Few topics in modern psychology are as divisive as the growing use of plastic surgery to modify the appearance of men, women, and an increasing number of young adults. There are those who strongly oppose the very idea, seeing it as a sad reflection of a culture obsessed with external beauty and the pursuit of prolonged youth. Meanwhile, others accept it as an opportunity to improve or even prolong their health, as well as the ‘vitality’ of their outward appearance.
Yet despite this ongoing debate, plastic surgery experts anticipate an increased use of cosmetic plastic surgeries across a broader range of people as safer, more advanced, and affordable techniques evolve. According to the latest report from the American Society for Aesthetic Plastic Surgery, approximately 13 million cosmetic procedures were performed this year in the United States alone — a 155% increase compared to the last decade. As this trend grows, fueled by television, social media, and the rising popularity of plastic surgeries, it appears that plastic surgery is here to stay.
For this reason, it is vital to consider not only the cosmetic effects but also the psychological implications of this ever-growing trend (Counseling Support).
The Importance of Psychology in Plastic Surgery – Counseling Support
Plastic surgery is often associated with improving appearance, but it also stems from the need to restore physical functionality after accidents, illnesses, or other conditions. Patients seeking plastic surgery often have concerns about their body image and self-esteem. At this point, psychology plays a pivotal role.
Counseling Session – The Approach
The psychologist or psychotherapist approaches patients seeking physical changes through plastic surgery in the same way they would any other patient wishing for change in therapy. Initially, the psychologist aims to make the patient feel as comfortable as possible. The goal is to explore the reasons leading to the decision for cosmetic plastic surgery. At no point is this choice judged. The patient’s desire for change or improvement is treated with respect, while understanding the underlying motivations. It is emphasized that changes of an aesthetic nature may seem superficial but are, in many cases, permanent, with significant emotional consequences worth thorough consideration. The question is NOT about whether it is right or wrong. The focus is on why the patient is interested in making this change. The primary goal is to help the patient understand if this decision will fulfill their internal or external objectives.
Information Gathering – Counseling Support
It is emphasized that the psychologist-psychotherapist must adhere to confidentiality protocols and data protection policies. The patient’s consent is fully secured throughout the session. A thorough psychological and psycho-social evaluation is conducted as part of the counseling support. The purpose of this is to assess if the patient fully understands the safety and implications of the plastic surgery procedure, both physically and psychologically. For example, a candidate with a medical history of severe depression, mania, anxiety, or lack of self-control has different prospects compared to a patient without a psychiatric history. Patients are asked about the use of psychotropic medications, as well as any history of eating disorders, alcohol, or drug use. It is vital for the psychotherapist to understand if a patient has, or has had, any such conditions, as these are serious contraindications for cosmetic surgery. Another potentially problematic diagnosis is Body Dysmorphic Disorder (BDD), which can occur latent in some candidates for cosmetic surgery. BDD involves an intense or obsessive focus on a perceived physical defect — one that may be overstated or even imagined by the patient. Performing surgery on patients with BDD or other serious mental illnesses can exacerbate their symptoms, worsening depression and anxiety, leading to adjustment problems or self-destructive behavior. Requests for repeated surgeries may quickly follow, alongside expressions of anger towards the surgeon and staff, or even lawsuits for failing to “correct” their defect.
What – Why – For Whom
After the psychologist has reviewed the candidate’s medical and psychological history, the next critical step is to explore why the patient wishes to pursue cosmetic surgery. The psychologist listens carefully to psychological issues that might affect their satisfaction with permanent changes to their face or body. Patients are asked questions such as: “What do you hope to change?” Is this feature one that bothers the patient but appears normal to others? Patients are asked to point to the specific area they want to change, which sometimes is not even very noticeable. Is this a feature that makes them stand out, such as large ears, a scar, or an eye issue? Is it something causing pain or limiting daily activity, like an oversized breast or sagging abdomen? Do they have a slim figure but still want to be slimmer? From where do they want to remove excess fat, and how much? There is a difference between removing excess skin after massive weight loss and seeking multiple surgeries to remove slight areas of fat that only the patient notices. Removing a scar is different from removing a highly visible mark that interferes with shaving. Another vital question is whether the patient is seeking a change in a specific area or hoping it will make them a completely different person. Patients are also asked, “For whom is this procedure being done?” Are they doing this for themselves, or due to pressure from others? Although the initial answer is almost always, “Of course, it’s for myself,” further investigation often reveals deeper complexities. Sometimes, the request for surgery is driven by the desire to maintain a relationship. Patients might say, “My husband prefers women with larger breasts” or “My girlfriend is much younger, and I worry she’ll lose interest if I start looking older.” Occasionally, patients acknowledge that a partner, friend, or parent suggested the surgery. Sometimes patients even receive cosmetic consultations or treatments as gifts. Helping patients verbalize their motivations can be valuable, prompting them to reconsider both the surgery and their relationships.
Setting Expectations – Counseling Support
Perhaps the biggest challenge is to explore patient expectations. Studies have shown that the most satisfactory results are directly related to realistic expectations of the surgical process and its outcomes. Simple questions can reveal potentially unrealistic expectations. How does the patient expect the surgery to change their life? Are there deeper issues related to self-esteem, personal struggles, or marital and professional problems that the patient hopes the surgery will fix? Do they have an ideal celebrity image in mind, hoping to resemble that person? This can be a warning sign of unrealistic expectations. Do they expect to regain a younger version of themselves, or simply to look revitalized for their age? Patients must understand that looking fabulous at 50 is the new 50 — 30 is not the new 50. Are they seeking an easy fix to avoid active self-care, relying on surgery to bypass exercise, healthy eating, or moderation of alcohol and sun exposure? Are they convinced that this procedure will be a one-time solution, ignoring the effects of natural aging? Patients must be reminded that many non-surgical treatments (such as Botox and fillers) require regular maintenance, and that one surgery may lead to further treatments. A blepharoplasty can highlight the need for a neck lift, and so forth. Will their loved ones respond positively to these changes? Sometimes spouses, children, and parents feel powerless, sad, or even resentful about the results, making it valuable to address these feelings beforehand. Finally, can the patient afford the procedure, including recovery and time off work? Since plastic surgeries are rarely covered by insurance or public health programs, patients must consider the financial strain it might place on themselves or their family.
In every case, Dr. Daskalakis will guide the patient appropriately and recommend a qualified psychologist (Counseling Support) to discuss any concerns related to plastic surgery and its psychological implications.
