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."