Coping with the changes Psychological aspects of plastic surgery and cosmetic procedures

Cosmetic procedures, including minimally invasive procedures, cosmetic surgical procedures, and reconstructive surgical procedures, have become increasingly popular among men, women and even children in the United States.

This is despite the economic recession and a significant increase in unemployment during the same time period.

According to the American Society of Plastic Surgeons, there was an across the board increase in 2010 from 2009 of all categories of cosmetic procedures. Such procedures include everything from liposuction to tummy tucks, breast augmentation to facelifts, neck surgery to nose jobs, chemical peels to dermabrasion, and laser treatments to Botox and collagen injections.

There were a total of 13.1 million cosmetic procedures performed in the U.S. in 2010; up 13 percent from 2009. This includes 1.6 million cosmetic surgical procedures; up 2 percent, 11.6 million cosmetic minimally-invasive procedures; up 5 percent, and 5.3 million reconstructive procedures; up 2 percent.

They report that $10.1 billion was spent on such cosmetic procedures; up 1.2 percent. Business from repeat patients increased 13 percent, with a 5 percent increase in office-based procedures.

One would assume that patients who undergo such procedures are therefore quite happy. This is true for many of them, with many feeling better about themselves and their lives.

However, people who may be predisposed to depression, anxiety, personality disorders and other psychological issues are more likely to experience an emotional letdown after a plastic surgery procedure.

Often, emotional changes come as a result of dissatisfaction with the procedure or the impact on their life and relationships. Many plastic surgeons have begun to encourage preoperative and postoperative counseling for their patients, something that has already been required and become the norm in bariatric surgery candidates.

Research published in the journal Plastic and Reconstructive Surgery has identified several predictors of poor outcomes, especially for those who hold unrealistic expectations or have a history of depression and anxiety.

The researchers found that patients who are dissatisfied with surgery may request repeat procedures or experience depression and adjustment problems, social isolation, family problems, self-destructive behaviors and anger toward the surgeon and his or her staff.

In particular, the extent to which cosmetic surgery affects patients’ relationships, self-esteem and quality of life in the long-term offers many research opportunities for psychologists, says psychologist Diana Zuckerman, PhD, president of the National Research Center for Women and Families, a think tank that focuses on health and safety issues for women, children and families.

Some studies have even gone as far as linking dissatisfaction with cosmetic surgery procedures to suicide.

For example, in one study, the National Cancer Institute found in 2001 that women with breast implants were four times more likely to commit suicide than other plastic surgery patients of the same age as the women who underwent breast implants, says Zuckerman.

Various studies have indicated that the type of procedure and the area of the body involved are correlated with significant differences in the degree of satisfaction with the procedure and propensity in the patient to have emotional difficulties.

Some studies result in dramatic statistics, with as many as half of those seeking “nose jobs” or rhinoplasty suffer from clinical depression, and nearly a third has attempted suicide.

Dr. Henri Gaboriau, of the Department of Otolaryngology, Head and Neck Surgery, at Tulane University in New Orleans suggests that such studies are intended to help doctors decide in which cases plastic surgery is appropriate.

Focusing attention more on the fact that this is an issue deserving of doctors’ attention rather than using statistics in a way that may stigmatize, suffice it to say that a very significant percentage of patients who are seen by dermatologists and cosmetic surgeons suffer from anxiety, substance abuse, addictive personalities, personality disorders and even suicidal tendencies.

Research findings demonstrate a high level of conflict between surgeons and patients suffering personality disorders after surgery, and that these patients were more likely to seek legal redress.

A special area of concern are patients who suffer from a mental illness which is directly related to their appearance. They find themselves seeking cosmetic procedures rather than psychotherapy and psychiatric treatment. These patients include those individuals with anorexia, bulimia and especially body dysmorphic disorder (BDD). Individuals who suffer from BDD are characterized as having a preoccupation with an aspect of one’s appearance, and attempt to repeatedly change or examine the offending body part to the point that the obsession interferes with other aspects of their life.

They may have an imagined defect in appearance or markedly excessive concern with a minor physical flaw. These include a diversity of imagined flaws of the head, (including too much or too little hair), ears, skin, shape of the face, or other facial features.

Various body parts may be focused upon, including genitals, breasts, buttocks, extremities, shoulders, and overall body size.

Such preoccupation persists even after significant and repeated reassurance. BDD sufferers, especially those who remain undiagnosed, fail to recognize their problem originates in their brain. Instead, they mistakenly believe that if they could only fix their “deformed” physical appearance, their life will be transformed. So they seek out plastic surgery, assuming that the surgeon will immediately see how severe their defects are, and will correct them.

It is not surprising, then, that patients with body dysmorphic disorder are found commonly among persons seeking cosmetic surgery. Several studies show that 7 to 12 percent of plastic surgery patients have some form of BDD, and that the majority of them do not experience improvement in their BDD symptoms as a result, often asking for multiple procedures on the same or other body features.

They may end up even more obsessed with any imperfections left after the surgery, and obsess about any scars or the slightest asymmetry of the result. Others shift their focus to another perceived defect that was not addressed by the surgery.

In either case, the BDD patient often doesn’t take long to seek out the next surgery. These patients are likely to become what the world at large perceives as “plastic surgery addicts.”

Many doctors who study BDD believe that plastic surgeons come into contact much more often with BDD patients than do psychologists or psychiatrists. It is a surgeon’s ethical responsibility to take into account the mental and emotional state of his patient before agreeing to operate, and most plastic surgeons are very aware of the nature and symptoms of BDD.

Therefore, many people who suffer from BDD are finally diagnosed as a result of being referred by their plastic surgeon to a psychologist or psychiatrist. It is important for all plastic surgeons to examine the nature of their patients’ dissatisfaction with their appearance, such as whether they may have an excessive concern with a body feature that appears normal to nearly anyone else.

Plastic surgeons and other doctors who come into contact with patients unhappy with their appearance need to be aware of which patients may not adjust well psychologically or psychosocially after surgery, and understand their patients’ internal motivations for surgery or other cosmetic procedure.

Dr. Lou LaPorta is a licensed psychologist in Spring Hill who writes regularly for Hernando Today. He can be e-mailed at

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