A critical conceptual review of appearance and participation in healthcare: Introducing the aesthetic relational care framework

Appearance may influence healthcare engagement through how patients and clinicians interpret and respond to being seen. This critical conceptual review develops the Aesthetic–Relational Care (ARC) Framework by integrating appearance research with stigma, clinical communication, and health self-regulation. ARC specifies how appearance-related appraisals may alter opportunities for participation, how patients’ responses can shape the evidence available to clinicians, and how these exchanges may influence subsequent engagement. It distinguishes observable cues, both partners’ self-experience, appraisals, enacted behavior, and perceived recognition. The framework proposes conditional pathways rather than a universal attractiveness advantage or four necessarily independent constructs. Evidence supports selected component links but does not establish the integrated process. Comparisons with existing theories identify where ARC offers a focused specification and where established explanations may suffice. Four propositions distinguish transient impressions, reciprocal reinforcement, recognition-related engagement, and appearance-specific repair. We outline discriminating experiments, longitudinal designs, measurement requirements, and findings that would weaken these propositions. Clinical applications concern formulation, consent, communication, and proportionate repair, not appearance modification or routine use of unvalidated measures. ARC’s value depends on whether its appearance-specific predictions improve explanation or care beyond existing approaches.