The recent tragic demise of pop star Michael Jackson brings forth many images and memories. I was in my youth during the height of his stardom and his music and videos will live with my generation for the rest of our lives. His music elicits memories of where we were at that time and what we were doing. Whatever one may think of him during the latter part of his career, the positive side of his talents will be remembered much longer.
As a plastic surgeon, I am also drawn and intrigued by his physical metamorphosis over the years. While the number of plastic surgery procedures that he underwent is speculative and will never be precisely known, it is fair to say that he had an extreme number of them. Much conjecture has been made as to his motivations for doing so, but only he truly knows for sure. Whatever his reasons where, however, he clearly suffered from body dysmorphic disorder (BDD), a well known form of cosmetic surgery addiction. However, Michael Jackson was not alone when it comes to this psychiatric disorder which manifests in continuous and ongoing plastic surgery procedures to the point of deformity.
BDD is a condition that can affect even an already attractive person. While it initially appears that those afflicted with the disorder appear to be overly vain, in reality they actually feel ugly inside. In essence, they have a significant misperception of reality and don’t see themselves as others do. While this difference in how we look and others see us is actually common, BDD is an extreme expression of it. As a result, BDD victims tend to be withdrawn and need constant reassurance that their looks are acceptable. Because they can never satisfactorily internalize (believe) any outward accolades, they see cosmetic surgery as the only solution to getting rid of their imagined ugliness.
Contrary to what one may think, it is not initially easy to spot a patient with BDD. Because some procedures require multiple stages or have naturally high potential rates of revision, a patient who wants or undergoes multiple procedures does not necessarily throw up a red flag. Many patients after a plastic surgery procedure are very critical of the result in the understandable interest of getting the best result and return on their investment. This makes it difficult sometimes to tell someone that this is as good as you can do and they should live with their current level of improvement. I have learned over the years that the best way to control the ‘perfectionist’ is to not do revisional surgery for free. This helps the patient place a ‘value’ on their pointsd of critique. In the case of Michael Jackson, where money was no object, there is virtually no stop sign in this regard.
While it is true that an ‘ethical’ plastic surgeon should stop operating at some point and refer a patient for psychological counseling, that approach becomes very difficult when the patient is a celebrity. (it is difficult even when the person is not a celevrity for that matter) And even if the BDD patient is turned down by one plastic surgeon, there is always other plastic surgeons who will perform ‘revisional’ cosmetic surgery an unlimited number of times. As long as the patient has money, they can always find their next cosmetic surgery fix.
But BDD appears to have two different variations. Some BDD patients (Type 1) keep operating on the same things in search of perfection, often until they develop a deformity or problem. Other BDD patients (Type 2) seek to literally change their appearance, undergoing operations on different areas with the objective of creating a new look or to be a different person. Type 1 BDD patients are more common and I have seen several in my Indianapolis plastic surgery practice over the years. Type 2 BDD patients, such as Michael Jackson, are extremely rare even though they seem more common due to the media attention that they garner.
Dr. Barry Eppley