The Picture of Dorian Gray: A Plastic Surgeon’s View

We women, as someone says, love with our ears, just as you men love with your eyes, if you ever love at all.

—Oscar Wilde (1854–1900)

Years ago, I participated in an annual meeting of the Anatomical Society held in Dublin. After the conference, all the participants were invited to the “literary walk,” a tour program in the literary city. We visited a pub (The Duke) where James Joyce was a regular, and Trinity College, where Oscar Wilde studied. At the end of the tour, which lasted until late at night, a tour guide gave us a quiz: Which sport did Oscar Wilde love best? I did not know the answer. An anatomist raised her hand and won a T-shirt as a prize by giving the correct answer: polo. Although I remembered short stories written by Wilde, such as “The Happy Prince” and “The Selfish Giant,” I learned during the tour that his father, William Wilde (1815–1876), began the era of modern mastoidectomy with his introduction of the eponymous retroauricular incision and that Oscar Wilde suffered from chronic otorrhea and died from meningitis caused by otitis.

On arrival home, I read the only full-length novel written by him and enjoyed the movie of the same name: The Picture of Dorian Gray. This is the story of a very handsome young man (Dorian Gray) who admires and envies his portrait, and wishes that the portrait would grow old, instead of him (Fig. 1). To resist the physical corruption of time and nature, and being unable and unwilling to mature, he gives his soul away, and his wish is granted. The oil portrait and protagonist represent the dyad of the person and the mirror. While the protagonist is virtuous and loves his girlfriend, his portrait remains beautiful—but when he abandons his lover and she commits suicide, his portrait becomes ugly and a larva comes out of the eye.

Fig. 1.

A scene in the movie “The Picture of Dorian Gray.” A, Portrait of young Dorian Gray. B, The portrait becomes old and ugly instead of the protagonist.

In a search of PubMed using the keyword “Dorian Gray Syndrome (DGS),” I found only one article. This article presents three diagnostic criteria: body dysmorphic disorder, narcissistic regression, and denial of the maturation process. Brosing suggested treatment strategies for DGS: psychodynamic therapy with properly motivated patients, additional medication with psychoactive drugs in serious cases of chronic body dysmorphic disorder, intensive psychotherapy, and cognitive-behavioral methods as an alternative to psychodynamic approaches.¹

As a plastic surgeon, I have a somewhat distinctive viewpoint on the novel. Humans have tried to maintain a youthful appearance using beauty treatments since long before the development of aesthetic plastic surgery. Descriptions of yearning for youth can be found even in ancient literature, as the Fountain of Youth was first described by Herodotus (484–425 BC). Spanish explorer Ponce de Leon (1460–1521) heard a legend about a fountain that made people young again, which provoked his curiosity and started a journey to find this mystical place. Through the long journey of Ponce de Leon, we can realize that humankind’s quest for youth has been endless. A wrinkled face is the harshest expression of the reality of aging.²

Psychodynamic therapy, medication, intensive psychotherapy, or cognitive-behavioral methods might help the syndromic symptoms of DGS. Nonetheless, suppressing patients’ quest for youth is not possible by psychiatric methods.

Although many panaceas have been used, they could not help with the problem of a furrowed profile until the modern era. The only pragmatic alternative to the inevitability of aging is plastic surgery, the narrow path to the Fountain of Youth.