Cosmetic Surgery: Making a Decision

• Introduction to cosmetic surgery
• Factors to consider
  • Special considerations for teenagers
  • Self-esteem and body image
  • Quality of life
  • Psychological conditions
• Benefits of cosmetic surgery
• Risks associated with cosmetic surgery
  • Physical health risks
  • Psychological health risks
• Considering the risks and benefits of cosmetic surgery

Introduction to cosmetic surgery

Cosmetic surgery is a procedure for which there is no medical need, but from which a person may experience significant, sometimes life-long, complications. As such, anyone considering cosmetic surgery must weigh up the potential risks and benefits of the surgery, as well as their personal circumstances. It is important to talk to health professionals and obtain information about the risks and benefits of cosmetic surgery, as well as how cosmetic surgery can (and cannot) affect an individual psychologically. Taking the time to discuss and consider all aspects of cosmetic surgery is important for ensuring that an appropriate and informed decision is made.

Factors to consider

Special considerations for teenagers

It is particularly important that adolescents considering cosmetic surgery talk extensively with a range of health professionals before deciding whether or not to undergo the surgery. They should also obtain written information about the cosmetic surgery procedure they are considering. Many health professionals have raised concerns about the appropriateness of performing body-changing surgery such as breast augmentation and lipoplasty on young bodies which are not yet fully developed. For example, it is not uncommon for a young woman’s breasts to continue developing until her early twenties.

Cosmetic surgeries performed on adolescents also raise concern because adolescents are not old enough to legally give informed consent and may not have developed cognitive functions that make them capable of giving informed consent (people are more prone to taking risks until about 25 years of age, at which time their brain fully develops mechanisms that impair risk taking).

While adolescent bodies are rarely fully developed, adolescent minds have typically already developed strong ideas about body image which are influenced by parents, peers and the media. Research shows that seeing images of very thin women in the media encourages teenage women to want to be thin. It also increases the likelihood they will have positive views of breast augmentation (implants) and liposuction. Thus it appears that teenagers’ body image is shaped more by popular culture images of ideal bodies, which are often unnatural, unhealthy and unrealistic, than by concerns about health in the immediate or long term.

Teenagers may also undergo surgery to please someone else (e.g. a boyfriend or parents) or with unrealistic expectations about how the surgery will change their image and self-perception. It is therefore especially important for adolescents to be clear about why they want plastic surgery and what to expect from having the surgery.

Doctors will enquire about your motivations for and expectation of surgery in the consultations for a cosmetic surgery procedure, so that they can help you to understand whether or not your expectations are realistic. It is important to speak openly and honestly with your doctor.

When considering cosmetic surgery, adolescents should also bear in mind that teenagers’ body image becomes more positive as they age and mature, regardless of whether they have cosmetic surgery or not. Adolescents as a group tend to be dissatisfied with their bodies, and teens who undergo cosmetic surgery are even more likely to be dissatisfied with their appearance. This is not because teenagers who undergo surgery are physically different to teenagers who do not. On the contrary, teenagers who undergo cosmetic surgery have different perceptions regarding what constitutes an ideal body, and on average they prefer larger breasts and thinner bodies. These body image issues are in part resolved by age 18, regardless of whether the teens do or do not undergo cosmetic surgery.

On the other hand, studies of teenage women who have undergone breast augmentation show that most experience no improvement (or worsening) on measures of self-esteem and quality of life two years after the surgery. Evidence also suggests that many adolescent women will benefit more from therapies which aim to improve their self-confidence and perception than they do from body changing surgery. Adolescents should therefore also consider alternative treatments (e.g. cognitive behavioural therapy) which are less invasive and also likely to be less costly.

Self-esteem and body image

Cosmetic surgery is undertaken with the aim of improving the appearance of certain body parts. People often undergo the surgery to correct body parts with which they are unhappy, despite the body parts usually looking and functioning normally. For example, a woman may be unhappy with the size or shape of her breasts despite their appearance being essentially normal. In these cases, surgery is undertaken to improve self-perception, and with that there may also be an expectation of improved body image and self-confidence after the operation. For example, the American Society of Plastic Surgeons promotes plastic surgery as an intervention which “encourages and promotes a strong, positive self-image … allowing an individual’s self-confidence to flourish.”

It is important to be aware that issues with self-image and esteem are usually psychological, rather than physical, in origin. For example, women who have had breast augmentation rate both women’s and men’s ideal breast size as significantly larger than women of similar body shape who do not undergo breast augmentation. They also report greater levels of distress regarding their overall appearance.

People who have psychological difficulties loving themselves and their bodies may not experience psychological improvements following surgery. These people should not undergo surgery and are likely to benefit more from psychological treatments. People who are more likely to fulfil this criteria include anyone:

• Experiencing a time of crisis such as divorce or job loss;
• With unrealistic expectations, including expectations to look like and achieve the lifestyle of someone else, or of returning to a former state of youthful beauty;
• Obsessed with minor imperfections; and
• With a psychological health condition such as depression.

It is important to critically analyse all information about cosmetic surgery, particularly whether or not the proposed benefits of cosmetic surgery are realistic. There is a vast amount of information available to individuals considering cosmetic surgery and much of it is misleading. Information from popular media (e.g. cosmetic surgery reality television programs, and women’s “health” magazines) often glorify plastic surgery and plays on a person’s insecurities regarding their body image, for example by implying that features of ageing such as wrinkles and sagging skin are unsightly or ugly. It is important to remember that the media has a strong influence on how cosmetic surgery is perceived, and consider the ways in which the media may have influenced a decision to undergo surgery.

Quality of life

An individual may undergo cosmetic surgery with the aim of improving their image for someone else, such as friends or a sexual partner, or in order to improve other aspects of their life such as work. But evidence shows that individuals who undergo cosmetic surgery for reasons other than to change their appearance (e.g. to change their lifestyle or fix life problems) are less satisfied with the surgery outcome.

Research suggests that individuals face greater pressure to undergo the surgery for reasons not related to their own satisfaction with appearance. For example, women who work in occupations in which success is more likely to depend upon physical appearance (e.g. administration) are more likely to have certain types of cosmetic surgery than women who work in occupations where appearance is less of a focus (e.g. trades). It is therefore important to consider whether or not factors such as work, sexual partners or others are influencing the decision to undergo cosmetic surgery, and be aware that cosmetic surgery can change appearance, but has not been demonstrated to improve quality of life.

Psychological conditions

There are concerns that a considerable proportion of people who seek cosmetic surgery experience psychological conditions including eating disorders and mood disorders. Some 6–15% of patients who receive cosmetic surgery consultations suffer from body dysmorphic disorder, a condition characterised by preoccupation with minor body faults which are not noticed by others. This is significantly higher than the prevalence of the condition in the general population. Body dysmorphic disorder is a contraindication to cosmetic surgeries, as people suffering from the condition are overwhelmingly unsatisfied with the results of cosmetic surgery procedures and are unlikely to benefit from it. The disorder can be successfully treated with medication and cognitive behavioural therapy.

People who feel obsessed with their appearance or have other psychological conditions (e.g. anxiety, lack of self-esteem, depression) should discuss these with the doctor or plastic surgeon to ensure that the most appropriate treatment plan is devised.

Benefits of cosmetic surgery

Many people report being more satisfied with their appearance following cosmetic surgery, but there is no evidence that cosmetic surgery improves quality of life or other psychological conditions. Other benefits of cosmetic surgery vary depending on the type of procedure.

Risks associated with cosmetic surgery

Physical health risks

There are numerous physical health risks associated with cosmetic surgery procedures. While many of the risks vary depending on the exact surgical procedure, all procedures carry risks associated with the anaesthetic and surgery. Surgical health risks include excessive bleeding, infection and poor wound healing. There is also a risk of:

• Poor aesthetic outcomes, including unwanted scarring;
• Asymmetry;
• Fluid accumulation;
• Necrosis (death of cells or tissues);
• Skin loss;
• Blood clots;
• Pain;
• Skin changes, including numbness and other sensory changes, discolouration, and prolonged swelling;
• Deep vein thrombosis;
• Heart and lung complications;
• Complications with sutures (stitches); and
• Needing revisional surgery (another operation).

Different types of cosmetic surgery also carry specific health risks. For example, breast augmentation carries risks such as leakage of silicon from the implants and reduced nipple sensation; and liposuction carries risks including death and organ damage.

Psychological health risks

Research indicates that the risk of psychological complications following cosmetic surgery is greater than the risk of physical complications. One study observed that post-operative psychological complications were more common than post-operative infections amongst cosmetic surgery patients. Amongst the 281 cosmetic surgeons surveyed, almost all had encountered patients with anxiety (95%), disappointment (95%), depression (95%) and sleep disorders (88%) following plastic surgery. People who experienced physical complications were more likely to experience psychological complications than those who did not. However, there is a lack of knowledge amongst health professionals about which interventions best help people to overcome psychological complications following cosmetic surgery.

It is important to remember that cosmetic surgery is not an effective treatment for underlying psychological issues, including body dysmorphic disorder and low self-esteem. Individuals who experience these conditions may experience short-term improvements following surgery, but are unlikely to improve their psychological health in the long term.

Considering the risks and benefits of cosmetic surgery

Individuals considering cosmetic surgery must ensure they are informed about the health risks and benefits of the procedure they are considering. It is important to weigh up the risks and benefits of the surgery, and in doing so consider personal factors (e.g. medical history, personal circumstances) as well as the risks and benefits other people have experienced following similar cosmetic surgery.

When considering the benefits of surgery, individuals should examine their expectations of the surgery and whether or not they are realistic, as well as how long they expect the benefits to last. Cosmetic surgery changes appearance, but it does not reverse the ageing process. Body features such as wrinkles and sagging skin will reoccur as the individual ages.

It is important to weigh the typically short-term benefits of cosmetic surgery against both the long- and short-term risks associated with the surgery. These include death and organ damage for some procedures, as well as post-surgery complications that can arise in the near or distant future. For example, the surgery may be unsuccessful and need to be undertaken again, or problems with implantable devices (in particular breast implants) may occur a long time after the surgery and require re-operation. Individuals should also consider unknown risks. The risks of cosmetic surgery can incur considerable unexpected financial costs.

Individuals considering cosmetic surgery should ensure they speak to a range of health professionals and obtain reliable information so that they are fully informed. They should then take some time to consider all the risks of the procedure they wish to undergo and weigh these against the potential benefits, which may only occur in the short term.

More information

For more information on plastic surgery consent including, counselling, decision making and planning, see Plastic Surgery: Consultation and Procedure.

 

References

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