In the eye of the beholder: the art of the plastic surgeon

Nurse - the pencil . . . Emma Cook on an aesthetics awareness course for doctors

IT IS mid-afternoon in a rather musty lecture hall in the Royal College Of Surgeons. Twenty plastic surgeons, deep in concentration, are sketching at easels in between staring appreciatively at their subject: a statuesque naked woman reclining on a slab of marble in the centre of the room. For all of these surgeons flesh is an everyday spectacle, but drawing it, rather than operating on it, requires a different range of responses. In particular, aesthetic appreciation.

One man peers over his bi-focals, frowning at the model. "I find this fascinating," he says, shading in a generously proportioned breast with his charcoal. "We tend to confine ourselves to the bits of body we're working on without fully appreciating the relationship between them all as a whole."

This is the fourth day of a week-long annual course called the Art of Reconstructive Surgery, designed and taught by sculptor Pandora Melly and consultant plastic surgeon Professor Roy Sanders. At the beginning of the course, surgeons are introduced to the basic principles of making heads in clay to enhance their perception of facial planes. They then practise simple drawing techniques as well as trying to sculpt an image of their own head.

"We teach them how to use art as a way of remembering," says Melly. "If someone has had their nose bitten off by a Rottweiler, it's so difficult to know how all the features fit together when you come to rebuild the face." She encourages them to sculpt their own faces using touch only - no mirrors. "It's almost like their eyes fighting with their hands."

According to Professor Sanders, plastic surgeons are trained solely in anatomy and physiology so they have less understanding of proportions, relationships and form. "There are so many errors of concept derived from the theory of anatomy," he says. "When they first make a mouth out of clay, it will be absolutely flat, when there's actually a very sharp curve to it."

A row of primitive clay forms stand waiting to dry, most of them lopsided, some with bulbous eyes, others with large lumpy foreheads and puckered complexions. It seems hard to imagine the same hands that made these can, in real life, routinely create the perfect nose or chiselled cheekbones. "Even experienced surgeons may say, `I can't make this face look like a woman's'," says Professor Sanders. "The reason is the proportions are wrong."

Malcolm Deane, a plastic surgeon from Nottingham, is busy moulding a thin, tapered nose onto his clay statue. "I know the face intimately," he says. "But to actually model it like this is entirely different.This is a darn sight easier than dealing with living tissue." He disposes with the nose and rolls it up into a small ball to start again. "If you don't like it, you can just cut a bit off or slap a bit more on. It's super."

As Melly points out, this part of the exercise is about experimentation and exploration. "This is waking up their artistic ability but for scientific purposes." Unlike artists, plastic surgeons are normally allowed very little freedom of expression. Although, she says, their surgical work - like art - is attributable. "In the same way that you can spot a Rodin or Giacometti, each surgeon has a trade mark. Their style evolves."

In this context, would a surgeon consider him or herself to be an artist? "I suppose we are sculptors in flesh," muses Timothy Milward, a plastic surgeon working in Leicester. "We do an enormous amount of reconstruction. The aim is to match what was there before." Nick Jones, a rhinologist from Nottingham, agrees. "I think of myself as a sculptor in my job," he says, his apron splattered with dried clay. "You're trying to meet people's cosmetic and aesthetic needs. But you inevitably impose your own ideas as well."

Melly is convinced she has identified a particular "artist" already. "I can spot quite a number of actresses who've had their noses done by one person on the course," she says. "You can tell because it looks like the same one repeated on each face."

Yet no surgeon, it seems, wishes to be known for their individual style or work. "I would view it as an insult if someone could recognise my line of plastic surgery," says Milward. "Because then it means I'm deciding what the patient wants."

But to some extent their work will be informed by personal ideals of attractiveness, which is why a central part of the course is the consideration of beauty, distortion and the grey area in between. Melly will ask them to sculpt what they percieve to be either an ugly or a beautiful head. Often, she says, they will create something that "feels" rather than "looks" beautiful. "In the end, it's about what gives them pleasure to produce."

As one participant sums up, staring critically at his sketch of the nude: "The main thing I've learnt is that there's no such thing as absolute beauty."