True beauty lies in intangibles

Las Vegas - For all our society’s emphasis on physical beauty, nothing is sexier than self-esteem. This was the theme of “Subliminally Exposed,” a performance given by Steven Dayan, M.D., and Valerie Monroe, beauty director of "O, The Oprah Magazine," at Cosmetic Surgery Forum, held here.

The performance intermingled scientific data with Dr. Dayan’s observations regarding the importance of physical attractiveness in contemporary society and Ms. Monroe’s reflections on how such influences have impacted her life.

Much research supports the observation that physical attractiveness confers advantages, from the bedroom and boardroom to the ability to get out of parking tickets, Dr. Dayan says. While men compete based on resources and status, he adds, women often express this dynamic by competing via physical beauty. For example, “Who Wore It Best” sections - a common theme in fashion magazines targeting women - ask readers to judge which celebrity looks better in a certain outfit. However, he says, such sections never appear in men’s magazines.

Making comparisons

Ms. Monroe says she began comparing her appearance to that of other women early in life. Her mother was a living Barbie doll, she explained, a raven-haired, statuesque model with “unrealistic proportions.”

Like the doll, she adds, Ms. Monroe’s mother had an extensive wardrobe - including matching mother-daughter outfits.

“I remember thinking about the two of us dressed alike - one, a full-blown goddess, larger-than-life, the other, a skinny, freckle-based tadpole, an anonymous, unfinished pencil sketch. As far as my appearance was concerned, I was undefined, except in relation to another woman,” Ms. Monroe says.

It’s easy to fall short in such comparisons, says Dr. Dayan, a plastic surgeon who practices in Chicago. A neuropsychiatry study revealed that subtle and barely perceptible alterations in a face can completely alter another person’s perception of that face (Walker M, Vetter T. J Vis. 2009;9(11):12).

Additionally, he says, attempting to guess the age of attractive people based on facial photos causes the brain’s pleasure centers to spike.

“But if I ask you to judge how beautiful a person is, your pleasure centers are no longer rewarded at that same level,” Dr. Dayan says. “Only when it happens subconsciously do you experience the full pleasure of something beautiful. This was the ‘aha’ moment for me: I realized that if you have to think about beauty, you’re no longer rewarded by it.”

Next: Value of subtlety

Subtle changes

This truism largely explains the value of subtlety in cosmetic surgery, Dr. Dayan says. In short, results aren’t perceived as beautiful if people can tell a patient has had work done.

To see if treatment of the forehead with abobotulinumtoxinA allowed patients to make a better first impression, Dr. Dayan and colleagues conducted a study involving 40 patients whose post-treatment photos were evaluated by unknowing observers (Dayan SH, Lieberman ED, Thakkar NN, et al. Dermatol Surg. 2008;34 Suppl 1:S40-S47).

Ultimately, he says, “I couldn’t see a difference. And I have a trained eye.”

Dr. Dayan says, however, his young daughters immediately could tell which of two patient photos looked more attractive.

“Then when I put the photos in contrast, I could see that the difference wasn’t about wrinkles. It’s not that we’re removing wrinkles - we are widening the eyes, making them look further apart and more infantile. We are all attracted to wide, infantile eyes” because they appear safe and nonthreatening,” he says. “So if we can take someone who has narrow eyes, whose appearance scares us, and widen their eyes using neuromodulators, fillers or whatever measures we have, we instantly make them appear more friendly and attractive.”

Conversely, aging extracts a toll. In this regard, Ms. Monroe recounts her experience greeting patrons at the door of a friend’s art exhibit.

“‘Hi there,’ I would say with warmth and what I thought was a touch of modest charm. Time and again, from the men, I got a limp, dismissive, ‘Hi’ in response. It wasn’t the Whistlers or the Chagalls that were diverting the art lovers’ attention - it was my friend’s lovely assistant,” Ms. Monroe says.

The assistant wasn’t flashy or glamorous, Ms. Monroe says. “But she had the smooth, milky, 20-something complexion, and the sweet, expectant, wide-eyed look of youth. Thirty years ago, I might have been her.”

But now, Ms. Monroe says, “I’m 63, and I look it. Almost every morning, I discover another small reminder that I’m growing older - an age spot, a new wrinkle. And I discovered at that art fair that if you have benefited from the currency of your looks, when that currency loses its value, you can feel pretty bankrupt.”

The lack of appreciative male glances reminded her, somewhat rudely, that she’s no longer fertile, Ms. Monroe says.

“That means, in a Darwinian sense at least, that I’m over. The thing is, though my production line has shut down, the factory is still very much open. And I believe there’s more work to be done before it closes for good,” she says.

Next: Aesthetic satisfaction

Finding satisfaction

The late psychologist Erik Erikson suggested that there are many ways to express a concept he called generativity - the need to produce something that contributes to the betterment of society, which not only helps others, but also makes us feel more content as we get older, Ms. Monroe says.

“That will be my focus, as I march, largely invisible, into my future. But I can tell you this: Even if you don’t see me, you will know that I am here,” she says.

Dr. Dayan adds, “As we mature, we grow more satisfied with who we are. However, we still care about our appearance - whether it’s makeup, or brushing your hair or putting on nail polish or a new outfit, wanting to feel beautiful is natural at all ages.”

After cosmetic treatments, he says, “Our self-esteem rises, regardless of the treatment. And there’s evidence that cosmetic treatment - from makeup to hair care to clothing to aesthetic treatments (Dayan SH, Arkins JP, Patel AB, Gal TJ. Dermatol Surg. 2010;36 Suppl 4:2088-2097) - improves our mood.”

Therefore, Dr. Dayan says, “The goal of aesthetic medicine is not necessarily to be beautiful, but to feel beautiful. People who feel beautiful have better posture - they stand taller. They are more extroverted and likable. People who feel beautiful look beautiful. They smile more,” which elevates their mood through biofeedback.

With current aesthetic technology and a mathematical understanding of the ideal intercanthal distance, Dr. Dayan says, “We can make the perfect face. But many other things go into it - most importantly, nothing is more attractive than self-esteem.”

An anecdote from Ms. Monroe illustrates this point.

“As I’m walking down a crowded city street, a gorgeous young creature - sleek and glossy as a black cat - crosses my path. ‘You’ll never look like that again,’ says my comparing mind. The woman and I stop at a curb. Her beauty imbues her with a mild haughtiness. In her regal way, she turns her head in my direction, and I catch her eye. ‘You,’ I say, ‘are simply magnificent.’ The haughtiness vanishes instantly. Slightly taken aback, the woman smiles and says ‘Thank you.’”

Ms. Monroe replied, “‘It’s my pleasure to tell you.’ Because I not only remember how happy I have felt as the recipient of an authentic complement, but now I can also enjoy the additional gratification in being able to give one. After years of passively accepting a definition of beauty other than my own, of striving to be a noticeable object, I’ve now taken on an active role, too: appreciator of all things beautiful.”

As an appreciator, Ms. Monroe says, “I’m setting my own standards. Shall I compare thee to a summer’s day? No. I won’t compare you or myself to anything. Because a thing of beauty needs no comparison - only an eye to behold it.”

Disclosures: Ms. Monroe’s comments originated as articles in "O, The Oprah Magazine." Dr. Dayan reports no relevant financial interests.