Post Cosmetic Surgery Depression and Body Dysmorphic Disorders
By: Shervin Naderi, MD, FACS
Board Certified Facial Plastic Surgeon
Undergoing elective cosmetic surgery can be a physically and mentally challenging ordeal. While most surgeries are due to necessity such as trauma or cancer, cosmetic surgery patients are otherwise healthy patients who choose to undergo surgery. Essentially Plastic Surgeons take healthy patients, put them through the meat grinder, make them bruised and swollen and distorted and give them pain mixed with numbness, all in the hope of improving what the patient perceives as a cosmetic issue.
Obviously there are various degrees of this. You can argue that a simple upper eyelid blepharoplasty is a relatively benign surgery with a benign recovery – if everything goes well and the surgeon is skillful. You could also argue that a total body lift combined with a facelift and browlift and breast reduction is certainly much more involved surgically and post-surgically than a simple skin only upper eyelid lift. So objectively there are differences between cosmetic surgery procedures. But the human element cannot be under estimated. Subjectively there are patients who are much more bothered and adversely affected after a “simple” upper eyelid blepharoplasty while other patients may seem totally fine after an extreme body and face makeover lift. There are patients who break down socially and mentally after a slightly asymmetric nasal tip post Rhinoplasty, while other lead very healthy and productive happy lives after being butchered by extremely over aggressive Rhinoplasty. To each their own. We are not all created equal and we do not all react to the physical and mental stress of elective cosmetic surgery the same way. There is no right or wrong. But it is the plastic surgeon’s responsibility to evaluate and assess his patient’s physical and mental capacity for dealing with elective cosmetic surgery.
All surgeons would agree it is important to catch bleeding disorders or correct high blood sugars in a diabetic patient before undergoing plastic surgery. However, many surgeons fail to spend enough time getting to know the person and the character behind the patient in their office. It is crucial to understand the mental reserve of our patients. We must understand their goals and fears and driving motivations. We need to get to know their friend and family network. Why is a patient choosing to undergo a Rhinoplasty is much more important than the size of their nasal tip or dorsal hump.
Throughout the years I have seen several unique but reproducible patient characteristics that can lead to “post-operative mental complication.” I have tried hard to educate and dissuade these patients from undergoing elective cosmetic surgery. Some have taken my advice. Some took the time to self introspect and identify their inner adversely driving issues and then came back with a much healthier mindset and attitude, undergoing surgery with great post-operative outcome. And yet others have bad mouthed me on the internet saying things like “he does not know what he is talking about,” or “he did not see my problem,” etc.
What I have seen that alarms me as a surgeon and as a compassionate human are the following scenarios:
- Patients who have had over critical parents. Parents who have destroyed their self-esteem. These are heart-breaking cases. I have witnessed moms and dads in my office point to and grab their children’s faces, noses and chins so aggressively, and talk harshly about their offspring’s features in a way that would bring shame and depression to any child or young adult. While the post surgical results may be excellent and the patient may be very happy, the parents often are impossible to please and continue to “point out” non-existent issues on their children’s faces! I much rather deal with a parent who does not think his or her child needs plastic surgery and is against it than one who encourages and urges their child to get plastic surgery.
- Patients who have over critical friends, siblings or spouses. These are not as troubling as over critical parents but these patients do have external motivating factors which are not healthy causes for seeking cosmetic surgery.
- Patients who are in the search of “perfection.” Often these patients are very well put together and pay particular attention to their looks and attire but they simply do not understand the limitations of science and plastic surgery and continue to seek cosmetic surgery after cosmetic surgery.
- Patients who do not seem to care about their body or look or attire or even hygiene but for some reason are focused on one feature and want that feature to be perfected.
- Young and middle aged male patients who are self absorbed and even narcissistic in some respect and feel more important than other patients. They may be single or married but often have very unhealthy preoccupation with their looks and especially noses.
- Patients with Body Dysmorphic Disorder. These are patients who perceive their own faces and bodies as flawed and no matter what, they see a different, more negative image of themselves than the rest of the world sees of them.
- Patients who are overly emotional when discussing their perceived or real flaws. For example, patients who break down in tears remembering being teased in school for having big ears or a big nose.
- Patients with dependant personalities but with lack of support from friends and family for elective surgery.
- Patients with unrealistic motivations such as helping save a rocky marriage or landing a great job after improving their nasal tip, etc.
The patient characteristics listed above are all worrisome characteristics that can set up patients for mental depression and perception of surgical failure after elective cosmetic surgery, despite potentially fantastic surgical results.
Being able to cope with post op edema and healing variations takes mental fortitude. Being able to block out the negative comments of ill-advised friends or relatives takes mental strength. These are all issues too often neglected by plastic surgeons for lack of time, attention to detail, or fear of losing an eager to pay cosmetic surgery patient.
While usually increased self-confidence and self-esteem and happiness can be brought on after and as a result of elective cosmetic surgery, deepening depression and social and mental dysfunction can also result from such procedures. Loss of normal human function and preoccupation with chat rooms and blogs can take over ones life. Proper patient selection and education are keys to post surgical patient happiness and avoidance of such serious issues. While a bad nose job can be fixed, the perception of a bad nose job cannot easily be corrected. Obviously the importance of an artistic surgeon’s skills cannot be highlighted enough but that alone does not guarantee patient happiness when it comes to elective cosmetic surgery and especially Rhinoplasty.