Monthly Newsletters on Plastic Surgery

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Improving your self-image with plastic surgery

Each of us has a "self-image," a perception of how we believe we look to others. People who are happy with their self-image are more likely to be self-confident, effective in work and social situations, and comfortable in their relationships. Those who are dissatisfied tend to be self-conscious, inhibited, and less effective in activities.

Plastic surgery -- whether cosmetic or reconstructive -- encourages and promotes a strong, positive self-image. Even a small change on the outside can create an extraordinary change on the inside, allowing an individual's self-confidence to flourish.

Because the changes resulting from plastic surgery are often dramatic and permanent, it's important that you have a clear understanding of how surgery might make you feel-- long before a procedure is scheduled.

This brochure will provide you with a basic understanding of the psychological issues involved with plastic surgery. It can't answer all your questions, since your individual circumstances and your self-image must be considered. Ask your surgeon if there is anything you don't understand about the possible psychological aspects and effects of your planned procedure.

Appropriate candidates for surgery
If you are considering plastic surgery, you must be honest with yourself. Exactly why do you want surgery? And, what are your goals for surgery-what do you expect plastic surgery to do for you?

There are two categories of patients who are good candidates for surgery. The first includes patients with a strong self-image, who are bothered by a physical characteristic that they'd like to improve or change. After surgery, these patients feel good about the results and maintain a positive image about themselves.

The second category includes patients who have a physical defect or cosmetic flaw that has diminished their self-esteem over time. These patients may adjust rather slowly after surgery, as rebuilding confidence takes time. However, as they adjust, these patients' self-image is strengthened, sometimes dramatically.

It's important to remember that plastic surgery can create both physical changes and and changes in self-esteem. If you are seeking surgery with the hope of influencing a change in someone other than yourself, you might end up disappointed. It's possible that friends and loved ones will respond positively to your change in appearance and self-confidence, however understand and accept that plastic surgery will not cause dramatic changes in people other than you.

Inappropriate candidates for surgery
Not everyone is an appropriate candidate for plastic surgery, despite physical indications which are ideal for any given procedure. Experienced plastic surgeons can usually identify troubled patients during a consultation. Sometimes, plastic surgeons will decline to operate on these individuals. Other times, they may recommend psychological counseling to ensure that the patient's desire for an appearance change isn't part of an emotional problem that no amount of surgery can fix. If your plastic surgeon recommends counseling for you, feel free to ask your surgeon how he or she expects the sessions to help you.

Though there are exceptions, individuals who may be advised to seek counseling prior to any consideration of surgery include:

Patients in crisis, such as those who are going through divorce, the death of a spouse, or the loss of a job. These patients may be seeking to achieve goals that cannot be obtained through an appearance change-goals that relate to overcoming crisis through an unrelated change in appearance is not the solution. Rather, a patient must first work through the crisis.

Patients with unrealistic expectations, such as those who insist on having a celebrity's nose, with the hope that they may acquire a celebrity lifestyle; patients who want to be restored to their original "perfection" following a severe accident or a serious illness; or patients who wish to find the youth of many decades past.

Impossible-to-please patients, such as individuals who consult with surgeon after surgeon, seeking the answers they want to hear. These patients hope for a cure to a problem which is not primarily, or not at all physical.

Patients who are obsessed with a very minor defect, and may believe that once their defect is fixed, life will be perfect. Born perfectionists may be suitable candidates for surgery, as long as they are realistic enough to understand that surgical results may not precisely match their goals.

Patients who have a mental illness, and exhibit delusional or paranoid behavior, may also be poor candidates for surgery. Surgery may be appropriate in these cases if it is determined that the patient's goals for surgery are not related to the psychosis. In these cases, a plastic surgeon may work closely with the patient's psychiatrist.

The consultation
During your initial consultation, your plastic surgeon will seek honest answersto how you feel about your appearance, how you believe others see you, and how you'd prefer to look and feel.

Honesty, with yourself and with the surgeon is essential. It's important that you set aside any awkwardness you might feel, and speak candidly about the changes you'd like to see. At the end of the consultation, you should feel confident that you and your surgeon understand each other completely.

Also, it is unwise to stress a minor functional problem if your true desire is to have an improved appearance. A patient who pretends to be seeking relief for a functional problem may confuse the surgeon about that patient's true goals for surgery.

Often these patients stress a functional problem with the hope of obtaining insurance coverage for the procedure even though a functional problem does not exist. If your goals for surgery are not clearly communicated to your surgeon, you may not be satisfied with the final result.

Plastic surgery for children
Parents may face considerable confusion and anguish in making surgicalchoices for their children, or when their children show a desire to change or correct a physical characteristic.

For reconstructive procedures such as cleft lip and palate repair, or infant skull surgery, the benefits of early treatment are usually quite clear. Parents typically meet with surgeons, psychologists, and other specialists who provide abundant assurances that surgery is the best choice for their child.

However, in elective procedures like otoplasty (ear pinning), the choices may be more indefinite. If the child doesn't seem to notice that he or she looks "different," parents may be advised not to force the issue of surgery. However, if the child is being teased or feels he or she doesn't belong, parents should probably consider surgery for the emotional health and self-esteem of the child. It's important to follow the recommendation of a pediatrician and to consider the feelings of the child and the parents.

Certain cosmetic surgery procedures may also be of significant psychological benefit for some teenagers, provided that he or she is well-adjusted both socially and emotionally. Parents need to keep in mind that feelings about self-image tend to change with maturity, and that cosmetic surgery should never be forced on a teenager, nor should a teenager force an issue which a surgeon feels is not an appropriate cause for surgery.

Timing of surgery
Plastic surgery procedures can impose stress in addition to that which we encounter on a daily basis, both on the body and mind. It's important that surgery is timed at a point when you don't feel exceptional stress, or physical or emotional burden.

To make sure you're emotionally prepared for surgery, your plastic surgeon may ask some rather personal questions about your relationships, home life, work problems, and other private matters. Once again, honesty is essential. In general, surgery should not be scheduled during a time of high activity or emotional upheaval. Patients who go into surgery feeling preoccupied or pressured with other matters may face longer and more difficult recovery periods.

Adjusting to change
It may take a while before you find you have emotionally recovered from surgery and have adjusted completely to change. This is particularly true if the procedure you've had has significantly changed your body image. If you're planning a relatively straight forward cosmetic procedure like chemical peel or eyelid surgery, you'll probably adjust easily to your new look. Your reflection in the mirror will be a familiar one--a refreshed, younger-looking you.

However, if you plan to have breast surgery, nose surgery, or another procedure that may involve a dramatic body change, the post-operative adjustment period may take longer. Until you learn to accept your redefined body image as your own, your reflection may seem somewhat unfamiliar.

Getting the support you need
It's essential to have someone to help you, both physical and emotionally, during your recovery period. Even the most independent patient needs some emotional support after surgery. Remember, during the first week of recovery, you'll have days when you'll feel depressed and look swollen, bruised, and rather unpleasant.

Be sure to select a support person who will be just that--supportive. Graciously decline offers of help from those who may be critical of your decision to have surgery or may be overly troubled by your temporarily bruised and swollen appearance.

Also keep in mind that it's not unusual for a well-meaning friend or relative to say "I liked the way you were before," or "You didn't really need surgery," Comments such as these may cause or worsen feelings of regret or self-doubt, particularly during the early recovery period. Rely on your support person or your surgeon to help you though these difficult times--and try to focus on the reasons you decided to have surgery in the first place.

Coping with post-operative depression
After surgery, most patients experience mild feelings of unhappiness. However, for an unlucky few, post-operative depression may be more severe.

Post-surgery let downs usually set in about three days after surgery-at a point when you may be regaining some of your physical stamina, but your post-operative appearance has not yet begun to improve. In fact, some plastic surgeons call this condition "the Third-Day Blues." It may last anywhere from a few days to several weeks. This emotional let down may be caused by stress, exhaustion, metabolic changes, or the frustration of waiting for results to appear. Depression may be especially stressful for patients undergoing staged procedures, who must cope with an unfinished "interval image" until the final stage of surgery is complete. Patients who are most vulnerable to depression are those who have a history of depression, or who were already somewhat depressed before surgery.

Knowing what to expect in the post-operative period may help you cope better in the days following surgery. It's helpful to remember that the depression usually lifts naturally within about a week. Brisk walks, light social activity, and small outings may help you shake the blues faster.

Handling the critics
The results of your surgery are likely to elicit some comment from friends and family members--and usually, it's not all positive. If you've had purely cosmetic surgery, you may be criticized for being foolish or frivolous. If your surgery involved changing an ethnic trait, you may be accused of trying to deny your cultural heritage. And, if you changed a family trait, prepare yourself for some surprised or disapproving glances. You may even get the cold shoulder from close friends who feel threatened by your improved appearance.

Some patients find it's helpful to arm themselves with a standard reply to post-operative criticism, such as, "This is something I did for myself--and I'm very happy with my results."

Remember, if you are content with how the results of plastic surgery make you look and feel, then the procedure was indeed a success.

Data reprinted from the American Society of Plastic Surgeons (ASPS).

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