Beauty surgery and its legal status
Beauty is everywhere around us and instinctively attracts our attention. Beauty is desired and beauty is valued by everyone. With our innate interest, we focus our attention on a beautiful landscape, well-designed buildings, pictures or anything that is aesthetically beautiful. Beauty is, by definition, a privilege, being above standards. Beauty is the best word that represents all the positive emotions of a person, the most beautiful adjective that makes every noun and action it describes extraordinarily effective. Sometimes we use the adjective beautiful to describe a landscape, sometimes a baby sleeping innocently. But the most commonly used meaning of beauty is that a person, especially women, is physically attractive. We instinctively tend to look at beautiful faces. In fact, perhaps the thing that attracts our most attention is looking at a beautiful human face.
Our faces are our doors to the outside world. They are the most dynamic and expressive part of our body. We can express many emotions, even things that words cannot express, with our facial expressions. Beauty is a tool for admiration for most people. Beauty is the thing that affects the first impression the most, and the first impression is the idea that is the hardest to change about a person. 0.15 seconds is enough for a man to see a woman and scan her and decide whether she is attractive. The same process applies to women. We establish a direct proportion between a person’s physical beauty and her health and fertility.
The importance of beauty, its effect on the development of personal life, whether beauty is important or not, and how much external beauty reflects internal beauty are debated, but the truth is undoubtedly that external beauty is an important factor and the most important indicator of a person’s self. The culture we live in, especially for women, values beauty more than any other innate or acquired characteristics. Beauty is seen as a curse for stupid women, a reward for smart women, and a weapon for ambitious women. For men, “success” is perhaps a more valued characteristic. In our culture, beauty is like a single-note musical instrument; “you either have it or you don’t.” Beauty plays an important role in choosing a spouse, choosing friends, and even finding a job. It is said that a beautiful face is a good letter of recommendation. The best example that properly explains the importance of this sentence is the indispensable cliché of job advertisements, the word “presentable.” In fact, there are limited things that can be done for such a characteristic that affects almost every part of life. Beauty books, magazines, diet books, fitness clubs, and increasing cosmetic surgery prices reveal the social benefits and importance of beauty in practical life. There is a belief that beautiful people find jobs more easily, are given priority, receive better service, and are tolerated more.
In ancient Greek civilization, it was said that beauty is relative or in the eye of the beholder. According to some, beauty is relative, while according to others, it is a concept that can be defined precisely. Both are actually right, sometimes “beauty” is in the eye of the beholder and sometimes in the face that is looked at. But according to most philosophers, beauty is not relative. Ugly is ugly, it does not change. What is relative is taste. The situation is completely different for the one who likes, and that does not concern anyone anyway. That is why Veysel says; “Beauty is worthless / If it were not for my love.” The problem lies in the misconception that arises between the concepts of beauty and taste. The concept of beauty is related to aesthetics and although it is not clear, it has reasonable criteria. It has a holistic meaning and is related to the beautiful perception of the whole rather than the individual parts. While Özdemir Asaf gives a mystical air to beauty by saying “Beauty is the result of a whole. Therefore, it is not easily seen, easily reached, easily understood,” Americans approach the issue more pragmatically and say, “I cannot define beauty, but if it enters a room, I immediately recognize it.” An Italian painter defines beauty in a more romantic way, saying, “It is a whole of parts that work together in a way that does not require anything to be added, removed or changed.” Despite the great importance given to beauty in today’s modern age, there is still no clear definition of what beauty is. The oldest texts we have also emphasize the importance of beauty. Homer glorified beauty in many characters in his works, the Iliad and the Odyssey. It was Helen’s beauty that would cause the ten-year siege of Troy. However, a determination made by Sappho, who lived in Lesbos in Ancient Greece in the 7th century, on beauty is very important. Sappho says, “What is beautiful is good.” Therefore, unfortunately, what is ugly is bad. Evil and demonic characters such as the Cyclops (the one-eyed monster that eats people) have always been depicted as ugly. These are important in terms of drawing attention to how old the idea of how we look is in Western history.
From a very young age, the importance and power of beauty is drilled into young minds. In the stories read to children before going to bed at night, we see the struggle not only between good and evil but also between beauty and ugliness. In these stories, evil is identified with ugliness. In Cinderella, the troubles experienced by the beautiful young girl with her evil and ugly step-siblings are discussed. The handsome prince, who sees the beautiful girl once, looks for her and when he finds her, they live happily ever after. Good things happen to beautiful people. The poles of beauty and ugliness coincide with the poles of moral goodness and evil. According to this logic, beauty is never purely physical, it is also moral. These values have seeped into literature for centuries. Evil people have always been depicted as ugly. The evil hunchback Richard in Shakespeare’s play, Dr. Frankenstein’s monster, the hunchback of Notre Dame, the one-legged Long John Silver in Treasure Island, Captain Hook in Peter Pan, the character of Dorian Gray by Oscar Wilde and Dr. Jackyl in the novel Mr Hyde, Hyde getting uglier as he gets worse, can be given as examples. What we see in all of these is the physical ugliness accompanied by moral deviation. In Hollywood movies, the reflection of evil as ugly is indispensable propaganda. Interestingly, it cannot be said that Mother Teresa, Nelson Mandela, Martin Luther King and Gandhi, who are universal figures who have done great humanitarian work in the 20th century, are very attractive types.
The famous sentence we all know from the story of Snow White and the Seven Dwarfs is: “Mirror mirror tell me; who is the most beautiful in this world?” This is not a simple question, it has a deeper meaning. The queen is in conflict with the loss of her own beauty and the possibility that someone else could be more beautiful than her. Beauty is not only a physical entity but also a symbol of power and position. At the end of the story, the queen loses not only her beauty but also her position and power as a queen. That is why she tries to poison Snow White. In other words, it is appropriate to harm someone else if necessary in order to be the most beautiful. Beauty is the curse of the world; it is true that countless evils have been done to achieve the beauty that has been sought after since the beginning of humanity, everyone wants to use the most striking adjective, beauty, in order to be liked in some way or, more importantly, to find themselves liked. Whatever is sought after, it can force people to do terrible things. The queen in the story of Snow White and the Seven Dwarfs can be given as an example, in the story, the queen was able to ruthlessly kill people in order to be the most beautiful. But at the end of the story, just like in Cinderella, the beautiful one wins again and they live happily ever after with the handsome prince.
But when we say beauty, for some reason, we always think of positive things. Then an irony comes to mind; doing things that are not beautiful for the sake of being beautiful. Of course, what should be taken from this sentence is not that everyone who wants to be beautiful does harm to others, people can risk their own bodies at the expense of being beautiful today. When I look at women today, I see that being beautiful is the top priority for them. For a very small segment, the search for beauty and youth is at the level of obsessive obsession and narcissism. But young girls are introduced to make-up, fashion and other factors of the similar sector from a very young age. According to a survey conducted by Washington University, 53% of 13-year-old girls are not happy with their bodies. This rate increases to 53% when they are 17 years old. The market volume of make-up and cosmetic products in 2010 is 382 billion dollars.
Globalization of beauty
Although it is difficult or even impossible to define beauty, it can be said with certainty that beauty has a universally widespread and accepted importance. Each culture has its own aesthetic understanding, although its norms are different. However, when we look at it on a global scale, there is a progress towards a universal, uniform aesthetic ideal. According to a study published in Nature, Japanese and Scottish students find European faces attractive. Beauty is a learned behavior affected by social pressures, and a person’s ideals of beauty are dynamic. In today’s multicultural world, different cultural understandings of communities merge and intertwine, or one dominates the other. Social hybridization is increasing due to marriages between people of different races and cultures and the children born as a result of these marriages. It is based on the idea that the concept of beauty actually has a social basis, not a physiological one, and that the nation that makes imperialism the most successful and widespread imposes its own concept of beauty on people. In today’s dominant culture, which we call modern, there are beauty criteria imposed on us, especially through written and visual media. Accordingly, the blue eyes of the white European, the classic small nose, the full Spanish-style lips, the hairless Asian skin, the tanned Californian skin, the butt of the Jamaican club dancer, the long Swedish legs, the small Japanese feet, the belly of the sports instructor in the fitness center, the waist of the adolescent, the arms of the black women and the firm breasts of the Barbie doll constitute the ideal aesthetic criteria and are in demand.
When we focus specifically on the female face, a narrow face shape, a thick upper lip, a large distance between the eyes, dark narrow eyebrows, thick long dark eyelashes, prominent cheekbones, a narrow nose, no bags under the eyes, and tight lids provide an attractive and beautiful appearance. In men, the findings that show the effects of exposure to the testosterone hormone, namely masculine structures, attract attention. These can be exemplified as a narrow face shape, a less full upper lip, symmetrical lips, dark dense eyebrows and eyelashes, a wider upper face than the lower face, prominent cheekbones, a protruding chin, a non-expanding forehead, and no wrinkles. In short, the signs that show that the opposite sex has a high reproductive capacity are perceived as attractive and beautiful.
Science / mathematics of beauty
Beauty analysis is undoubtedly a science. Many researchers work on this subject and try to define beauty mathematically. Evaluating abstract concepts such as aesthetics, beauty, and attractiveness in a concrete way can be possible by making some proportions, measurements, and comparisons between the parts that make up a whole. If something looks nice to our eyes, it definitely has some acceptable measurements and ratios that we are not aware of. The definition of the ideal-perfect face has been tried to be explained with ratios and proportions for centuries. And finally, the number phi (φ), also known as the golden ratio, 1.6, has been reached. Accordingly, if the ratio of the two parts divided when a line is divided from any point is equal to the ratio of the undivided line to the divided large part and this ratio is 1.618, there is a golden ratio. According to the studies conducted, there is a golden ratio between various reference points of both our face and our body. The golden ratio is a special ratio found in the shape and structure of countless living and non-living things in nature. It is a geometric and numerical ratio relationship observed between the parts of a whole in nature, applied in art and architecture for centuries, and thought to provide the most perfect dimensions in terms of harmony. It was discovered by the ancient Egyptians and Greeks and used in architecture and art. It is a very pleasing ratio to the eye.
Many reference points on our face and body are 1.6 times longer than the other. For example, the ratio between the width of the nose and the width of the mouth is golden. The ratio between the length of the nose and its projection is golden. The ratio of the sides of the rectangle where the human face sits is golden. The ratio of the long and short sides of the rectangle formed by our two front incisors is golden. The location of the belly button divides the body into two parts, the ratio of which is golden. The ratio between the base and height of the breast is golden. The ratio of the parts that make up the fingers is golden. It is possible to increase the number of these examples. However, such a golden ratio has no practice for us as aesthetic surgeons. We do not try to make such measurements and create these ratios for any of our patients. Length measurements and angles are more important to us. We make these precise measurements especially in surgeries where we perform bone surgery and jaw advancement and recession, but we do not pursue the golden ratio (Example: Nose length = ear length = average 65 mm (55-80); Nasofrontal angle 115-130; Nasolabial angle 95-105 in men, 102-115 in women). Any woman who is said to have golden ratios can be truly beautiful, her face can truly have golden ratios. But who knows that a woman without golden ratios on her face is ugly, for example, Türkan Şoray does not have golden ratios.
Symmetry, youth and thinness in beauty
Since Da Vinci, beauty has been expressed through symmetry. However, no face is actually symmetrical. In fact, it can be said that absolutely symmetrical faces are not attractive. An absolutely symmetrical face is unnatural and less attractive. Symmetry is the feature that best describes proper genes. A symmetrical physique gives the idea that there is no disorder in the genes. Symmetry is mechanical, asymmetry is natural. When we divide a face photograph in half and combine the mirror images of each to obtain an absolutely symmetrical face, we can obtain two different faces. Unfortunately, beauty equals youth. Beauty is like summer fruits that rot quickly and do not last. The Nambikwara Indians express the concepts of youth and beauty with the same word, and the concepts of old age and ugliness with the same words. Unfortunately, time is especially cruel to women. Getting old may not be a pleasant thing, but at least for now, it is the only known way to live long.
Beautiful must definitely be thin. In fact, it was not always like this. At least, it is said to be so. As we see when we look at the paintings of Raphael (1505) or Rubens (1615) named “Three Graces” and “Venus before the mirror”, thinness was perceived as something specific to the poor, while it is claimed that especially noble and well-income families tried to look fat due to good nutrition. Then, the period when a thin waist was acceptable began, which is still continuing. The waist circumference of the United States beauty queen of 1920 was 67 cm and her hip circumference was 95 cm. The lowest and most useful of the ratios is the Waist-Hip Ratio (WHR). A value of 0.7 is ideal for women. WHR is slightly higher in men. Before puberty, the ratio is equal in girls and boys and is 0.9, then the pelvis grows in women under the influence of estrogen and fat accumulates in the hips and upper thighs-hips in women, reducing the ratio to 0.7. In men, it remains at 0.9. A researcher named Devendra Singh studied WHR. Between 1920 and 1980, the WHR of all American beauty queens was measured between 0.72 and 0.69. During these years, weight and height changed a lot, but this ratio never changed. Even though their weights are very different, what Marilyn Monroe, Sophia Loren, Twiggy and Kate Moss have in common is that their WHR is 0.7.
Aesthetic plastic surgery
In our country, aesthetic surgery has progressed rapidly and become widespread in parallel with its development in the world. Turkey is one of the most important countries in the world in terms of aesthetic surgery level. However, as it is thought or conveyed to the media, we plastic surgeons are not artists. We remove, change the place or make additions to the extent and limit of medical science. Artists are free. Their imagination is their limit. There is no room for fantasy and imagination in surgery, only science.
Resolution of legal disputes in plastic surgery
Since the beginning of human existence, the aim has been to achieve socially accepted beauty. In order to achieve this aim, clinical applications of medicine offer different, sometimes incredible opportunities to the individual. However, the provision of these opportunities also brings with it ethical dilemmas and legal problems. The main reason for the disagreements between the patient and the doctor in aesthetic surgery is that the expectations of the patient from the surgery are not met or what is promised is not provided. The surgeon aims to reach more beauty and better with the intervention he performs. However, an important problem arises here. That is the subjective criteria and relativity in the concept of beauty. Even if a good and correct technique is applied surgically and a regular result is obtained, this result may not satisfy the patient. Far from eliminating the distress in his mental state, it can make him more unhappy and cause more problems in terms of health.
In order to determine the legal liability arising from the damage caused to the patient due to the faulty behavior of the physician in aesthetic medical interventions, the legal name of the relationship between the physician and the patient must first be determined. The legal gap regarding the resolution of disputes in medical practices has been tried to be filled with the general provisions of the “Code of Obligations”. When evaluated according to the general provisions of the Code of Obligations, the first point to be emphasized is whether there is a valid contractual relationship established between the physician and the patient. It is accepted that the medical contract should be subject to the provisions of the “contract of agency”.
The agency contract is a contract of employment that is not subject to a specific time limit and does not pose a risk to the agent, depending on the will of the parties, and where the result is not certain and therefore does not pose a risk to the agent. All medical and surgical interventions are evaluated within this scope. However, only medical interventions performed within the scope of aesthetic surgery are evaluated within the scope of “contract of work”. Because it is accepted that aesthetic surgery interventions are not performed for treatment purposes. In the decision numbered 1993/2741 dated 05.04.1993 of the 13th Civil Chamber of the Supreme Court of Appeals, “If the doctor performing the surgery in aesthetic surgeries has given a certain guarantee regarding the aesthetic appearance, this contract between the parties is a contract of work.” According to the decisions of the Supreme Court of Appeals, aesthetic surgical interventions are evaluated as interventions that are not necessary for the maintenance of life and are not mandatory for life, and it is commented that they do not have a treatment purpose. It is accepted that the doctor can make a contract of work by promising a certain result and treatment, and that in aesthetic surgeries, the doctor guarantees the result, and thus aesthetic surgeries constitute a contract of work. The party who creates the work (physician) has the obligation to create the work (aesthetic intervention). From a legal perspective, aesthetic surgical interventions are considered as a building delivery, a product delivery and are evaluated within the scope of the work contract. A work may emerge after aesthetic surgery and all other medical-surgical interventions. However, this is to the extent that the body allows and requires. It cannot be determined how beautiful or satisfactory the new formation that emerges as a result will be. In this respect, evaluating such interventions simply within the scope of the work contract would be an extremely incomplete, incorrect and unfair interpretation.
The following paragraph was added to Article 471 of the Turkish Code of Obligations No. 6098, which entered into force on 01.07.2012, in contrast to the previous provision: “In determining the contractor’s liability arising from the duty of care, the professional and technical rules that a prudent contractor undertaking work in a similar field should demonstrate in accordance with the rules shall be taken as basis.” Although it is not sufficient to eliminate the problems in practice, with this change, when determining the scope of the physician’s liability in possible patient dissatisfaction in terms of aesthetic applications, the professional and technical rules that other physicians providing service in a similar field will be taken as basis as a legal obligation. In this way, the physician’s liability will be evaluated and determined in a more objective manner, including professional and technical bases.
Prof. Dr. Mustafa Keskin
