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Face Lift, Breast Lift, Tummy Tuck, Body Lift...Where Do We Draw the Line?
Written by Liberty Craig   

With cosmetic surgery on the rise, how are we faring psychologically?

two women's faces with bandages

Cosmetic procedures have never before been so accessible – or so acceptable – and North Americans have never had quite so many. Between 1997 and 2011, according to the American Society for Aesthetic Plastic Surgery, the number of cosmetic procedures in the US increased by 197 percent. Of these, surgical procedures increased by 73 percent, while nonsurgical procedures increased by 356 percent. Obviously, the evolution of injectable fillers and anti-wrinkle formulations like Botox has been responsible for the dramatic nature of this rise. But any way you look at it, North Americans are getting more and more procedures each and every year.

Most of us undertake a cosmetic procedure after careful consideration and perhaps a little research. Our intention is usually to improve some element of our appearances, thereby improving the way we feel about ourselves. We know that outward appearance does not make you who you are. What’s on the inside is what counts – yet there is a great deal to be said for feeling your best on the outside as well. When we feel good about ourselves, we are more confident, more outgoing, more positive; perhaps more energetic and full of a certain joie de vivre. And cosmetic procedures can indeed help us achieve these goals. But, as with many situations in life, there are those for whom the relationship between intention and outcome is not quite so clear cut. The psychological impact of cosmetic surgery is positive for most of us, yet we’ve all heard of those people who become “addicted” to plastic surgery and have one procedure after another. We’ve heard of client dissatisfaction following cosmetic procedures. As cosmetic procedures become increasingly common, we need to be aware of the psychological elements involved in our decisions.

The Psychology of Surgery

The field of psychology continues to debate the effects of cosmetic surgeries on a woman’s psychological wellbeing. A 2004 study published in Plastic and Reconstructive Surgery monitored 37 patients’ psychological and psychosocial functioning before and after cosmetic surgery. The study showed positive outcomes in many patients, with improvements in body image and possible improvements in quality of life. However, the same study also showed less positive outcomes for patients with unrealistic expectations, and for those with a history of depression and anxiety. Those patients experienced dissatisfaction and adjustment problems post-surgery, and some exhibited anger or self-destructive behaviours. Another study, published in the Aesthetic Surgery Journal, showed that one year after receiving cosmetic surgery, 87 percent of patients reported satisfaction with the surgery, improvement in their overall body image and improvement in the body feature on which the surgery was performed.

Other studies also show contradictory results and are often conducted with small sample sizes that may not provide particularly reliable information. Yet researchers, physicians and psychologists alike note a link between dissatisfaction after surgery and patients who fall into certain categories – particularly those with a personality disorder or body dysmorphic disorder.

Disorders Lead To Dissatisfaction

Certain personality “types” are understood to render patients undesirable candidates for cosmetic surgery. According to Dr Anthony P Sclafani, MD, in his article “Psychological Aspects of Plastic Surgery,” the personality types categorized in the Diagnostic and Statistical Manual of Mental Disorders, including schizoid, paranoid, histrionic and depressive personality disorders are unfit for cosmetic surgery. Another disorder to be wary of is called body dysmorphic disorder, or BDD. Surgeons are cautioned to watch for the following signs to determine if a prospective patient is fit for surgery.

  1. People with schizoid personality disorder tend to be socially withdrawn and introverted. They cannot express a concrete reason behind their desire for aesthetic surgery and cannot state their precise goals. They may avoid eye contact and show little emotion.
  2. Those with paranoid personality disorder have a pervasive skepticism of others. The individual is most commonly a young, unmarried male. They are loners who see themselves as victims, often argumentative and moralistic. They have trouble overcoming their suspicion and may have great difficulty relaxing during an appointment.
  3. Individuals with histrionic personality disorder seek constant approval and reassurance. They are emotional and attention-seeking, disorderly and non-punctual. They are excessively concerned with seeking attention through their external appearance.
  4. People with depressive personality disorder may seek cosmetic surgery to improve their self-esteem, rather than their physical appearance. They may be demanding regarding guarantees, repeat questions, and have little optimism regarding the procedure. Often, people in this category are dealing with a major life event, such as the loss of a loved one.
  5. People with body dysmorphic disorder (BDD) experience an excessive preoccupation with their appearance, to an extent that affects other areas of their lives. BDD is a psychiatric illness, first introduced in the Diagnostic and Statistical Manual of Mental Disorders in 1987. Those affected may be concerned with their entire appearance or may fixate on a particular area of the body. BDD is more commonly associated with bulimia, panic disorder and generalized anxiety disorder in women, and is as common in men as in women. Studies show that seven to 12 percent of plastic surgery patients have a form of BDD; the majority of which do not show improvement in their symptoms and often request multiple follow-up procedures.

Patient Assessment

As any qualified aesthetic surgeon will relate, the initial step of patient assessment is fundamental to a positive outcome. Diagnostic indicators are used to ensure a patient is fit for surgery and to avoid post-surgical disappointments or psychological difficulties. A prospective patient’s motivations for surgery are taken into account, to determine whether the patient is seeking treatment for appropriate reasons (rather than to please a relative or lover, due to outside pressures or to advance one’s career).

The surgeon might look for positive diagnostic indicators, including an actual disfigurement (minor or major) and emotional stability, while being wary of poor prognostic indicators like patients with repetitive psychiatric illnesses, patients who have received multiple cosmetic surgeries with which they are dissatisfied, or patients who have decided to have surgery on a “whim.” If the surgeon does not feel the patient is a good candidate for cosmetic surgery, it is his or her responsibility to refuse treatment.

“If you are not a good candidate for cosmetic surgery, a doctor who saves you from going under the knife is doing you a great service,” says Dr Arthur Perry, board certified plastic surgeon and Clinical Associate Professor of plastic surgery at the Robert Wood Johnson Medical School in New Brunswick, NJ. “You should heed that advice well, and think carefully before shopping around for another surgeon who is willing to accept your risks. The benefits of surgery should far outweigh the risks.”

“Each week I refuse to operate on patients for cosmetic surgery due to unrealistic expectations, psychological reasons, or just not an appropriate candidate for the surgery,” says Dr Stuart Linder, Beverly Hills board certified Plastic & Reconstructive surgeon and author of The Beverly Hills Shape: The Truth About Plastic Surgery. “We board-certified plastic surgeons have the responsibility to provide ethical care that meets the high standards of the American Board of Plastic Surgeons.”

For some, cosmetic surgery can have detrimental psychological effects, or can at least fail to produce the desired psychological change. For some, especially those with BDD, cosmetic surgery can lead to a series of unsatisfactory surgeries and can become a kind of addiction. For most people, however, a carefully considered cosmetic surgery with a qualified surgeon results in positive change in body image and even quality of life. If you know you have one of the disorders discussed here, you should know that you are not a good candidate for cosmetic surgery. If you are not aware of your disorder, it is up to your surgeon to spot it. If one surgeon tells you that you may not be a good candidate for cosmetic surgery, think carefully before finding a doctor who will do anything you want – at any cost. Cosmetic surgery should be a positive experience with positive results. It is between you and your physician to ensure that happens.

* A portion of this article was adapted from “Psychological Aspects of Plastic Surgery” by Dr Anthony P Sclafani, MD.

Liberty Craig - Editor

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