they were to start with,
but just more beautiful and balanced.
Yes, I agree with that.
Okay. So finally, to sum up,
can you tell us what trends have beenaffected by the increasingly more diverse
view of human beauty?
(21:29):
Sure. Well,
I think there's a lot of trends thathave come in the last few years that are
based on the diversity ofculture. If you want to look at,
I think lips being a little bitlarger and being a little bit fuller,
I think that's part of the culture trend.
I would say noses are definitelydifferent than they were a generation ago.
A little bit of a larger nose,
one that fits the face is moreacceptable today than it was in the past.
(21:53):
I think we should doa lot more brow lifts.
I think we're doing less brow lifts todaybecause people don't want a hollowed
out eye or large brows.They want the heavier,
thicker brow I think is more attractiveto say there was in the past a stronger
jawline. That's somethingthat was not necessarily,
was something that was notsought after in the past.
But now I have lots of womenwho want that strong jawline,
(22:14):
whereas they don't wantto have it be thinned out.
So I think those are probably some ofthe cultural changes that I've seen over
the last five to 10 years with anincreasing multicultural society.
And what are your takeaways, Dr. Bass?
Well, just to summarize, as we said,desire for beauty is universal.
(22:36):
Dr. Dayan and I a hundredpercent agree on that.
But the definition of beauty is highlydependent on your cultural identity,
along with your individuallife experience,
what you've been exposed toin the environment you're in,
which is really something separatefrom your cultural identity, per se.
(22:58):
The fashion industry, the beauty industry,
they're much moreculturally sophisticated and
diverse than in times gone by.
And we live in a much more interactiveworld and a much more interactive
national and international culture.
One where media shows us amuch bigger slice of the world
(23:20):
than previously, and a lotof different points of view,
different people's viewof what's beautiful.
So that has a profound influence on us.
How we individually viewbeauty based on what we've
been exposed to themedical beauty industry.
Plastic surgery and aestheticmedicine embraces a lot
(23:44):
more culturally diverseand individually diverse
images of beauty thanthey have previously.
And this has transformedthose medical fields
into a service that'sresponsive to individual
views of beauty with acustomized plan of care.
(24:06):
So Dr. Dayan,
I'd like to thank you for joining usagain today and sharing your thought
provoking insights on this topic.I always love talking with you.
Oh, thank you. It's a pleasure to be here.
I'll also share my thank you for joiningus again on the podcast, Dr. Dayan.
I really enjoyed our engaging discussion.
Thank you for listening to the ParkAvenue Plastic Surgery Class Podcast.
(24:30):
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Instagram @drbassnyc.
Welcome to Park AvenuePlastic Surgery Class,
the podcast where we explore controversiesand breaking issues in plastic
surgery. I'm your co-host, Summer Hardy,
a clinical assistant at BassPlastic Surgery in New York City.
I'm excited to be here with Dr. LawrenceBass, Park Avenue plastic surgeon,
educator and technology innovator.
The title of today's episode isCulture and Diversity in Aesthetics.
(00:24):
This seems like a verytimely topic, Dr. Bass,
what is the scope of whatyou're hoping to discuss today?
The desire for beauty isuniversal and not new.
How beauty is defined inpopular culture is somewhat to
very different in different culturesin different parts of the world.
(00:46):
From there, how that beauty issupported by beauty industries,
including medical beauty services,is part of our discussion today.
I've asked my colleague, Dr. Steve Dayan,
to join us again on the podcastto discuss this topic in detail.
Dr. Dayan is a facialplastic surgeon in Chicago.
(01:09):
He is a New York Times and USA
today bestselling author,
and he's been an exceptionallyprolific speaker and writer. His book,
Subliminally Exposed springs fromhis popular undergraduate course,
the Science of Beauty.
He's known for his dynamic keynotespeeches and deep understanding of human
(01:33):
behavior. In addition,
he's an entrepreneur havingfounded and run a medical
research company, amedical marketing company,
a skincare training center, anda medical education company.
His ventures placed him at theforefront of aesthetic innovation and
(01:53):
product development.
He's the recipient of the AMAFoundation's Leadership Award showing
recognition of his tirelesswork in advancing our
understanding of this fieldin medicine. Dr. Dayan,
welcome back to the podcast.
Thank you so much, Dr.Bass. It's nice to be here.
Summer's nice to be here as well.
(02:15):
I enjoyed it so much last time that Ithought I'd come back for another serving.
Welcome back to the podcast.
So can we start by hearing about thehistory of culture representation in
aesthetic medicine?
Every culture has adesire to be beautiful.
That's nothing new and that'sbeen going on for millennium,
but since the evenbefore recorded history.
So that's nothing new andthat's part of our DNA.
(02:38):
Now there are different styles and there'sdifferent things that happen within
our culture over time that varyslightly, but it always goes back,
in my opinion, to the primal
necessities to survive.
And that means to find someone that'sbeautiful so that we can ultimately mate
and have the perfect offspring. I thinkthat we're for that subconsciously.
(03:04):
That makes sense. Soyou kind of mentioned,
but exactly what kinds of distinctionsare you considering and are you
talking about?
Well, all cultures desire beautiful,
but how they manifest that isdifferent. So I'll give you an example.
(03:24):
In Africa, if you go tothe Mercy Tribes of Africa,
they put a 14 centimeterplate in their lips.
If I showed you that, you'd belike, oh, that's a little strange.
Why would they put a 14 centimeterplate? Their lip is expanded,
it looks distorted to us. Itwouldn't look very natural.
They think that's beautiful andattractive. We don't. But in our culture,
we may put collagen in someone'slips and we think that's attractive,
(03:46):
and they would say, why wouldyou do that? That's unattractive.
So we both have different waysof approaching the same concept.
What we're both doing iswe're highlighting a secondary sexual characteristic,
which is the lips. Lips areassociated with fertility,
lips are associated withyouthfulness. The bigger the lip,
the more prominent the lip,
the more attractive someone is. So weboth see it as a beautifying feature.
(04:06):
We both recognize it as a secondary sexualcharacteristic trait that's directive
in nature for females more so than men.
And we both have different ways ofhighlighting that within our cultures.
So that's kind of what thedifference between the cultures.
I'll give you another example.
If you look at bodies, if you go to Brazil
(04:27):
or even certain partsof Sub-Saharan Africa,
a large behind or a large buttocksis really attractive and that also
associated with fertility.
We may find that a little bit too curvyand unattractive to us because that
seems inappropriate in the us.
But you go to Cameroon andthere's cultures and there's tribes there that place
pillows into their clothing to highlighttheir butt to make it look bigger
(04:50):
because that in theory attracts a manbecause they look more fertile and they're
both doing the same thing.
We're highlighting the secondarysexual characteristics,
but we just may do it differently herein Western society than they do in some
of those other African societiesor South American societies.
So do you think it'sall about fertility and
(05:10):
attracting a mate or is it a sense of
self appreciation or how
you are representing yourselfto the outside world? I mean,
is there more than one reasonjust mating that we style
ourselves or does italways come down to that?
(05:33):
So great question Larry. I am areductiveness. So I think yes,
it comes down ultimately toour inherent desire to mate,
just like we have a desireto eat food and breathe air,
there's certain things that we can't helpthat are ingrained within us that are
subconscious, that are based on oursurvival, and two things in particular,
fear and procreation orfinding the ultimate mate to
(05:57):
have an offspring with. So everythingI think comes down to that. Now,
having said that,
we get self-esteem when wefeel pretty about ourselves.
We get self-esteem or handsome or weget self-esteem when others give us
positive feedback. So we feel goodabout ourselves and we seek self-esteem,
we seek feeling confidence justlike we seek any other type of
(06:18):
drug or anything else thatincreases our mood, our appetite.
So I think yes,
we want self-esteem and then we representit with the way we address the way we
present ourselves to the external world.
But ultimately I think the reason whywe do that is because we're pre-wired to
try to find a mate.
Traditionally the beauty industryin the US has been dominated
(06:39):
by certain kinds of ethnic looks that draw
from America's Eurocentric heritage
and certain parts of thebody that are getting styled.
Are we still in that vein orare we doing that the same
(07:01):
way,
or are we doing it a little morebroadly or a little more variably at
this point in time, butstill the same things?
Or are we just broadeningout in every way what we're
chasing,
what beauty features we're modifyingand what acceptable standards for
their modification may be?
(07:25):
Well,
this is where the cultural appropriationor the diversity and a culture really
has impact and influence. Ifyou look at the US population,
which today is very multicultural, butif you look at it in 1950s, it wasn't,
it was highly Caucasian at that time.
What was attractive wassomeone like a Twiggy.
I'm not sure if many people whoare listening know what Twiggy is,
but she was a cultural beautyicon in the 1950s. Big eyes,
(07:49):
very small nose and chin, and she wasvery infantile looking. Today, however,
beauty is somewhat with aheavier eyebrow, a wider nose,
bigger lips, strongerjawline, that's more feminine,
that's more attractive today.
But that's also based on the fact thatwe have a culture that's comprised of
many races and many ethnicitiesand many backgrounds.
(08:11):
So as more and morepeople come into the US,
we shift what becomes more attractiveto the average. And this goes for all of
us too.
If you live in a small community of justa group of people that look like you
and you don't extend outsidethat group very much,
then you find attractivewhat's in your community.
But if you live in a society that'svery multicultural and very diverse,
(08:32):
then what you find attractive tendsto move over a little bit to something
that's the average of all thepeople within your reference range.
And you can see that in our advertising.You can see that in our marketing.
You see that in our social media.
So the US has moved now to a moremulticultural beauty that we all find
attractive somewhere in between what itwas in the 1950s to what it is like now
(08:53):
in maybe a South African country,which may be all just one ethnicity.
So it varies distinctly,
but it's all based on our referencerange as a society and as an individual.
And it goes beyond beauty ifyou really think about it.
It goes to the same thing withideas, thoughts, politics, religion.
The more you expose yourself to morecultures, more ideas, more thoughts,
(09:14):
more disciplines,
the more your reference range changesto go towards the middle of that.
Okay, that makes a lot of sense actually.You've kind of touched on it a bit,
but
how do these diverse beauty standardsreally translate into differences in the
care that's sought and thecare that's then delivered?
(09:37):
It changes a lot. And that'sa great question, Summer,
because if you're a physician and youlive in a small town and you're just used
to one type of look,then that's all you do.
That's what you may make thatscooped out nose or you may make a
strong chin and that may not be somethingthat the people are coming to you if
they're from a different ethnicitywant. Last year or two years ago now,
(09:59):
I did a whole program on diversityin aesthetics. I traveled the world.
I went to five continents,seven different countries,
and we studied beauty inall different cultures.
And we went to Africa and we studiedbeauty in Africa with doctors in Africa
treating African patients.
And then we compared and contrast thatto doctors in the US who are treating
African-American patients,
the patients who are culturally fromAfrica or are black or dark-skinned in
(10:21):
color. We did the same thing with LatinAmerica, the same thing with Asia.
So we compared and contrast, it wasso unique to see the differences.
So when we were in Africa andwe were treating patients there,
the patients would come in,
they wanted their templestreated or their lips treated.
And I was thinking to myself, really,
that's not how it's donehere in the US so much,
or that's not what we wouldthink they would want treated.
(10:42):
Because if you look at them skeletallyand you look at them morphologically,
they seem to have a small chincompared to our Eurocentric standards,
and you think they want their chin bigger,
their lips are large by standardsthat we have in our rating scales,
which go up to five points.And you look at their lips,
there are four out of five youwould say they're already augmented,
(11:02):
they're already large, they don'tneed their lips bigger. But no,
they wanted their lips bigger.It wasn't so much bigger.
They wanted them treated,
they wanted them with a filler becausethey thought it gave 'em better shape.
But in the US you mightthink that's not necessary.
So you start to see that in these Africancommunities that was different than
the US population, theywere treated differently.
Now a US doctor has to understand this,
(11:22):
if they're going to treat those patientswho are coming over from that country,
and as they start to come to this country,
some of those desires then start toinfiltrate and become part of our
norms and customs. So last year Idid a paper I presented already.
It has not published this, but it'sbeen accepted for publication in
Facial Plastic Surgery & AestheticMedicine. So it should be coming out soon.
(11:44):
We did a study in African-Americanpatients and lips,
and it is a very interesting studybecause if you look at the clinical trials
that were originally done on lips,
there weren't African-Americanpatients in the lip studies,
and these are the pivotal trials to getapproval for filling in their lips. The
reason why is because for apatient to get fill in their lips,
they had to be deficient in theirlips. They had to emphasize one,
(12:04):
two on a scale of five in orderto qualify to get lip fill.
Well,
African-American patients wouldn'tqualify for that because natively they had
three, four, and five size lips. So astudy was done, the product gets approved,
but it didn't include African-Americanpatients and the FDA and others thought
that that wasn't appropriate.So the scale got modified,
(12:25):
but still there was no clinical trialsto look at these patients with larger
lips and say, do they want theirlips augmented and are they happy?
So we did a clinical trial two yearsago now we took patients who are
African-American who desiredhaving their lips treated,
and then we measured them on a scale andthey mostly came in at 3.4 to 3.5 and
what size lips they wanted, and theywant lips that were size four on a scale,
(12:48):
on a five point scale, four to 4.5.
And we were able to get them prettyclose to what they wanted and they were
happy with it.
And we were able to show that thesepatients desire their lips treated,
they want their lips a little bit bigger,
and that us as physicians areunderestimating undervaluing that those patients
may need those treatmentsand want those treatments.
So it's very interesting way to look atit from the patient's perspective and
(13:11):
what they desire and how it differentiatesfrom what the Eurocentric version of
lips are and what wewere taught in school.
So I'm curious to lookback at this issue of how
different cultural groupsinfluence each other. I mean,
I'm in New York City andif you get on the subway,
(13:32):
you're going to be in the subwaycar with a lot of different cultural
groups and seeing how people
look not only from the culturalgroup you're accustomed to,
but from many others influencesyour perception of what's normal or beautiful or
desirable, but not onlyin-person exposure,
(13:55):
but we're heavily exposed by media.
And we've talked about the impact ofmedia on self-image the last time you were
on the podcast,
but how does media expose usand how is that influencing our
perception of what's beautifulmaybe drawing from other
cultures?
(14:17):
This is a great question. This is,
I think one of the most beautiful thingsabout America is that we are a melting
pod or a salad, if you want to call itthat, of many cultures that come in here.
And if you're in New York,you're driving on the subway,
you're going to see a whole smorgasbordof different types of people from
different cultures.
And isn't that great that you lookacross the train and you're like,
(14:38):
I want to look like, I think that'sreally pretty. And it may be a tattoo,
it may be a piercing,
maybe a hairstyle or maybe the way theirlips are done or the way their eyebrows
are done. But gee, I think that's great.It's just like I love Italian food.
I love Middle Easternfood, I love Indian food,
and I take from that and I developcertain spices and I certain tastes for
certain spices after tasting it. The samething with beauty and the same thing.
(15:01):
When we all come together, we tendto find other things more attractive.
At first, they're unique and atfirst we're scared. We fear them.
We don't like them becausewe're not familiar with it.
But the more you see something,
the more you become attractedto it no matter what it is.
And the more you see a certain typeof look, you become more attracted it,
and eventually you start to adoptsome of those desires or needs or
characteristics.
(15:21):
So that's what I think is happeningwith beauty and media is just a way to
amplify that, especiallywith social media today,
because you're seeing all different typesof cultures come across your feeds and
you're going to find itattractive and it's great.
It's not just what's going on in theUS but you have what's going on in
different culture in different countries.
So you see what they're doing in Japanor Korea or wherever that may be that
(15:42):
you're following and you mightsay, Hey, I want to do that here.
I think it unifies usall as we move forward
into what we find beautiful.
This has been a really interestingdiscussion. I'm wondering though,
is aesthetic medicine and surgery doinga better job today of adjusting for the
(16:03):
cultural and diversity inthe patient population?
So I think that medicinetoday is definitely doing a better job because it has
to. It's got to meet thedemand of our patients.
When I was coming through training,
we were given the canons of beautyand the mathematical five formula,
which has proven itself over and overagain to not necessarily work for all
(16:24):
cultures the same, andit's very Eurocentric,
and that probably was abias training. Now today,
we look at people very differentlyand we look at them as what's
beautiful within their ownculture. I think that's important,
but we're also looking at the waypeople feel about themselves too.
We're looking at the psychosocialaspect of it as well.
I think as our students comethrough today and as we train,
(16:46):
that's part of the curriculum is makingsure everyone's more sensitive to these
other cultural desires. So yes,
I think we're doing a much betterjob say than we were in the past.
I think our clinical trials are makingsure to have a diverse population in
them,
and we're making sure our studies andour designs and our questions and our
patient reported outcomes are allasking questions that are necessarily
(17:06):
capturing the needs and desires ofdifferent genders and different cultures.
And then just to playdevil's advocate a bit,
are all of these kind ofmore like stereotypes and the care should just strive
to provide custom options to eachindividual patient based on the individual
preferences instead? I knowyou've talked about it a bit,
(17:27):
but I just wanted to throw that out there.
So of course, I think we shouldtreat people as individuals,
and I think when we get to cookiecutter treatments, we get in trouble.
And I don't think aesthetics struggleswhen we go to cookie cutter treatments.
And I think that's where aestheticsfalls apart and everyone tries to make us
cookie cutters,
but it just doesn't work in aestheticsbecause we're dealing with people's
emotions and we're dealing with culturesand societies and expectations that are
(17:50):
very different than someone who's hasgallstones and needs their gallbladder
taken out. It's not that simple.And when we try to simplify it,
I think we get into trouble. So yes, Ithink everyone should be individualized.
I had a patient come to me recentlywho wanted a hump put on her nose.
She was Italian. She goes, Iwant a hump on my nose. I'm like,
do you want to a hump on your nose?
She wanted a hump on her nose becauseshe thought that was elegant and
attractive and fitwithin her culture. Now,
(18:13):
I wasn't going to give her something thatI thought was inappropriate that would
make her look strange, but to give hera little bit of convexity to her nose,
okay, I can do that. But I thoughtthat was an unusual request,
but that was her desire.
So I think that we have to be sensitiveto what the desires is of that person
that's culturally appropriate for them.
That's interesting becauseI think historically a lot of patients sought plastic
(18:34):
surgery to try to blunt certain ethnic
identity so that theywouldn't look stereotypically
part of the ethnic group theycame from. And increasingly,
patients come in and want to modify,
harmonize, beautify,
but retain or amplifytheir ethnic identity.
(18:57):
And it's great that they canfeel comfortable and proud,
but either request is a fair request.
It's really just important to understandwhere the patient is hoping to go,
so you don't make a misstep in takingthem in a direction different from what
they're asking for.
So I think this is a great point,
(19:18):
and I want to emphasize this a littlebit more because if you look at patients
in the fifties and sixties,
when plastic surgery first cameinto the US and became part
of what we do to enhance our beauty,everyone wanted to be American.
They wanted to look American,they wanted to blend in.
They did not want to be different.They were hiding their ethnicity.
(19:39):
So you see a lot of these people comingin and getting a little scooped out
noses because that was the lookand that was the American look.
So you see a lot of thosepatients, they're now in their seventies and eighties,
but I'm sure you see them inyour office. I see them too.
There's a little scooped outnoses that doesn't work so well.
But that's what they wanted.And sometimes they come in,
now I see 'em with their grandkids,
but I saw 'em with their kids.Now I see 'em with their grandkids and the
(20:01):
grandkid comes in andsays, I want a nice nose,
but not like my mom's or my grandma's.And the mom or grandma's like, wait,
what's wrong with my nose?They love their noses,
but that's not what theywant say. So what I find,
and tell me if you seeit differently, Larry,
because this is a unique observation Imade, is that people who are first gener,
people come over on theboat, people who come in,
they just move to this country.They want to look American.
They want the scooped out noses.
(20:22):
They didn't want their identityto be so noticeable on their face.
The first and second generation that Iget, especially the second generation,
is so proud of their ethnicity, isthat they don't want any loss of it.
I want to maintain my ethnicity.
I want to make sure peopleknow that I'm Syrian,
or they want to make sure peopleknow that I'm Asian, Chinese,
whatever it may be. They don'twant to lose that ethnicity.
Whereas the people who come overright away from the other countries,
(20:44):
they want to look different. Theywant to look more Americanized.
Yeah, I think that'ssomething I've seen. And
I think people are lookingfor much more nuanced things.
People who are here are nottrying to stamp a certain
identity into their look.
They're just trying to createtheir own unique enhanced look.
(21:08):
That's who they were to start with,
but just more beautiful and balanced.
Yes, I agree with that.
Okay. So finally, to sum up,
can you tell us what trends have beenaffected by the increasingly more diverse
view of human beauty?
(21:29):
Sure. Well,
I think there's a lot of trends thathave come in the last few years that are
based on the diversity ofculture. If you want to look at,
I think lips being a little bitlarger and being a little bit fuller,
I think that's part of the culture trend.
I would say noses are definitelydifferent than they were a generation ago.
A little bit of a larger nose,
one that fits the face is moreacceptable today than it was in the past.
(21:53):
I think we should doa lot more brow lifts.
I think we're doing less brow lifts todaybecause people don't want a hollowed
out eye or large brows.They want the heavier,
thicker brow I think is more attractiveto say there was in the past a stronger
jawline. That's somethingthat was not necessarily,
was something that was notsought after in the past.
But now I have lots of womenwho want that strong jawline,
(22:14):
whereas they don't wantto have it be thinned out.
So I think those are probably some ofthe cultural changes that I've seen over
the last five to 10 years with anincreasing multicultural society.
And what are your takeaways, Dr. Bass?
Well, just to summarize, as we said,desire for beauty is universal.
(22:36):
Dr. Dayan and I a hundredpercent agree on that.
But the definition of beauty is highlydependent on your cultural identity,
along with your individuallife experience,
what you've been exposed toin the environment you're in,
which is really something separatefrom your cultural identity, per se.
(22:58):
The fashion industry, the beauty industry,
they're much moreculturally sophisticated and
diverse than in times gone by.
And we live in a much more interactiveworld and a much more interactive
national and international culture.
One where media shows us amuch bigger slice of the world
(23:20):
than previously, and a lotof different points of view,
different people's viewof what's beautiful.
So that has a profound influence on us.
How we individually viewbeauty based on what we've
been exposed to themedical beauty industry.
Plastic surgery and aestheticmedicine embraces a lot
(23:44):
more culturally diverseand individually diverse
images of beauty thanthey have previously.
And this has transformedthose medical fields
into a service that'sresponsive to individual
views of beauty with acustomized plan of care.
(24:06):
So Dr. Dayan,
I'd like to thank you for joining usagain today and sharing your thought
provoking insights on this topic.I always love talking with you.
Oh, thank you. It's a pleasure to be here.
I'll also share my thank you for joiningus again on the podcast, Dr. Dayan.
I really enjoyed our engaging discussion.
Thank you for listening to the ParkAvenue Plastic Surgery Class Podcast.
(24:30):
Follow us on Apple Podcasts,
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Be sure to join us next time to avoidmissing all the great content that is
coming your way. If you want tocontact us with comments or questions,
we'd love to hear from you,
send us an email atpodcast@drbass.net or DM us on
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