WASHINGTON, February 5, 2012 - There are plastic surgeons who screen prospective patients for chronic depression and body dysmorphic disorder (BDD), turning away people that will not benefit from surgery. These doctors understand that patients with a mood disorder or BDD may be trying to fix an internal problem by changing their exterior.
Maybe screening for certain mood and self-perception issues should be mandatory as a prelude to cosmetic surgery. Although, determined people will figure out how to answer the screening questions to get what they want. Unscrupulous surgeons will continue to take any patient that can pay.
Screening becoming mandatory is less important than people being aware of this issue for their own sake, and that of their family and friends. This caution is only for and about those who risk undergoing procedures that will never make them happy, no matter how many they have.
Dr. Donald M. Brown, a plastic surgeon practicing in San Francisco, recommends people discuss post-surgical expectations with their surgeon. Dr. Brown cautions, “Patients who remain depressed after surgery are often those who want the procedure to improve their life. That is an unrealistic expectation. Plastic surgery enhances the appearance of parts of the body, which improves a person’s confidence and self-esteem. However, a person’s pre-surgery life is the same one waiting for them post-surgery.”
Body Dysmorphic Disorder
Most of us know the basic symptoms of depression, but few know the characteristics of BDD. Approximately 8% of people in the U.S. have BDD and many do not seek treatment. They may not realize their preoccupation with an imaginary physical defect, or a minor blemish others cannot see.
BDD is a chronic, long-term illness; the cause is unknown. As with other mental and emotional problems, there are likely numerous factors of genetics and environment to consider.
The symptoms of BDD are:
- Compulsive and extensive use of time to pick at the skin, stand before a mirror, and attempt to cover a blemish of defect.
- Continuously asking for reassurance that the flaw(s) is not too noticeable.
- Poor concentration at school or work; their mind is on the defect.
- Touch or measure the blemish frequently.
- Have anxiety when around people, or avoid being in public places.
- Consult repeatedly with plastic surgeons or dermatologists about fixing their problem.
Only 2% of cosmetic surgery patients with BDD get some relief from symptoms post surgery. The rest are either not satisfied with the result, or they focus on a different, imagined defect. The issue people with BDD need to address is their skewed self-perception. That can be done with psychotherapy and possibly medication.
A diagnosis of major depressive disorder (MDD) often accompanies that of BDD. Even when MDD is a solo diagnosis it may prompt some people to undergo surgery to correct their life, or at least feel better about it. The likelihood of a depressed person getting relief after a cosmetic procedure depends on their post-op expectations.
Satisfaction with the outcome is more assured when patients already hves a good self-image. People who are depressed have a sense of worthlessness, and their self-esteem is usually in the toilet. If their poor self-image is entrenched in strongly held negative beliefs about themselves, an enhancement of lips, nose, breasts, or thighs will not improve it.
The best candidates for cosmetic surgery are those annoyed with a part of their body. This issue does not impair their daily activities and and they can name features of their body they like or appreciate. Generally, they have well-defined ideas of how they wish the annoying body part to look post-op, and an awareness the result of their procedure may not be “ideal.”
“Normal” Temporary Post-op Depression
Anesthesia chemicals can linger in the body up to three weeks post-surgery; a bit like a guest who does not seem to realize the party is over. In some people, this reaction to the anesthesia can cause listlessness, out-of-the-blue crying episodes, and feelings of hopelessness or despair.
There may be insecurities that crop up after surgery such as financial concerns. Sometimes spouses or partners can be envious of the new and improved version of best friend or lover.
There is also pain, swelling, stitches and bruising to contend with. The first look in the mirror post-procedure can be reminiscent of a “B” rated horror film. Some people get bored while they rest and recoup and endorphins levels decrease when their host person is couched. Pain killers can trigger nausea and depressive symptoms as well.
What Do You Expect?
Research shows that many adolescents and young adults, primarily women, are willing to risk scarring, poorly done procedures, and possible death for three reasons. First, they feel insecure about their identity and place in society, and know appearance makes a difference. Second, they want to increase their self-esteem by improving their looks. The third reason is to emulate celebrities or celebrity lifestyle. Those insecurities and desires are, up to a point, normal for this age group. Although, living in an air-brushed society makes the passage more difficult for many.
If you are a young adult, a parent with adolescents, or are older and considering a procedure, discuss realistic outcomes with your surgeon. If you are depressed or suspect BDD tell your doctor and make sure your post-op expectations are reasonable.
The best scenario is that all plastic surgeons will screen for serious depression or BDD as part of an initial consultation. If you see a surgeon who does not at least discuss the realities of plastic surgery with you, know that there are many available who do, as a matter of principle.
Resource: Dr. Donald M. Brown, M.D., FACS.
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