What motivates people to go under the knife?

Try­ing to get a fix on the psy­chol­o­gy of cos­met­ic surgery is a bit like look­ing through a kalei­do­scope. Shift the focus a bit and the whole pic­ture changes. Is surgery empow­er­ing, enabling women – and, increas­ing­ly, men – to change their looks as they see fit or is it sim­ply indulging van­i­ty? It depends who you ask.

“There’s no ques­tion that cos­met­ic surgery is far more accept­able,” says Rajiv Grover, con­sul­tant plas­tic sur­geon and pres­i­dent of the British Asso­ci­a­tion of Aes­thet­ic Plas­tic Sur­geons (BAAPS). “But the vast major­i­ty of my patients still pre­fer to see me dis­creet­ly and avoid any­one know­ing. Peo­ple do feel judged.”

It’s a no-win sit­u­a­tion. On the one hand, there’s the fix­a­tion with the youth­ful, clear-skinned, super-slim look parad­ed by mod­els and actress­es; on the oth­er, there is still an under­cur­rent of dis­ap­proval for those so bold to admit they take active steps to pur­sue this ide­al.

We know from the 2012 report from the All-Par­ty Par­lia­men­tary Group on Body Image that half the UK pub­lic suf­fers from neg­a­tive body image and for the major­i­ty of patients, who have been through a through con­sul­ta­tion and are in the right frame of mind, cos­met­ic enhance­ment can change that in a pos­i­tive way.

I would not advise surgery if a patient has very high expec­ta­tions

As Nor­man Wright, a psy­chother­a­pist who works with cos­met­ic surgery patients, points out, giv­en the num­bers of peo­ple suf­fer­ing with body dys­mor­phic dis­or­der – 600,000 cas­es diag­nosed and many more, sure­ly, undi­ag­nosed – the like­li­hood of prospec­tive cos­met­ic surgery patients hav­ing under­ly­ing emo­tion­al or psy­cho­log­i­cal issues is high, which is a prob­lem for sur­geons.

He encour­ages doc­tors and sur­geons to “see the per­son behind the patient”. He says: “What I’m try­ing to do is not to talk peo­ple out of hav­ing cos­met­ic surgery, but to get sur­geons to give patients the chance to explore the emo­tion­al and psy­cho­log­i­cal issues of the pro­ce­dure that they have cho­sen to have.”

So who shouldn’t have surgery? Research among BAAPS mem­bers shows they already turn down around 35 per cent of prospec­tive patients. “I would not advise surgery if a patient has very high expec­ta­tions beyond that of surgery, if the per­son is going through a major life event such as a divorce or has an under­ly­ing psy­cho­log­i­cal con­di­tion,” says Dr Julian De Sil­va, a cos­met­ic sur­geon based in cen­tral Lon­don. “Iden­ti­fy­ing these con­di­tions can be chal­leng­ing as often patient’s may not be aware them­selves.”

Psy­cho­log­i­cal screen­ing for prospec­tive patients would seem a vital move. The Cen­tre for Appear­ance Research at the Uni­ver­si­ty of the West of Eng­land has come up with a user-friend­ly psy­cho­log­i­cal screen­ing tool to iden­ti­fy which patients might be at risk of post-oper­a­tive dis­sat­is­fac­tion. It is cur­rent­ly being tri­alled by BAAPS sur­geons. In the mean­time, sur­geons must keep their pro­fes­sion­al anten­nae attuned for poten­tial prob­lems.