Cosmetic Surgery Addiction

The first question of this article is “can a patient become addicted to cosmetic surgery?”  The first answer is absolutely!

Cosmetic surgery is a means of artificially enhancing or reversing the aging process.  First and foremost is the fact that “no one needs cosmetic surgery, it is totally elective.”  So, here we have an entire specialty built around procedures that no one really needs!  We are not saving lives or healing (with the notable exception of reconstruction, and the like) but rather adorning ourselves to look better or younger in our eyes or in the eyes of others.  Pretty vain when you truly consider it.  Being a cosmetic surgeon, I am obviously a proponent of cosmetic facial surgery but like anything else in life it needs to be performed with a balance.  You don’t have to travel far to see patients whose faces and bodies scream “I am addicted to cosmetic surgery!  I have seen this in New York City, Canton, Ohio, Dubai, Venice and Athens.  Some people smoke too much, some people drink too much, some people gamble too much and some people have too much cosmetic surgery. 

I can write an entire text on the changes that the Internet has brought to cosmetic surgery.  Most of them are very positive but it has also brought some negatives.  One of the positives has been patients from out of town or out of the country.  In my practice I now operate on many patients from out of town and out of the country.  It is a joy and an honor and I have made friends from all over the world.  On the other hand I have evaluated many patients that seek surgery outside their domicile because no local surgeons will operate on them or already have.  Many of these patients have unrealistic expectations and are bothered by small physical flaws that are actually manifestations of a larger psychological disease.  A small percentage of these patients are not happy, have not been happy and will never be happy with their physical self.  Their quest is to change their life by having the next cosmetic procedure, in the same vein that a compulsive gambler puts his or her last dollar into a slot machine in the remote hope of a big payoff that may change their life.  Don’t get me wrong, as the vast majority of my out of town patients are very realistic in their wants and desires, but having a high profile practice also brings its share of unreality.  To operate on a realistic patient is a joy; to operate on an unrealistic patient only makes you the next surgeon that “didn’t do it correctly.”  When I lecture to young surgeons (as I frequently do) I tell them that one of the main ways to be successful is to operate on the “right” patients.  By this, I mean that the correct procedure on the correct patient is a reward for both the doctor and the patient and the inverse of this can spell disaster for both.  Unfortunately, there is no means to measure the psychological stability of a prospective patient and due to this sometimes the surgeon and staff are fooled.  The patient can get a good idea of the skill of a surgeon by looking at their credentials, before and after pictures, talking to other patients, etc., but it is pretty hard for a surgeon to garner the status of a new patient.  Most surgeons learn this the hard way by a series of misadventures throughout their early career.  “I will never operate again on a patient like that” is a common mantra among seasoned surgeons.  Each time that a surgeon experiences such a patient (or hears a story from a colleague) they pick up on the “red flag”.  After getting a little grey in the temples, these red flags become more easily recognizable and hence avoidable.  A good surgeon says “no” frequently and will not operate on any patient that comes through the door.  The doctor and staff become more adept with experience in picking up on these “red flags” and avoiding the wrong procedure on the wrong patient.

I do want to say that there are also “red flag” surgeons of which patients must beware.  These include surgeons that over promise, promote “miracle” treatments, do not offer their availability, and cannot produce substantiation of their results.  Doctors are not exempt from reality.

A patient that wants breast implants, a hair transplant or a facelift to look and feel better is a great thing.  A patient that wants one of these procedures to change their life or make up for personality defects or other psychological issues is not a good thing.  Some people crave attention.  They have ungodly loud stereo systems in their cars that scream “notice me, please”.  Some people do the same with their homes by decorating them ostentatiously and some people do it with their body by trying to look like something they are not.  These patients stick out like a sore thumb and are not a good testament to cosmetic surgery or advertisement for that surgeon.  It is said that quality cosmetic surgery should “whisper, not scream”.  In the quest to look natural, some patients become more unnatural.  For a surgeon, happiness comes in operating and it is difficult to turn down a patient who presents with that ability.  Every surgeon has had the situation where they say “I am so sorry that I operated on that patient.”  It is not a fun situation to be in and you become an additional cog in the wheel of unhappy experiences for that patient.  Sometimes it is even rewarding to say no.  When you see a patient in your chair with breast too big, lips to big, skin too tight, a perfect tan and make up too excessive you feel you are doing a favor to them and to your reputation by denying further surgery as they are addicted and you are enabling their disease.  By not operating on them, you may be actually helping them.  Every cosmetic surgeon is a part time psychologist and must be to be competent.  A surgeon must truly listen to what the patient is saying and council them on their decision process.  Once in a while, these patients simply need someone to listen to or bounce ideas off of about their physical appearance.  I have told many a patient to appreciate their inner beauty and focus less on their acne scars, lose skin or other physical appearance.  I have told them about other patients who are much more ravaged or afflicted and how happy those patients would be to look like the patient sitting in my chair at this moment.  I believe that sometimes they leave my office relived that they don’t need a cosmetic procedure, feeling better about themselves and thankful for the candid insight.  Other times I see that they have talked a surgeon down the street into the procedure and after having it, are still unhappy.

Again, there is no more rewarding feeling for a cosmetic surgeon than performing a successful procedure on a happy patient.  It is the essence of what we do and how it should be.  Hopefully most encounters will be like this, but we don’t live in a perfect world.  One way to make it better is to appreciate the fact that some patients are and can be addicted to cosmetic surgery and avoiding operating on these patients can enhance your practice and their life.

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia