assessments. These treatments are also often temporary and carry minimal risk compared to surgery. Patients can “wear” a subtle change and adjust to their chosen appearance, then add/ subtract or modify.2,12
When studying therapeutic guides to facial proportions and beauty, dermatologists may apply the rule of “horizontal thirds” or “vertical fifths”; however, considerate clinicians avoid this terminology with patients or in the lay public when describing individuals or their features because most people do not fit these measured proportions.13 Expert aesthetic physicians implicitly understand that preserving an individual’s character is paramount and that historical generalizations should only be used to guide therapy as a reference when it suits the patient’s aesthetic goals.
Many ingrained terms in dermatology accept traditional assumptions that ignore the many human variations that make us unique. Historical terms like “masculine”, “feminine”, or “skin of color”, split humans into discrete groups that exist more in imagination than in reality. People have more complex identities than these simplistic groupings suggest, and individuals might be offended when these terms are misapplied to them. The beauty industry, for one, is reckoning with its history of antiblackness and colorism.14,15 Rihanna’s Fenty Beauty 40-shade foundation range set a new benchmark for recognizing the nuanced shades, different ethnicities, and varying skincare concerns while describing skin shades specifically as fair, light, medium, tan, and deep, along with variations in undertones.16,17 Medicine also faces a reckoning with ingrained and archaic terminology that must be reconsidered. We cannot and should not lump individuals into bucket groups that marginalize and disregard those of mixed cultural or racial identities, transgender or nonbinary gender identities, or gender expressions that do not fit neatly into prescribed binary categories. The use of such general terms should be reconsidered in favor of more specific and accurate word choices.
Adopting a Genderless Approach to Aesthetic Language in Dermatology
While various transgender individuals identify with the historic binary genders, others may instead express themselves on the spectrum between, seeking to look neither traditionally feminine nor masculine but preferring their own, self-identified gender.1 Cisgender and nonbinary individuals also find themselves with varying and mixed preferences. Accordingly, dermatologists should adopt specific aesthetic language to describe facial and body features instead of generalizations. If generalizations are used to guide therapy, they should be qualified in a historical sense. For example, “A more convex, projected cheek and tapered jawline could be considered traditionally feminine.” Even better would be accurate physical descriptions of features that do not reference gender, ethnicity, or culture at all. For example, “Do you prefer (or feel more comfortable with) a convex, projected cheek and tapered jawline or a wider, more angled mandible?” Providing the patient with points of contrast for each feature can help the physician align more precisely with the patient’s goals.
In dermatology, we should be as exacting in differentiating an angular jawline from a softer, tapered jawline as we are in differentiating a patch from a plaque. Neutral, specific, and descriptive language enables dermatologists to provide better and more consistent care to all patients. We propose the terminology in Table 1 as a starting point for primary descriptors in aesthetic encounters.
Practical Implementations
Intake
Sensitive, thoughtful, and excellent medical care for all patients
