Is My Cosmetic Problem Bad Enough That I Need Surgery?
After you have selected your plastic surgeon(s) to consult, the next issue is describing or telling your problem or concerns to them. One of the most frequent statements that I hear patients say when I ask what brings them in is….’Now I don’t want you to think I am vain….’ or ‘You might think this sounds silly but….’ Trust me, on either count, I won’t! This is what I do for a living….people consider cosmetic surgery because things bother them….not their neighbor, friends, or spouse. Cosmetic surgery is all about, in the end, making you feel better about yourself. Cosmetic surgery is, in essence, self-image improvement surgery. The outward changes effected by plastic surgery may be big or small but the impact on one’s self-image can be enormous.
Therefore, the most important question is what physical problem bothers you. Why it does and how it does (although I always patiently listen) does not really matter. The very fact that it does is significant enough. While it is always written in plastic surgery textbooks and articles on patient selection for surgery that you should be certain that the patient’s motivation is their own and not someone else’s, I have yet to encounter any patient who has told me directly that they are doing this only for their husband, boyfriend, wife etc. I think it is virtually impossible to determine a patient’s motivation before surgery. Our time with patients is very short and we really never get to know them very well….or at all. And there is no test, short of an in-depth psychiatric assessment, that can pinpoint the ‘problem’ patient or patients that shouldn’t have cosmetic surgery. We may find out…after surgery….some motivating factors or personal characteristics/problems that had we known beforehand may have dissuaded us from undertaking the surgery. (and all plastic surgeons have had these unpleasant surprises)
I always tell patients that….if it bothers you….then it is a problem. My task as a plastic surgeon in assessing a patient’s motivation is to get a feel for the ratio of the problem to the concern. This is the only barometer that I know that gives some insight into the ‘appropriateness’ of any patient for cosmetic surgery. Big problems are easy….if you have a large hump on your nose or a flat chest for example…..there is little concern about a problem/concern imbalance. Conversely, if the size or shape of your nostrils, for example prevents you from going out in public or makes you a recluse at the office…..then we have a significant concern/problem imbalance…..and plastic surgery alone is not really to change a self-image whose problematic symptoms have been merely tranferred to a physical location. Such patients are rare and are relatively easy to spot…and avoid. (and are often referred to someone else!) The subtler version, but just as potentially problematic, is the patient whose physical flaws while present are slight. For example, …my one ear sticks slightly out more than the other…..can you see how this bulge on my hip sticks out more than the other? While these physicial flaws are real, the margin of error for an operation to achieve perfect symmetry is very small……otherwise known as a poor benefit/risk ratio.
Dr Barry Eppley
Indianapolis, Indiana