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Deciding Whether to Go Ahead With Cosmetic Surgery Not Easy : Health: Many people face opposition from family and friends. There's also a fear of the results as well as the pain of recovery.


Is there a woman alive who hasn't considered changing something about her body?

From sweet-16 nose jobs to tummy tucks and final face lifts, women--and, surgeons say, increasingly men--get the message that if you can make a change and feel better about yourself, why not?

But deciding to have cosmetic surgery is easier said than done. Ask women who have considered it, and you'll find many faced complex, even agonizing questions.

First, there is the normal fear of surgery, including the knowledge that, in rare cases, people undergoing cosmetic procedures do die on the operating table. And there is the fear of physical pain, not to mention worry about the success of the outcome.

"You're worried about the pain compounded by the fear you're going to end up looking like a laughingstock," says one 40-something woman who for years contemplated but decided against changing her nose. "It's got to come out good or you're dead. . . . It's a very terrifying thing."

To make it more painful yet, you cannot expect the same kind of sympathy for an elective procedure as for one that is clearly medically necessary--"real surgery"--as one woman put it.

"Everybody said, 'You're crazy,' " says a petite 39-year-old Manhasset, N.Y., woman who had liposuction to remove fatty bulges from her hips, stomach and thighs. "I disguised (the problem) well. I wore leggings . . . an oversized top. All you saw was stringy arms, stringy legs. . . . Some people said (of the liposuction), 'Oh, I've only heard bad things about it.' "

A 43-year-old Port Jefferson, N.Y., woman with a "slight bump" on her nose wrote to Newsday: "(I) . . . went as far as deciding on the surgeon, the taking of pre-op pictures, pretesting and setting up the date of the procedure, then backing out at the last minute. The reason was a constant barrage of family and friends saying, 'You're so pretty as you are. Why do you want to change? What if you don't like it? You can't change it back!' "

So you look for support and end up feeling sabotaged. Some of the concerns may have merit. Some may not. But in the end, as one woman put it, unless you are one of the Ladies Who Lunch, where everyone gets face lifts, you are very much alone.

Which is probably as it should be, say experts, who will tell you that one of several keys to whether a woman is making a healthy decision about cosmetic surgery is the extent to which she is making the decision for herself alone.

"It's a very, very personal decision," says Dr. Thomas Rees, a plastic surgeon who retired from his New York City practice in 1992. Rees is a professor of plastic surgery at New York University Medical Center and an author of textbooks as well as a popular book "More Than Just a Pretty Face" (Little Brown, 1987), available in libraries.

Rees explains that it is a red flag to responsible surgeons when a person's reason for having surgery seems to be tied to someone else--a woman who enlarges her breasts because her boyfriend wants it, for example, or who thinks a face lift will win back a husband who left for someone else.

As Self magazine pointed out in a list of reasons not to have plastic surgery: "If you think higher cheekbones and tighter skin will save a relationship, we have two words for you: Ivana Trump."

Most surgeons are wary indeed of women who come in with unrealistic expectations--for example, the middle-age woman who comes in carrying a wedding photo or magazine images of Claudia Schiffer or Christie Brinkley. "These patients are expecting things you're never going to be able to deliver," says Rees.

Mental-health professionals also caution against a common tendency to organize all of one's frustrations around a single flaw. It is too easy to see surgery as a magical cure when there may be a number of things people can do to improve their lives, from quitting smoking to going back to school.

"You probably can achieve most of what you want in life in other ways," says Rita Freedman, a psychologist in Scarsdale, N.Y., and author of "Bodylove: Learning to Like Our Looks--And Ourselves" (Harper & Row, 1989).

"You can achieve self-esteem, get love, get ahead in a career. You don't need to look superlative. . . . Our lives are filled with a number of ordinary people who have done a lot with their lives and whom we respect," she says.

Freedman suggests that feelings of inadequacy are easy to come by in a consumer economy that feeds on people's feelings of discontent. "A great deal of money is being spent to teach us that we are inadequate the way we are, that we need some product, some process to complete us, to make us happy, normal, to make us acceptable," says Freedman, adding that women are especially vulnerable to messages about appearance.

"There is an enormous amount of pressure for women to find out who they are by looking in the mirror."

Another warning flag to surgeons is a decision precipitated by a single event, such as a child's college graduation or wedding. It is important to think beyond the event. For example, is the wedding or graduation a message to a mother that her children are taking their place as adults, and is she perhaps reluctant to move on to the next phase of her own life?

"Making a permanent decision at a time of high stress may not be a wise decision," says Freedman. "The most serious question is, why am I doing this? What do I want it to achieve? Why now?"

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