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• W2129763399 abstract "JAMA Facial Plastic SurgeryVol. 15, No. 2 Free AccessComing Face to Face With Our Own BiasSteven H. DayanSteven H. DayanCorrespondence: Dr Dayan, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Illinois at Chicago, 845 N Michigan Ave, Ste 923 E, Chicago, IL 60611 (E-mail Address: [email protected]). Chicago Center for Facial Plastic Surgery, Chicago, Illinois; Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Illinois at Chicago; School of New Learning, DePaul University, Chicago; and DeNova Research, Chicago.Search for more papers by this authorPublished Online:1 Mar 2013https://doi.org/10.1001/jamafacial.2013.630AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Doctor, I thought I wanted plastic surgery, but my friend just had a face-lift and she looks so strange. Now, I am sure I will never have plastic surgery. Besides, I can always tell when someone had something done. It never looks right. I want to look natural.This is often heard in our offices multiple times a day and is not merely limited to surgery. Expressionless foreheads, overstuffed cheeks, and expanding lips hurt us all. While we can try to deposit blame on a few bad apples exercising poor judgment or out-of-field practitioners performing misguided treatments, maybe we should take a closer look at our current training modicums and state of affairs. Could there be an inherent bias within our core specialties deviating toward the unnatural?Our blinding affair with “better” and “youth” may have steered us on a path past natural to the supernatural. And while peering through the lens of effacement, we must admit something does not look quite right when a small petite nose is on an ethnic male face or a large Romanesque nose on a young Asian girl. However, in isolation, these results often look great in photographs. In the attempt to show our heroic efforts, we may flash up great photographs at presentations or boast of our accomplishments in the “How I do it” sections of our journals. As respected masters set the tone with these grandiose results, medical training complied, responding with more pulling, lifting, and sucking in attempt to recreate a better somatic form of youth. In turn, eager residents wanting to emulate their mentors could not wait to adopt bolder, newer techniques and mountain-moving procedures. However, what was often neglected to be mentioned in our presentations or articles was the outcome.In other words, what did we actually achieve? Were we objectively achieving to make individuals more attractive? Were our interventions resulting in our patients projecting a more favorable first impression? And, most importantly, were our patients happy? This critical evaluation has been glossed over since the inception of our field. Could there be an inherent bias to show bigger and better results to impress each other, but not focusing on the task at hand? Should not our goal be to focus on what makes our patients happy? Should we temper our enthusiasm for newer and better techniques with our ability to improve patients' feelings of self-worth? Often, impressive photographs are from patients who are not happy with their outcomes. What is the point of showing a “great result” if the ultimate outcome of pleasing our patient was not achieved? Sometimes a different perspective is appreciated, and perhaps a closer evaluation at what makes someone appear and feel attractive is needed; the social psychology and evolutionary biology literature is a great place to start.Does it surprise you to know that “[s]ubtle and hardly perceivable differences in faces are powerful enough to cause judgments of personality”?ref-qvp120002-1(p11) In a 2009 article, Walker and Vetterref-qvp120002-1 showed that less than a millimeter change in the oral commissure, eyes, and nose could completely change the way someone was perceived. These small isolated changes in facial features are consciously imperceptible. However, once appreciated, it becomes glaringly overt to the trained eye. In another relevant article outside of our literature, Winston and colleaguesref-qvp120002-2 showed that when unknowing observers were asked to judge the age of attractive individuals, their reward centers in their medial orbital frontal cortex and medial prefrontal cortex were stimulated. Yet, when the observers were directly asked to evaluate the attractiveness of the faces, their reward centers were paradoxically understimulated. This suggests that if beauty is brought from the subconscious to the conscious, we are no longer rewarded by it. For a beautification effort to be successful, it has to purpose its effect in a subconscious manner. While the conclusions from social psychology and evolutionary biology were based on computer manipulations of photographs, studies within our literature have demonstrated similar results using surgery, neurotoxin, and fillers. These findings showed that mild augmentations and alterations to the corner of the mouth, tail of the brow, or angle of the nose resulted in an individual projecting a more favorable first impression.ref-qvp120002-3,ref-qvp120002-4,ref-qvp120002-5The essential element to the improvement is that the effect has to be natural appearing and subconsciously perceived. It is subtle alterations that positively alter projected appearances and the judgments received. However, the slightest evidence of cosmetically alteration tips off the primitive subconscious mind that something has been done, resulting in the opposite effect of that which was intended. It screams that a genetic weakness exists. It is the reason a well-done nose that does not fit the face makes a patient look worse and why women are perceived more favorably when facial makeup is placed in moderation but are rated negatively when it is placed in excess.ref-qvp120002-6Unfortunately, it seems that within our training, we may overlook the psychosomatic and image-enhancing benefits of slight, strategic, and covert cosmetic alterations. To demonstrate our results, whether in our journals or in our presentations, it becomes necessary to emphasize our morphological accomplishments, and perhaps, leading to a perpetual bias within our own field. We push to see and show obvious changes when maybe we should spend time highlighting the subtleties that our eyes and primitive subconscious finds attractive. It is not a coincidence that our patients are asking the same of us. It would be shortsighted not to realize the winds of change are upon us, and our academies and societies have to appeal to the majority wanting minimally invasive changes that result in subtle, yet effective and natural improvements.As much as our hard earned and well-deserved egos want to believe that our educational status, techniques and hands are the most critical component to success, it is important to consider that both our individual and collective victories are deeply rooted in patient satisfaction. As Chung et alref-qvp120002-7 have previously demonstrated, the most important predictor to patient satisfaction in outpatient plastic surgery is not the technical skill of the physician, but rather those factors that relate to efficient clinic operation, and most importantly, the quality of the patient-physician interaction.Often, graduating fellows ask, “What is the secret to getting busy?” Rather than a unique technique or specific product or device, the answer, albeit perhaps more of a philosophical one, seems deeply rooted in the ability to understand what makes someone feel attractive and why. While this may offer an abstract answer to the eager, focused efforts at serving the aesthetically minded, the skills and tools to see past the obvious would benefit us all. The better we train, the more we all rise. So much time is spent teaching and learning technique, but so little time is spent trying to understand the more difficult to understand intangible components to being successful. Incorporating lessons on what is beautiful and why, while recognizing our own inherent biases, may be the key to avoid irrelevancy moving forward both individually and collectively, thereby not only assuring better patient outcomes but also securing our society's successPublished Online: January 17, 2013. doi:10.1001/jamafacial.2013.630Conflict of Interest Disclosures: None reported.REFERENCESWalker M, Vetter T. Portraits made to measure: manipulating social judgments about individuals with a statistical face model. J Vis. 2009;9(11):12.1–12.13 20053075 Crossref, Medline, Google ScholarWinston JS, O’Doherty J, Kilner JM, Perrett DI, Dolan RJ. Brain systems for assessing facial attractiveness.. Neuropsychologia. 2007;45(1):195–206 16828125 Crossref, Medline, Google ScholarDayan S, Clark K, Ho AA. Altering first impressions after facial plastic surgery.. Aesthetic Plast Surg. 2004;28(5):301–306 15529199 Crossref, Medline, Google ScholarDayan SH, Arkins JP, Gal TJ. Blinded evaluation of the effects of hyaluronic acid filler injections on first impressions.. Dermatol Surg. 2010;36(suppl 3)1866–1873 20969664 Crossref, Medline, Google ScholarDayan SH, Lieberman ED, Thakkar NN, Larimer KA, ,Anstead A. Botulinum toxin a can positively impact first impression.. Dermatol Surg. 2008;34(suppl 1)S40–S47 18547180 Medline, Google ScholarRichetin J, Croizet J-C, Huguet P. Facial make-up elicits positive attitudes at the implicit level: evidence from the implicit association test.. Cur Res Soc Psychol. 2004;9(11):145–164 Google ScholarChung KC, Hamill JB, Kim HM, Walters MR, Wilkins EG. Predictors of patient satisfaction in an outpatient plastic surgery clinic.. Ann Plast Surg. 1999;42(1):56–60 9972719 Crossref, Medline, Google ScholarFiguresReferencesRelatedDetails Volume 15Issue 2Mar 2013 InformationCopyright 2013 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.To cite this article:Steven H. Dayan.Coming Face to Face With Our Own Bias.JAMA Facial Plastic Surgery.Mar 2013.78-79.http://doi.org/10.1001/jamafacial.2013.630Published in Volume: 15 Issue 2: March 1, 2013PDF download" @default.
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