As Seen in The News Journal 8-25-16
With the Rio olympic games underway, we are treated every day to images of the most fit, elite athletes in the world. The athletes’ muscular bodies are sculpted to perfection, without an ounce of excess fat or skin.
Even the venue for the 2016 olympics, Rio de Janeiro, is associated with sun-worshipping bodies that have been toned, tucked, and augmented to the max.
Research has shown that beautiful people are judged as more friendly, competent, intelligent, and trustworthy as compared to those that are less attractive.
Whether we like it or not, in our society attractive people are at an unfair advantage. This is part of the impetus for improving our appearance, by whatever means possible.
Most people would agree that someone involved in a trauma deserves plastic surgery to restore the pleasing appearance of the face.
Similarly, when a baby is born with a birth defect such as a cleft lip, and there is a surgical procedure that can vastly improve the appearance with minimal risk, correcting the defect can change the course of the child’s life for the better.
So, where is the line between “cosmetic” and “reconstructive”? In my opinion, there is none. It is a spectrum, from the baby with the birth defect, to the self-conscious teen with the big ears, to the woman with disabling back pain due to her large breasts, to the mommy whose tummy is wrinkled and scarred after the birth of her children, with the other end of the spectrum being patients who seek excessive cosmetic surgery with unreasonable expectations.
The law of diminishing returns is the point at which the level of benefits gained is less than the amount of money or energy invested. In plastic surgery, this law explains how too many procedures on the same area can give unattractive results, sometimes to the point of looking completely unnatural.
Usually the first few procedures look fantastic. Subsequent procedures can be less dramatic, yet have the same (or increased) risk. With repeated surgeries it becomes very difficult, if not impossible, to restore the scarred, damaged tissue to a normal appearance. It is a very slippery slide.
Prior to performing a “secondary” or repeat procedure on the same area, the surgeon must be very clear about what to expect from the procedure and whether the prior surgery increases the risks of the secondary one, due to scarring, for example. Facelifts are an excellent example of this.
The first facelift usually has excellent, very natural results which “turn back the clock” a decade or more. A secondary facelift 15 or 20 years later can tighten up the skin which has continued to loosen, but may also begin to give the face an excessively wide smile or unnatural tightness of the eyes if not performed conservatively.
The plastic surgeon needs to be part psychiatrist during an initial consultation. An ideal candidate for cosmetic surgery is one who has a clearly identifiable body difference, and realistic expectations for correction.
Beauty can be subjective, so a plastic surgeon has to spend some time to completely understand what bothers the patient and what they hope to achieve in order to recommend the best course of action (or, in some cases, recommend no surgery).
When a patient presents obsessed with a very mild defect in appearance, it could be a sign of Body Dysmorphic Disorder (BDD). Body Dysmorphic Disorder is a mental illness in which a person fixates on minor or imagined flaws in their appearance, spending a great deal of effort to hide or correct them.
It is important to recognize BDD prior to operating on a patient, since having plastic surgery will not make them feel better. The patient will continue to have anxiety and dissatisfaction with their appearance until the underlying illness is treated. BDD is effectively treated in many cases with behavioral therapy and antidepressant medications.
Any surgery that can make someone feel better about how they present themselves to the world is worth considering. Part of that consideration, however, includes the risk/benefit ratio of the procedure.
A procedure with low risk and a high chance of making a significant improvement is ideal. When the risk goes up or the benefit is lower, the patient and his or her plastic surgeon must carefully weigh the decision.