Q&A with jonathan yeo and miles berry
Miles Berry Cosmetic Surgeon MS, FRCS (Plast) is a specialist in cosmetic surgery. Since 2010 he has provided Jonathan Yeo with insight, knowledge and an ability to experience cosmetic surgery procedures first hand. These opportunities have proved indispensable in Jonathan's process in creating this body of work. This discussion took place in January 2018.
The text is also included in the 2018 monograph Skin Deep, published by The Bowes Museum and Jonathan Yeo Studio.
JONATHAN YEO: When I first started on this series of work, almost ten years ago, I was conscious that, despite increasing frequency of surgical procedures and widening interest in the subject, it wasn’t something that had been tackled very much in art or popular culture, at least in an objective way.
At the time I was coming at it mostly from my perspective as a portraitist, but I quickly realised there were many areas it touched upon in our individual psyche, in our wider culture and perceptions about appearance and beauty.
It also had a historical angle, not least because it is a rapidly evolving area, with very few of the current procedures even having been possible a century ago, and most likely to be improved upon or superseded in the coming decades.
Therefore, it seemed to be a fascinating opportunity to evaluate where we are at this moment in time and I became aware that you, the surgeon, as the point of contact, were in an extraordinary position of insight into people’s concerns and motivations.
Something I’ve also realised in the seven or so years since we met is that several of the things you referred to at the time, which to me seemed very marginal, have since become much more mainstream. One of these was a shift back towards people having more modest breast enhancements and with surgical procedures in general trying not to make it too obvious when they had things done. Another was the beginning of a shift, you thought, towards more gender reassignments, which has become a widespread topic of conversation
in recent years. Are there any other changes you have noticed in the intervening years, or are noticing at the moment, which we didn’t see at the time, and are those patterns you predicted before still continuing?
MILES BERRY: Breast augmentation continues to be a more natural ‘has she/hasn’t she?’ objective. The other major shift has been away from invasive facial surgery, particularly facelifts, towards non-surgical treatments, such as Botox and fillers, which involve far less downtime, fewer risks and lower cost. Regarding gender reassignment, I am seeing a continued increase with the issue emerging further from the shadows, becoming more mainstream and patients getting younger. Moreover, a new category has appeared where people do not wish to have a gender label assigned: so-called ‘agender’, gender neutral or gender fluid.
JY: So, is it mostly men or women going agender or is it equally divided?
MB: I tend to see more trans men: females undergoing masculinisation of the chest following mastectomy. Natal females with large breasts are particularly inhibited, especially at the gym and when wearing lighter clothes as they have to bind themselves tightly to camouflage their chests.
JY: One of the first things I noticed when I started looking at this collection of work retrospectively was the fact that all the subjects were women. It wasn’t ever a decision to focus on one gender. In fact, back in 2010–12 when I did most of the paintings, I was keen to include male subjects too, but it was easier said than done. Firstly, as I recall, there were far fewer of them going under the knife at all and, secondly, the few who did were much less happy about being portrayed in this way. Women, on the other hand, seemed to be much more open to it. Perhaps it’s an indication of greater body awareness and/or confidence, and it happens to tally with some of my own experiences in portraiture, which is that it’s male rather than female subjects who complain! Maybe women are more comfortable with, or at least in touch with, and more open about what they look like. Has the proportion of male to female patients changed at all and do you think that men might now be more amenable to being part of a project like this than they were then?
MB: I think it is a very slow shift. If anything my practice has probably remained very similar, at 85%+ female. I still think men are relatively lowly represented.
Returning to your point ‘why women?’: women may go through considerable, fundamental changes with childbirth and menopause that men simply do not experience. The vast majority of women I see are those seeking little more than a restoration of what they had previously. It may be that men find it difficult to comprehend because their bodies don’t change so radically. Furthermore, women’s bodies are often very much a part of their identity, whereas most men derive a great deal of identity from what they do in life rather than how they look. I am no sociological expert, but my experience suggests women are judged far more harshly on a physical level.
JY: This period we’re talking about, since around 2011–12, when the majority of the works were made, has coincided with the rise of social media platforms like Instagram, which have been blamed for increasing pressure on young people to look, dress, behave and perhaps conform in certain ways. Some have claimed also that the heavily stylised, altered or photoshopped images of many celebrities add to the pressure by suggesting an unrealistic level of perfection that’s attainable. I feel that probably underestimates the younger generation’s sophistication in navigating this area, but I wonder if you have noticed any differences in your work because of these things?
MB: Indeed, and one has been the number of people thinking their noses are too big because smartphone cameras magnify them when taking a selfie. People are also now more aware of asymmetry: they say ‘I prefer this side for photographs – can you make the other side the same?’
JY: That’s very interesting because, of course, we have always had an idea of what we looked like, which was based mostly on seeing ourselves in the mirror. That image was front only and reversed, and you were always conscious of being looked at, yet it was still basically in proportion.
Phone ‘selfies’, on the other hand, have a wide-angled, often 28 mm, lens and the distortion increases the closer they get.
MB: The real challenge to self-perception that digital cameras and social media have added of late is the range of views. Accustomed to seeing our reflection we have, hitherto, been unused to seeing more oblique views. However, being tagged by others opens up entirely new vistas that others have seen, but you have not, and this can be rather disturbing.
JY: Like hearing our own voice in recordings, perhaps? It seems wrong to us because we’re not familiar with it. I remember you saying before that when patients initially come for a consultation and you can tell they are wavering, that you are able to talk them out of procedures when you don’t think it’s worth doing. At other times, when it’s been a long-term hang-up or perhaps something they were teased about as a kid, then the fact is, even though you know that changing their nose or pinning their ears back isn’t actually going to make a difference to their life, if they are convinced it is going to make their lives better then that expectation can actually make it a self-fulfilling thing. One of my reasons for doing several ‘before and after’ diptychs was when you noticed perceptible bikini marks in the second image, as well as a change in posture, as that conveyed this sense of increased confidence post-surgery. This is one of several subtle layers of narrative that I hadn’t anticipated before I started on these works but which was reinforced by our conversations about the patients’ background psychology.
Staying on faces for a moment, though, and influenced by my own experience of certain contemporaries who have had surgery, I’ve noticed that when some people have nose jobs that, while they seem to exude more confidence as a result of the change, for me it has taken away one of the key features that made their face interesting.
Clearly, as a portraitist, I’m looking for aspects of peoples’ appearances that make them identifiable so the underlying tendency with surgery to create a kind of global homogenisation is potentially something that makes my job harder! Again it probably comes back to people’s history and if they’ve been made uncomfortable when younger for standing out too much or looking different then the ability to look more ‘normal’ or fit in with others might be seen as a greater advantage than someone who’s always wanted to be noticed more.
MB: One has to take care not to detract from a unique feature and render it homogenous. Fashions change, so they may like it now, but in five or ten years’ time they may be in a completely different place in life.
JY: So potentially body fashions change as fast as other fashions but, obviously, it’s something that is more difficult to switch back later if things move on.
You mentioned that the recent fashion for men having beards has affected the number of men currently opting for facelifts, as the hair obscures the offending area, which is skewing the stats and perhaps masking the overall pattern. This idea of various fashions of appearance intersecting in unexpected ways leads me onto the wider question of aesthetics and whether the surgeon or patient is really making judgements based on universal standards or more on personal taste. I was struck when I first exhibited the diptychs that many of the visitors expressed surprise and a preference for the ‘before’ painting rather than the ‘after’, especially when the latter made it much more obvious that there had been some work done. It’s a question of whether the surgeon is correcting things that are wrong or making aesthetic judgements. Do you ever find yourself, or can you see other people, in a situation where you make a decision and it’s partly a matter of personal taste and preference?
MB: And that shows itself when you are able to tell who did a patient’s nose job, because some surgeons have their own signature.
JY: As an artist then my instinct would be for it to be unique and identifiable, which is presumably the opposite of how you should approach this?
MB: We’ve talked about this before, haven’t we? That you have a very recognisable style, but mine, when most successful, is completely anonymous.
JY: I suppose this comes back to the question of whether it’s better to appear more natural and perhaps what ‘natural’ means to people in different parts of the world.
That reminds me about something else we’ve discussed, which is the regional variations and attitudes to what’s culturally acceptable and even natural. I had just come back from a long trip to China where it’s a big taboo out there to even talk about, let alone acknowledge, whether you’ve had any work done. I believe it’s the same in the Middle East and certain other parts of the world, where it’s frowned on to do things that detract from local ethnic characteristics, and actually this fits with my professional aversion to homogenisation.
In the UK I sense it’s become more acceptable and I think obviously in the US, California especially, it’s more than accepted, it’s becoming normal. There are parts of the world where it goes beyond this and I’m told by some surgeons that in Eastern Europe, for example, it’s seen as a fashion accessory and they don’t therefore mind it being obvious because they are happy for others to know they’ve spent the money. In some parts of South America, it’s so much a part of life that it’s almost expected.
There’s also a strange flip side: some of the places where it’s most accepted are also where some more natural imagery is still viewed with suspicion or prudery. When I exhibited some of the works in Berlin in 2012, I included a recent painting of Sienna Miller pregnant to juxtapose images of unnatural ‘beauty’ with one that was unquestionably natural, yet not often seen, even in these days of oversharing. The locals were largely unfazed by the painting of Sienna, yet found the surgery paintings uncomfortable, while back in the UK, and to some extent the US too, it was the other way around and several commentators suggested the depiction of pregnancy was gratuitous. This was despite years of celebrities repeating the famous coy Annie Leibovitz photograph of a pregnant Demi Moore, usually for reasons of self-promotion.
More recently I’ve noticed that social media itself practises a weird form of moral censorship, one that precludes even a hint of nudity yet, as we all know, seems less bothered by violence and other psychologically worrying imagery.
My portrait of Lily Cole breastfeeding, for instance, has been repeatedly removed when posted on Facebook and elsewhere, despite the fact you don’t actually see her breast at all. It’s strange that some of us now seem more comfortable with images of people who’ve been physically altered than with ones that depict us in a state of being that is entirely natural, one that literally all of us are a product of and many have experienced.
I’ve digressed slightly, but on the overall question of regional differences, do you recognise my rather broad generalisations and, if so, do they still apply?
MB: Everybody likes to feel beautiful and everybody likes to feel it is all natural. I think Britain remains more subtle, but there is a strong psychological defence mechanism of the human brain that helps to conceal things like aesthetic procedures. If they feel happy, they do not want to acknowledge even in their own psyche that they have accepted some outside assistance.
JY: So that’s also part of the general process of feeling better about themselves, which is part of the motivation in the first place? Nichola Rumsey (Professor at UWE), who has written an essay for this book, said that in an ideal world people would be coached instead to feel good about themselves without having to do this. I think most of us would agree with this in principle, that it would be better if people didn’t feel such pressure from fashion magazines and social media, but I can’t see that change happening quickly. It’s in our nature to compare ourselves to others and try to find ways of improving ourselves.
MB: Which we do in many spheres, but academic, for example, is more highly prized than physical. It also means you jump on the bandwagon of demonising surgery to the benefit of psychology and cognitive therapy. Is it better to use ‘brain’ tricks or surgical tricks to increase human happiness?
JY: Maybe it’s a question of degree and whether what we do to improve has unforeseen side effects. Most of us expect an improvement in our appearance when we have a haircut, for example, and I haven’t heard anyone complaining about that. My original interest in surgery came about from the point of view of facial procedures and especially facelifts. I’d become increasingly aware of people with very noticeable alterations to their features, while, at the same time, I knew there were others who’d done things successfully without distorting their expressions, and it made me wonder what made patients keep going beyond the point where it started to get noticeable.
Apologies if I’m paraphrasing your observations, but I recall you saying the problem comes when people are very pleased with the results of a facelift, for example, where they have a year or two basking in the increased attention and compliments but then it gradually wears off and they start to want another hit. The rule of diminishing returns starts to apply if patients keep coming back to it, which means you’re no longer picking up slack in the skin but actually starting to move the muscles of the face and, consequently, change the direction of movements. This came home to me very powerfully the first time I watched you perform a facelift op, that is, what is the point at which it becomes problematic because, obviously, we are programmed as human beings to respond to non-verbal communication, something I am very aware of in my day job, which is often very subtle and not something we’re necessarily aware of generally. Can you tell the point at which something’s going to stop being beneficial and start to become problematic?
MB: The best example is the lips and one can always tell when a practitioner does not really understand natural harmony, when they make both the upper and lower lip the same thickness: the lower should be larger. Most women start to lose redness and volume of the lips with menopause and the thinner upper is addressed first. Forgetting to augment the lower lip and keeping the proportions is common.
JY: That’s very interesting and not an area I’d really thought about. You mention proportions. Are there quantifiable metrics for what certain parts of the face should be in relation to others that can be applied across the board?
MB: Yes, Phi, or the Golden Ratio, which is 1:1.618.
JY: Is that top to bottom, or bottom to top?
MB The bottom lip should be 1.618 times larger. It also applies to many other areas: the face in general, the bones of the fingers and the nautilus shell to name but a few of the myriad examples in nature.
JY: How does it work with the face?
MB: Look at the face in thirds: the upper from the hairline to eyebrow, the middle to the nasal base of the nose, and the lower third down to the chin.
JY: I’m very interested in this 1.618.
MB: Which is the Golden Ratio, or Divine Proportion, as it was called by Renaissance artists.
JY: I should know these things. I didn’t know this applied to faces.
MB: So it’s been seven years and I’m finally able to teach you something!
JY: Again I’m reminded of the overlap between your world and mine. I know you don’t acknowledge it but one of the most fascinating things about aesthetic surgery, as it increasingly seems to be termed, is the fact that surgeons have to have an aesthetic sensibility, in order to visualise how someone’s appearance can be changed in a way that will improve it. In a sense, the surgeon is also sculpting, albeit with a human being rather than a block of clay or marble. Some viewers have picked up a reference to this in the surgical pre-op markings in some of the paintings, which, divorced from the rather dramatic preview they give of the precise incisions to follow, have a decorative and almost tribal look about them. They are also, literally, drawings, which again is something more associated with art than medicine. One huge difference, of course, is that in my job it’s much less of a problem if your judgement is wrong and the painting doesn’t turn out well. I can just put it down to experience and hope the next one works better.
MB: I do feel I have that constraint and I don’t have a completely blank canvas. I have to have an idea of where it’s going to go. So I’m happier in that slightly limited view.