Television makeover shows like The Swan and Extreme Makeover portray contestants as delighted with the results of their plastic surgery and ready to begin new, improved lives. But for the millions of cosmetic-surgery patients whose transformations aren't televised, the aftermath of a procedure can be a bit more complicated, including feelings of depression and letdown.
"Some people have this fantasy that if they change their bodies, they'll change their lives," says Ann Kearney-Cooke, PhD. "That perception is reinforced by the media. Unfortunately, it's not that simple and can result in a lot of disappointment for certain patients."
Kearney-Cooke is a psychologist and author of Change Your Mind, Change Your Body: Feeling Good About Your Body and Self After 40.
While research shows that 85%-95% of people who have elective cosmetic surgery are ultimately satisfied with the results and report improvement in their body image, it can take a while to get to this point.
The period immediately following the surgery is a particularly vulnerable time for many patients. Some plastic surgeons, in fact, talk about the "third-day blues," referring to the third day after surgery, when patients have regained some of their physical stamina but are still bandaged and black and blue.
"I don't think a lot of patients understand how banged up and bruised they'll be after surgery," says David B. Sarwer, a psychologist at the Center for Human Appearance at the University of Pennsylvania School of Medicine. "A lot of these patients tend to be busy and active. Recovering from surgery shuts your life down for a few weeks."
The majority of patients do feel better, physically and emotionally, after two or three weeks. Those that continue to be unhappy or depressed probably had unrealistic expectations in the first place, Sarwer tells WebMD.
"If you're expecting a Cinderella-like transformation you're likely to feel let down," he explains. "A cosmetic-surgery procedure is not going to save a failing marriage, change your social life, or cure emotional problems."
Sarwer adds that people who want to fix a very specific physical trait -- such as a bump on their nose or love handles -- are usually more satisfied than people who go to a surgeon's office with an attitude of "I'm ugly. You're the beauty expert. Fix me."
Choosing the Right Patient
While there is no standard protocol for screening patients ahead of time, many plastic surgeons, including Miami surgeon Stephan Baker, MD, believe patient selection is critical. He meets with patients three times before operating in order to establish realistic expectations.
"This is not like surgery for appendicitis, where you don't care how the patient feels about it because it has to be done," says Baker, a spokesman for the American Society of Plastic Surgeons (ASPS). "This is emotional surgery and it's very important for the patient to be honest with themselves, to understand the likely outcome, the potential complications, and their own emotional reserves."
Baker asks patients what is driving them to have surgery and what their expectations are. He often turns people away if they think fixing a feature will also fix other problems, or if a patient seems like "one of the Michael Jacksons of the world."
"I am very hesitant to operate on anyone who has had the same feature fixed twice already," Baker tells WebMD.
Imagined Ugliness Syndrome
People who get repeated surgeries on the same feature possibly suffer from a psychological condition called body dysmorphic disorder (BDD), also known as "imagined ugliness syndrome." Body dysmorphic disorder, which affects 7%-12% of cosmetic-surgery patients (men and women equally), is characterized by an obsession with an imagined physical flaw to the point that it can interfere with normal functioning. Someone with body dysmorphic disorder might avoid social situations because they feel too ugly to be seen, or compulsively try to hide the offending feature with clothing or gestures.
Cosmetic surgery doesn't help people with body dysmorphic disorder and is not advised. "Surgery doesn't work because the physical flaw isn't the real issue." says Kearney-Cooke. "BDD is a psychological problem that needs to be treated with antidepressant medications and behavioral psychotherapy."
Kearney-Cooke worries that the emphasis on body perfection is at an all-time high in our society, creating more dissatisfaction than ever among the general population. "It's no longer just rich people and actresses who are getting plastic surgery," she says. "It used to be that the rest of us looked around and saw people who were 45 looking like they were 45. Now, it's our neighbors who look 35 at age 45 because they've had some kind of cosmetic procedure. It puts pressure on all of us." According to the ASPS, 9.2 million Americans had cosmetic surgery in 2004, up 5% from 2003.
While she is not opposed to cosmetic surgery, Kearney-Cooke emphasizes that it should be done as part of a larger self-improvement plan, not as the answer to an otherwise unfulfilling life.
"I have a patient in her 50s whose husband left her recently," she says. "She got her eyes done because she's dating again and wanted to look better, but she's not expecting that alone to change her life. The important thing is that she is also in therapy, working on herself in other ways, and examining what went wrong with her marriage."
So much of cosmetic surgery is about looking for approval outside yourself, says Kearney Cooke. "It's the people who have a sense of balance, who can incorporate surgery into the bigger picture -- which means also looking within one's self to develop self-confidence and a healthy body image -- who are going to feel most satisfied in the long run."