The classic phrase, “Beauty is only skin deep”, belies the truth. The relevance and importance of beauty is pervasive, penetrating deep into all societies. It has long been acknowledged that people who are deemed physically attractive have a societal advantage. Numerous studies, using photographs, have shown that those who are judged to be physically attractive receive preferential treatment in virtually every societal situation examined including education, employment, medical care, legal proceedings and romantic encounters. Clearly, appearance does matter. This emphasis on beauty is the engine that drives the demand for modern day cosmetic plastic surgery.
While the role of beauty in society is readily apparent, the relationship between cosmetic plastic surgery and its psychological effects is not as clear. The early assumption was that external physical changes lead to psychological improvement. (e.g., higher self-esteem) Such assumptions gave medical credibility to cosmetic surgery. In this regard, cosmetic surgery was viewed similar to a psychiatric or psychological intervention.
In the middle of the last century when cosmetic surgery began to emerge from the shadows of medicine, it was felt that rampant psychopathology existed amongst cosmetic surgery patients. As psychiatry developed and more standardized assessments were used ( e.g., DSM-IV) the presumed psychopathology of cosmetic surgery patients was not nearly as extensive as previously believed.
Today, it is fairly well known that the satisfaction of most cosmetic surgery patients is high. I have seen studies that show two thirds to 90% of all the cosmetic surgery patients were satisfied. Most would recommend cosmetic surgery to a relative or acquaintance and most stated that they would do it again. Satisfaction levels do differ, however, based the type of procedure with breast reduction, breast augmentation, and facelifts being quite high, while rhinoplasty, for example, is lower.
But what is the psychological effect of cosmetic plastic surgery? Contrary to popular belief, one’s personality or psychological characteristics doesn’t change after surgery. Numerous studies have shown that you end up after surgery just who you were before surgery. This is why one should never expect their lift to change or improve after an external physical change. This is also why many lottery winners do not end up ‘happier’ after receiving a lot of money. (that they didn’t really earn) Conversely, one’s personality traits doesn’t seem to influence the psychological outcome of cosmetic plastic surgery either. In my Indianapolis plastic surgery practice, I can safely say that some people with unusual personalities can be completely satisfied with cosmetic surgery results while more ‘normal’ patients often are prone to complaints. In short, you can not accurately predict beforehand whom may be unhappy afterwards.
There are, however, some patients who are definitely at higher risk for after surgery dissatisfaction. Males, younger patients, and patients on depression or anxiety medications are well known examples. Marital and relationship discord is a high risk for a negative psychological outcome, but this is virtually impossible to know beforehand in most patients. Some plastic surgeons consider a patient who is disproportionately affected by a small deformity to be high risk also.
The most recognized problem patient that should be avoided in cosmetic plastic surgery is body dysmorphic disorder. (BDD) These patients are virtually impossible to satisfy. This is known in the older psychiatric literature as dysmorphophobia and is defined as a markedly excessive preoccupation with a very mild or imagined physical defect. This preoccupation causes significant distress in relation to their ability to work and interact socially. The incidence of BDD is estimated to be about 5% in any given cosmetic surgeons population and the prevalence in the general society is less than 1%. BDD patients tend to be younger, single and/or separated and unemployed. They have an increased tendency for anxiety disorder, depression and OCD and they are more likely to believe that surgery will somehow change their life. As obvious as this type of patient sounds to spot, sometimes they are not. I have seen some that are quite eloquent and well read and quite convincing that a little change here or there is all they need. Their obvious BDD, unfortunately, only becomes apparent after surgery.
Dr. Barry Eppley
Indianapolis, Indiana