"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.
Phillips and her colleagues studied 200 people with BDD who had cosmetic surgery or minimally invasive cosmetic procedures. Only 2% of them had even slight improvement in their BDD symptoms after their procedures. Even when their obsession eases, Phillips says they often switch their focus to another body part.
Her study also found that, of the 200 patients in the survey, only one-quarter were refused cosmetic treatment at some point by physicians. Surgeons were less likely to turn down surgical treatments than minimally invasive procedures.
The ASPS trains its members to recognize people who may have body dysmorphic disorder, who often have multiple surgeries on the same body part. They will sometimes try to hide the other surgeries, or they will claim previous procedures have been botched and "heap a lot of praise," Haeck says, on the new surgeon, saying he or she will be the one to get it right.
"Any surgeon who has been through this once regrets operating on someone with body dysmorphic disorder," Haeck says. If you're obsessed with any part of your body, consider delaying your cosmetic surgery plans until you've talked to a counselor. Getting clear about those issues may help you appreciate any procedure you eventually decide to get.
Before you get a cosmetic procedure done, you'll consult with your surgeon. At the consultation, you should talk to them about your goals and your motivation for getting the procedure. You should make sure your expectations are in line with the likely results, and that you understand the risks.
Reath says that there aren’t a lot of major health risks if you're in good health. Still, problems can happen.
Liposuction, for instance, can be done safely as long as only a certain amount of fat is being taken out. The risk increases, he says, if the amount becomes excessive.
Doctors also have to be careful not to do too much of anything at one time. "Surgeon fatigue is a consideration," Reath says. "No one is as sharp in their eighth hour as they are in their first hour."
Scar tissue and tissue that dies during the healing process can become an unhealthy issue after multiple surgeries. Breathing problems can happen after too many nose surgeries, and people can have dry corneas, which cause eye damage, from eye lifts. Infection is also a risk with any surgery.