Who doesn't want to look younger, thinner, and prettier? With plastic surgery so readily available, you can get rid of that stubborn few pounds on your lunch hour and "extreme makeovers" are a viable "reality" television topic.
Sound too good to be true? For some prospective candidates with unreasonable expectations, it just may be, leading plastic surgeons tell WebMD. Just because we all can undergo plastic surgery doesn't mean we all should.
Nearly 6.9 million cosmetic surgical and nonsurgical procedures were performed in the U.S. in 2002, according to the American Society for Aesthetic Plastic Surgery (ASAPS). And the overall number of cosmetic procedures has increased 228% since 1997.
Are you or someone you love a plastic surgery candidate? Or is psychotherapy really what you need?
"Plastic surgeons do their best when they evaluate a prospective patient to see whether what they want is realistic or if there is an underlying emotional problem driving the need for the surgery," says New York plastic surgeon Lawrence Reed, MD.
One such problem may be body dysmorphic disorder (BDD). People with BDD are obsessively preoccupied with a perceived defect in their physical appearance even if others reassure them they look fine. Common obsessions include moles or freckles being too large, acne appearance, or breast size.
According to ASAPS, patients with underlying health or emotional problems may not be good candidates for surgery, and may be dissatisfied with objectively successful surgical results.
But Reed adds, "If someone comes in with pre-existing problems and they are seeing a psychiatrist, you can gently ask, 'Have you spoken to your therapist about your plans for surgery?'"
Together with his staff, Reed looks for red flags among prospective plastic surgery candidates. "If a 60-year-old woman brings in a picture from high school that she wants me to re-create, I get tense because that is not realistic," he says.
There are, however, some very good reasons to undergo plastic surgery, he says. Some people want to look younger so they can get or keep a job, he says
"Appearance may not matter for a college professor or a scientist, but in certain jobs it does matter and plastic surgery can help," he says.
Teenage patients who come in "want to be pretty and you can't hold that against them," Reed says. "Sometimes you do their nose and their whole personality changes because they see themselves as a different person," Reed says. "They still may not get asked out on dates, but their body image is enhanced."
On the flip side, "When kids come in with their parents and the parents do all the talking, I walk away because I want to hear the kids say what they mind about their face or body -- not what their parents mind," Reed says.
According to ASAPS, cosmetic surgery for people 18 and younger represents only about 3% of the overall total of procedures done each year and the most frequently performed surgical procedure was nose reshaping.
In other words, plastic surgery may make you feel better about yourself, but it is not a magic bullet that will change your whole life.
Knowing When to Say No
The relationship begins with a thorough consultation, says Laurie A. Casas, MD, communications chair of ASAPS and an associate professor of surgery at Northwestern University Medical School in Chicago.
"I start by asking, 'How can I help you?'" she tells WebMD. "When they are focused, you are on the right track and then you can delve into their medical, surgical, psychological, and nutrition history."
For example, "I say, 'Look in a mirror at the body part you are considering surgery for and tell me what you think the problem is," she tells WebMD. "If it's a nose and they say, 'I see a huge bump, a crooked nose, and my tip is fat,' and I don't see the same thing, this concerns me because there is no way to meet their goals and meeting patient expectations is the ultimate goal for an aesthetic and plastic surgeon."
"The first red flag is inappropriate expectations and the second is inappropriate self-assessment," agrees Paul Carniol, MD, plastic surgeon and clinical assistant professor of surgery at UMDNJ-New Jersey Medical School in Newark, N.J.
"Someone who is looking at themselves appropriately with reasonable expectations are typically the best candidates, "Carniol says.
Liposuction or removal of fat may pose special challenges.
"If a patient comes in who see-saws their weight -- 50 pounds up and 50 pounds down -- and they want liposuction, I make sure they tell me about nutrition and exercise habits because liposuction is just one moment in time and they have to be able to maintain the weight loss after surgery," Casas says.
"If I remove two to three pounds of fat from their abdomen and they gain 20 pounds, I can't predict where the weight gain will go," she says.
Carniol has this to add: "Most Americans are overweight," he says. "Liposuction does not replace weight loss and it isn't going to make you thin, but we can improve contours at your current weight," he says. "If the outside of your hips have extra bulges and it really affects the way their clothes fit, liposuction can help your clothing fit better and may drop a size and look prettier -- and that's a good thing."
The bottom line? If you are considering plastic surgery, "be sure that the procedure you are asking the doctor to do will meet your goals," Casas says, "Make sure that the surgeon you choose is certified by the American Board of Plastic Surgery (ABPS) and a member of ASAPS," she says.
Published May 20, 2003.