There was a fascinating story on National Public Radio (NPR) on May 8 about social media/selfie body dimorphism and the impact of snapchat and Instagram filters on the beauty image of people in their 20s and 30s. Several doctors were interviewed about the changes they see in the market due this purely elective set of injections and procedures that help young, primarily women, achieve smoother skin, tippier and more rounded noses, and fuller cheeks. There are some doctors that will not accommodate these procedures, seeing them as unethical – but many more who will and end up with a lucrative market of people spending up to several thousand dollars a year becoming ‘beautiful.’ The debate around ethics is a particularly sensitive one in our field, as almost every procedure we see is technically elective. Obviously, for those TSLMS members who work primarily in reconstructive surgery and other services, this is not true – but for the rest, it largely is.
The question for our field as a whole, as to the ethics, will not be settled today or deeply addressed here. However, it is brought up to raise the question: how can we approach cosmetic and aesthetic procedures as both functional and beauty enhancing?
An Eroded Stigma: Plastic Surgery
Psychology Today has a fantastic article that should be mandatory reading in medical school, “Why Undergo Cosmetic Surgery?”
One of the clearest benefits of cosmetic surgery is that it improves appearance. If it didn’t, nobody would spend the money or go through the pain associated with these procedures. Most of us would rather be more than less attractive than our peers because attractiveness confers all kinds of benefits, including the ability to compete for higher-value partners. But we don’t cease efforts to improve our appearance as soon as we secure a partner. As regular readers of this blog will know, humans are motivated to keep a partner just as much — if not more so — than they are motivated to acquire a partner.
There was also a National Institutes of Health published paper on the topic, looking at “Factors That Motivate People To Undergo Cosmetic Surgery.” In it, the authors point out that “measures of self-esteem, life satisfaction, self-rated physical attractiveness, religiosity and media consumption” matter.
Two factors emerged from a factor analysis of their attitudes toward surgery: likelihood to undergo, and benefits of undergoing cosmetic surgery. Females with low self-esteem, low life satisfaction, low self-rated attractiveness and little religious beliefs who were heavy television watchers reported a greater likelihood of undergoing cosmetic surgery. Stepwise regression analysis with the two attitude factors as criterion variables showed two major predictors for likelihood: religiousness and low self-esteem, and four major predictors for benefit: religiousness, media consumption, life satisfaction, and sex. The role of religion is considered in this context.
Essentially, these articles, which are both scholarly in nature, agree that the stigma that used to exist around getting cosmetic procedures has largely disappeared. A fact backed up by the NPR story cited above.
When Procedures Help More Than Beauty
The National Institutes of Health also published a fascinating paper “Does Cosmetic Surgery Improve Psychosocial Wellbeing?” The authors reviewed a substantial amount of literature in the field and found that while there is a definite subsection of the population of men and women who get procedures done who become more healthy overall, there are still a lot of people for whom procedures create even worse issues.
Both men and women are becoming increasingly concerned about their physical appearance and are seeking cosmetic enhancement. Most studies report that people are generally happy with the outcome of cosmetic procedures, but little rigorous evaluation has been done. More extensive (“type change”) procedures (eg, rhinoplasty) appear to require greater psychological adjustment by the patient than “restorative” procedures (eg, face-lift). Patients who have unrealistic expectations of outcome are more likely to be dissatisfied with cosmetic procedures. Some people are never satisfied with cosmetic interventions, despite good procedural outcomes. Some of these have a psychiatric disorder called “body dysmorphic disorder”.
For almost everyone else, these procedures actually do accomplish both beauty and function. However, when they do not, it might behoove you to recognize the signs and symptoms of a client that is worth turning down and guiding toward a different kind of help.
Recognizing Body Dysmorphic Disorder in Your Clients
As noted by the Mayo Clinic:
Body dysmorphic disorder is a mental disorder in which you can’t stop thinking about one or more perceived defects or flaws in your appearance — a flaw that, to others, is either minor or not observable. But you may feel so ashamed and anxious that you may avoid many social situations. When you have body dysmorphic disorder, you intensely obsess over your appearance and body image, repeatedly checking the mirror, grooming or seeking reassurance, sometimes for many hours each day. Your perceived flaw and the repetitive behaviors cause you significant distress, and impact your ability to function in your daily life. You may seek out numerous cosmetic procedures to try to “fix” your perceived flaw. Afterward, you may feel a temporary satisfaction, but often the anxiety returns and you may resume searching for a way to fix your perceived flaws.
Cosmetic and aesthetic procedures are not going to help these individuals. And while the large majority of us do not practice counseling or psychology, we owe it to the people we see who are obviously struggling to get them help instead of just enabling their disease – or do we?