Motivation for Surgery

Posted Tuesday, September 11, 2007 to PROFILES > Plastic Surgery

Posted by The Original Anti-Aging & Cosmetic Surgery Magazine

Los Angeles psychotherapist Neil Zanville discusses the psychological impact of cosmetic surgery.

My wife, a plastic surgery consultant and patient advocate, frequently discusses with me the complex role plastic surgery plays for the individual and our society in general. For many years, the desire to improve one;s appearance was considered a superficial gesture limited to the affluent. Plastic surgery was discussed in secret or speculated on when a Hollywood personage suddenly resurfaced looking years younger or with figure enhanced. A frequently voiced argument against plastic surgery was to accept the way you look - beauty lies within. But what of those born with less than attractive features, by society's standards that they have forever kept them on the sidelines? They expected to accept their situation even if they struggle with self image and psychological pain? These are not easy questions to answer. Obviously, it comes down to individual choice.

Cosmetic surgery is now out of the closet. Once considered the realm of the rich and famous, cosmetic surgery is now actively pursued by a broader spectrum of society.

If a patient is conflicted over his or her appearance and has associated to it negative psychological meaning over a lifetime, cosmetic surgery without therapy may be ill advised. Of what benefit is a surgical procedure if there remains a psychological malignancy that causes that patient to view themselves in a distorted fashion? I'm suggesting that if your appearance has caused you considerable psychological pain, you also seek therapy to address that conflict; try to process all the attendant feelings and ascertain its meaning; seek to resolve these conflicts and then consider how surgical changes might affect you.

Often, cosmetic surgery can have dramatic positive results that hours of therapy alone might fail to provide. Together, they can create a formidable effect.

Who Shouldn't Have Surgery?

Psychologically speaking, who is not a good candidate for cosmetic surgery? Body Dysmorphic Disorder (BDD) is a particularly debilitating illness in which a person may spend hours every day focusing and obsessing on a perceived defect in their appearance. The perceived defect, often unnoticeable to anyone else, may result in that person being unable to function at work or enjoy a normal relationship, as it commands so much of their time and energy BDD is especially painful to those afflicted as they receive little empathy from others. Frequently, people suffering from BDD will seek out surgeon after surgeon to correct their perceived defect. Even if they can find a surgeon willing to perform the unnecessary procedure, they are often displeased with the result and will then focus on that. The emotional and behavioral consequences associated with BDD can be devastating. (Readers seeking more information on BDD are referred to The Broken Mirror, Understanding and Treating Body Dysmorphic Disorder by Katherine A Phillips, MD)

Most Americans are more familiar with the eating disorders Anorexia Nervosa and Bulimia Nervosa which have received more attention than BDD. Anorexia Nervosa is defined as a refusal to maintain body weight at or above a minimal normal weight. It is characterized by an intense fear of gaining weight or becoming fat, even though underweight. The patient's perception of body weight or shape and the correlation to self esteem is grossly exaggerated; the patient is in denial as to the seriousness of the current low body weight. With Bulimia Nervosa, there are recurrent episodes of binge eating characterized by a lack of control. In order to prevent weight gain, the patient may self induce vomiting, use laxatives, diuretics, enemas, medications or try fasting and/or excessive exercise. Again, one's self evaluation is unduly influenced by body Shape and weight. For such people, liposuction or other surgical procedures may seem appealing. People with eating disorders have a damaged dissonant relationship with their sense of self and how they relate to others, which no surgical procedure can correct.

BDD and eating disorders pose obvious concerns for those seeking cosmetic surgery. Additionally, those who experience the following would be well advised to seek out medical, psychiatric or psychological counsel before considering cosmetic surgery:

Mood Disorders (major depression, bipolar disorder, dysthymic disorder)

Anxiety Disorders (panic disorder, social anxiety disorder, agoraphobia, obsessive compulsive disorder, post -traumatic stress disorder, generalized anxiety disorder,

Substance-Related Disorders (drug abuse or dependence)

Somataform Disorders (body dysmorphic disorder, hypochondriasis) physical complaints that aren't fully explained by a medical condition

Personality Disorders (paranoid personality disorder, schizoid personality disorder, schizotypal personality disorder, antisocial personality disorder, borderline personality disorder, histrionic personality disorder, narcissistic personality disorder, avoidant personality disorder, obsessive compulsive personality disorder)

Psychotic Disorders (delusional disorder, schizophrenia, schizoaffective disorder)

Ficticous Disorders intentional production or feigning of physical or psychological signs or symptoms

Any patient experiencing suicidal tendency is especially directed towards therapeutic help.

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