When asked "How often do the
results of surgery look exactly like a drawing? "
The answer is "Never."
No result is just like a
drawing. The result is not the same as a drawing.
There is always some difference.
So if that is true, and the
results are never just like the drawings that are
chosen then the question is
"Why do drawings?"
The following are some of
the reasons we do drawings.
Drawings are of great
benefit to both patient and surgeon.
They are a form of
communication better than words.
Drawings are done on
various views of the of the subjectís face.
The photographs can be
digital or film or both.
With drawings the surgeon
and his assistants can see the
improvements in appearance that may be possible.
Many drawings can be done
searching for what looks best.
With the many
possibilities placed before them, one can choose
what looks best.
The patient's choice is
The drawings can be taken
home and shown to trusted family and friends for
helpful advice and criticism.
If someone is very
critical of the proposed change in appearance,
it is good for the person who is considering it
to hear the objections before the surgery rather
The surgeon can express
his thoughts of desirable appearances, shapes,
forms, contours and beauty etc. through the
drawings much more precisely than with words.
The drawings of the
proposed changes overwhelm the descriptive words
The words for example may
be every synonym of beautiful, glamorous,
attractive, sophisticated, exciting, absolutely
wonderful, gemlike in quality, cute,
flirtatious, irresistible, gorgeous, etc. for
what the surgeon intends to do.
Descriptive words are more
like opinions and can be vague and subjective.
Drawings are more objective and exact. And
if you donít see it in the drawings, it isnít
It is much, much easier to
draw something beautiful and to change it than
to do it with a scalpel.
Design can be done better
with drawing than during the operation.
The design tells us what
we want to achieve in the final appearance and
may require more time and study than the surgery
Anything can be drawn.
For example if the face of
the young beautiful model or celebrity were
chosen as an ideal, then that face or any part
of the features can easily be placed on our
This is especially easy
with digital drawing. And who knows, whether it
is the eyes, cheeks, nose, chin or lips those
features of hers may be the best and the ones
We must be careful in
choosing features of celebrities.
We are dealing with looks
here, and with actors such as a personality or
famous actor or singer, their fame and the love
we have for them may be due to a lot more than
It is safer to stick with
unknown models who are gracing the pages of
magazines advertising things that have to deal
with looks such as cosmetics, fragrances or
Those models, who are not
otherwise known, are chosen for their
And sometimes they are
chosen from many photographs both of themselves
and other models with just the right look that
subtly makes us think that perhaps we could look
that good if we could wear whatever it is they
The advertisers spend
millions on these ads every year.
They study and track the
response to the ads as objectively as they can
to know how well their advertising budget is
Many persons from the
advertising agency from the photographers, to
the advertising and magazine lay out artists and
to the executives and aspiring executives all
have their careers on the line as they make
these judgments of what looks good and what does
Each of us can pick up one
of these magazines such as Seventeen, Glamour,
Allure, Vogue and many others from many
different countries and in different languages.
We can look at all the ads
from month to month and even years back as
fashions change and study the figures and faces
to see what is beautiful and what is not in our
What is the true,
fundamental nature of beauty we hope to find.
For our goal is not to
appeal to a fad.
If we to have the same
hair style and clothes as were worn in the
fifties, sixties or seventies it could be
very noticeable and wrong today.
And sometimes we seem to
see that in a person who looks good in one
particular hair style - say the bouffant with a
lot of hair spray - and they know how to do it -
so they keep it up decades after it has gone out
That is not the face we
We would prefer that all
the changes made, be toward great beauty that
will be eternal.
Our opinions change as do
We can look at the ideals
of beauty from all of the artwork of the world
representing human forms and faces from ancient
to modern times.
Ideas of what looks good
and what does not change can be sought from all
over the world and from all of the art of the
past and the projected styles of science fiction
predicted for the future.
The changes from Egyptian,
to Greek, to Roman and on into medieval,
renaissance and modern times are known and are
available to us and can be studied.
What we are searching for
is the answer to the question of what is beauty?
And is there for the human
face or the part we are working with a
characteristic that is essential?
And is a characteristic
without which the maximum or some part of the
sought after beauty is lacking?
For example in comparing
the ancient to the modern - the size of the
muscles of men progressively increases through
Egyptian, Greek, Roman and renaissance periods.
The body builders of
today, with steroids or without, frequently
surpass all of the ancient statues of Hercules
from the Greeks, Romans, renaissance and modern
times no matter how muscular and ideal they had
The beautiful faces seen
gracing the magazine ads seem much more
strikingly beautiful than were done in ancient
art and that is even though the Egyptians
obviously wore a lot of eye makeup, wigs and
The female faces and forms
we have today with very small waists and breasts
of any size chosen seem to surpass everything of
Only the cartoons and
science fiction type drawings of exaggerations
of muscularity and male and female sexuality are
able to surpass the actual shapes of the bodies
of our times.
With all of the knowledge
including diet, exercise, nutrition and cosmetic
dentistry and surgery of our times, there are
many opportunities for everyone to have
improvements in face and body.
And so there are still
many sound reasons for everyone not being
perfectly chiseled and physically beautiful with
all that can be done. But there are many things
more important such as character, morality,
knowledge and wisdom.
And there are limitations
of course. Perfection is a matter of opinion and
But it is amazing as we
draw the more perfect faces and then create them
with surgery, how few limitations there are.
The drawings chosen serve
as a goal. A destination. The decisions of how
the face should look have already been made.
There is no need to ask or try different looks
on the table to see which is better. The surgeon
knows already where to go and the only question
then is how best to get there - to achieve the
As some scientists have
said - if it can be imagined, it can be done.
And as Einstein said
"Imagination is more important than knowledge."
This fits the importance of drawings.
And it is from imagination
- imagine how this face could be - that we
choose our goal. It is interesting to ask how we
know what looks best when we see it. Or
how much of our knowing comes from culture and
experience and how much is born in us.
If we look at a set of
drawings that represent alternatives of how our
face can be improved, and if we know, that the
drawings - since anything can be drawn - are not
good enough, then in a sense, our imagination of
possible improvements in those drawings leads us
to improve them.
As we study our history,
the atoms and molecules of the human genome and
explore the universe at ever increasing speed,
it seems to be true that our intuition tells us
what beauty is and is not. And some of that
intuition may be genetic.
And certainly in the
experience of cosmetic surgery the imagination
of what beauty is and choosing the goal that
truly is most beautiful is of equal to or
sometimes even greater importance than the
actual doing of the surgery that is to create
With the famous Sistine
chapel ceiling of Michelangelo, the concept was
as important as the doing.
As with the last supper by
da Vinci, the concept stays and is forever
beautiful as the actual painting crumbles.
And these artists did not
get up there eighty feet high on a wooden
scaffold with a broad brush and start painting
the face of God. They planned it first.
Without planning, it
could only have been a disaster.
Some of the sketches and
drawings Michelangelo made in the planning still
A beautiful building is
credited to the architect such as a Frank Lloyd
Wright building or an I M Pei, or Frank Gehry
building. They made the plans. They did the
They imagined the concept
and chose the concept from what their
imagination had conceived. And did not do the
fundamental putting together of building the
And so my contention is
that in most of the great works of art we most
admire, the beauty is more in the imagining, the
conceptualizing, the planning, and design than
in the actual work of creating what was
And it is the planner, the
one who imagines what could be, and who makes
plans and records them for others to see who is
given credit for the work of art. And not the
artisans who put or help put the concept to
Therefore, for the maximum
beauty of the result we need all the input of
all the artists and architects of the world and
all the opinions of all the critics ( in
drawings please - words are almost worthless)
from which to choose so that we arrive at the
correct concept of what is truly most beautiful.
And beautiful to whom.
Let me tell you. Not just
to one but to everyone.
The patientís choice is of
higher priority than the doctorís or anyone
else. The patient is who is going to see the
result everyday for the rest of her/his life is
most important. And s/he has the final say of
what it should be, how it should look, and what
is the final choice.
But there is a judge that
we want to please even more than the patient.
And that judge of this beauty contest is the
human genome. We are of a species. If we were
grasshoppers or ants we might make entirely
different choices of what looks good and what
does not. But we are of this species. And we
want it to look good to everyone.
We want everyone who ever
sees the result think that it is as perfect as
it can be, that it cannot be improved upon and
that it looks completely normal.
We should consider all
recorded history of what has been considered
beautiful thousands of years ago, and
extrapolate into the future and predict what
will be considered still beautiful for the rest
of our lives, for centuries to come and for
thousands of years from now.
When they dig you up or
see your photographs thousands of years from
now, we want all the people of the future to be
amazed at your beauty, at the beauty of what was
done and not know or be able to tell that
anything was ever done.
We want to aim for the
most beautiful face the world has ever seen or
ever will see. And I say face, because no matter
what part or parts we are working on, we want
the whole face to be beautiful, and so it must
Letís say we can make your
face anything we want it to be. Then that is the
question The big question is what do we want it
to be? I would like to have that question
answered as accurately as possible before we
begin to do it. And you will want to know as
Drawings are a search for
the answer. We are searching for beauty. The
maximum beauty. The most beautiful it can be.
We are searching for what
will fill all or our criteria of what looks
The question is "What do
we want the face to be"
And the answer is in the
We keep searching until we
are sure, certain that we have found the goal
that cannot be beat. Cannot be improved. Cannot
Another very good reason
for drawings is so that the patient and the
surgeon have agreed upon all the details of what
final appearance is desired. .
In the final meeting with
the patient we together make a list of all the
things we wish to accomplish. The average length
of the list is about twenty things. Twenty items
that are to be modified in such and such a way
as shown on the chosen drawings.
Sometimes there are only a
few things like six or eight. But sometimes the
list is as many as fifty things long - and more.
We then go over the list a
prioritize those things that are most important
to be sure that the doctor knows the patients
wishes regarding all those things.
Then we discuss with the
patient all the pros and cons of each of the
changes being made and the alternatives for each
area, such as the lips, chin, cheeks, forehead,
frown lines, ear lobes etc.
All of these areas have
their own set of possibilities, alternatives,
pros and cons, and common complications.
At times such a detailed
discussion of so many facets is fatiguing,
confusing and maybe really unnecessary.
Sort of like a taxi driver
explaining every corner he is going to turn
before you get in the cab. It does not actually
change the trip.
Would we do drawings even
if the subject were blind and could not
appreciate them. Yes. Definitely. And the reason
is that we need them as a map; as a guide. A
compass that points the surgeon and takes us in
the proper direction at all times .
The surgeon has enough to
think about for the patientís welfare in doing
the procedure and in getting from here to there.
It greatly lifts a burden
from the surgeon to know just what the plan is.
The direction. The destination . The chosen
And the result of the
operation we want to be as close to perfection
as anything a human has ever created. It will
not be an accidental accomplishment done with
the eyes closed.
We know that it is going
to be as close to perfection as anything a human
has ever created in advance because the drawings
are the most perfect possible.
Or else the surgery should
not begin. We need to know where we are going
before we start.
Or else we could wind up
getting no where by going in the wrong
So that every movement the
surgeon makes, every step he takes is in the
right direction it is greatly to his advantage
to have the map showing clearly the correct
direction in front of him.
Instead of searching as he
goes along, the surgeon who knows the
destination has only to cover the ground from
here to there.
He can run with only the
goal in mind, to the destination, which is
The winner of a race is
not necessarily the fastest. S/he must also be
in the right direction; i.e. toward the finish
If the direction has not
even been determined before we begin, all the
time of the surgery could be spent trying to
make the correct decisions about what is going
to look best for this person for the rest of
And that is how cosmetic
surgery has usually been done. It is almost
surprising that it comes out ok most of the
We therefore keep
improving the drawings until we are satisfied
that they are truly beautiful. - and that they
are so beautiful and close to perfect that no
further work on them will make a significant
This can take many hours
of study and comparing. It can take days - weeks
and often years.
One of my favorite
patients was 19 when she first came. We took her
pictures and did some drawings.
She was interested in art
and knew many artists.
She knew the art teachers
she had in high school.
She knew other artists in
the area .
And she knew the art
teachers of and artists at her college.
She also had many trusted
friends and relatives.
She came back to see me
several times over the next few months bringing
drawings and modifications of photocopies of
drawings of both the front and side views.
Over the next year I did
the noses of some friends of hers from her high
school or college.
She finally concluded
after all this input and study, on a front view
drawing done by a professional artist and
portrait painter, and a profile drawing I had
done for her.
Finally at age 21,
approximately 2 years after I had first seen
her, we did the nose.
And the result was as good
as I had ever had or better.
It was an excellent
No ever found any flaw in
it. Her face was beautiful. And the nose was
fitting and flawless.
From this I learned the
importance of drawings to the person.
She wanted precisely her
choice of front and profile views - no more and
no less than on the chosen drawings.
And I learned the
importance of drawings to me as the surgeon in
many ways that I will explain,
But basically from this
experience I learned that if I were to achieve
the beauty that had been so carefully put into
these drawings, then the patient and I and all
her friends and relatives would approve and like
Are we the only ones who
We are certainly not alone
in planning with drawings.
From Imhotep till now, all
architecture is drawings. Plans.
Did other artists draw
Many drawings that
Michelangelo made still exist. Planning the
ceiling or a sculpture.
And some of his sketchings
have holes in them where they were placed on the
area to be painted, and the holes allowed dots
to be traced onto the surface to be done.
Then the dots were filled
in to reproduce the sketches - drawing plans -
and the drawing was thus transferred to the
surface, then to be painted in by the dots.
plans for the Vatican were made over a period of
thirty years and still exist, before the final
plans of Michelangelo (at age 72) for the dome
And the credit is given to
the planner, the one who conceives,
conceptualizes and communicates it, rather than
the one who does it.
Surgeons not only have had
drawings in the past but have used casts of the
patients face and then modifications of the face
in plaster and other materials.
We have tried the plaster
casts and still do them occasionally, as well as
the rubber alginate materials and acrylics.
But the casting procedures
are very, very time consuming and do no look
very life like unless color is added and that
can require many , many hours,.
Even then, the face is
usually up with the person lying on their back,
and that very often obscures many of the things
we hope to improve. Especially if they are over
Nevertheless, the study of
whatever medium is chosen, should continue until
it is clear that the goal far out weighs the
present appearance and it cannot be improved and
is as close to perfect as possible.
Therefore, study the
drawings for years if necessary or forever even,
if that is required to be sure in ones heart and
Which is more important words or the pictures?
Try a questionnaire on
friends or the general public asking:
"To find out what can
be done with cosmetic surgery, is it better to
1. See pictures that
show what can be done - or
2. Read a written
description of what can be done? "
It will be found that the
great majority who understand the question much
prefer pictures of appearance over words
But if a third
alternative is added - 3. Both
pictures and written description -
then that will be the choice of the most. And so
we have both. The text is in the " Index
of information" and the "Questions and Answers"
in the columns on the right side above.
Also text is best to show
the results of the procedure in the words of the
patient's experiences which are shown in the
Anesthesia Questionnaire and the
from the index in the
left column on the front page.
- While pictures are
most important, a lot of words are there in the
index of information.
Without pictures, a
cosmetic surgery site or explanation is like
talking about art without showing it, without
seeing it or in the case of music without
Therefore, do drawings.
Plan and design what is going to be the most
Then with the drawings
showing what everyone agrees is the most ideal
perfect appearance on that face, we can choose
to proceed to try to achieve that result.
How close to the drawings
can we usually come with the surgery results? is
an excellent question.
There are two ways to
One way is to look at the
before and after pictures of the patients we
have who allow their pictures and drawings to be
seen, to see for yourself how close to the
drawings did the results of surgery come. We can
show you dozens quickly and easily or you can
look at most of the more than ten thousand
patients we have done over the years.
The other way is to look
at the results questionnaires of the patients
who fill them out for us and tell us if we came
close or not. Some of those results
questionnaires are shown on the internet at
There you will find that of several hundred
results questionnaires 97% of patients said they
are close to their chosen goal drawings. And 62%
said they had exceeded or had better results
than the drawings.
William Roy Morgan M.D., F.A.C.S.