Should patients wanting cosmetic procedures be psychologically assessed before surgery?

Posted: 12/02/2014

It is clear from both our experience and media comment that there is an increase in the number of people who either suffer complications or do not get their expected outcome after cosmetic surgery and subsequently develop psychological problems. People who have issues with their self esteem or self/body confidence can often have unrealistic expectations about how they will look after a procedure and, if these expectations are not met, they may feel depressed.

The current debate is whether people electing to undergo cosmetic surgery procedures should be psychologically assessed pre-operatively to determine whether surgery will benefit them or possibly put them at risk of psychological harm.

In an age where cosmetic surgery is increasingly popular and accessible and the media seem to glamorise those celebrities who appear to regard it as ‘the norm’, the real question is why there is such an obsession with physical appearance and “beauty” - to the degree that people will put themselves at risk to look better. When an 18 year old requests a blepharoplasty or a very slim person asks for liposuction, should surgeons be asking themselves: Why is this person asking for an “improvement” and how do they expect the “improvement” to affect them day to day”? In cases where it is objectively difficult to see the need for a procedure but the patient appears to be attaching great importance to it, should a mandatory referral be made for psychological assessment?

Many people lack self-esteem and are poor judges of their own physical attractiveness and our subjective views about how we look are often different to how other people see us. In terms of psychological well-being, if you think you look good, you tend to feel good. Therefore can a “quick fix” procedure increase people’s self-esteem or is it just a momentary fix until you start feeling worse about another part of your body or feel that you do not look very different after the procedure? In some of these cases, surgical improvement is unlikely to resolve underlying issues and this would be revealed by a targeted psychological assessment.

Recent reports suggest that more people suffering from Body Dysmorphic Disorder (BDD) are having cosmetic surgery. People with BDD are often uncomfortable with and critical of their physical appearance, despite having no obvious imperfections. In many situations, those who have surgery with this disorder make their condition worse. Following the correction of one imagined defect, those with BDD quickly become fixated with another imagined defect, and so the cycle continues.

A psychological assessment may help some patients to determine that surgery is unlikely to have a positive outcome and a proper exploration of someone’s motivations for wanting surgery could avoid some post-operative problems.

Amy Milner, associate in the Penningtons Manches clinical negligence team, comments: “We are seeing an increase in enquiries from people with pre-existing psychological problems who are trying to get a quick fix by undergoing cosmetic procedures. More often than not, their condition worsens and their self-esteem is further reduced. Given the increasingly high rates of cosmetic surgery, it is imperative that those offering cosmetic surgery should thoroughly explore a patient’s medical history, particularly if the procedure being requested is unusual and it is not immediately obvious why it is needed. If a consultation with a psychologist prior to any cosmetic procedure is neither available nor appropriate, it is vital that surgeons, as part of the consent process, do a thorough assessment of the patient’s history and reasons for wanting surgery and are very clear on what can and cannot be achieved by the proposed procedure.”

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