Cutting Through the Stigma of Plastic Surgery
Story by Allison Clowers | Photos by Kassandra Eller | Design by Sara Roach
Do you ever look in the mirror and have feelings of absolute disgust or shame in what you see? In how you feel? You may not, but people with Body Dysmorphic Disorder do.
Body Dysmorphic Disorder, or BDD, is an extension of Obsessive Compulsive Disorder (OCD) that causes individuals to feel absolutely disgusted and ashamed of themselves. Sometimes to the point that they seek out plastic surgery to ‘fix’ a problem they may see. But what happens after that cosmetic change? Do the feelings of disgust go away?
Jennifer Yeh, licensed mental health counselor at Seattle Anxiety Specialists, explains, people with BDD are “full of such shame and self-disgust and it's a torturous disorder.”
Where there was once a negative stigma that society placed on plastic surgery, more and more people are speaking out about their plastic surgery experiences, making this a more accepted practice in today’s society.
Psychology Behind Plastic Surgery
Does the stigma of plastic surgery play a bigger role on people’s psychological heath? Absolutely. There are many driving forces that bring someone to want plastic surgery, and psychological reasons are a big contributor.
According to a press release from the American Society of Plastic Surgeons, nearly two percent of the population is affected by BDD, and up to 10 percent of those individuals seek out plastic surgery.
Yeh describes someone who has BDD as “a person [who] is obsessively preoccupied with something of their appearance … It could be related to something that they perceive as a disfigurement or a flaw in their appearance.”
She notes, “What makes it a disorder is that they are specifically focused or excessive, given the reality of their appearance.”
BDD is an intense disorder that can have a major effect on how someone views themselves to the point where they want to change something about themselves, which is when they may seek out plastic surgery to ‘fix’ this problem.
Although this might seem like a logical next step in an individual’s journey with BDD, it is quite the opposite.
“By getting the cosmetic surgery, they really haven't addressed the core issue,” Yeh explains. “The body itself was never the problem but how they relate to their body, how they can be in their body and be okay with their bodies. I think that leaves them feeling hopeless, like it was going to fix their body and then it didn’t.”
Dr. Shaun Desai, MD, associate professor of Facial Plastic and Reconstructive surgery at the Johns Hopkins Department of Otolaryngology, says, “Plastic surgery doesn't help patients [with BDD], the treatment for that is really more psychological treatment, medicine and behavioral therapy.”
BDD is very complex and there is really no cure, just therapy that introduces more positive rituals into daily life, rather than the negative ones such as constantly checking your appearance.
According to an article from Huffington Post by Olivia Loving who lives with BDD, the therapists she received help from constantly reminded her that they could not change her thoughts, only her actions, but if she reduced her rituals enough, her thoughts may eventually change as well.
A primary issue with BDD is not only does it affect someone’s view of themselves, but that internal struggle also affects how they interact with people.
Yeh explains how they, “really have disgust or anxiety about how they look … It makes it hard for them to engage with other people.”
She adds, “It's going to affect your job; it's going [to] affect your relationship. You carry your body everywhere you go and think about how difficult that would be.”
However, with all of this in mind, plastic surgeons are educated on BDD and other mental disorders, so they can effectively decide if an individual is a good candidate for their services.
“We should make sure that why they are choosing to see us isn't based on some misinformed psychological view of themselves or body dysmorphic difficulties,” explains Dr. Ginger Longo, MD at Mariposa Aesthetics in Ellensburg.
“I say, ‘you tell me what's bothering you, what you see in the mirror, what you see in pictures’ and then if it seems like their vision of themselves [is] more rooted in a dysmorphic place where they're never going to see themselves as beautiful … I usually try to limit the treatments or talk to them about what we can do to fix that,” Longo says.
She notes, very often, patients will come to her and ask her to do whatever she thinks would look good on them, cosmetic-wise, but that isn’t how plastic surgery works. This is what’s so hard about BDD, the individuals affected are constantly checking and re-checking to make sure they look okay and it is not something that plastic surgery can fix.
“Someone can be really driven on the surface because they're desperately checking to ease the feeling of disgust about themselves,” Yeh says.
Indulging in plastic surgery isn’t going to be the thing that brings these individuals out of their compulsive stage of constantly feeling ugly. After they have the surgery, the disorder will find something else about them to concentrate on whether it is a real deformity or not.
Regardless of if someone is seeking out plastic surgery from a dysmorphic place or not, they shouldn’t just jump right to plastic surgery as the only option.
Desai says, “I don't believe in doing kind of quick decisions for this sort of elective cosmetic surgery, so … I usually have patients thinking about [the] decision over time and really make sure it is what they want to do.”
“Part of the vicious cycle is that the problem was never actually [there]; it was more of a preoccupation and rigid belief that something is wrong. Even if they were to engage in the behavior of plastic surgery or a cosmetology procedure, they might not feel like it fixed the problem,” Yeh says.
Addressing the Stigma
CWU Family Sciences alumna Monica Blair who has gotten Botox and lip filler, shares her opinion on the stigma. “Now that social media and influencers are taking over the world, it's kind of dying down. I don't see it as much; I feel like people are now encouraging it more if it is what makes you happy.”
Plastic surgery has become more popular among the stars we see in the media, whether those individuals are having good experiences or bad ones, the conversation about it has lessened the stigma.
Yeh talks about Kylie Jenner’s impact on the discussion of plastic surgery after she got lip filler. “The fact that she felt that she had to hide it told me that she was feeling shame about it and that she felt that pressure and did not admit [it].”
Although, at first, Jenner did not talk about her choice to get lip filler, she did eventually decide to address it and look where it took her. She created a whole cosmetic line centered around her lips and the confidence lip fillers gave her.
According to Erin Jahns at Byrdie, a digital beauty magazine, Jenner was first interested in getting her lips done due to a comment made by a boy when she was younger. He mentioned that she had very thin lips and that she was likely a bad kisser because of that.
Yeh explains, while her initial interest in the cosmetic procedure was rooted in a childhood insecurity, she was able to build a “multi-million-dollar mega industry… around her lips,” and it is very influential.
The stigma surrounding plastic surgery could be related to the unrealistic expectations society puts on individuals and their appearance.
While the media does play a major part in fostering a safe place to have this much needed discussion on plastic surgery, the media may also play a role in why people feel that there is a negative stigma about it.
According to Longo, the stigma exists due to a lack of education on cosmetic procedures. “So many people, when they think of Botox, they think of movie stars with big lips [and] altered faces.”
Desai explains, “In real life, plastic surgery can be very different from what you see on TV and most people nowadays want plastic surgery results to look really natural, and they don't want to look like they've had plastic surgery.”
Longo also explains, “Many of the women don't have the stigma, but their husbands or their partners will say ‘oh, you don't need that. You're beautiful like you are.’”
She notes that while this argument from their partners may be true, she believes that the cosmetic procedures she provides offer people an opportunity to gain, “more confidence that shouldn't be stigmatized.”
Longo compares cosmetic procedures to changing the cut or color of our hair or changing our clothes. She explains, the procedure as “an extension [of] what we do to alter our appearance aesthetically for ourselves.”
“I feel like stigmas are what keep us from doing a lot of things in life,” says Longo. “So if there's a chance that someone could come in and get a little advice, even if the discussion is just about skincare and how to keep your skin healthy or how to make you feel better in the long run … there shouldn't be a block to come in and to see what there is to offer what people might be interested in.”
More than just Aesthetics?
But what about plastic surgery that isn’t done to improve someone’s appearance? There are so many reasons people go to plastic surgeons. Some plastic surgeons also perform procedures that treat body abnormalities or address past traumas.
Desai mentions he sees patients for congenital reasons, referring to altering a physical abnormality someone was born with. For example, he explains, some congenital anomalies he sees are children who are born with cleft lips and palates. He performs procedures that fix that issue, which can lead to a lifetime of happiness for the patient and their family.
Another big part of reconstructive plastic surgery is related to helping the effects of medical diseases, “for instance, breast reconstruction after cancer surgery,” says Dr. Davis Bronson, MD, Fellow of the American College of Surgeons at Astria Health.
Additionally, Desai treats “patients [who] have had cancers on their face, or in their jaw or their skulls and … patients who have had trauma to their face.”
Experiencing a traumatic disease such as cancer or going through a terrible accident will affect someone in almost every way possible, and a lot of that cannot be reversed or fixed. But one thing that can be fixed is their appearance, through reconstructive plastic surgeries.
Road to Recovery
Although there are some very negative effects of plastic surgery and the stigma still seems to loom above us, there are also some positive aspects to it.
Bronson talks about how his work benefits his patients. “They are trying to achieve a certain goal and we achieve that goal and they become more self-satisfied with their own body habitus and their thinking,” he says.
Additionally, Longo says, “The number of people, with just small transformations, [who] feel more comfortable with themselves, or like they got some of what their appearance was 10 years ago back, has been really amazing to me, and that’s rewarding.”
Blair explains, she will eventually go back and get her lips re-done once the filler wears off, and she says, “I definitely think that everyone should try it if they want to.”
She also expressed interest in exploring other cosmetic or plastic procedures, saying, “I think about, maybe after I have kids, getting my boobs done, like a lift.”
The positive aspects of plastic surgery not only affect the patients receiving a new look, or an improvement on something that has caused them trauma; it impacts the doctors as well. They are able to see the way someone feels about themselves change drastically. They get to help people gain more confidence.
Not only does it allow people to gain confidence but plastic surgery is also “functional and improve[s] their quality of life,” explains Desai.
Patients who have had plastic surgery following a disease such as cancer or a child born with a cleft lip get a new lease on life and that has a great impact on the surgeons.
