Physician solves mystery of Mona Lisa’s smile

The ‘Mona Lisa’ has her own room in the Louvre, where she attracts six million visitors each year. Her room is frequently crowded with frenzied guests attempting to catch a glimpse of her enigmatic smile.

Over a year ago, Boston physician Dr. Mandeep R. Mehra was in that endless line, hoping to do the same. During the long wait, he pondered the details of La Giaconda’s strange looks — her yellowing skin, her thinning hair, and of course, her lopsided smile, inverse.com wrote.

In that time, he came to a realization: This woman is ill.

“I had the chance to just stand there for an hour and a half staring at nothing but this painting,” Mehra, medical director of the Heart and Vascular Center at Brigham and Women’s Hospital, tells Inverse. “I’m not an artist. I don’t know how to appreciate art. But I do sure know how to make a clinical diagnosis.”

Over the next year, Mehra dug into the history of Lisa Gherardini, the woman in the legendary portrait, as well as the public health records of historical and modern-day Florence, where the painting was created.

As he outlines in a new paper in the Mayo Clinic Proceedings journal, Gherardini suffered from an ailment that is still common — and quite treatable — today.

“I don’t know how to appreciate art. But I do sure know how to make a clinical diagnosis.”

When you are stuck in a small room at the Louvre, looking very closely at the ‘Mona Lisa’, said Mehra, you start to notice a lot of strange details.

Take, for example, the inner corner of her left eye: There’s a small, fleshy bump there, just between her tear duct and the bridge of her nose. Her hair is oddly thin and lank, and her hairline is receding behind her veil. She has no eyebrows, whatsoever.

If you look closely at her eyes, you’ll notice they are oddly yellow — far more so than her skin.

The right side of her neck has a slight but pronounced bulge, and her face is slightly puffy.

And on her right hand, folded delicately over her left, there’s a noticeable bulge between her index and forefinger.

“It became clear to me that there was something wrong with her,” said Mehra.

There have been countless theories explaining why the “Mona Lisa” looks the way she does. Most historians agree that she is Lisa Gherardini, a woman in her late twenties and wife of Francesco del Giocondo, a wealthy Florentine silk merchant. But beyond that, not much else is known for sure. “People have proposed many theories,” said Mehra.

“He was Leonardo Da Vinci himself in feminine form. Or his rendition of what an ideal form of a woman should look like. “But as I began to look at this painting with some great depth, it became clear that neither of those two theories could be supported because he would never have allowed those imperfections and the accuracies of the imperfections to emerge if that was the case,” he continued.

Da Vinci, after all, was not only one of the most celebrated painters of his time but also an exceptional anatomist. When it came to capturing small details, he did not mess around. And so the bulges on the eye and neck, the lank hair, the yellowing sclera could not have been accidental.

“I knew I was looking at a masterpiece by an extraordinary artist who would have captured every small embellishment in an incredible way,” said Mehra.

As Mehra outlines in his paper, each of the physical abnormalities he spotted on the ‘Mona Lisa’ has a known medical correlate.

The bump next to her eye, for example, is likely a xanthalesma, a yellowish cholesterol deposit under the skin, usually near the eye. Similarly, the bulge on her hand is probably a type of fatty benign tumor known as a lipoma or a xanthoma, if it’s rich in cholesterol.

The bulge on her neck, meanwhile, could be the beginnings of a goiter, an abnormal enlargement of the thyroid gland. “It’s not an aquiline neck,” said Mehra. “You don’t actually see the trachea.”

“So, I’m basically looking at a receding hairline, loss of eyebrows, a swelling in the neck, coarse, thin hair,” he said.