Why Psychological Evaluations are Necessary for Cosmetic Surgery

Plastic surgery has become a huge business due to the sheer number of individuals seeking cosmetic procedures. In 2009 alone, nearly 10,000,000 individuals sought cosmetic procedures in the U.S. alone (Sclafani, 2010). With this growing interest and number of people seeking cosmetic procedures, it has also become important to evaluate the patient's motives and understand what they think plastic surgery can do for them. Unrealistic expectations or impure motives can lead to problems for both the individual undergoing the procedure, as well as the doctors involved in performing the surgery. It is for this very purpose that many individuals are now being referred for psychological evaluations before cosmetic procedures are agreed upon. And in cases when patients may not need formal evaluations, cosmetic surgeons are being trained to be more aware of what to look for in applicants for cosmetic surgery.

Plastic surgery is one of the only surgical procedures considered elective, and because of this surgeons need to be wary of who they work on, and why they're doing it (Sclafani, 2010). While a less reputable surgeon may opt out of psychological evaluations, this part of the surgical procedure is extremely important for both patient and doctor. This same principle applies for weight loss surgeries, although most people consider them essential, rather than optional. In fact, a 2007 CBS News Health Watch report stated that nearly one in every five applicants for bariatric procedures were disqualified. Several of the reasons listed for this denial were "overeating to cope with stress or emotional distress, having an eating disorder, and uncontrolled mental problems, such as depression" (CBS, 2007).

While other cosmetic procedures, such as face lifts, may not seem the same, they are. Surgeons, psychologists and psychiatrists look for the same sorts of emotional and mental health signs to qualify or disqualify an individual for a cosmetic procedure. According to Med News (2005) "body image dissatisfaction is often associated with decreased self-esteem, self-confidence and psychological well-being" which can all be huge triggers for reluctance in performing a procedure. One might ask why the desire to improve one's appearance is such a bad thing, but the bigger issue here is the psychology behind the desire for improvement. If an individual is seeking improvements in order to feel better about themselves, improve their self-confidence, and self-esteem, then their reasons aren't actually positive reasons. "some studies show that extensive cosmetic surgery may make psychological issues worse" (Med News, 2005). This is because the underlying issue isn't being treated, and instead patients are hoping a simple physical change will change who they are. In reality, cosmetic procedures can only change how you look, and psychological issues and insecurities need to be addressed and remedies prior to beginning surgery.

How Psychological Evaluations Work

So, how exactly do surgeons and mental health professionals evaluate patients for plastic surgery? What do they look for? And how do they know whether plastic surgery is right or wrong for a particular patient or condition?

In any social meeting, first impressions are extremely important; the same is true in meeting with a plastic surgeon. Surgeons are encouraged to look for signs in demeanor, dress, and speech. For example, a cosmetic practitioner will look for the way a patient carries themselves. Are they confident with only reasonable levels of nervousness about the procedure? Do they seem anxious? Are they making eye contact when talking, or looking around the room or at the ground? Are they easily excitable or overly shy? How are they dressed? Are they dressed in an extremely revealing manner, or overly conservative (Sclafini, 2010). Each of these things can give the doctor a good view of who this person is, and whether they may have underlying social and psychological issues that they may be seeking to fix through plastic surgery.

While it is impossible for a plastic surgeon to properly diagnose an individual with a psychological issue, the previously mentioned cues can clue them in to whether a deeper evaluation is needed. For example, body dimorphic disorder is a serious concern for responsible cosmetic surgeons. Individuals with this disorder find fault with their bodies in many ways, even when there is nothing wrong. Individuals like this have a preoccupation with body image, and are at risk for cosmetic surgery addiction as they are always seeking to improve upon their body image in hopes to finally satisfy their expectations. As previously mentioned, there are very few instances in which this need will ever actually be met, as plastic surgery cannot solve psychological issues. It would seem entirely unethical to perform the surgery on an individual like this since the expectations associated with the surgery are unrealistic and unattainable. The truth is, bodies are flawed. We can have procedures done to improve them, but those seeking cosmetic procedures also have to understand that no one is ever perfect, and surgery cannot make them attain perfection. This is especially true in those with mental illnesses that prevent them from ever being satisfied with their body image, or those that refuse to address deeper psychological anxieties, depression, etc.

Another area of concern comes in with gender differences in cosmetic surgery procedures and expectations. In contrast to popular belief, males tend to present more risk than females when performing plastic surgery. Sclafini (2010) notes that men are generally less specific about what they are looking for when discussing a cosmetic procedure, and they are more likely to want to undergo plastic surgery because of psychological issues. While males do tend to seek cosmetic procedures less often, it is important to properly conduct evaluations when dealing with men in order to avoid a barrage of problems.

Whether male or female, proper motivation for the procedure is essential. WebMD and the Cleveland Clinic (2011) noted that good reasons for plastic surgery include: doing it for yourself, not others in your life; the desire to feel younger due to discord with the way one feels and the way one looks; and dissatisfaction with aging (although with the realization that aging is natural). Furthermore, the same source advises that individuals consider the surgery for a decent amount of time, noting that most successful cosmetic surgery patients have considered having the procedure done for "5 years of more" (WebMD & Cleveland Clinic, 2011).

Poor reasons for surgery are doing it for another person, doing it in order to make oneself feel better after a break-up or death, and doing it in order to boost one's professional or career outlook (Sclafini, 2010). Even patients who seek plastic surgery to correct scars, burns, or other accident injuries have to pass these evaluations showing that they understand what sort of realistic results they can expect. For example, an individual with PTSD will not be able to correct their psychological trauma by eliminating the scar; however, with realistic expectations and proper psychiatric treatment, these individuals may be prime candidates for positive cosmetic surgery.

When seeking plastic surgery, or any other cosmetic procedure, it is important to be honest with oneself. Answer honestly why you want the surgery, and take a good amount of time to think about it. Your motivation, and the amount of time you've thought about the procedure are both things your physician will ask you, so be sure to give both some thought before seeking out a doctor and facility. Don't allow yourself to be pressured into cosmetic surgery. Even if you're able to undergo the procedure, you may find you are extremely dissatisfied with the results, and all results are not able to be reversed. Lastly, be sure you're taking the time to consider the results and the possible risks and consequences. Even the most minor procedure can be risky, listen to the surgeon to be sure you understand what you're getting yourself into.

Some people tend to scoff at the need for psychological evaluation before elective surgery, but in reality it is an essential part of the surgical procedure and benefits both the doctor and the patient. With more cosmetic procedures being performed than ever, and the greater demand on body form and image, it is extremely important people are getting procedures done for valid reasons, and not in a quest for impossible good looks and other unrealistic results. Cosmetic surgery, whether breast implants, facial surgery, or bariatric procedures, cannot solve mental issues, so if you're experiencing these seek psychological help before seeking out or considering seeking out a more serious option like cosmetic procedures.

References:

Med News (2005). The Psychology Behind Cosmetic Surgery Decisions.

WebMD Medical Reference & Cleveland Clinic (2011). Choosing Cosmetic Surgery.

Sclafani, A.P. (2010). Psychological Aspects of Plastic Surgery. MedScape Reference.

Von Soest, T. Kvalen, I.L. & Skolleborg, K.C. (2009). The Effects of Cosmetic Surgery on Body Image, Self-Esteem, and Psychological Problems. J Plast Reconstr Aethet Surg, 62(10); 1238 - 44.