The place of art and science in cosmetic surgery:

What is the art and science of cosmetic surgery?

Definition of art

Art is defined in the Webster collegiate dictionary as follows:

Art = The making of what is expressive or beautiful.

1.) The disposition or modification of things by human skill, to answer the purpose intended above. 

2.) The conscious use of skill and creative imagination, especially in the production of aesthetic objects; also : works so produced 

A working definition of art

Here is one definition of art, after considering the above definition and those of all the dictionaries regarding what art is and what place it has:

Art is an expression. Almost any expression will do. It can be speech, song, gesture, acting, writing, mothering, every form of music, cooking, building, work, sports, romance, and any other imaginable activity. One can witness the art of war, the art of leisure, the art of anything. 

All expressions are art and all who create them are artists.

The creator derives more pleasure than any other person when an artistic expression or work of art is made.

In scientific disciplines, there always exists some science and some art.

Communication of art

Art is often rated on how much or how many it pleases. It can be packaged and sold in the form of books, movies, and records. If it is pleasing to many, it can make the artists famous and wealthy. The lack of appreciation for art is much more common.

Art must be communicated to please others. 

The arts that can be recorded and preserved (i.e. writing, drawing, painting sculpture, tool making, architecture, music, literature, etc.) are the ones that survive for long periods of time. The oldest implements are tools, followed by cave paintings, writing, the painting of murals, and architecture and sculpture of China, Mesopotamia and Egypt that have endured thousands of years.

It can be a sad loss if art is not communicated and not recorded. The communication may be almost as important as the creation. We would not know of Shakespeare, Bach or Beethoven if their works had not been written and preserved. 

The place of art in general

As defined, we are surrounded by art and all its creators are artists, even the animals and the plants. The creator of the universe who began much of which was only recently discovered and most of which by far is yet to be discovered (what with the overwhelming scope of creations from quarks to pulsars) is the ultimate artist.

The pursuit of art requires time after fundamental needs are met.  For humans in Maslow’s pyramid of human needs, the physiological needs are primary and consist of air, water, food and shelter, followed by safety, and then love and belonging. Once these basic requirements are reasonably met, there can be time enough for pursuit of art of all forms including sports, learning, personal growth etc.

In the army we are taught safety first – even before all physiological needs are met. And that standard fits cosmetic surgery and surgery in general. Safety comes before everything. Science is before art in surgery. 

Science and cosmetic surgery

We usually hear the phrase, "Art and Science", with the word “Art” first. But as explained above, science comes first and makes the art possible. It is upon science that safety relies, as in the case of principles taught and practiced in Advanced Cardiac Life Support (created by the American Heart Association).

Science serves art by providing opportunities for more than just a meager hand-to-mouth existence for many people. It raises the standard of living so all are freer from poverty. Everything is more abundant and more easily obtained due to science and technology. Because of the benefits of science, art becomes easier to acquire and produce in all forms, and is more available to everyone. Everyone reading this can write a book and print it him or herself, or can write and record music, or make movies; people are able to not only create, but communicate their art.

It is science that defines the Stone Age, up to the implementation of natural resources like copper, bronze, iron, steel, and hence leading to the industrial revolution. And today, science is defining the new technological information revolution. 

Without science many people, just as I, would be preoccupied simply with trying to obtain enough food, water, and shelter, as many in the third world countries are today. 

Science without all the controls we are accustomed to in our Constitution, laws, and democratic government is like harnessing the power of fire, electricity or atomic energy. It can be used either for bad or good. For example, the perpetrators of the holocaust were some of the most technologically and scientifically advanced minds of their time. They were not technologically primitive. Nor is the evil empire in Star Wars.

Science makes cosmetic surgery possible. Science gives us the “How” to do it. But it does not make it good.

Cosmetic surgery can be scientifically, technically, and correctly performed and yet still have a bad result. This is a common occurrence. 

Science is necessary for modern medicine, dentistry, and surgery of all kinds. It is the foundation of knowledge without which modern cosmetic surgery could not exist. It is necessary for modern health and safety. 

Yet all the scientific tools and medicines do not by themselves make a beautiful result. There are dozens of monitors available. As many as fifty-plus types of micro-dermabrasion instruments and lasers exist. None alone can make a beautiful result. Having all the tools possible does not make beauty. 

Art and cosmetic surgery

First, it is good to know what beauty is. In our search for beauty, how will we ever know when we have found it? How do we find it?

There are many disparate opinions of what is beautiful. All are valid. Our perception of beauty may be a primitive, genetically determined aspect, or perhaps a hormonal reaction rather than an intellectual and reasoned judgment that prevails. 

What is most important to the cosmetic surgeon is to be able to determine what qualities are most appealing to all persons of all time. See the section on  Beauty for a useful working definition of the word “beauty”. We are constantly judging a beauty contest of any one individual’s face, and this helps us to find and decide what is best. 

Literature, art, philosophy etc. help show us the way. They help us seek and find what is beautiful and what is right and good.  

Art that is and is not beautiful 

Art or the study of art (including all forms of expression such as literature) helps us find, appreciate, and create beauty. The works of the masters of the past in music and the fine arts is a challenge to all of us who follow to exceed in beauty what they have done.  See http://www.nga.gov/feature/vermeer/index.html for an amazing in-depth study of one of Vermeer's works. 

Most of what is called “beautiful art” is considered by many to indeed be extraordinarily beautiful or striking. Such examples of these works range from the cave drawings of France to the present works of modern time such as the music of Stefania de Kenessey, the paintings of Janet Fish or Jacob Collins, and the sculpture of  Frederick Hart. 

As described by Tom Wolfe referring to the sculpture of Hart: "It reminded the entire art world of what art had been, of what art tried to do throughout most of history, which was to give humanity a sense of inspiration, of uplift."

As Jacob Collins says’ "Of course they're old-fashioned (his paintings), but I guess I'm trying to make them really beautiful. And I don't think anybody would mistake one of my paintings for a painting that was done at any other time. I mean, I'm trying my hardest to do something well and to do it with creativity and passion."

Contemporary and modern art

Let us call modern art any art of the last two hundred years, so that we may also include the impressionists. Contemporary art (as referenced by some critics) includes modern art that is neither beautiful nor intended to be beautiful. Its primary purpose may be to appeal as novelty, or, as author Lynne Munson says, to shock or to sell. 

Hilton Kramer, who was the chief art critic at the New York Times for seventeen years, says:
"The problem with contemporary art today is a profound lack of belief in what we used to, without embarrassment, call 'the higher values of life,' whether they are religiously, socially, or morally defined. With that lacking in the art, then you're left with a kind of free-floating hostility toward life itself, and that's what defines a lot of this contemporary art. What happened in the sixties was a complete breakdown in the institutions of what they could any longer define as art. You no longer had to create a work of art, you could nominate something to be a work of art."

Lynne Munson, the author of “Exhibitionism: Art in an Era of Intolerance”, says:

"When standards are jettisoned, and anything becomes art, then it's just a matter of how well you can sell the thing that you have created. If you want to have a career in art, and you want to show at the best galleries, and you want to win grants and awards and be included in the most important museum shows and have a successful career, making shock art is the safest thing that you could do today. Today's establishment class of artists - the “Shock Artists” - what they do is instead of pleasing the public, they kind of find clever ways to criticize the public, or really attack the public in some ways, in an effort to please art elites.

David Levy, the director of the Corcoran Gallery of Art in Washington, DC, says:

"The Abstract Expressionists were being driven by the sense that they had to move fast, and they couldn't wait for the normal evolution of art-making. They stopped looking at the world. They were looking inside their heads, or whatever, and they were making action painting and all of this stuff which is really quite self-indulgent in many respects. I do think it's a wrong turn."

There is no place for shock art in cosmetic surgery. Some decorations are being cemented on teeth, but hopefully they are reversible. Tattoos are usually not attractive in time, are not reversible, and often regretted.  

The aesthetic challenge for cosmetic surgeons is to meet the standards of the old masters and the great artists of today such as Fish, Collins, Hart and many others whose works are very beautiful and an inspiration to those who value and seek beauty. We are challenged by our dental colleagues, who are capable of making durable restorations that are normal and natural in appearance, almost permanent, and incredibly beautiful. We are also challenged by the many artists among us who are masters of many types of work and who make our lives better by what they do for us. 

The goal of cosmetic surgery is beauty: To make the face or area being worked on as natural and permanently beautiful as possible. 

The results of good cosmetic work should not suggest the appearance of having any form of surgery. Instead, natural beauty should be evident as a permanent result of the work done, with no marks to be seen that would be necessary to hide. 

Art shows the way 

The arts and especially literature, including the Bible, the Koran, and all of the written communication of concepts, ideas, beliefs, laws, history, and points of view lead us in the right direction and - in our individual lives and as a society - show us the way. They show us the way to go as well as the way not to go. 

And lest there be any doubt, many of the most faithful and religious leaders of all the major religions and their families have cosmetic surgery. And the way of Christ, or of Mohammed, or the path of Buddha is toward goodness, peace, truth and beauty. 

And the direction should be toward beauty.  And if some interpretation of a body of beliefs and traditions are not leading us to the good, we should change it. And that requires more literature and art - whether poetry, songs, columns, novels, opinions, speeches, writings of all kinds, laws, court cases, etc. - until the right direction is found and communicated gently but powerfully enough that we the people as individuals and as a society make the right choices. 

To have our art and literature be able to lead us or show us a new and better direction, art, literature, and all voices must have the freedom to be seen and heard - so long as it is not immediately harmful to innocents. All critics and critiques of ourselves and society should be heard. E-mail us your critiques, we want to hear from you.

Without the spiritual, legal, moral, ethical concepts and ideas we are taught through our families, schools and churches, we could have all the science in the world and still be going in the wrong direction. Hence, the “Evil Empire”. Lives of hell on earth. 

Apropos to the "Evil Empire" just mentioned from Star Wars, science fiction predicting and clearly showing the possible future are parts of art that are needed for our survival. Both George Orwell's “1984” with the concept of "Big Brother" and “Animal Farm” with the statement of , "Everyone was equal…But some were more equal than others" clearly showed the potential problems with a totalitarian state and communism. 

Cosmetic surgery of today must have science to exist. It can be a powerful tool. But it must be carefully applied, or results will suffer. Certain principles (see Principles & Ethics of cosmetic surgery), like the laws of the road, protect us and help keep us going in the right direction. 

We have many more unique and special ethical principles that must be observed in the art of cosmetic surgery, and less freedom of expression than in many art forms such as painting, sculpture and literature. 

Anyone trying an art form such as picking up a musical instrument for the first time will find that they do not sound like the virtuosos of that instrument. Considering all art good is like considering all human behavior good. 

In attempting any art form, at first it is much easier to make something that is unattractive than to make something that is beautiful. Since great beauty is rare, it is more difficult to create. It may take more practice and experience or more talent in many forms of art. One can often tell the difference between the works of an amateur and a virtuoso. 

While it is desirable to have the results of cosmetic surgery be considered a beautiful work of art, it cannot be a Picasso with both eyes on one side of the face. In cosmetic surgery, there are limitations in the appearance of results desired. But there should be no limitations on the creation of beauty. 

In trying to create beauty, it would be helpful to know what beauty is. Not knowing makes trying to create it on the operating table difficult. It is within the realm of art more than science to say what is beautiful and what is not. 

Not every operation, even though it can be done, should be done. That is the same as saying that even if a car is capable of 140mph, it usually would not be good to go that fast, especially on a 25mph city street. And for all other forms of surgery, it means not performing any surgery that is not indicated or absolutely necessary. 

And yet a person who wants very much to look the best they can will occasionally choose something that is not going to look good.

So what in cosmetic surgery is indicated and what is not? That is a question we must answer in general, and specifically for every small part of surgery we plan to do. It must be answered for every change we want to make. 

And what in cosmetic surgery makes something indicated and not indicated? And how do we know the difference? What should be done and what not? When should the powerful tools of science be used to change a person's appearance and when should they not? All of these questions need to be answered generally and specifically for each person and for each change in a person that is considered. We will try to answer all of these questions.

When a person has a technically sound and correctly performed face or eye or nose surgery, the results may not be as good hoped.  The science was there. The difference in what is attractive and what is not may all be due to the judgment of the surgeon. In deciding which beauty contestant, flower arrangement, or work of art is more beautiful, scientific measurements are of little help.

People want what they can see is beautiful, and not a verbal explanation. They would rather visually behold the simple appearance of natural beauty as seen in a rose, which requires no scientific explanation to be beautiful. In making the judgment of what is or is not attractive, the opinion of a child has validity. But the same child who would choose a painting of a clown over all other art offered may grow up into a very sophisticated artist who would make an entirely different choice a few decades later and choose a Van Gogh over the clown.  The point is that some appreciation of beauty is genetic and some is learned. Some is influenced by the culture, and in each culture the style and fashion of the moment can determine one’s perception of beauty.

And fortunately the artistic determination of what is or is not beautiful can be made not only before the surgery is done, but before the decision is made whether or not any surgery is worthwhile on the basis of what can be accomplished. 

For a definition of  Beauty and what it is, click here