"It’s acceptable, expected, and you can get it on your lunch break," says California State University San Marcos women's studies professor Natalie Wilson, PhD.
How much is too much? At what point has someone gone too far?
David Reath, MD, a plastic surgeon in Knoxville, Tenn., says he doesn’t see a lot of people wanting extreme amounts of cosmetic surgery, but it does happen and it's not always easy to recognize at first.
"Sometimes you start working with someone who is reasonable, and the more you work with them, you begin to realize you will have to extricate yourself," he says.
Knowing if there is a problem starts with figuring out why someone wants the surgery.
It's not uncommon for people to have two or three surgeries done at once, according to Phil Haeck, MD, past president of the American Society of Plastic Surgeons.
Wilson has also heard stories of some practices that "up sell" procedures and offer credit plans while reducing prices for multiple procedures."Not all surgeons do that, and some turn people away," Wilson says. "But that is how they make their money -- by doing surgery."
She sees a subtle change in recent years in how people feel about physical appearance, fueled by airbrushed media images. Some people also get hooked on compliments and praise that come from the results. "It makes us feel better and want that high again," Wilson says.
Of course, not everyone who seeks cosmetic surgery is vulnerable to that. Part of the reason it is difficult to know how much is too much is that it varies from person to person, Reath says.
Determining what procedures can and can’t be done safely is the surgeon's call. "You have to make sure it is a reasonable operation and the patient has appropriate motivation and knows what she is getting into," Reath says.
People with BDD obsess on a flaw that is minor or imagined. Katharine Phillips, MD, director of the Body Dysmorphic Disorder Program at Rhode Island Hospital, says that people with the disorder look normal, and are often considered beautiful. But they don’t see themselves that way. Instead, they obsess about their perceived flaw. "It is very distressing and can sometimes make them housebound," she says.
People who have BDD sometimes have the same body part operated on multiple times. Phillips says that surgery is rarely effective since mental health is the root of the problem.