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Have you ever been bothered by facial or bodily features? Have you ever felt the urge to change those features? Media, poor body image, peer pressure, and disorders (such as body dysmorphic disorder) are all factors contributing to whether someone will undergo plastic surgery or not [1]. Body dysmorphic disorder is when a person suffers from mental stress, depressed mood, or anxiety because of dissatisfaction with a physical feature or a bodily area. It may lead to repetitive behaviors such as mirror checking, obsessive thoughts, and comparing self to others [1].
Nowadays, minimally invasive plastic procedures are more popular than invasive plastic surgeries [2]. This “can be seen from the statistics of the American Association of Plastic Surgeons” [2]. Invasive plastic surgeries “showed an average decline by 12% from 2000 to 2014 as compared to minimally invasive procedures, which showed a dramatic rise of 154% in the same period” [2].
“The top five minimally invasive cosmetic procedures performed were botulinum toxin injection, soft tissue fillers, chemical peels, laser hair removal, and microdermabrasion” [2]. Regarding invasive plastic surgeries, it differs between men and women. For women, breast augmentation and reduction are the most common worldwide, whereas, for men, the most popular surgeries are “gynecomastia reduction (58%), liposuction (17%), blepharoplasty (13%), and facelift (10%)” [1].
With this being said, there are some questions to ask: do plastic surgeries affect mental health? If they do, how do they affect it, and to what extent? Are plastic surgeries generally safe for health?
Before answering the question regarding the effect that plastic surgeries has on mental health, it is worth mentioning that the used study focused on research that “included solely invasive cosmetic surgery rather than noninvasive (e.g., Botox) or reconstructive surgeries for functional purposes” [1]. Also, definitions of some psychological outcomes of plastic surgery must be addressed first to establish accurate comprehension.
Body Image includes what you think and how you perceive your physical self, starting from how you feel about your appearance to the state of your health [1].
Self-esteem is “an individual’s self-evaluation of his/her value can be quantitatively measured.” [1].
Depression is manifested as depressed moods with no interest in previously enjoyed activities. It is accompanied by the feeling of guilt or worthlessness, weight changes whether loss or gain, low concentration, and suicidal ideations [1].
Anxiety is “excessive fear, worry, or nervousness; inability to concentrate; weakness or tiredness; avoidance of triggers; increased heart rate; hyperventilation; and a sense of impending doom” [1].
Since 1960, plastic surgery psychology research has shown that people who seek plastic surgeries “tend to experience lower levels of self-esteem and higher levels of anxiety and depression” than people who weren’t seeking plastic surgeries [1]. It is important to mention that when the effect of plastic surgery on body image is discussed, it must not be separated from self-esteem, depression, and anxiety, as they are exquisitely related [1].
A study using self-assessment reports was made to assess patient satisfaction with overall body image and body image specific to the bodily area operated on. The results showed significant enhancement in “patients’ postoperative self-ratings of overall appearance and attractiveness of the specific feature altered” [1].
Although experts consistently agree that “body image improvement is a common outcome of cosmetic surgery,” they widely disagree about the positive effect plastic surgery has on self-esteem, depression, and anxiety. However, “it was noticed that anxiety and depression changed in the same direction. This phenomenon can be explained by their comorbidity and/or interconnectedness.” [1].
The mentioned disagreement can be shown in the conflicting results of the following studies. A study of patients who underwent nose jobs showed improvement in the patient's psychological state by a significant reduction in their anxiety level when assessed 6 months and 5 years after the operation [1]. On the contrary, another study examining a large group of teenage girls who underwent several plastic procedures showed that their depression and anxiety levels remained fairly stable before and after the operations. “These researchers proposed that negative psychological states not only predicted cosmetic surgery but also appeared to worsen postoperatively” [1]. Thus, further research and studies are needed to reach a conclusion regarding this issue of conflict [1].
When talking about the safety of plastic surgeries, mental health should not be the only source of concern. Physical complications must be addressed as well. Complications and adverse effects resulting from various plastic procedures are being noticed due to the increase in demand, in addition to long follow-up periods, especially with soft tissue fillers [2]. Authors also tend to publish the best results from the plastic surgery industry while very few publications may focus on complications, which can mislead the reader into believing that complications are lighter in severity or fewer in number when compared to reality, they are fairly common [2].
For instance, fillers may be taken lightly but their adverse effects and complications may be persistent or very serious, such as permanent blindness. This may occur due to accidental arterial injection or forceful injection; therefore, cannulas are now used instead of sharp needles for safer injections [2].
Another example is “Rhinoplasty” or nose jobs. Rhinoplasty is not only done for cosmetic reasons but may be done to fix some functional problems such as airway obstruction and breathing difficulties [3]. Rhinoplasty can also be done for both reasons together; cosmetic and functional [3].
“Besides postoperative deformities, many other risks and complications have to be considered” [4]. In case of reduction rhinoplasty, difficulties in breathing may occur “which are reported in 70% of all revision-rhinoplasty-patients” [4]. Scars and loss of mucosal membrane may give the sensation of a blocked nose [4]. There are also complications pertaining to skin and soft tissues such as “atrophy, fibrosis, numbness, cysts originating from displaced mucosa or subcutaneous granulomas caused by ointment material” [4]. There are also more severe complications that may be life-threatening [4].
As mentioned previously, breast cosmetic surgeries are the most popular among women worldwide [1,6]. “According to a US surgeon's report, breast augmentation surgeries have increased by 300% over the past decade” [5]. “In 2019, nearly 2 million breast augmentation surgeries were performed, comprising 15.8% of all plastic surgery procedures” [6]. It was found that dissatisfaction of married women with their breasts affected their self-esteem and their marriage, which could evidently lead to divorce [5]. “In Iran, this issue is the cause of more than 50% of marriages that lead to divorce” [5]. “Studies show that breast augmentation surgery increases the quality of marital life in women by 80% to 95%” [5].
Despite being that popular, new complications have aroused concerns such as “breast implant associated anaplastic large cell lymphoma (BIA-ALCL) or breast implant illness (BII)” [6]. “Until now, the American Society of Plastic Surgeons Patient Registry has already collected 518 cases of BIA-ALCL from 25 countries, with the incidence defined at approximately one to three per million per year. Nevertheless, the incidence of this condition is more prevalent than expected, as shown in recent Review by Santanelli di Pompeo et al” [6].
Finally, the risk of complications in plastic procedures, in general, can be decreased by careful patient selection, taking detailed patient history, and performing thorough examinations [2]. Some patients are of higher risk as “chronic smokers, immunocompromised patients, and patients with cardiovascular and pulmonary diseases” [2]. Awareness should be spread as complications risk rises when the procedures are made in spas, and salons with unqualified or untrained personnel [2].
The question the patient should ask him/herself “is it worth it or not?”
References
[1] Kam, O., Na, S., La Sala, M., Tejeda, C. I., & Koola, M. M. (2022). The psychological benefits of cosmetic surgery. Journal of Nervous & Mental Disease, 210(7), 479–485. https://doi.org/10.1097/nmd.0000000000001477
[2] Khunger N. (2015). Complications in Cosmetic Surgery: A Time to Reflect and Review and not Sweep Them Under the Carpet. Journal of cutaneous and aesthetic surgery, 8(4), 189–190. https://doi.org/10.4103/0974-2077.172188
[3] Rudy, S. F., & Most, S. P. (2017, October 10). Rhinoplasty. JAMA. Retrieved September 23, 2022, from https://jamanetwork.com/journals/jama/fullarticle/2656812
[4] Rettinger G. (2007). Risks and complications in rhinoplasty. GMS current topics in otorhinolaryngology, head and neck surgery, 6, Doc08.
[5] Noorizadeh, H., & Bari, B. K. (2020). The effect of breast augmentation surgery on quality of life, satisfaction, and marital life in married women using BREAST-Q as a validation tool. Journal of family medicine and primary care, 9(2), 711–713. https://doi.org/10.4103/jfmpc.jfmpc_1013_19
[6] Pelc, Z., Skórzewska, M., Kurylcio, A., Olko, P., Dryka, J., Machowiec, P., Maksymowicz, M., Rawicz-Pruszyński, K., & Polkowski, W. (2021). Current Challenges in Breast Implantation. Medicina, 57(11), 1214. https://doi.org/10.3390/medicina57111214
Contributors:
Author: Catherine Sarwat
Editor: Kayjah Taylor
Health Scientist: Catherine Sarwat