Author: Jessica Gjeloshi, 4th Year Medical Student, London.
Specialising in cosmetic surgery can be an incredibly rewarding career path, particularly when patients report high levels of satisfaction post-operatively. However, concerns continue to rise about the psychological toll aesthetic medical procedures are taking on patients who undergo them.
During the pandemic, cosmetic surgeons have reported a large surge in patients seeking treatment, whether it be a surgical or non-surgical intervention (Holt, 2021). Cosmetic surgery is frequently driven by dissatisfaction in one’s appearance (Paraskeva, Clarke and Rumsey, n.d.). This is described as “normative discontent”. This dissatisfaction is shown to be becoming increasingly prevalent in society. Some cite the media as a source of provocation, particularly the recent dawn of social media influencers (Holt, 2021). Many argue that these influencers perpetuate unrealistic body image standards and reinforce the unrealistic belief that cosmetic surgery is a ‘miracle’ intervention.
Due to the pandemic many of us have spent lengthy periods of time on virtual platforms, such as Zoom, looking back at distorted images of ourselves (Rice, Graber and Kourosh, 2020). These often amplify natural facial asymmetries. Studies have shown that this has actually intensified people’s desire for cosmetic treatment. Research has long suggested the power of social media in driving people’s decision to undergo surgery. Editing photos of ourselves has even been identified as a potential trigger for body dysmorphic disorder (BDD), with an influx of patients seeking aesthetic procedures to look more like their selfies. This has been dubbed ‘Snapchat Dysmorphia’.
Often when surgery has a technically satisfactory outcome, patients report satisfaction with their results (Paraskeva, Clarke and Rumsey, n.d.). However, many people do not gain any benefit from undergoing these procedures and instead have poor post-operative outcomes. If a patient is being driven by underlying psychological issues, such as BDD, to undergo surgery, it is particularly unlikely that they will have positive post-operative outcomes. Although the technical results may be satisfactory, if a patient is pathologically unhappy with their appearance, it is unlikely surgery will alter this. In fact, it is likely to only exacerbate these pre-existing issues. There is a greater prevalence of psychiatric disorders amongst those who undergo cosmetic surgery then the general population. People with mental health disorders, especially disorders such as BDD, are particularly driven to wanting to undergo cosmetic treatment. Amongst cosmetic surgery patients, 5-15% suffer from BDD, whilst only 1-3% of the general population who are reported to have BDD.
Systematic reviews have also demonstrated that if patients enter cosmetic surgery with unrealistic expectations then they are prone to having poor psychological outcomes post-surgery. This emphasises the need for in-depth discussions with patients prior to surgery, which emphasis both the benefits and risks of undertaking cosmetic procedures because surgery can in fact exacerbate pre-existing mental health issues. In fact, patients with BDD experience no improvement in their symptoms after cosmetic surgery.
It is essential for cosmetic surgeons to perform pre-operative screening on patients to identify any psychological issues which may be influencing their decision to undertake surgery. Not only is undergoing surgery a stressful and an expensive experience, the results can also be life-altering. It can also be incredibly disheartening and time-consuming to attempt to treat a patient who has an underlying psychological issue such as BDD because they are likely to be unhappy and distressed regardless of the outcome of your work. Screening tools enable doctors to identify if their patients have unrealistic expectations or any underlying psychological disorders.
A particularly effective screening tool which cosmetic surgeons can use pre-operatively is the RoFCAR tool. This was created to enable surgeons to identify any psychological factors in their patients which could increase their likelihood of having a poor psychological outcome after surgery. This enables cosmetic surgeons to undertake assessments on their patients themselves, rather than have to refer them to a psychiatrist to do this initial assessment. The tool only comprises of nine questions and is not procedure specific. However, it does cover a range of psychological concepts and is applicable to a wide variety of patients. The goal of this screening tool is not to stop people who have underlying psychological issues from undergoing cosmetic surgery, it does however increase the chances that both patient and doctor will experience a positive outcome. It also enables the doctor to refer this patient to the appropriate services which may be able to provide them with support for their mental health. Patients, particularly with BDD, will benefit far more from pharmacological and therapeutic interventions then from surgery.
So often in medical school we are taught the importance of the bio-psycho-social model. This is a perfect example of why taking this approach is essential to patient’s health and wellbeing.
Holt, B. (2021). The nobody-nose job: How the Pandemic Led to a Rise in Plastic Surgery. [online] The Guardian. Available at: https://www.theguardian.com/lifeandstyle/2021/jan/06/plastic-surgery-pandemic-rise [Accessed 7 Feb. 2021].
Paraskeva, N., Clarke, A. and Rumsey, N. (n.d.). The Routine Psychological Screening of Cosmetic Surgery Patients.
Rice, S.M., Graber, E. and Kourosh, A.S. (2020). A Pandemic of Dysmorphia: “Zooming” into the Perception of Our Appearance. Facial Plastic Surgery & Aesthetic Medicine, 22(6), pp.401–402.