Dr. DayanChicago-based facial plastic surgeon Steven Dayan, M.D., says that plastic and cosmetic surgeons who look beyond the obvious in 2016 stand to have happier patients.
What does that mean? According to, Dr. Dayan, aesthetic physicians who only look at how a patient presents on the outside are missing something important: the patient’s mind. Look at the mind, says Dr. Dayan, who is well known and widely published for his “subliminal difference” concept, which suggests that what makes someone beautiful — and why — is subconscious.
Related: Subliminal beauty theory
“What’s happening with the mind when we’re doing these procedures?” Dr. Dayan questions. “If you’re following Botox, it’s now in phase 2 trials for treating depression. I’m not saying that plastic surgeons should treat depression. What I am saying is that what we’re seeing now is that we can likely affect mood with Botox.”
Dr. Dayan’s research today focuses on looking at how facelifts, neurotoxins and fillers affect the mind and mood. The facial plastic surgeon is author of The New York Times’ and USA Today bestseller, Subliminally Exposed: Shocking Truths about Your Hidden Desires in Mating, Dating and Communicating. Use Cautiously (Morgan James Publishing, 2013).
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The Happiness Effect
There’s good evidence from before the turn of the 20th century that facial expression can affect emotion. The facial feedback hypothesis was first identified by Charles Darwin, who suggested that by freely expressing outward signs of emotion, we intensify that emotion. Repressing outward signs of emotion, softens it. American philosopher and psychologist William James later suggested that awareness of bodily changes activated by a stimulus is the emotion.
According to James, an intellectual thought without accompanying bodily changes is devoid of emotional warmth. And passion dies without one’s willingness to express it, according to Wikipedia’s Facial Feedback Hypothesis entry.
“… they were able to show that, if you frown, you become angry, and, if you smile, you become happy,” Dr. Dayan says. “There’s actually a disconnect — an uncoupling — in the limbic system of the brain between emotions and expression. So, if you don’t express anger, you don’t become angry.”
It’s also true that those around people who don’t express anger don’t recognize anger as much, according to Dr. Dayan.
“If you look at somebody and you can’t perceive if they’re angry, you don’t feel the anger. What happens is you spread this happiness effect. That’s what I think is happening when Botox is used to treat depression because it doesn’t seem to cross the blood-brain barrier. So, if Botox can do it, why can’t a facelift do it? Why can’t fillers do it?” Dr. Dayan says.
Dr. Dayan says he has looked at past pictures of all his filler and facelift patients. He has asked others to look at the before and after photos and tell him how they think the patients in the pictures are feeling. People report, for the most part, the patients look happier after they’ve been treated, he says.
“Why do they look happier? Are they actually happier, or do they just look that way? I think what happens is, when we get these treatments, we actually become happier because we either force a smile or prevent a frown. And our animated looks have more smiling or less frowning,” he says. “When people have big marionette lines, and we remove the marionette lines, not only do they look happier, I think they actually become happier.”
Self-Esteem Doctors
The thinking that cosmetic surgery can actually make people happier puts into question the concept that people have aesthetic procedures for vanity reasons, alone, according to Dr. Dayan. In fact, cosmetic surgery is not just for vain people.
“Who doesn’t want to feel good about themselves? School teachers. HIV victims. Kids with acne,” he says.
Using aesthetic medicine as a way to make people feel better, mentally, might someday be quantified and dosed. But we’re not there, yet, he says.
For now, aesthetic physicians should recognize that cosmetic procedures are doing more than treating form and function.
“We’re affecting mind and mood. We don’t have all the science behind it, yet, but I think in the next five to 10 years we will. That’s why I’m saying look beyond the obvious,” Dr. Dayan says.
Some might not like to hear it, according to Dr. Dayan, but aesthetic physicians are mind and mood doctors. And they need to recognize their patients’ minds and moods.
“We’re self-esteem doctors. We may use surgery. We may use nonsurgical procedures; we may use skin care; or we may use nothing at all. But our job is to increase self-esteem,” he says. “I can do a perfect nose, but, if a patient is unhappy, I fail. Colleagues might think I’m great because I show a great before and after picture, but if the patient is unhappy, I’ve failed.”
Looking at the mind is no easy task. It takes work, patience and even retraining of doctors, Dr. Dayan says.
“We have mathematical formulas to make a perfect face, but I’m saying wait a second, that’s not our only outcome. Our result is not to get the perfect face. Even though we want it to be because we love beauty and art. A lot of patients want that. But that’s not the final outcome,” he says. “My success is based on the happiness of my patients. That’s what our marker of outcome should be: the patient’s happiness.”
Recent related studies by Dr. Dayan and colleagues:
Dayan SH. Mind, mood, and aesthetics. Aesthet Surg J. 2015 Aug;35(6):759-61.
Dayan SH, Cho K, Siracusa M, Gutierrez-Borst S. Quantifying the impact cosmetic make-up has on age perception and the first impression projected. J Drugs Dermatol. 2015 Apr;14(4):366-74.
Dayan S, Coleman WP 3rd, Dover JS, De Boulle K, Street J, Romagnano L, Daniels S, Kowalski JW, Lei X, Lee E. Effects of OnabotulinumtoxinA treatment for crow's feet lines on patient-reported outcomes. Dermatol Surg. 2015 Jan;41 Suppl 1:S67-74.
Dayan SH. Coming face to face with our own bias. JAMA Facial Plast Surg. 2013 Jan 17:1-2.
Dayan SH, Arkins JP. The subliminal difference: Treating from an evolutionary perspective. Plast Reconstr Surg. 2012 Jan;129(1):189e-90e.
Dayan, Steven H. What is beauty, and why do we care so much about it? Arch Facial Plast Surg. 2011. 1(13): 66-67.
