Craftsmanship or Artistry: Which Matters Most in Aesthetic Surgery?

Craftsman: one who creates or performs with skill or dexterity, especially in the manual arts.

Artist: a person who creates art using conscious skill and creative imagination.

—Merriam-Webster Dictionary

A colleague once said to me that to be a plastic surgeon in private practice is to be a “journeyman.” He was right in the sense that, like a tradesman, our living is dependent on what we accomplish with our hands. We don’t operate, we don’t survive. We may have nurses or technicians performing procedures in our office that contribute to the bottom line, but generally speaking, what pays the bills is our manual labor. Like skilled tradesmen, many of us have what are known as “good hands.” Watching surgeons with good hands operate is a joy as they make even complicated techniques look easy. Their performance is characterized by manual dexterity, excellent eye-hand coordination, and a steadiness that bespeaks confidence. Surgeons with good hands are, by the dictionary definition, craftspeople. But plastic surgeons must also bring artistry to their work.

Craftsmanship is sometimes compared to following a “recipe,” whereas artistry involves the successful realization of a creative concept. In our field, artistry is the ability to envision a nuanced aesthetic result that has been tailored to the individual patient. Craftsmanship enables us to achieve that intended outcome. I may have an artistic vision of what I want for my patient, based on her desires and my judgment, but unless I am expert in my craft, the final product is likely to fall short of both our expectations. Artistry needs craftsmanship, because without correct implementation, no mental concept can become a physical reality.

Perhaps it is a reflection of my heritage, but when I think of craftsmanship, I picture a Persian carpet. I have always been in awe of the stunning and complex designs of antique rugs, most of which were woven by women and children for use within their own homes or the homes of loved ones. The unique artistry of these old rugs makes them prized possessions today, but exceptional craftsmanship is what has allowed them to survive through generations of wear and tear. Persian rugs are prime examples of craftsmanship handed down by tradition, learned and practiced, and then infused with the weaver’s individual artistic expression. In the weaving of these magnificent carpets, learned skill was a necessary prerequisite to invention.

When The Aesthetic Society was founded in 1967, its stated mission was to advance the art and science of aesthetic plastic surgery. Throughout the Society’s history, artistry has been emphasized as an important component in the practice of aesthetic surgery. Certainly, it is. However, if I had to choose which is the more essential to aesthetic surgery—artistry or craftsmanship—I would select craftsmanship. One can do a quite decent job as a craftsperson with limited artistic flare, but surgeons without a mastery of their craft have little hope of attaining an ideal outcome.

I always stress to the residents and fellows with whom I work that artistry in plastic surgery develops slowly. One does not rush into experimentation with new ideas, regardless of how exciting they may seem. Many of the breakthroughs in our field are the result of inspiration, but what comes before is essential. Preparation of the ground leads to a successful harvest.

But is the kind of artistic vision necessary to breakthroughs, or to achieve extraordinary results in aesthetic surgery, within the purview of only a select few? I think not. Just as craftsmanship is a learned skill, artistry can be cultivated through training. While some individuals undoubtedly have more innate artistic ability than others, the gap can be narrowed through education and practice.

A study of structural brain differences in relation to artistic ability provides insights into the properties of the developing artistic brain. The work of a cohort of 44 graduate and postgraduate art students and non–art students engaged in drawing tasks was scored and then correlated with the regional gray and white matter volume in cortical and subcortical structures. Students with observational drawing abilities showed an increase in gray matter density in the left anterior cerebellum and the right medial frontal gyrus. Artistic training (art students vs non–art students) was correlated with increased gray matter density in the right precuneus. The authors write: “These results suggest that observational drawing ability relates to changes in structures pertaining to fine motor control and procedural memory, and that artistic training in addition is associated with enhancement of structures pertaining to visual imagery.” ¹ In a similar observation on the value of art training, plastic surgeon Janek Januszkiewicz writes: “Awaken the R-mode (right hemisphere) and you will release the artist hidden within the plastic surgeon.” ^2,3

In 2012, Sepehripour et al carried out a survey with plastic surgery training representatives in England (n = 26), finding that most respondents had some type of art background, such as formal qualification, attendance at art courses/classes, or art as a hobby. Fifteen surgeons agreed or strongly agreed that artistic skills are important in plastic surgery.⁴ In 1969, Thompson et al reported on an art course for plastic surgeons at the Indiana University Medical Center (Indianapolis, IN). After 16 hours of practice on drawing, clay modeling, molding, and casting, the residents’ development was remarkably evident when drawings from before and after the course were compared.^2,5

Artistic abilities can, to varying degrees, be learned, a finding with great relevance to plastic surgery because one cannot become a successful plastic surgeon without a grasp of aesthetics. Whether performing a cosmetic or reconstructive procedure, the outcome must be pleasing to the eye. Once we realize the importance of treating the whole person, not just the individual parts, we understand that artistry is just as intrinsic to reconstructive work as it is to aesthetic surgery.

So, I come back to the notion that craftsmanship and artistry are, in many ways, inseparable. It is mostly a matter of which comes first. A painter of abstract art may be able to realize her creative vision with a minimal of formal training, but an aesthetic surgeon obviously cannot. Neither does an experienced aesthetic surgeon always follow a precisely prescribed formula when performing procedures to enhance an individual’s appearance. The specific approach to a procedure is based on perception and conceptualization, then actualized through craftsmanship.

A discussion of the importance of craftsmanship vs artistry is bound to end up in a quandary similar to “Which comes first: the chicken or the egg?” With respect to plastic surgery, the order matters only as a cautionary tale. One may be born with an innate artistic sense, but such ability does not guarantee superb results in the operating room. An artistic genius may be born; an aesthetic surgeon must be made.⁶ Part of every plastic surgeon’s education should include background and training in the arts. Such education may help surgeons to enjoy greater confidence in their observational and conceptual abilities, creating a more optimal environment for successful outcomes.

Disclosures

The author declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.

Funding

The author received no financial support for the research, authorship, and publication of this article.

REFERENCES

Author notes