The elective nature of cosmetic procedures puts an extra burden on the plastic surgeons and the patients alike and this burden relates to judging if the overall impact of a procedure would be beneficial to the patient.

The need for such judgement is underscored by a statement of Jesse A. Taylor, a plastic surgeon of Penn Medicine who says -“You are taking a healthy person with no medical problems and doing something invasive which has known risks”.

The intent of the above statement may be supplemented by another factor which is the uncertainty of the outcome of a procedure in meeting the patient’s goals. Covering the risks and meeting the patient’s goals are the two beacons against which the success of a procedure is determined.

The abundance of information available on the television and the internet and the allure of the movies often fuel patients’ expectations to reach unrealistic levels. Many of them overlook that cosmetic procedures have limits and that all change over may not be suitable or be possible for everyone.

Mark Solomon, a practising Cosmetic plastic surgeon in Bala Cynwyd, Pa with 26 years of experience, considers himself as “A Psychiatrist with a scalpel” and to him judging patients’ expectations and operating skill are equally important. He says that he declines up to 30 percent of prospective patients mostly because he cannot meet their unrealistic expectations. Jesse A. Taylor says he turns down up to 40% of the cases for the same reason.

That many prospective patients have high level of expectations in transforming their bodies and appearances is indicated from the number of repeat procedures and the instances of one individual taking up more than one procedure. The statistics of the American Society of Plastic surgeons reportedly shows that in 2010, half of all cosmetic surgery patients were repeat patients and 47 percent had more than one procedure.

The patients’ exaggerated expectations aside, there could be wrong motivation for the procedure.

There are people who fall short in daily functioning due to dissatisfaction with minor blemishes in appearance and belong to a small group of population (1 to 2%) suffering from Body Dysmorphic Disorder (BDD).

As per David Sarwer, Associate professor of Psychology at Penn medicine and an authority on mental issues in cosmetic surgery, a significant number (5 to 15%) of the patients who seek cosmetic procedures suffer from this disorder and about 90% of them remain dissatisfied after receiving the procedure and as a consequence, may go for law suits or, worse, even killing their plastic surgeons which occurred in four cases since 1990.

Wishing to Take cosmetic procedure to satisfy one’s partner or to revive a failing affair or to get a promotion which has been denied (instead of an inner desire to improve self esteem) are the wrong motivations and the surgeons are expected to turn down these cases. It is futile to expect that cosmetic procedures would bring in profound changes in judgement of a patient’s appearance or on how other people would interact with the patient.

David Sarwar, an authority on mental health issues in cosmetic surgery who offers a course at the annual conference of the American Association of Plastic surgeons, recommends three questions each for the plastic surgeons to ask the patients and for the patients to ask themselves.

For the physician

Can the cosmetic surgeon really see the defect?

Does the patient report impaired daily function based on his or her appearance? [“If they say, ‘I’m not dating because of my appearance or I’m not working because of my appearance,’ ” says Sarwer, “that could be a sign of BDD” (body dysmorphic disorder).]

Does the patient have a history of psychiatric treatment? [“About 20 percent of patients presenting to plastic surgeons are engaged in mental health treatment.”]

For the patient

Do other people see the feature they’re concerned about? Do close friends and family members see and agree with their concern?

Is the interest in surgery internally motivated, coming from a desire to improve their self-esteem, rather than, say, trying to save a sinking romantic relationship? Or get the promotion the person hasn’t received?

Is there recognition that the changes are often quite subtle? [“People expecting a Cinderella-like transformation may be setting themselves up for disappointment.”]

[Source: This write up is sourced from the article “Montco plastic surgeon: Judging expectations as important as skill” January 16, 2012 by Paul Jablow, for The Inquirer]