The emotional side of choosing cosmetic surgery

When life hurts, instinctively we reach out to find things to fix it, to make the pain go away. Passed up for promotion? Cue, a sparkly pair of Kurt Geigers. Dumped by your boyfriend? Time for a snazzy new hair-do. We are programmed by our beauty-biased society to think, ‘If I look better, I will feel better’. Or, ‘If I look great, I’ll be able to cope with this.’ Now, with Botox and do-it-in-your-lunchtime cosmetic surgery procedures becoming more commonplace, increasingly women – and men – are reaching out to their friendly local plastic surgeon for an aesthetic boost. Unfortunately, though, this is all it is. Feeling happy with your appearance can undoubtedly boost your confidence, but when it comes to emotional traumas and deep-rooted insecurities, no number of shoes, hair styles or cosmetic surgeries will help the healing process. And, while the price of discovering that those new heels or that new hair-do didn’t make you feel any better after all is minimal, with cosmetic surgery you risk chronic pain, permanent disfigurement, exorbitant bills, emotional and social upheaval, and sometimes even death. When it comes to professions notorious for their lack of scruples, plastic surgeons are right up there with lawyers and second-hand car salesmen. A reputation that, although stereotypical, often holds true. Dubai-based Brit, Gail Clough, 45, is a cosmetic surgery devotee, who had her first surgery at the age of 17 and has spent some Dh250,000 on making adjustments to her body ever since. In 2004, Gail launched her company, Dubai Surgery, which sets out to facilitate people wanting to come to Dubai for cosmetic surgery. She says, “The majority of surgeons will get a new patient and think, ‘How can I turn this person into an addict?’ People need to spend time researching which surgeon they go to. It’s been said that women spend more time choosing a handbag than they do a plastic surgeon, and I think it’s true.” Gail works regularly with a couple of surgeons whom she says are the ‘good ones’ – the ones with morals. One of these is Dr Sanjay Parashar of Cocoona (www.cocoona.ae). According to Dr Parashar, there are right and wrong reasons for electing for cosmetic surgery – and when he meets new clients, he is on the look-out for particular warning signs. He says, “At Cocoona, we refuse surgery to approximately 60 per cent of patients who come through the door, for a variety of reasons. Yes, it’s a business, but an unhappy customer is bad for business in the long run and they can give the industry a bad name. When we train, we are taught about the importance of patient selection. If you screen the patient properly, you’ll have a higher success rate, which means increased work. I have referrals come through people whom I have refused surgery to, so actually it’s no loss to us to do the right thing by the patient.” The wrong reasons Dr Parashar and Gail are united in their categorisation of what constitutes the right and wrong reasons to elect for surgery. Dr Parashar says, “First, I identify whether there is a physical need, or a psychological/social need. A physical need would mean there is an obvious alteration needed – for example, a crooked nose, baggy eyelids – these are good reasons, and the effects would be evident. Then, there are the psychological and social needs; a guy might be struggling to get a job and may think it is because of the way he looks. You have to be careful here; if you give him the surgery and he still doesn’t get a job, he may attribute it to the surgery.” Another reason not to give surgery would be if someone is suffering from body dysmorphic disorder (BDD) – a mental illness that causes people to become obsessed with a flaw in their appearance, to the extent that it disrupts their normal life. Research published in scientific journal Innovations in Clinical Neuroscience reports that, while BDD occurs in less than 1 per cent of the population, between 7 and 15 per cent of cosmetic surgery patients have it. In a Belgian study of patients seeking a nose job for cosmetic reasons, 43 per cent of patients were found to have BDD. Similar research from Tulane University, which analysed surveys of cosmetic surgery patients pre-operation, found that 50 per cent were clinically depressed, 70 per cent suffered from anxiety, 20 per cent had issues with substance abuse, nearly 30 per cent had attempted suicide, and two-thirds suffered from personality disorders, such as narcissism, obsessive compulsive disorder and schizophrenia. Dr Parashar says, “With BDD, patients see an abnormality that nobody, not even an expert, can see. Other patients suffer from plastic surgery addiction, where they just keep coming back to you... either it’s because they have found the effects so amazing that they want more, or it’s because they’re not happy. Sometimes people have undergone an emotional trauma and try to relate it back to their physical appearance... they feel negatively about themselves, because of the emotional upset, and try to fix it with surgery. All of these are stressful and can reduce the productivity of a surgeon. This is why counselling and consultations are such an important part of my job. I always have two consultations with clients before I agree to go ahead with a procedure so I can understand the patient and work out the psychology behind why they want surgery.” Fix emotions first Helen Williams is a counsellor and the founder of LifeWorks Counselling Dubai (www.lifeworksdubai.com). She says that she has many clients coming to her with depression following plastic surgery. According to Helen, in most cases the depression is not caused by the surgery, but caused by a deeper-rooted issue that pre-dates the surgery – the surgery was just the patient’s attempt at trying to fix the issue. This theory is supported by scientific evidence – a study by the National Cancer Institute found that women with breast implants are four times more likely to commit suicide than other women. Experts believe that the issue is not the new breasts, but a long-term depression, or psychological issue, which women try to fix aesthetically. Helen says, “The reason for counselling before surgery is to process the emotions behind your decision out loud. It allows people to look at their intentions, and to cross-reference those against the physical risks of surgery. When people are in a healthy, secure place mentally, it’s OK. But if the motivation is fuelled by low self-esteem, no surgery will change that. Also, if people are trying to deal with a situation, such as divorce, redundancy, or loss of a loved one, surgery won’t help.” Cosmetic surgery advocate Gail agrees. “Beauty is a depreciating commodity, but it’s not the be-all and end-all. It’s good for people to sit and think about what it is they actually want to achieve. If a woman comes to me and rattles off a list of body parts they feel unhappy with, they need counselling to shift their mind-set so they can see the good bits. If you’re feeling desperately unattractive, or desperately unhappy, cosmetic surgery probably won’t make you feel any better.” Nosejobs, facelifts, tummy tucks – no matter what flippant, innocuous-sounding terms we use to describe these procedures, the reality is that they are still surgeries. And they should be respected as such. For the millions of people who have cosmetic surgery every year, and walk away happy with the results, there isn’t a problem: the issue is not with the industry, or the procedures, it’s with the motivation of the client. Does the potential for benefit outweigh the risk? Helen says, “Some people think that a new nose will fix all aspects of their life, but it won’t. Issues like body dysmorphia and self-loathing are mental health issues often attached to deep-rooted issues from childhood. If someone thinks surgery is going to cure them of this, they’ll have a real problem. I’ve had patients who have had cosmetic surgery because of an emotional pain and ended up detached from themselves and more depressed. A lot of them say that if they’d had counselling first, and had understood themselves better, they would never have had it done.” "I wish I never had surgery" British expat Susan Hayward*, 44, went for Botox in the summer of 2008, a year after her mother passed away from cancer. Something that should have been routine went badly wrong, and has spiralled into non-stop surgeries and procedures totalling Dh120,000, as well as long-term clinical depression. Looking back, she says that what she really needed was counselling. “After Mum died, I threw myself into fundraising for cancer charities. A few months later, it struck me that Mum would never ring me again. Reality hit. I was really up and down – trying to overcome grief with drinking, exercise, keeping busy, learning to ski. “Around the year anniversary of her death, I woke up one day, looked in the mirror and said to my husband, ‘I look rough’. I went to see a plastic surgeon who had been recommended by friends and said, ‘I’ve had a tough couple of years. I need a pick-me-up.’ He suggested Botox around the eyes. A couple of days later, my right eyelid started to droop, which eventually caused the skin under my eye to bunch up. The surgeon recommended a blepharoplasty to remove excess skin from under my eyes and an eyelift, which also went wrong. My eyes were droopy, sore, and gritty. One morning, I woke up and my eyes were stuck together because he’d removed muscle from beneath my eyes, which you are never meant to do. This meant that my eyes weren’t closing at night. I’ve been taping my eyes together at night ever since. “By this point I was thinking, ‘What have you done, you stupid person.’ I had never even had a manicure in my life, so I couldn’t believe I had actually done this to myself. I was holding it together during the week at work, but crying in bed all weekend. I was in chronic pain, I didn’t want people to look at me... It affected my husband, my kids, my social life... I was crying for the grief of losing my mother, for the pain, for the person I used to be. I started blaming everyone and everything for my pain – I blamed Dubai, my husband, the surgeon, myself... mostly myself. I hated myself. Looking back, I realise that I didn’t need a plastic surgeon, I simply needed a holiday. I’m now going for counselling and my counsellor, Helen Williams, says to me, ‘You didn’t need a plastic surgeon. You needed your Mum.’” “This summer, I had a face lift – all the muscle in my face was cut off my bones and reattached higher up. I went to Barry Jones, a surgeon in the UK – I had checked him out on www.makemeheal.com, a website where people post their cosmetic surgery experiences. After the facelift, I started seeing Helen. She has helped me see that I’ve never looked after myself emotionally. Now I’m learning how to do just that. Helen says I’m a coper – I put on a brave face but don’t deal with the pain... like when my Mum died. If I could go back in time, I’d say to myself, ‘The reason you think you look so tired and awful is because you feel so tired and awful. Go and see Helen.’ “To people who are considering surgery, I would say that things can go wrong and, if they do, it can be life-changing. Think about why you are doing it... If you hate your nose and it stops you from going out, fair enough. But if you’ve always been happy in your own skin, go and speak to a counsellor. “Everyone has stress and it shows on your face – instead of changing your face, try and get rid of your stress. Look at the websites, and the horror stories. Think, ‘Could I cope if that happened to me? And is it worth the risk?’” Think first According to the ASPS, the American Society of Plastic Surgeons (www.plasticsurgery.org), most cosmetic surgery patients fall into two categories: those with a strong self image, who want to improve or change an aspect of their physical appearance; and those who have a physical imperfection, which has knocked their confidence, or self-esteem, over time. The ASPS advises the latter group to have some psychological counselling before they have surgery. They also advise surgeons to be on the look-out for the following types of patients, who they say would need psychological treatment: patients who are in crisis; patients who have unrealistic expectations; patients who are impossible to please; patients who are obsessed with a very minor defect; and patients who have a mental illness. Red flag warnings Dr Sanjay Parashar, cosmetic surgeon at Cocoona Centre for Aesthetic Transformation (www.cocoona.ae) gives us his list of red flag warnings when screening a patient. >> Patient: “Make me look younger.” Dr Parashar: This person may have unrealistic expectations and their lack of specifics can lead to them feeling dissatisfied with the results. >> Patient: “I want Megan Fox’s nose.” Dr Parashar: This is an example of ‘patient demand’. In this situation, I would question whether the patient really needs it, why they want it, and if she can get the effect she wants from a simpler procedure. >> Patient: “Make me look more beautiful.” Dr Parashar: Are there other issues underlying this request, which need other treatment rather than plastic surgery? For example, weight loss support, or counselling. >> Patient: “First I want a nose job, then breast implants, then a face lift.” Dr Parashar: Either this person is suffering from BDD, or they have a cosmetic surgery addiction. I would advise them to have counselling and come back, but some people take offence to this – plastic surgeons are trained in psychological counselling to be able to counsel their patients, but not all surgeons do. I’d need to have in-depth consultations with this patient, and may end up refusing them surgery.