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THROUGH THE LOOKING GLASSES OF PHYSICIANS, DENTISTS, AND PATIENTS* DONALD B. GIDDON* Although there has been an increasing interest in the importance of physical attractiveness to interpersonal perception [1], there has been Uttle consideration of the socioeconomic impact of the achievement and/or maintenance ofattractiveness. Such increased preoccupation with attractiveness is reflected in the increasing number of cosmetic surgical procedures for men and women of all ages. While the majority of procedures involve the orofacial area, other parts of the body are being changed as well, regardless ofwhetiier they are visible usually or only in intimate relationships. For the oral facial area in particular, die magnitude ofthe problems is such diat aesthetic correction by orthodontic or prosthetic means is the primary reason for seeking other than emergency dental care in developed countries. It has been estimated that as many as 80 percent ofthose who seek orthodontic treatment do so for cosmetic reasons [2-6]. Although there is an understandable lag in statistical reporting, the available data indicate that requirements for orthodontic services have increased severalfold since 1959 [7]. Because the number of personnel trained to provide these corrective plastic and reconstructive services is quite small, die costs have become extremely high, hence reducing access for large segments ofthe population . Unfortunately, Uttle concern for this inequity has been expressed by government, insurance carriers, and employers or union groups, because less than half of the plastic and reconstructive procedures in the United States are estimated to quaUfy for third-party payments (D. Whaley, personal communication, 1982). Moreover, correction ofminor orofacial deviations has not been seen as a major public health problem This paper is based in part on a symposium on facial aesthetics and behavior, Osaka, Japan, June 1980. ?Professor, New York University, 421 FirstAvenue, New York, New York 10010. Visiting professor, Harvard University and McGiU University; and Department of Psychology, Brandeis University.© 1983 by The University of Chicago. All rights reserved. 003 1-5982/83/2603-0326$01 .00 Perspectives in Biology andMedicine, 26, 3 · Spring 1983 | 451 because such conditions have been perceived as having litde consequence for physical or mental healtii. What accounts for this great motivation for enhancing attractiveness, especially since there does not appear to be an absolute standard of attractiveness of the face—or, for that matter, any part of the body? In addition to some fragmentary evidence of a genetic basis for some components of aesthetic perception, there may be a learning or imprinting process which differs from one culture to anotiier with respect to the time and type of stimulus which will later bejudged to be attractive. For humans at least, some audiors conclude that such a "standard" becomes fixed or integrated by age 7 [8]. From the history of visual arts, there is also some evidence of the universal acceptance of the "golden proportion" in the face as well as other parts ofthe body [9, 10]. It follows that parts ofthe body which are perceived as deviating from such a proportion will not be judged as aesdietically pleasing as those that conform. Thus, it seems that such standards are primarily culturally determined by peer groups and relatives who constitute the popular domain. Research in diis area has mainly been directed to finding out what is judged to be attractive or aesthetically pleasing to odiers. It is, then, die perception of how others perceive us relative to these inferred standards which greatly influences the success or failure of interpersonal relationships and related mental health [5, H]. Apparendy, however, these popular cultural standards are very different from those which determine the behaviour of the healdi professional such as die orthodontist or oral or plastic surgeon who undertakes procedures designed to improve appearance [6, 12, 13]. More often than not, the surgeon or orthodontist bases his or her decision and corrective procedure on his or her own rather than the patient's perceptions . This right or responsibility ofthe health professional to make such ajudgment hasjustifiably been questioned [14]. From the patients' point of view, most people want to look like odier persons widi whom they wish to identify for purposes of enhanced selfesteem or professional gain; for example, movie or television stars, fashion models, or attractive...

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