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Cosmetic surgery

If you are considering cosmetic surgery, you must be honest with yourself. Why do you want surgery and what do you expect surgery to do for you? According to the American Society of Plastic Surgeons (ASPS), there are two categories of patients who are good candidates for surgery:

  1. The first includes patients with a strong self-image who are bothered by a physical characteristic that they'd like to improve or change.
  2. The second category includes patients who have a physical defect or cosmetic flaw that has diminished their self-esteem over time.

It's important to remember that cosmetic surgery can create both physical changes and changes in self-esteem. But if you are seeking surgery with the hope of influencing a change in someone other than yourself, you might end up disappointed.

ASPS list of inappropriate candidates for surgery

  • 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 met 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 that is not primarily, or 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.

Because the changes resulting from cosmetic 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.

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Safety

If you're thinking about getting cosmetic surgery, it's your job to become an informed consumer. Selecting a qualified doctor, with a lot of training and experience in the procedure you'd like to get, is essential.

Ask the right questions to get the best treatment:

  • In which state is the doctor licensed to practice surgery?
  • Is the doctor board certified? With which board? The doctor should be certified by the American Board of Plastic Surgery.
  • How many years has the doctor performed this type of surgery?
  • Does the doctor have life-saving equipment and monitoring devices?
  • Who administers the anesthesia? Ideally, this person is a board-certified anesthesiologist or certified registered nurse anesthetist.
  • What are the risks of the procedure?
  • What is the expected recovery for the procedure you're having?

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Check out your doctor's credentials

If you're thinking about having your surgery in the doctor's office, there are advantages and disadvantages. The office might be convenient, private, and have more amenities than a hospital or ambulatory care center (non-emergency, outpatient facility). But it may not be safe. Don't assume that the doctor has the right credentials or the right equipment to keep you safe in the office.

Contact these organizations to find out your doctor's education, licensure, and board certification in addition to the doctor's or ambulatory care center's accreditation:

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Body dysmorphic disorder (BDD)

Body dysmorphic disorder (BDD) is a serious illness in which a person is preoccupied with minor or imaginary physical flaws, usually of the skin, hair, and nose. A person with BDD tends to have cosmetic surgery, and even if the surgery is successful, does not think it was and is unhappy with the outcome.

Symptoms of BDD:

  • Being preoccupied with minor or imaginary physical flaws, usually of the skin, hair, and nose, such as acne, scarring, facial lines, marks, pale skin, thinning hair, excessive body hair, large nose, or crooked nose.
  • Having a lot of anxiety and stress about the perceived flaw and spending a lot of time focusing on it, such as frequently picking at skin, excessively checking appearance in a mirror, hiding the imperfection, comparing appearance with others, excessively grooming, seeking reassurance from others about how they look, and getting cosmetic surgery.

Getting cosmetic surgery can make BDD worse. They are often not happy with the outcome of the surgery. If they are, they may start to focus attention on another body area and become preoccupied trying to fix the new "defect." In this case, some patients with BDD become angry at the surgeon for making their appearance worse and may even become violent towards the surgeon.

Treatment for BDD

  • Medications. Serotonin reuptake inhibitors or SSRIs are antidepressants that decrease the obsessive and compulsive behaviors.
  • Cognitive behavioral therapy. This is a type of therapy with several steps:
    1. The therapist asks the patient to enter social situations without covering up her "defect."
    2. The therapist helps the patient stop doing the compulsive behaviors to check the defect or cover it up. This may include removing mirrors, covering skin areas that the patient picks, or not using make-up.
    3. The therapist helps the patient change their false beliefs about their appearance.

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Additional resources on cosmetic surgery

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Botox

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  • Botox® Injections (Copyright © American Academy of Facial, Plastic, and Reconstructive Surgery Inc.) — This fact sheet provides recommendations for those considering Botox® injections.
    http://www.aafprs.org/media/media_resources/fact_botox.html
  • Wrinkle Fillers: Information for Patients — This fact sheet explains the factors you should consider before choosing to have Botox® or injectable cosmetic wrinkle fillers. It discusses the safety concerns, the risks, and who should not use these types of treatments.
    http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/CosmeticDevices/WrinkleFillers/ucm126662.htm
  • Wrinkle Relief: Injectable Cosmetic Fillers — This fact sheet explains cosmetic wrinkle fillers, including what the filler materials are made from and what side effects you may experience. It also explains how wrinkle fillers differ from Botox® injections.
    http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm049349.htm

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Liposuction

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  • Cellulite — This Web page explains what cellulite is, how you get it, and how you can try to avoid it.
    http://www.nlm.nih.gov/medlineplus/ency/article/002033.htm
  • Do's and Don'ts for Liposuction (Copyright © ASDS) — This fact sheet offers some tips for having realistic expectations about the results of liposuction. It includes information about preparing for and recovering from surgery.
    http://www.asds.net/_ConsumerPage.aspx?id=720
  • Liposuction — This publication has information about types of liposuction procedures, risks of the surgery, as well as what to expect before and after liposuction.
    http://www.nlm.nih.gov/medlineplus/ency/article/002985.htm
  • Liposuction — This publication explains what liposuction is, how it is done, and its pros and cons.
    http://www.fda.gov/ForConsumers/ByAudience/ForWomen/ucm118540.htm
  • Liposuction: What Are the Risks or Complications? — This publications describes the risks of liposuction.
    http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/SurgeryandLifeSupport/Liposuction/ucm256139.htm
  • The Skinny on Liposuction — If you are considering liposuction, there are many factors to consider. This Web page discusses regulations, risks, and other information about liposuction.
    http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm049314.htm

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Varicose or spider veins

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  • Varicose Veins and Spider Veins Fact Sheet — This fact sheet provides information about varicose and spider veins, including the causes, prevention, potential dangers, and treatment.
    http://www.womenshealth.gov/publications/our-publications/fact-sheet/varicose-spider-veins.cfm

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Safety

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Additional resources on body dysmorphic disorder

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  • Anxiety Disorders Fact Sheet — This fact sheet from womenshealth.gov explains the five types of anxiety disorders, treatment for anxiety disorders, and how to get help.
    http://www.womenshealth.gov/publications/our-publications/fact-sheet/anxiety-disorders.cfm

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Content last updated September 22, 2009.

Resources last updated September 22, 2009.

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