How Much Cosmetic Surgery is Too Much?
Before Michael Jackson’s passing, there was a rumor floating around that he had undergone excessive plastic surgery on his nose and as a result, had to wear a prosthetic one - as there simply wasn't enough skin left to sustain functionality. Regardless of whether or not it was true, if you compared photos of him from the 70s through the late 90s, it was quite clear that he had completely changed the look of his nose repeatedly… which begs the question – Why wasn’t he ever fully satisfied with the results?
Plastic surgery is great, because it provides an individual with the ability to transform themselves in the manner they deem appropriate – but what happens when someone is simply never satisfied… constantly seeking out multiple procedures to attempt to alter or fix something that really doesn’t need fixing? When a person seems to be pursuing an excessive number of surgical procedures as some celebrities do, it calls into question whether or not these surgeries are necessary, or if this person is suffering from a condition known as body dysmorphic disorder. So how, if at all, can a plastic surgeon identify and handle such a patient?
I went straight to an expert on the subject, Dr. Claude Oppikofer, who is the chair of the Patient Safety Committee for the American Society for Aesthetic Plastic Surgery (ASAPS), to get his insights on how much cosmetic surgery is too much?
1. When would you refer a person to a psychiatrist if you felt they were demanding an unreasonable procedure, and on what criteria would you base this decision?
I would only refer a patient to a psychiatrist if I am convinced that there is a true psychiatric pathology. Asking for an unreasonable procedure is usually not pathological. Nevertheless, it is my professional and ethical mission to inform any patient when I do not think a specific procedure is appropriate for them, or if I feel their expectations are unreasonable. It is not our job to "sell" surgical procedures to patients, but to provide them with the best possible advice based on their expressed desire. If we don’t think an operation will make them happier or improve their quality of life, then we must explain why. In most cases, patients understand this and are grateful for such advice.
2. We see many people in show business who have had extensive plastic surgery, including Michael Jackson, Melanie Griffith and the late Joan Rivers. When do you draw the line on the extensive use of plastic surgery?
There really is no general rule. I can understand that some people may consider any aesthetic procedure to be excessive, and I can respect such an opinion, even if I don't share it. I would not judge if some celebrities have had too much plastic surgery, but for my practice, I want to make sure that for every procedure, even consecutive operations, there is a correct indication that respects the wishes of the patient, the possible outcome, the risks of each procedure, and basic ethical considerations. “Primum non nocere”— First, do no harm! Patient safety must always be our first priority. It should guide every physician’s actions in any manner of practice.
3. What is considered too much plastic surgery?
Again, it is difficult to have definitive criteria. A lot of our consultation is intuition and is enhanced by training and experience. Over time, you develop a sense for people that you simply should not operate on. Every so often, you can tell when a person won’t be satisfied with the outcome even if I agree to operate. It isn’t as much “too much plastic surgery” as it is a matter of managing realistic expectations. Accordingly, when I can tell that a patient will be happier if I operate, I will gladly do so.
4. What are some signs that a person has body dysmorphic disorder?
There are patients who come to me with precise issues they wish to correct and then there are patients who can’t define what they are looking to achieve or even precisely what they want, and these are red flags. If someone comes to my office and asks me to look at their face and tell them what I think can be improved upon – it’s a red flag. I could wind-up suggesting changes to a person’s appearance that they may never have even considered. Again, it isn’t my job to ‘sell’ procedures. A patient should come in with a distinct idea of what they want and why. If they can’t identify those things, I will advise them to spend their money on a nice vacation in lieu of surgery.
5. How do you handle a patient who is demanding an unnecessary and/or unreasonable procedure?
As physicians, we have a pretty decent handle on the psychology of a patient, and develop an instinct for which patients are appropriate candidates and which are not. That being said, even if I turn someone away, there is a decent chance they will find another surgeon who is willing to perform whichever procedure(s) they’re seeking out.
As for my own practice, we always look to the basic tenets of patient safety. This includes a patient’s age, lifestyle and their expectations in terms of how reasonable they are. We must also examine factors like the physiology of particular patient’s skin - and be able to determine how well it will or won’t heal following a surgical procedure. Patients who have undergone many procedures on the same part of the body face a greater risk for troublesome outcomes and even the possibility of irreparable damage. It is our responsibility to use our best judgment when it comes to operating and there are many factors involved.
Ultimately however, beauty is in the eye of the beholder - and while I am happy when patients don’t ask to get extremely exaggerated big breasts or an overly-lifted face – I defer to the patient’s personal desires respecting what they wish to achieve. If it seems that an operation is truly what a patient wants and will make them happier, and I determine that the procedure is safe for them, then there shouldn’t be an absolute “no.”