Is there a link between plastic surgery and self esteem and body image? Absolutely!
Imagine, losing a breast to cancer, or multiple fingers to an accident, you cannot tell me that a patient won’t feel more whole, complete, and ‘normal’ after reconstruction of these problems. Why, then, is it so hard to imagine fixing the nose you inherited from your parents, or adjusting the difficulty you have fitting into a swimsuit top, won’t have an effect your self esteem.
To be sure there are people in this world who have unrealistic expectations and ideas as to how they should look. Likewise, there are those who think that if they only had a newer car, nicer house, skinnier husband, bigger breasts, or a cuter nose their life would be much better.
Body dysmorphic disorder (BDD) is a condition of perceived ugliness. Enrico Morselli, a psychiatrist in Italy, first described BDD more than 100 years ago (1), noting that “The dysmorphophobic, indeed, is a veritably unhappy individual, who in the midst of his daily affairs, in conversations, while reading, at table, in fact anywhere and at any hour of the day, is suddenly overcome by the fear of some deformity … (which) may reach a very painful intensity, even to the point of weeping and desperation”
The incidence of BDD is reported at between o.7% and 13% of the general population(2). Patients with BDD also most commonly had the associated condition of depression. It is likely that more people visiting the plastic surgeon have issues with body image than any other medical specialty.
So what does this mean? Does it mean that every patient needs to be referred to a psychiatrist for assessment prior to undergoing plastic surgery? Hardly, but a few pointed questions or observations may tip of the surgeon that this person has unrealistic expectations. Have I ever sent patients to be assessed by their psychologist or psychiatrist? Sure. And surprisingly, once the problem is identified and managed (usually through therapy and antidepressants) these patients can enjoy the benefits of plastic surgery too.
With proper instruction expectations can be managed. Outcome expectations can be adjusted to the point were the patient can then decide whether the benefits of surgery will outweigh the risks and whether the expected outcome will meet their educated expectations.
1.Morelli E. Sulla dismorfofobia e sulla tafefobia: due forme non per anco desecrate id Passé con idee fisse. Boll R Accede Genova. 1891;6:110-119.
2. Phillips KA, Castle DJ. Body dysmorphic disorder. In: Castle DJ, Phillips KA, editors. Disorders of body image. Hampshire: Wrightson Biomedical; 2002. pp.101-120.