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    The Pursuit of Validation

    Over my many years of practice and more than ten thousand conversations with people about their perceptions of beauty, I have learned that most perceptions and insecurities about how beautiful or ugly they are come from a need for external validation, versus an internal validation and appreciation for who they are.

    External validation is related to why we want to look a certain way; internal validation is more about how we feel about ourselves when we look in the mirror. As a plastic surgeon, patients come to me for external validation, which requires me to be acutely aware of the influential position I am in and never misuse it.

    One of my first professional mentors, Dr. Bruce Feldman, placed a significant emphasis on empathy. He taught me that our first responsibility to our patients is to give them empathy; let them know they’re not alone in what they are thinking and feeling. Give them that validation they are seeking.

    He saw every encounter as a human interaction more than a business interaction and taught me to never take that opportunity for granted.

    In the Pursuit of Perfection

    A woman traveled from New York to LA to meet me after five failed rhinoplasties; this consultation was for surgery number six. At this point, she seemed to simply be trying to find someone who could save her nose—but it went deeper than that.

    After just a few moments of speaking with her, I could tell that although everything in her world seemed to revolve around her nose, she really wanted someone to save her.

    Her very first surgery happened when she was still a teen in the 1980s. Her Manhattan socialite mom had made her do it: “Your nose just isn’t nice enough.” For the next twenty-plus years of her life, she had a rhinoplasty about every three to five years.

    She would have the surgery, spend six months recovering, two years lamenting the results, and another year finding the next surgeon to visit. It was a vicious cycle in pursuit of what she thought would finally make her beautiful.

    By the time I met her that day to discuss a sixth surgery, she was in her late forties or early fifties. I knew immediately I would not be doing surgery, because it simply wasn’t necessary. But we needed to have a deeper conversation.

    When I asked her what bothered her about her appearance, she offered a detailed analysis of her nose: This nostril is higher than the other. The tip is asymmetric. This side dips in a little bit more right here with a little curve…. She went on and on, breaking down every single square millimeter of her entire nose.

    Finally, I interrupted to deliver a little tough love: “Hold on! You’re so hyper-focused on your nose right now, but you have to zoom out! Look at how beautiful your eyes are, and your cheeks, and your lips. Every part of your face is beautiful, and your nose fits. It works for your face.

    “You’ve spent twenty years trying to make your nose something that it’s not. Now after all these years and five surgeries, you still haven’t achieved it. There is nothing you can do to your nose that will ever make it acceptable to you. You just have to stop and accept that you are beautiful just the way you are.”

    The Cure for Perfection

    You might be wondering how in a 20-minute conversation I could change the mind of someone who had spent years—decades, actually—believing she needed more surgery to be beautiful.

    It all comes down to validation.

    I believe in that moment of our conversation she came to realize something she always knew deep down but never wanted to accept. It was almost as if she just needed to hear someone else—someone she viewed as an authority on the topic—say what she really believed but couldn’t accept. She was already beautiful.

    The problem is that when you look into the external world for beauty validation, you’re always being sold. As a result, rarely will someone talk to you honestly about beauty. Think about it: almost everyone you encounter in the beauty business is a salesperson.

    So, in this particular woman’s case, when I spoke directly and honestly to her, it was as if she thought, I’ve always kind of felt like that, but no one’s ever said it to me. After all, she had to understand that at some point, more surgery was absurd.

    I think that encounter was the first time someone talked to her honestly from a professional standpoint. Perhaps she thought, Wow, a plastic surgeon in Beverly Hills who makes money doing surgeries is telling me I’m OK! I’m sure she was taken aback at first.

    The message of her beauty had never resonated externally because she had never heard it externally. She’d been depressed because of all the external sales and marketing telling her, If you don’t like it, just fix it. I had the good fortune to be the right person at the right moment to provide healthy external validation.

    The Opportunity to Change a Life

    Another potential patient came to consult with me. She was a young girl of 15. As I talked with her, I learned she was an average student who was a little less than motivated to succeed. She wasn’t really popular and didn’t have a lot of friends, so she was pretty down in the dumps.

    Her parents were clearly loving and concerned and had tried providing her with professional therapy since she was about eleven years old. At some point, she had expressed wanting to get her nose done, so they brought her in for a consultation.

    During the consult, I noticed a few things. One was that the girl herself was quite anxious and nervous. She wouldn’t make eye contact with me. The parents did the talking, telling me about her.

    I eventually got her talking a bit and pulled her story out, allowing me to hear more from her perspective, by saying, “You have to tell me what you want if you want to even continue this consultation.”

    When it all started to come out, she basically felt like she was not pretty enough. None of the boys liked her. None of her friends thought she was pretty. But when she first walked in, like I always do, I told her how pretty she was. You’re so gorgeous! You have a beautiful face. I love your eyes. I love your smile.

    As we continued to talk, she told me that when I said that to her, it was literally one of the first times someone had openly told her how pretty she was. At that moment, it was something that she felt was hugely impactful. As a result, she chose not to have surgery.

    About two years later, her mom called to tell me that the conversation that day, coming from an “expert in beauty” (what her daughter calls me), really made something click for the young lady. If an expert in beauty thinks I’m beautiful, clearly I’m not as bad as I think.

    From that day forward, her entire life changed in terms of how she behaved, how she acted, how she carried herself, and even how she did in school. Everything changed.

    All I did was tell her how pretty she was. That’s it. She needed some external validation from someone other than her parents, and, happily, I had the opportunity to provide it.

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