As far as why a patient would seek cosmetic surgery, a few themes have also become lucid. In a general sense, it falls into the category of something about their appearance really bothers them and it is impacting their quality of life either by affecting their self-image or self-confidence. For example, the patient seeking rhinoplasty for a hump on the nose often feels self-conscious by it. They typically don’t like to be photographed or seen from certain angles. Many feel like the nose doesn’t belong to them. As a result, they spend a lot of time avoiding certain social and interpersonal situations. As you can imagine this type of constant self-awareness can be inhibiting and distracting for the individual as well as consume a lot of conscious energy. Now, notice I said the “rhinoplasty patient” with a hump and didn’t say the person with the hump. Because not everyone with a nasal “hump” feels bothered by it or feels like they want to correct it. It is only those patients who are significantly bothered by that particular feature or appearance that seek cosmetic surgery. When they have the surgery done successfully, they feel that their new nose was the nose they were meant to have. It is really interesting how often I hear those sentiments. They are finally at peace with themselves.
Insight Into the Motivations of the Facial Plastic Surgery Patient: A Surgeon's View
When I was a 1st-year medical student I fell in love with the field of Facial Plastic and Reconstructive Surgery. At that point, however, I never knew any actual patients. Interestingly, the field of Facial Plastic Surgery was not very popular at that time. People did it, but it did not have the same level of public interest. My interest was based purely on three things. 1) I loved surgery. That’s why I went into medicine in the first place. I loved working with my hands and in my mind; surgery was the greatest way of helping those in need. It’s immediate gratification. 2) I loved the idea of thinking through things and offering creative, unique solutions based on the case at hand. In facial plastic surgery, there are very few patients who look the same or have the same problem. 3) I loved the idea of helping someone enhance or restore his or her appearance. Undeniably, the face is one of our greatest assets and it is so valuable to each of us. Even though at that point, I had never met a facial plastic surgery patient, I could only imagine how important it would be for that person to get the greatest outcome possible. I knew the challenge and pressure of working on the face and meeting or exceeding my patients’ expectations would keep me excited and enthusiastic throughout my career.
These were all impressions I had early on. After a decade of specialized training, I had finally started working with my own patients. From very early on, one of my primary philosophies about plastic surgery has always been that it is 100% about the patient. What I mean by that is that it is so important to really understand the patient’s motivation and goals for undergoing cosmetic facial surgery. I have always been one to spend a lot of time trying to really get a handle on their expectations and desires. As I spent more and more time having these lengthy and interesting conversations, a few clear concepts came through. First, no one approaches cosmetic surgery lightly. Despite the reputation that cosmetic surgery patients are vain or superficial, most patients approach the decision with thoughtfulness and solid personal reasons. It is not a trivial decision. Whatever the problem, it is emotionally bothersome enough for them to seek the help of a plastic surgeon to correct it. Second, 99% have a very clear idea about what they hope to achieve. They are not simply saying, “Doc, just make me look younger or prettier.” They typically know what it is that bothers them and they know if they correct it appropriately they will feel better about themselves. Third, 100% are worried about ending up looking unnatural and “operated-on.”
The #1 reason women or men tell me they want to pursue facial rejuvenation procedures is that they simply feel younger than they look. They say the image they have of themselves is that of a younger person. Yet, when they look in the mirror and the jawline and neck are sagging, or they see the bags under their eyes, they almost can’t recognize the face that is staring back at them. For those who land in my office, this sensation is so bothersome that their quality of life is literally affected. For example, my mother-in-law, for whom I performed a facelift, told me she would avoid the mirror as much as she could because the face she saw was depressing her. This is a beautiful confident person with a tremendous amount of self-esteem. Yet, she had grown tired of her aged appearance because despite being in top shape and full of energy and health she could no longer tolerate looking so different than her internal self-image. Interestingly looking so much older than she felt was starting to make her feel older and act older. It is interesting because this wasn’t the first time I heard that. What’s truly wonderful is that once the procedure is performed successfully and the “problem area” is corrected, there is a fundamental change in their self-impression, which translates to many other positive changes in their life. That has always been the best part of what I do.
As great as the motivation is to address these issues, the fear of looking “plastic” or “operated on” is even stronger (for most patients). A good chunk of the consultation is spent listening to their concerns then trying to explain that it’s not the surgery it’s the surgeon that creates those unpleasing looks. Well-done plastic surgery is essentially unnoticeable. Unnatural-looking results occur because the anatomy has been distorted by inexperienced hands or an overzealous surgeon. It has nothing to do with the degree of change or correction. In other words, one can have a dramatic result yet look totally unoperated. This is actually the primary goal of excellent cosmetic surgery. Many of my patients' joke that most of their friends and coworkers tell them that their new hairstyle makes them look 15 years younger. No one knows that they just had a mini-lift!
