Psychological Issues Virginia
While the majority of patient seeking and undergoing Rhinoplasty are well adjusted mentally and have positive outcome after surgery, there are some important exceptions that must be noted. The information below is a combination of simple observations and scientific facts, none of which are meant to judge or degrade any patients. These are just some pearls and a collection of random points that should be understood by all patients who have undergone or plan to undergo a Cosmetic Rhinoplasty.
Rhinoplasty has sometimes had a certain secrecy or taboo associate with it. In certain people’s eyes, it is somehow more acceptable for patients to undergo a facelift or a tummy tuck, since these are aimed at reversing signs of aging. This way of looking at cosmetic surgery seems to justify a surgery that “reverses aging” over a surgery aimed at “changing or modifying” someone’s look. We see this kind of phenomenon occasionally with patients who have no problem getting Botox shots in a Spa but “are not ready” to get Botox shots in an actual Plastic Surgeon’s office. In the patient’s mind, one seems to be a “spa treatment” while the other seems to be “Plastic Surgery!”
Several decades ago there was much attention given to the male Rhinoplasty patient after psychological “experts” published scientific papers claiming male Rhinoplasty patients suffered from gender identity issues and that the nose represented a phallic symbol that was being altered!
There are also plenty of patients who have had nose jobs in the past but will call it a “Septoplasty” or “sinus surgery” even when providing their past medical and surgical history to their own doctors. Some will go through enormous lengths in order not to reveal their “secret” to their own family or spouses.
Some patients will refuse to be seen in public with the nose cast after surgery while others will not go in public until the swelling has completely resolved. Some will retreat, become depressed and introverted and “live” on Plastic Surgery chat rooms online, if there is even the least minor of asymmetries or aesthetic issues; while others will be perfectly fine, happy and extroverted, leading perfectly productive lives even with the worse “botched nose jobs.”
Body Dysmorphic Disorder (BDD) is one of the most common psychological diagnoses amongst Rhinoplasty patients. Depression is also a common presenting symptom with patient seeking Rhinoplasty or Revision Rhinoplasty. While a patient with BDD should almost never be offered a cosmetic Rhinoplasty, depression is usually not a pure contraindication to getting a Rhinoplasty.
With all of the taboo and underlying psychological issues that may be present with Rhinoplasty, it is extremely important for the Rhinoplasty Specialist to get to know the patient seeking a nose job. A nose job is not a “simple procedure.” A nose job is not reversible like Botox; it does not wear off in a few months. It’s not like getting a hair cut; it won’t grow back.
Therefore it is very important for the Plastic Surgeon to understand the underlying motivations or rationale for the patient seeking Rhinoplasty. Regrettably, sometimes we see Plastic Surgeons who place their own financial motivations before their patients’ well being. More often we see Plastic Surgeons who just simply do not take the time to diagnose such nuances of Rhinoplasty. And sometimes even the sharpest and best well-intentioned Plastic Surgeon may be fooled or may fail to pick up warning signs of a problematic patient. As the old saying goes, “you cannot please all the people all the time,” but it’s important to identify such patients who will potentially be unhappy with even the best of Rhinoplasty results.
Unfortunately, too often we see parents who are extremely critical of their children. These parents often grab their teenage child’s face in a rough manner and point to its flaws harshly. Many times these parents have had Rhinoplasty themselves and may have had parents who did the same to them.
Sometimes, we see teenagers that have been teased badly in school by their peers or bullied on social websites such as facebook or youtube or twitter. Many times their parents add to the stress by ridiculing their desire for improvement of their nose instead of participating in a healthy dialogue.
But we often see that it is much better to have a situation with a parent who does not think their child needs a nose job than a scenario where the parent is the primary driving force behind pushing their child towards an early nose job. Parent’s role should focus on providing support and enhancing their children’s emotional self confidence, rather than tearing down the self confidence of their children by pointing out physical flaws.
At times older patients in their 30’s, 40’s or 50’s come in for Rhinoplasty and break down in tears recalling how their parents or friends teased them and treated them harshly when they were younger. These old comments have left deep psychological scars that can become refreshed by certain social triggers.
The parents, friends and relatives of a patient can provide a good support network but they can also be very detrimental to the patient by not understanding the facts and providing untimely negative comments.
Sex change or transgender patients often seek changes in their nose to fit their more feminine or masculine goals. With proper screening and counseling, these patients many times have very successful outcome.
Certain patients come in with evidence of lack of attention to the rest of their visage or appearance. Some times these patients are morbidly obese, have not taken care of their bodies or faces and may not be wearing presentable or even clean clothing but for some unexplainable reason, they are focused on their nose and want that “perfect nose.”
Some patients have already had 4, 6 or even more “successful” previous Rhinoplasties by some of the top Rhinoplasty Specialists in the world but they continue to be unhappy and seek that “perfect unachievable nose.”
The ideal Rhinoplasty patient is a healthy patient, both mentally and physically, who wants to improve their nose and does not expect the new nose to change their life drastically. The goal of a nose job should not be to get a better job or a better spouse or to change one’s face from “self perceived ugly” to “beautiful.”
The goal of a nose job should be to improve the nose and balance the face. That’s it!
However, we do see time after time, how a good outcome after a Rhinoplasty can improve the self confidence of a patient and their “quality of life.” A successful Revision Rhinoplasty can help heal some of the emotional scars left behind by a previous plastic surgeon’s negligent scalpel.
These are all complex matters that require careful thought and attention by the Rhinoplasty Specialist, as well as his staff, who get to witness each patient’s behavior from the initial phone call onwards.