Having lived in four countries across three continents, one aspect of culture that never fails to pique my interest is aesthetics. ‘What is beautiful?’ is a question as old as time, with the answer being collectively constructed by the hands of culture through history.
So, what is beautiful? A large forehead? Round eyes? An hourglass figure? Whether we are hugely conscious of them, or in blissful denial, values woven in society can pose a powerful influence over what many of us decide to do with our bodies. We often choose to believe that aesthetics is a personal choice, stemming from intrinsic motives; but ultimately, the line between intrinsic and extrinsic motivation to pursue aesthetic changes is never that clear-cut, and we cannot disregard the role that culture plays in shaping aesthetic views of ourselves. Sometimes, as it may seem, cultural views on aesthetics can be problematic, and it is pivotal for cosmetic practitioners and patients alike to grow awareness on this topic.
In this comment article, therefore, I seek to explore aesthetic procedures commonly pursued in different corners of the world and also touch upon practices that can be seen as controversial. Crucially, I also invite thoughts on the cultural role of aesthetics and what they imply for cosmetic practitioners in multicultural contexts such as the UK.
Blepharoplasty and Asian blepharoplasty: we need to talk about race
Coming from an East Asian background, blepharoplasty seemed to be a surgery widely sought after where I grew up. Blepharoplasty (also commonly known as eyelid surgery) is a procedure to remove unwanted or ‘excess’ fat from the eyelids specifically; it is widely practised and often carries an acceptable risk profile (Zoumalan and Roostaeian, 2016). The National Health Service, for instance, mentions blepharoplasty as a way to address drooping eyelids or eye bags (NHS, 2019).
What I find specifically tied to cultural contexts is the practice of Asian blepharoplasty. In very simple terms, Asian blepharoplasty is where a patient gets an upper eyelid crease, mostly to create the illusion of bigger eyes. The surgeon needs to heed cultural aesthetics when performing Asian blepharoplasty, which not only concerns the techniques used to perform the surgery, but also how the existence of the surgery itself may stir a debate on ethnic preservation of identities (Lam, 2016).
As an East Asian woman, I am uncomfortable with the idea of Asian blepharoplasty. For me, the frequency of this practice seems to imply that we aren't content with what we are born with, that our natural race isn't ‘beautiful’. This may stem from a deeper, more complex issue of race-related self-perception on a global scale, and from my point of view it could even be an invisible product of colonialism in history. I am aware of the common comment on Asian eye shapes in global media, and therefore the terminology, and even existence, of Asian blepharoplasty is problematic in my view. I resonate with Jablonski (2011) that sadly, some of us have the unhealthy perception that ‘certain racial features, in both size and shape, have historically been associated with social superiority (or, conversely, inferiority)’ (p. 352), and I also concur that ‘such surgery becomes a social phenomenon of great concern when the ultimate motivation is to make facial features appear more like those perceived to be socially superior, based on a history of discrimination’ (p. 353). My stance is that the uptake of Asian blepharoplasty could be a result of East Asians having an unhealthy reaction, either consciously or subconsciously, to the observation that their eyes are shaped or sized differently from many other races in the world.
Albeit uncomfortable, it is absolutely crucial for practitioners to revisit the transformation of racial characteristics and contemplate whether it is appropriate for aesthetic surgery. In such cases, although patients can claim that their treatment uptake stems from ‘intrinsic motivations’, the psychology of aesthetic treatment uptake is complex, multi-layered, and often guided by the subconscious mind. To what extent is treatment uptake motivated by perceptions of race in given cultural contexts?
I am aware, however, that people may hold different opinions towards Asian blepharoplasties, and I welcome the possibility of other interpretations of the phenomenon.
JAN THROWBACK ON CULTURE AND AESTHETICS
‘Facial aesthetic treatments in East Asian populations’ by Dr Souphiyeh Samizadeh
When it comes to facial aesthetic surgery, it is crucial for the practitioner to keep in mind the different structural architecture of faces among different races. What is considered ‘facially beautiful’ also differs from culture to culture, which can have an impact on how expectations are communicated.
Writer Dr Souphiyeh Samizadeh, an expert on facial aesthetic treatments for East Asian populations, has published in JAN on this very topic in May 2022.
Perks, ‘perky’ buttocks and slimness
Buttock augmentation may be a common surgery in parts of the American and European continents—a phenomenon that can perhaps be reflected in the countries where butt augmentation research is done (see Dai et al, 2023).
From experience, it is not practised as much in other corners of the world, however. Where I grew up, I recall that rounder butts were frowned upon, especially since they do not complement the ingrained (and to me, unhealthy) cultural expectations of ‘slimness’. Ironically and paradoxically, the common saying you'd hear is that mothers-in-law would often ‘inspect’ a prospective daughter-in-law's buttock areas, with larger buttocks implying signs of fertility. This, interestingly, aligns with global ideas of the size of the female gluteal regions and what they imply for rearing children (de la Peña et al, 2006).
To tan or not to tan? Same question, different answers
Growing up, I certainly saw tanning as being not too popular in East Asia. As I write, I do not actually know the term for tanning in my native tongue Mandarin, which goes to show how uncommon it is. In East Asia, darker skin tones are not traditionally thought of as associated with race, but rather social class. Those who do labour for a living would need to work outdoors in nature, resulting in darker skin tones over time. This belief, albeit very problematic to me, still persists today, although the increased interest in tanning in countries such as China may indicate that cultural views on skin tones and aesthetics are shifting (Jing Daily, 2022).
Beyond geographical contexts, however, tanning is a matter to be discussed seriously, both in the aesthetics sector and among the public more generally. With increasing race awareness in recent years, tanning has become a matter that needs to be handled with extra sensitivity. Skin tones are ultimately associated with identity, so what would tanning imply? Renowned singer Ariana Grande's tanning practices, for example, had led to accusations of her doing ‘race-fishing’ on the news (TheThings, 2022). Tanning might have been an innocent choice, but it may be seen as an attempt to make one's race more ambiguous. Where, if at all possible, is the line drawn? This, again, may sensitively relate to the earlier-mentioned issue of using aesthetic surgery to alter one's racial characteristics.
JAN THROWBACK ON CULTURE AND AESTHETICS
‘Colour me beautiful: examining the shades related to global skin tone ideals’ by Dr Nadia Craddock
Skin tones can be a racially sensitive topic. In modern times, with the influence of media, Caucasian women seem to desire a tanned complexion, while whiteness is often craved by women born with darker skin tones. Nevertheless, the alteration of skin tones by skin lightening or tanning can come with serious health risks. Dissatisfaction of skin tones deserves attention not only on a biological but also a psychological-societal level.
Writer Dr Nadia Craddock, an active researcher in body image and self-esteem, has written a compelling article for JAN on this topic in June 2016.
‘Nosy’ culture? Rhinoplasties and what they mean for different people
A recent article in The Juggernaut recounted the origins of the nose job in India. Medically known as rhinoplasties, the nose job began as a surgery to help those who were unfortunately mutilated as a result of judicial punishment in history. In many parts of South Asia, the nose is an organ of respect, and any changes made to it is traditionally seen as shameful. This thought still stands, and it accounts for why the nose job is still seen as taboo in Indian society. In modern times, though, people are pursuing it on their own terms.
As editor of JAN, I've read about many rhinoplasties done on people who, in my completely honest view, already have absolutely gorgeous noses. Doctors often mention to me how patients of different cultures often have different requests for surgery outcomes. An ongoing Internet meme states that self-love should begin with accepting one's own nose, but interestingly, no culture seems to agree.
JAN THROWBACK ON CULTURE AND AESTHETICS
Aesthetics around the globe with Aysha Mendes
In the last decade, JAN columnist Aysha Mendes had regularly written about cultural perceptions of human beauty around the world and how these have an impact on aesthetic nursing practices. From Germany to Mexico, and from the world of Islam to India, Aysha provides professional insight that many of us wouldn't have otherwise known.
For more on her column, search ‘Aysha Mendes aesthetics’ on https://www.magonlinelibrary.com/journal/joan
Is cultural aesthetics an endless pursuit of ‘what we weren't born with’?
For better or for worse, humans around the world have been seeking ways to change the way they look. Cross-culturally, history holds that people around the world have been in an endless pursuit of ‘what they weren't born with’. In modern times, however, where people have more opportunities to do critical thinking, it is pivotal to reflect on the origin of cultural aesthetics and whether any trending surgeries are possibly a result of unhealthy psychological attempts to alter ‘racial characteristics’ (Jablonski, 2011). The psychology of seeking aesthetic treatments is highly complex, influenced by a host of factors that humans might not always be conscious of. But the truth, self-evident—albeit perhaps unknown to many treatment seekers—is that people of each culture are born beautiful in their own unique ways.
Implications for practitioners
As aesthetic practitioners in multicultural Britain, it is pivotal to understand that cultural values can play a complex role in patients' cosmetic treatment uptake, and I believe it is therefore important to incorporate this into the psychological assessment of a patient before a procedure. As mentioned, the alteration of racial characteristics is a tricky issue, so this topic must be handled carefully with patients.
If it is decided that the patient is not at psychological risk, it would be then be helpful to factor in cultural values of beauty and what these imply for the consultation process (ie arriving at realistic expectations of the procedure).
JAN THROWBACK ON CULTURE AND AESTHETICS
‘Treating Afro hair loss: signs, symptoms and specialist interest’ by Dr Ingrid Wilson
Hair loss is a global phenomenon, but since ‘hair’ carries different meaning across cultures and comes with different biological properties, the experience of hair loss isn't the same for everyone.
Writer Dr Ingrid Wilson, a well known trichologist, has written in good detail about the specific case of Afro hair in JAN in June 2021.
Have you ever thought about culture and its role in aesthetics?
Here at JAN, we are keen to spread more awareness on cultural diversity and its impact on aesthetics.
If you have ever considered the role of diversity in aesthetics in any form, we'd like to hear all about it! Please get in touch with us at jan@markallengroup.com.