Concerns about how much the patient’s opinion should be reflected in treatment
D&PS: You seem to agree that there are no absolute standards of attractiveness but doctors do need reference points for each procedure. However, such references may not match what the patient wants. How do you resolve differences of expectations with your patients?
Rhee: One good example would be a patient with body dysmorphic disorder. And there are patients that may not have body dysmorphic disorder but desire extreme changes from the procedure. I try to persuade the patient who does not agree with my goals and if that does not work, I do not perform the surgery. For example, if a patient that keeps asking for a mandibular reduction surgery when she does not need it, I tell the patient I cannot do the surgery.
Choi: It may be the doctor’s personal opinion to decide the patient does not need further surgery. If the patient feels that s/he needs more change, I try to accept the patient’s requests as long as it does not damage the balance of the overall facial structure.
Hong: One has to consider emotional aspects when talking about what is considered attractive. The patient would not be satisfied until she’s changed something. I would recommend a slight mandibular reduction, rather than a drastic one.
Choi: I think I exactly follow the patient’s request in about 50 percent of cases.
Hong: In my case, I reflect the patient’s demands in 20 percent of the times. In most cases, I try to persuade the patient to agree with me. This does not mean that I ignore the patient’s demands completely. I try to achieve a compromise between what I think would be the best outcome and what the patient wants.
Choi: The patient who comes to see me does so because he or she needs a procedure. Even if the patient has a vastly different expectation from mine, I still try to listen to their demands carefully and add my opinions to them. I believe this helps optimize the outcome. This is why I pay close attention to the patient’s opinion.
Hong: One has to be aware that patients are not always consistent in terms of what they want. Let’s say that a patient followed the doctor’s suggestion rather than insist on her own. Initially, she may not be fully satisfied with the results, as people around her compliment on the improvement, she may come to believe that it was a good decision to go with the doctor’s suggestion. If the patient is sensitive to what other people say about her looks, she may change her mind later. This is why I often push my opinions and try to persuade the patient to make the correct medical decision. This is not easy and requires some skill.
Rhee: Recently, I read an article about an American woman surgically removing three of her ribs to make her waist narrower. How would you react if a patient demands that you remove three of her ribs for a narrower waist because if she cannot get the surgery, she will commit suicide?
Choi: In this case, the problem is not just an aesthetic improvement. There are various factors involved. Removing three ribs would not only cause functional problems but may endanger her life. I don’t think it’s a good idea to perform the surgery.
Rhee: What if the female patient wants just liposuction?
Choi: If the patient wants a drastic outcome that breaks the healthy balance of the body, I would suspect that she has psychological issues. I would try to advise her about the danger of a distorted body image. If the patient’s expectations are reasonable, I would perform the procedure.
Rhee: I hold a different opinion. A patient asked for a botulinum toxin injection for her nasolabial lines. The problem here is that botulinum toxin does not correct nasolabial lines. However, the doctor did the patient’s bidding and she went home feeling very satisfied. Do you think this was a correct decision by the doctor?
Choi: Just because the patient is satisfied, it does not mean that her looks have improved. Therefore, I would not perform the botulinum toxin injection.
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D&PS: When we talk about attractiveness, we tend to focus on female attractiveness. The society may have higher expectations for women in terms of physical beauty. What are your thoughts on this?
Rhee: Women are more accepting of physical flaws in men. Some of the most popular Korean celebrities have looks that are not traditionally considered handsome. On the other hand, men tend to prefer a traditional, youthful and cheerful countenance in women. This is related with socioeconomic status, cultural authority and chauvinism. In animals, male animals are more beautiful. Only the human species expect the female to be beautiful. This has to be examined from the social, political, economic and cultural perspectives. However, male celebrities with effeminate looks are also becoming popular and a muscular body line is also becoming a desirable trait in women. I think this, in a way, indicates improved social status of women.
Hong: Women’s physical attractiveness has been important for their survival. On the other hand, men had to have power, authority or money to get ahead in life. This directed men to focus less on their physical appearance. However, as women are rising in their status, men are expected to look more attractive as well.
Choi: It is true that more men are seeking aesthetic procedures. Women are veering away from the traditional feminine style to a more Amazonian look with more muscles and curves.
Rhee: In the past, women wanted to resemble Kim Taehee or Son Yejin who are famous for their wide-eyed, girly appearances. But today, popular female celebrities such as the singer Sulhyun have a baby face with a slightly curvy body. Instead of just a pretty face, women are expected to appear physically fit as well.
Hong: This is a good example of the relative aspect of attractiveness. I hope more research is done in the future regarding men’s physical attractiveness.
-To be continued
