Aesthetic Surgery: Respecting the Body or Following Trends?

Within the Italian educational system, reconstructive plastic surgery has always represented a cornerstone in the training of young surgeons. The integration of aesthetic surgery into specialization programs, however, has followed a different path. Indeed, aesthetic surgery has developed mainly within private facilities, making its organic inclusion in training programs traditionally linked to public hospitals more difficult.

As a result, for many years there has been a gap in the training of young specialists, who were required to engage with a field that is highly relevant to surgical practice without having an adequate, structured educational pathway.

«Fortunately, in recent years some universities, led by more forward-thinking program directors, have extended training to include aesthetics as well. Currently, we welcome students and young surgeons from several Italian and international universities, who take part in a rotation of about two to three months. This allows them, at the very least, to gain a basic grounding in surgery, including aesthetic surgery».  explains Dr. Chiara Botti, reconstructive and aesthetic plastic surgeon, medical director of Villa Bella Clinic in Salò, and lecturer in plastic and periorbital surgery at the Universities of Verona and Padua, as well as at the Gemelli Polyclinic in Rome. 

Aesthetic surgery, moreover, falls within the broader field of reconstructive surgery, which represents «the mother of everything and therefore encompasses certain techniques that are also applied in aesthetics – Botti continues – The students who come to us, therefore, are not completely ‘starting from scratch’ when it comes to cosmetic surgery techniques. It is simply a different application of techniques that they may have already acquired in another field».

Aesthetic Surgery and Social Media: An Open Debate

The role of social media in aesthetic surgery is the subject of an ongoing and wide-ranging debate, due both to the opportunities they offer and to the critical issues they introduce.

On the one hand, they represent a powerful tool for young surgeons at the beginning of their careers: they make it possible to build visibility, gain recognition, and communicate directly with a broader audience. On the other hand, the complete lack of regulation allows the spread of inaccurate information, illusions, and false myths, profoundly influencing patients’ expectations.

«Patients get the idea that instead of a scalpel I have a magic wand, and that I can transform, for example, a very elderly woman into the version of herself she was at twenty something that is absolutely impossible».

This dynamic alters the traditional balance of the doctor–patient relationship, as Botti explains: «Compared to the past, at times we feel almost cornered by our patients. If, for instance, we refuse to perform a procedure that is requested of us because we believe it is not ethical or not even feasible, the patient can immediately write a negative review about us -. says Botti – I am not saying that in the past a doctor–patient relationship heavily skewed in favor of the doctor was right. As human beings, we are absolutely on the same level, but at that moment the patient turns to us and we are professionals. If the surgeon is experienced enough, they know how to manage this aspect, but in my opinion, for a young surgeon this can represent a real threat».

Continuous Training Driven by Innovation

In plastic surgery, as in every field of medicine, training never stops. Every new technique, device, or diagnostic approach requires surgeons to constantly update their skills, because the knowledge acquired during specialization represents only the foundation: real progress happens step by step, through study, experience, and ongoing engagement with innovation.

«In our field there is a truly significant commercial component, which means that new devices and new injectables continue to be produced and are immediately introduced to the market without sufficient filtering, even by governmental bodies. Sometimes, after a few years, they turn out to be very dangerous -. Botti explains – We not only have to stay up to date with the latest innovations, but we must also be able to screen them critically. It is not always easy for physicians, as such, to understand what will actually work and what the potential negative implications of a new technique might be. Personally, I tend to remain cautious and usually wait several years before adopting a new technique, because I am always concerned that there may be side effects that were not declared from the outset».

On the other hand, it is undeniable that today there is a wide range of valuable tools available. These include ultrasound technologies and injectables, as well as increasingly precise and long-lasting microsurgical procedures. Not to mention advances in breast implants, which are becoming ever more similar to human tissue, and the use of artificial intelligence to «help us understand where there are volume deficits and, if necessary, intervene to compensate for them. In short, in plastic surgery, as in the rest of medicine, technology and evolution are undoubtedly crucial and, as always, must be used for the benefit of the patient and not exploited for profit».

Surgery Does Not Create Beauty, It Restores Dignity

Reconstructive surgery was not created to produce beauty, but to restore normality and dignity.

From breast reconstruction procedures to the correction of scars and trauma, its goal is to restore functionality and quality of life to those who have suffered injuries or illnesses, often radically changing patients’ personal and social destinies.

«In reconstructive surgery there is also a functional aspect, because very often an aesthetic issue is accompanied by a functional one -. Botti explains –Facial surgery, for example eyelid surgery, has a very important functional role, because if an eyelid does not close properly, this can represent a serious discomfort for the patient. It can also lead to actual medical conditions, since an eye that does not close is more prone to infections and inflammation. Reconstructive surgery, since its inception, has improved the lives of human beings.”

The impact of reconstructive surgery extends beyond the borders of developed countries. In many developing nations, where physical deformities can lead to social exclusion and reduce opportunities for work, marriage, or family life, these procedures take on an even greater social and human value.

«In the developed world, we have a culture that allows us to include even those who are somewhat different, but in other parts of the world this does not happen».

The Body Is Not a Filter: Choosing with Awareness

The impact of social media on aesthetic surgery is most evident in patients’ expectations, particularly among younger people. Platforms have accelerated the spread of aesthetic trends, imposing often unrealistic and homogenized standards.

«Plastic surgery is not completely reversible. As a result, if you choose to modify your body in a certain direction, that choice often becomes permanent. Trends can change overnight, and it is difficult to go back to how you were before and that is quite frightening».

This phenomenon has lowered the average age of patients seeking aesthetic treatments, driven by filters and idealized images to request unnecessary or potentially harmful changes.

«It is important not to alter tissues for as long as possible, because once tissues are altered, this can lead to consequences that may be negative in the long term. Patients need to be informed, and in my opinion there is an age at which you are simply too young to have such clear ideas about what you will want for your future».