The current focus on cosmetic dermatology has spurred interest among dermatology residents and practicing dermatologists about how to master this growing subspecialty.
I am frequently asked by newly graduated dermatology residents for ideas about how to begin a cosmetic dermatology practice. They want to know what products to sell in their office, or if they should consider practicing with an aesthetician. They want to know if vitamin C cream is better than sea algae cream, or if microdermabrasion is better than a glycolic acid peel.
What am I referring to? I am referring to the "art."
What do I mean by "art"? Medicine is an art, but the use of the word "art" is different in this context. When we speak of medicine as an art, we are referring to the fact that much of what we offer is not grounded in firm science, but in data gleaned from personal experience.
Another facet of medical "art" is the fact that it is currently impossible to predict which medication will have which effect in which patient.
For example, it is not possible to determine which patient will be penicillin-allergic prior to administration of the drug.
As the cost of drugs has increased exponentially, it is more important to make an educated decision as to which medication is most likely to provide the desired clinical outcome, eliminating the trial-and-error method that currently must be employed when prescribing.
Appreciation of beauty
But this is not the "art" of which I am speaking, either. The "art" that I am describing is the appreciation of beauty.
If we as dermatologists are called upon to perform procedures and apply products that are designed to improve appearance, then we must clearly define in our minds what constitutes beauty. This is the "art." Any medical personnel can inject botulinum toxin and induce muscle relaxation, or inject hyaluronic acid to thicken the skin. This is not the "art." This is just sticking a needle in the skin. The "art" is sticking the needle in the skin to achieve beauty. Mastery of this concept is necessary to the mastery of cosmetic dermatology.
Perceptions about the face
An interesting study was conducted by a large skincare company to explore the concept of beauty.
Researchers took a facial photograph of an attractive 40-year-old woman and critically analyzed the image. Digital correction was used to carefully remove forehead and periorbital rhytides. Her slight natural facial asymmetry was balanced. The size of her eyes was improved by lifting the margin of one slightly drooping eyelid.
Once the photograph was corrected to create an image of more perfect beauty, it was printed, and both the original image and the improved image were presented to 200 randomly selected, untrained consumers for evaluation.
The consumers were not asked which woman was more beautiful, but rather which woman they would like to meet and speak with on the street. Amazingly, consumers overwhelmingly stated that they would rather meet the "imperfect" woman than the "perfect" woman. The consumers thought the untouched image represented a woman with more personality. What does this mean to the dermatologist? Is it our wrinkles and facial asymmetry that give us personality?
This is the dermatologic "art" of which I am speaking. It is the art of removing the unattractive and leaving the attractive. But how do we learn what is unattractive and attractive? There are no universally accepted guidelines of beauty. Each dermatologist must develop his or her own concept.