Experts have issued some stern reminders to cosmetic practitioners to screen prospective patients for mental illness, such as body dysmorphia, before proceeding.
Roberta Honigman; social worker and researcher, had some strong words on the topic at Sydney’s recent Breast Master’s Symposium, hosted by the Australasian Society of Aesthetic Plastic Surgeons (ASAPS). Honigman estimates up to 5% of patients present ‘red flags’, suffering from some degree of mental illness and are seeking relief via cosmetic solutions.
“They’re the patients who need a psychologist, not a face lift, and will seek revenge on the plastic surgeon who fails to fix their non-existent physical flaws,” she says. “They’re the 5 per cent who make you want to retire prematurely and run screaming from the building.”
She says typically these patients can vary from body dysmorphia to addiction disorders, OCD and borderline personality disorder, and will fixate on a perceived flaw as opposed to themselves as a whole.
“They believe they are hideous … They think people are staring at them in the street and they think that fixing their appearance is going to solve all their problems. They have intrusive negative thoughts that drive obsessive behaviours such as repeatedly checking themselves in mirrors, excessive grooming and in extreme cases, “do-it-yourself surgery” and suicide.”
Honigman also explained that the problem extends well beyond the surgery itself, and regardless of positive results from a procedural perspective, operating on mentally unwell candidates can have some serious repercussions long after the surgery is done.
“If you are the surgeon, whether you like it or not, no matter your skill or good intentions … the promise they heard you make when you said ‘oh yes, I can do that’ was broken and they will blame you for ruining their lives,” she said. “They will be out for revenge not only with negative online reviews but they will keep hounding you and demanding further surgery, often at no cost.”
“If you suspect they have [body dysmorphic disorder] ask if they see, or will see, a mental health professional. If they decline? Goodbye. If they tell you they want to be happy, say goodbye.”
Honigman stated that these types of patients are never satisfied with their results, and will often undergo multiple procedures through different surgeons without disclosing their history.
Dr Richard Barnett, Chairman of the Australasian Foundation of Plastic Surgery, agreed that plastic surgeons need to go to great lengths to properly screen prospective patients, particularly young ones.
Case in point was a 20-year-old client of Dr Barnett’s that he recalled wanting to remove a lump from her nose, only to discover she had already had 10 previous procedures over the past 2 years. “She came back and wanted me to put it back the way it was,” said Dr Barnett.
“She was so distressed she could barely walk out the door. That sort of patient stays with you. I think ‘how could I have missed that?’”
ASAPS president Dr Naveen Somia says that sadly nowadays, this is an increasingly common occurrence. “Not surprisingly, plastic surgeons now encounter people with body image issues more frequently than any other medical group,” he said.
One expert, Psychologist Michelle Roesler suggested that the best solution to the problem would be having a psychologist on hand at every practice – a statement disagreed with by Dr Somia for its impracticality, saying a screening program is more efficient.