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| Articles : Cosmetic Surgery News : Psychology of plastic surgery |
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7% of patients suffer from "body dysmorphic disorder."
1 in 12 candidates would be better served by therapy. Here's how a leading doctor decides who goes under the knife -- and who shouldn't. Getting nipped and tucked used to be viewed as the ultimate in vanity. Today, cosmetic surgery seems to be the buzz on practically everyone's Perlane-plumped lips. Nearly 7 million cosmetic procedures were performed in the United States in 2002, both surgical (face-lift, tummy tuck, implants) and non-surgical (Botox, chemical peel), according to the American Society of Aesthetic Plastic Surgeons -- an increase of 228% from 1997. The same is true throughout the CosmeSurge centers in the Middle East. But with this growing trend comes concern that surgically altering one's looks may not always be psychologically sound. Although experts believe emotionally stable patients with realistic expectations can boost their self-esteem with a change in appearance, for others a procedure can add to stress or amplify psychological problems. An estimated 7% of patients suffer from "body dysmorphic disorder," in which they are so obsessed by a minor flaw in their appearance that cosmetic surgery alone does not offer the answer. So how do surgeons determine who is a good candidate? Max Sawaf, MD medical director of CosmeSurge shares some typical cases from his Dubai practice and discuss them from a mental health perspective. A 33 year mother who is 46 kg overweight comes for liposuction. She is depressed because of her weight. Dr. Max: Liposuction is not the solution for obesity. She needs to be referred to a nutritionist and her depression be addressed. Some women with depression use food to elevate their mood. I would counsel her to exercise instead. In certain obese patients, I may advise to have gastric banding provided conservative therapy failed. The mother of a teenager comes to the office with her child and says, "My daughter wants to be a model, so we have to get this nose fixed." Dr. Max: When the parent is doing all the talking and the teenager, the potential patient, is not involved, I get concerned that it is the parent's issue rather than the child's, and [in that case] surgery is not appropriate. However, if there is a balanced discussion between parent and teen, the child is self-confident and understands what is going on and is realistic, then I would probably be in favor of surgery. A big-eared father brings in his big-eared son for corrective surgery and has his own ears operated on first to give his son courage. Dr. Max: Both are perfect patients. The dad has been teased about his big ears and doesn't want his son to suffer. He has the surgery himself to show his son it's OK. That's a healthy situation. A girl wants breast implants for a high school graduation present so she can look like Britney Spears. Dr. Max: A girl with normal breasts who wants to look like someone on TV is a patient you say no to. On the other hand, if she has an absolutely male physique, surgery can be a positive thing, as long as you take the time to discuss it over several visits and make sure she and her family understand the complexities of the procedure. As long as the girl has a positive attitude and a supportive family, the surgery can help her feel more feminine and comfortable with her peers. A 22 year old girl comes to the office wanting her eyebrows removed and replaced with tattoo in the form of an arch. She brings with her the photograph of a Lebanese actress who has the same shape she wants. Dr. Max: This is a fad that will not pass the test of time. It is totally inappropriate and the young girl should be advised to accept her present look and stay away from these fads. A 30 year old mal comes in with enlarged breasts. He is too embraced to remove his shirt in the presence of my female nurse. Dr. Max: Gynecomastia or breast enlargement affects seven percent of men and can be very embarrassing to them. A simple liposuction can restore their confidence and allows them to go to the beach or swimming pool. The fact that he was too embarrassed to have the female nurse take his photographs is very common and understandable. A 50-something man emerging from a bitter divorce wants face and neck surgery so he can start dating with confidence. Dr. Max: If he's doing it for his own self-esteem and realizes surgery alone won't guarantee success in a relationship, it's OK. However, if he's still suffering from the divorce and doesn't have enough emotional reserves to deal with the stress of surgery, I would delay the procedure. A young woman seeking nose surgery shows up with a picture of an actress she'd like to resemble. Dr. Max: A lot of plastic surgeons ask patients to bring in pictures of noses they find attractive. But if they bring in a photo of a feature that isn't consistent with the shape of their face, you have to point that out. You have to lower their expectations. When Elvis died, plastic surgeons' phones rang off the hook with calls from people who wanted to look like him. Obviously, it was unrealistic, and for the most part they were turned down. A man in his 30s is so preoccupied with the wrinkles around his eyes that he does not want to be seen in public because he thinks everyone is staring at him. Dr. Max: This person needs psychiatric help. He may be suffering from body dysmorphic disorder. A cosmetic surgeon will never satisfy this man, and surgery will never correct his emotional difficulties. A woman repeatedly visits a plastic surgeon over a period of years, first for eye surgery, then for a face-lift, then liposuction (body-contouring surgery). Dr. Max: If the timing seems appropriate, if it is different areas of the body, if she is building a relationship with one doctor over a long period, it's probably all right. I would be more concerned about the mental health of a patient who is hitting Doctor A, then Doctor B and Doctor C, having multiple or repeat surgeries with multiple doctors. That might be an overly anxious patient who is never satisfied. A woman in her 40s who has always been a size 16 below the waist and a size 10 above wants liposuction on her hips and thighs so she can look more balanced and have an easier time finding clothes. Dr. Max: A lot of women have a two-, three- or four-size differential between their top and bottom halves. If you help them improve the contours so the halves match, it can be a positive thing. We're not talking about turning a size 18 bottom into a size 2. But making her body more proportional can help a patient feel much better about herself. A 35 year old Middle Eastern woman who was just divorced comes to the office wanting to have her skin whitened and a facelift. Dr. Max: I am always against skin whitening since it is unnatural and dangerous. Her request for a facelift at this early age and given her recent divorce makes me say no to her request. A 70-ish woman who works in real estate wants a face-lift so she will be more appealing to potential clients. Dr. Max: That's not inappropriate; she wants to look as good as she feels inside, and that is mentally healthy. People who look older but don't feel older are perceived as being older. Our society, which at one time revered older people, now looks down on them with some disdain. Age is considered a bad thing. However, if the older man or woman is in poor physical condition, with heart disease or severe diabetes, then that is a person who is in denial about his or her situation and would be an inappropriate patient. Dr. Max Sawaf advises patients to reflect on their reasons for seeking treatment. |
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