Culture and Diversity in Aesthetics w/ Dr. Steven Dayan

Summer Hardy (00:01):
Welcome to Park Avenue Plastic Surgery Class, the podcast where we explore controversies and breaking issues in plastic surgery. I'm your co-host, Summer Hardy, a clinical assistant at Bass Plastic Surgery in New York City. I'm excited to be here with Dr. Lawrence Bass, Park Avenue plastic surgeon, educator and technology innovator. The title of today's episode is Culture and Diversity in Aesthetics. This seems like a very timely topic, Dr. Bass, what is the scope of what you're hoping to discuss today?

Dr. Lawrence Bass (00:31):
The desire for beauty is universal and not new. How beauty is defined in popular culture is somewhat to very different in different cultures in different parts of the world. From there, how that beauty is supported 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 podcast to discuss this topic in detail. Dr. Dayan is a facial plastic surgeon in Chicago. He is a New York Times and USA today bestselling author, and he's been an exceptionally prolific speaker and writer. His book, Subliminally Exposed springs from his popular undergraduate course, the Science of Beauty. He's known for his dynamic keynote speeches and deep understanding of human behavior. In addition, he's an entrepreneur having founded and run a medical research company, a medical marketing company, a skincare training center, and a medical education company. His ventures placed him at the forefront of aesthetic innovation and product development. He's the recipient of the AMA Foundation's Leadership Award showing recognition of his tireless work in advancing our understanding of this field in medicine. Dr. Dayan, welcome back to the podcast.

Dr. Steven Dayan (02:11):
Thank you so much, Dr. Bass. It's nice to be here. Summer's nice to be here as well. I enjoyed it so much last time that I thought I'd come back for another serving.

Summer Hardy (02:18):
Welcome back to the podcast. So can we start by hearing about the history of culture representation in aesthetic medicine?

Dr. Steven Dayan (02:26):
Every culture has a desire to be beautiful. That's nothing new and that's been going on for millennium, but since the even before recorded history. So that's nothing new and that's part of our DNA. Now there are different styles and there's different things that happen within our culture over time that vary slightly, but it always goes back, in my opinion, to the primal necessities to survive. And that means to find someone that's beautiful so that we can ultimately mate and have the perfect offspring. I think that we're for that subconsciously.

Summer Hardy (03:04):
That makes sense. So you kind of mentioned, but exactly what kinds of distinctions are you considering and are you talking about?

Dr. Steven Dayan (03:15):
Well, all cultures desire beautiful, but how they manifest that is different. So I'll give you an example. In Africa, if you go to the Mercy Tribes of Africa, they put a 14 centimeter plate in their lips. If I showed you that, you'd be like, oh, that's a little strange. Why would they put a 14 centimeter plate? Their lip is expanded, it looks distorted to us. It wouldn't look very natural. They think that's beautiful and attractive. We don't. But in our culture, we may put collagen in someone's lips and we think that's attractive, and they would say, why would you do that? That's unattractive. So we both have different ways of approaching the same concept. What we're both doing is we're highlighting a secondary sexual characteristic, which is the lips. Lips are associated with fertility, lips are associated with youthfulness. The bigger the lip, the more prominent the lip, the more attractive someone is.

(04:04):
So we both see it as a beautifying feature. We both recognize it as a secondary sexual characteristic trait that's directive in nature for females more so than men. And we both have different ways of highlighting that within our cultures. So that's kind of what the difference between the cultures. I'll give you another example. If you look at bodies, if you go to Brazil or even certain parts of Sub-Saharan Africa, a large behind or a large buttocks is really attractive and that also associated with fertility. We may find that a little bit too curvy and unattractive to us because that seems inappropriate in the us. But you go to Cameroon and there's cultures and there's tribes there that place pillows into their clothing to highlight their butt to make it look bigger because that in theory attracts a man because they look more fertile and they're both doing the same thing. We're highlighting the secondary sexual characteristics, but we just may do it differently here in Western society than they do in some of those other African societies or South American societies.

Dr. Lawrence Bass (05:05):
So do you think it's all about fertility and attracting a mate or is it a sense of self appreciation or how you are representing yourself to the outside world? I mean, is there more than one reason just mating that we style ourselves or does it always come down to that?

Dr. Steven Dayan (05:33):
So great question Larry. I am a reductiveness. So I think yes, it comes down ultimately to our inherent desire to mate, just like we have a desire to eat food and breathe air, there's certain things that we can't help that are ingrained within us that are subconscious, that are based on our survival, and two things in particular, fear and procreation or finding the ultimate mate to have an offspring with. So everything I think comes down to that. Now, having said that, we get self-esteem when we feel pretty about ourselves. We get self-esteem or handsome or we get self-esteem when others give us positive feedback. So we feel good about ourselves and we seek self-esteem, we seek feeling confidence just like we seek any other type of drug or anything else that increases our mood, our appetite. So I think yes, we want self-esteem and then we represent it with the way we address the way we present ourselves to the external world. But ultimately I think the reason why we do that is because we're pre-wired to try to find a mate.

Dr. Lawrence Bass (06:35):
Traditionally the beauty industry in the US has been dominated by certain kinds of ethnic looks that draw from America's Eurocentric heritage and certain parts of the body that are getting styled. Are we still in that vein or are we doing that the same way, or are we doing it a little more broadly or a little more variably at this point in time, but still the same things? Or are we just broadening out in every way what we're chasing, what beauty features we're modifying and what acceptable standards for their modification may be?

Dr. Steven Dayan (07:25):
Well, this is where the cultural appropriation or the diversity and a culture really has impact and influence. If you look at the US population, which today is very multicultural, but if you look at it in 1950s, it wasn't, it was highly Caucasian at that time. What was attractive was someone like a Twiggy. I'm not sure if many people who are listening know what Twiggy is, but she was a cultural beauty icon in the 1950s. Big eyes, very small nose and chin, and she was very infantile looking. Today, however, beauty is somewhat with a heavier eyebrow, a wider nose, bigger lips, stronger jawline, that's more feminine, that's more attractive today. But that's also based on the fact that we have a culture that's comprised of many races and many ethnicities and many backgrounds. So as more and more people come into the US, we shift what becomes more attractive to the average.

(08:17):
And this goes for all of us too. If you live in a small community of just a group of people that look like you and you don't extend outside that group very much, then you find attractive what's in your community. But if you live in a society that's very multicultural and very diverse, then what you find attractive tends to move over a little bit to something that's the average of all the people 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 more multicultural beauty that we all find attractive somewhere in between what it was in the 1950s to what it is like now in maybe a South African country, which may be all just one ethnicity. So it varies distinctly, but it's all based on our reference range as a society and as an individual. And it goes beyond beauty if you really think about it. It goes to the same thing with ideas, thoughts, politics, religion. The more you expose yourself to more cultures, more ideas, more thoughts, more disciplines, the more your reference range changes to go towards the middle of that.

Summer Hardy (09:22):
Okay, that makes a lot of sense actually. You've kind of touched on it a bit, but how do these diverse beauty standards really translate into differences in the care that's sought and the care that's then delivered?

Dr. Steven Dayan (09:37):
It changes a lot. And that's a great question, Summer, because if you're a physician and you live 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 that scooped out nose or you may make a strong chin and that may not be something that the people are coming to you if they're from a different ethnicity want. Last year or two years ago now, I did a whole program on diversity in aesthetics. I traveled the world. I went to five continents, seven different countries, and we studied beauty in all different cultures. And we went to Africa and we studied beauty in Africa with doctors in Africa treating African patients. And then we compared and contrast that to doctors in the US who are treating African-American patients, the patients who are culturally from Africa or are black or dark-skinned in color.

(10:21):
We did the same thing with Latin America, the same thing with Asia. So we compared and contrast, it was so unique to see the differences. So when we were in Africa and we were treating patients there, the patients would come in, they wanted their temples treated or their lips treated. And I was thinking to myself, really, that's not how it's done here in the US so much, or that's not what we would think they would want treated. Because if you look at them skeletally and you look at them morphologically, they seem to have a small chin compared to our Eurocentric standards, and you think they want their chin bigger, their lips are large by standards that we have in our rating scales, which go up to five points. And you look at their lips, there are four out of five you would say they're already augmented, they're already large, they don't need their lips bigger.

(11:04):
But no, they wanted their lips bigger. It wasn't so much bigger. They wanted them treated, they wanted them with a filler because they thought it gave 'em better shape. But in the US you might think that's not necessary. So you start to see that in these African communities that was different than the US population, they were treated differently. Now a US doctor has to understand this, if they're going to treat those patients who are coming over from that country, and as they start to come to this country, some of those desires then start to infiltrate and become part of our norms and customs. So last year I did a paper I presented already. It has not published this, but it's been accepted for publication in Facial Plastic Surgery & Aesthetic Medicine. So it should be coming out soon. We did a study in African-American patients and lips, and it is a very interesting study because if you look at the clinical trials that were originally done on lips, there weren't African-American patients in the lip studies, and these are the pivotal trials to get approval for filling in their lips.

(11:58):
The reason why is because for a patient to get fill in their lips, they had to be deficient in their lips. They had to emphasize one, two on a scale of five in order to qualify to get lip fill. Well, African-American patients wouldn't qualify for that because natively they had three, four, and five size lips. So a study was done, the product gets approved, but it didn't include African-American patients and the FDA and others thought that that wasn't appropriate. So the scale got modified, but still there was no clinical trials to look at these patients with larger lips and say, do they want their lips augmented and are they happy? So we did a clinical trial two years ago now we took patients who are African-American who desired having their lips treated, and then we measured them on a scale and they mostly came in at 3.4 to 3.5 and what size lips they wanted, and they want lips that were size four on a scale, on a five point scale, four to 4.5. And we were able to get them pretty close to what they wanted and they were happy with it. And we were able to show that these patients desire their lips treated, they want their lips a little bit bigger, and that us as physicians are underestimating undervaluing that those patients may need those treatments and want those treatments. So it's very interesting way to look at it from the patient's perspective and what they desire and how it differentiates from what the Eurocentric version of lips are and what we were taught in school.

Dr. Lawrence Bass (13:20):
So I'm curious to look back at this issue of how different cultural groups influence each other. I mean, I'm in New York City and if you get on the subway, you're going to be in the subway car with a lot of different cultural groups and seeing how people look not only from the cultural group you're accustomed to, but from many others influences your perception of what's normal or beautiful or desirable, but not only in-person exposure, but we're heavily exposed by media. And we've talked about the impact of media on self-image the last time you were on the podcast, but how does media expose us and how is that influencing our perception of what's beautiful maybe drawing from other cultures?

Dr. Steven Dayan (14:17):
This is a great question. This is, I think one of the most beautiful things about America is that we are a melting pod or a salad, if you want to call it that, 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 smorgasbord of different types of people from different cultures. And isn't that great that you look across the train and you're like, I want to look like, I think that's really pretty. And it may be a tattoo, it may be a piercing, maybe a hairstyle or maybe the way their lips 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 Eastern food, I love Indian food, and I take from that and I develop certain spices and I certain tastes for certain spices after tasting it.

(14:59):
The same thing with beauty and the same thing. When we all come together, we tend to find other things more attractive. At first, they're unique and at first we're scared. We fear them. We don't like them because we're not familiar with it. But the more you see something, the more you become attracted to it no matter what it is. And the more you see a certain type of look, you become more attracted it, and eventually you start to adopt some of those desires or needs or characteristics. So that's what I think is happening with beauty and media is just a way to amplify that, especially with social media today, because you're seeing all different types of cultures come across your feeds and you're going to find it attractive and it's great. It's not just what's going on in the US but you have what's going on in different culture in different countries. So you see what they're doing in Japan or Korea or wherever that may be that you're following and you might say, Hey, I want to do that here. I think it unifies us all as we move forward into what we find beautiful.

Summer Hardy (15:55):
This has been a really interesting discussion. I'm wondering though, is aesthetic medicine and surgery doing a better job today of adjusting for the cultural and diversity in the patient population?

Dr. Steven Dayan (16:08):
So I think that medicine today is definitely doing a better job because it has to. It's got to meet the demand of our patients. When I was coming through training, we were given the canons of beauty and the mathematical five formula, which has proven itself over and over again to not necessarily work for all cultures the same, and it's very Eurocentric, and that probably was a bias training. Now today, we look at people very differently and we look at them as what's beautiful within their own culture. I think that's important, but we're also looking at the way people feel about themselves too. We're looking at the psychosocial aspect of it as well. I think as our students come through today and as we train, that's part of the curriculum is making sure everyone's more sensitive to these other cultural desires. So yes, I think we're doing a much better job say than we were in the past. I think our clinical trials are making sure to have a diverse population in them, and we're making sure our studies and our designs and our questions and our patient reported outcomes are all asking questions that are necessarily capturing the needs and desires of different genders and different cultures.

Summer Hardy (17:12):
And then just to play devil's advocate a bit, are all of these kind of more like stereotypes and the care should just strive to provide custom options to each individual patient based on the individual preferences instead? I know you've talked about it a bit, but I just wanted to throw that out there.

Dr. Steven Dayan (17:30):
So of course, I think we should treat people as individuals, and I think when we get to cookie cutter treatments, we get in trouble. And I don't think aesthetics struggles when we go to cookie cutter treatments. And I think that's where aesthetics falls apart and everyone tries to make us cookie cutters, but it just doesn't work in aesthetics because we're dealing with people's emotions and we're dealing with cultures and societies and expectations that are very different than someone who's has gallstones 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, I think everyone should be individualized. I had a patient come to me recently who wanted a hump put on her nose. She was Italian. She goes, I want a hump on my nose. I'm like, do you want to a hump on your nose? She wanted a hump on her nose because she thought that was elegant and attractive and fit within her culture. Now, I wasn't going to give her something that I thought was inappropriate that would make her look strange, but to give her a little bit of convexity to her nose, okay, I can do that. But I thought that was an unusual request, but that was her desire. So I think that we have to be sensitive to what the desires is of that person that's culturally appropriate for them.

Dr. Lawrence Bass (18:29):
That's interesting because I think historically a lot of patients sought plastic surgery to try to blunt certain ethnic identity so that they wouldn't look stereotypically part of the ethnic group they came from. And increasingly, patients come in and want to modify, harmonize, beautify, but retain or amplify their ethnic identity. And it's great that they can feel comfortable and proud, but either request is a fair request. It's really just important to understand where the patient is hoping to go, so you don't make a misstep in taking them in a direction different from what they're asking for.

Dr. Steven Dayan (19:17):
So I think this is a great point, and I want to emphasize this a little bit more because if you look at patients in the fifties and sixties, when plastic surgery first came into 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. So you see a lot of these people coming in and getting a little scooped out noses because that was the look and that was the American look. So you see a lot of those patients, they're now in their seventies and eighties, but I'm sure you see them in your office. I see them too. There's a little scooped out noses 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.

(20:00):
Now I see 'em with their grandkids and the grandkid comes in and says, 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 they want say. So what I find, and tell me if you see it differently, Larry, because this is a unique observation I made, is that people who are first gener, people come over on the boat, people who come in, they just move to this country. They want to look American. They want the scooped out noses. They didn't want their identity to be so noticeable on their face. The first and second generation that I get, especially the second generation, is so proud of their ethnicity, is that they don't want any loss of it. I want to maintain my ethnicity. I want to make sure people know that I'm Syrian, or they want to make sure people know that I'm Asian, Chinese, whatever it may be. They don't want to lose that ethnicity. Whereas the people who come over right away from the other countries, they want to look different. They want to look more Americanized.

Dr. Lawrence Bass (20:48):
Yeah, I think that's something I've seen. And I think people are looking for much more nuanced things. People who are here are not trying to stamp a certain identity into their look. They're just trying to create their own unique enhanced look. That's who they were to start with, but just more beautiful and balanced.

Dr. Steven Dayan (21:16):
Yes, I agree with that.

Summer Hardy (21:20):
Okay. So finally, to sum up, can you tell us what trends have been affected by the increasingly more diverse view of human beauty?

Dr. Steven Dayan (21:29):
Sure. Well, I think there's a lot of trends that have come in the last few years that are based on the diversity of culture. If you want to look at, I think lips being a little bit larger and being a little bit fuller, I think that's part of the culture trend. I would say noses are definitely different than they were a generation ago. A little bit of a larger nose, one that fits the face is more acceptable today than it was in the past. I think we should do a lot more brow lifts. I think we're doing less brow lifts today because people don't want a hollowed out eye or large brows. They want the heavier, thicker brow I think is more attractive to say there was in the past a stronger jawline. That's something that was not necessarily, was something that was not sought after in the past. But now I have lots of women who want that strong jawline, whereas they don't want to have it be thinned out. So I think those are probably some of the cultural changes that I've seen over the last five to 10 years with an increasing multicultural society.

Summer Hardy (22:28):
And what are your takeaways, Dr. Bass?

Dr. Lawrence Bass (22:31):
Well, just to summarize, as we said, desire for beauty is universal. Dr. Dayan and I a hundred percent agree on that. But the definition of beauty is highly dependent on your cultural identity, along with your individual life experience, what you've been exposed to in the environment you're in, which is really something separate from your cultural identity, per se. The fashion industry, the beauty industry, they're much more culturally sophisticated and diverse than in times gone by. And we live in a much more interactive world and a much more interactive national and international culture. One where media shows us a much bigger slice of the world than previously, and a lot of different points of view, different people's view of what's beautiful. So that has a profound influence on us. How we individually view beauty based on what we've been exposed to the medical beauty industry. Plastic surgery and aesthetic medicine embraces a lot more culturally diverse and individually diverse images of beauty than they have previously. And this has transformed those medical fields into a service that's responsive to individual views of beauty with a customized plan of care. So Dr. Dayan, I'd like to thank you for joining us again today and sharing your thought provoking insights on this topic. I always love talking with you.

Dr. Steven Dayan (24:16):
Oh, thank you. It's a pleasure to be here.

Summer Hardy (24:19):
I'll also share my thank you for joining us again on the podcast, Dr. Dayan. I really enjoyed our engaging discussion. Thank you for listening to the Park Avenue Plastic Surgery Class Podcast. Follow us on Apple Podcasts, write a review and share the show with your friends. Be sure to join us next time to avoid missing all the great content that is coming your way. If you want to contact us with comments or questions, we'd love to hear from you, send us an email at podcast@drbass.net or DM us on Instagram @drbassnyc.