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After the nip and tuck

There's an emotional fallout with cosmetic surgery that few patients -- or their families -- expect.

October 10, 2005|Lisa Gill | Special to The Times

EVE MICHAELS gave herself the 50th birthday present she had dreamed of: a lower face-lift, chin implant and nose job. It was the long-anticipated high point, she says, of nearly a decade of self-improvement: weight loss, fitness training, improved eating.

The decision to have the surgeries was so that she could "project who I really was," says Michaels, now 52 and an image coach in Beverly Hills. "The cosmetic surgery was the icing on the cake."

Two weeks into the healing process, though, Michaels suffered a brief, but emotional, breakdown in an all-mirrored elevator in her apartment building. Her new nose, she thought with shock, "looked like everyone else's."

Her son, then 13, also had difficulty accepting his mother's new look, dismissing her actions as simple vanity.

The decision to undergo cosmetic surgery is not usually arrived at lightly, but even so, life after the procedures is not always what patients -- or their family, friends or partners -- expect. Alterations to physical appearance can have a profound effect on emotions and self-perception, changing how people interact with others and how loved ones, and even strangers, perceive them.

But only now are surgeons and researchers beginning to quantify those changes -- and asking how they can better prepare their patients, even if it requires dissuading some from having surgery.

"If we look just at the scientific studies that have been done, we know pretty conclusively that patients report improvements in body image after surgery," says David Sarwer, associate professor of psychology at the Center for Human Appearance, University of Pennsylvania School of Medicine. "In terms of improvements in self-esteem and quality of life, the impact of surgery is less clear."

In one of the largest studies of psychosocial outcomes of breast augmentation, for example, more than 90% of the 360 patients studied reported they had an improved body image two years later. And, the 2002 study found, 75% to 85% said that the benefits of the surgery outweighed the risks.

But a 1999 survey of 281 plastic surgeons by Dr. Gregory Borah and colleagues at the division of plastic surgery at Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, found that almost all respondents had encountered at least some patients who had experienced disappointment, depression, anxiety issues or sleep disorders after cosmetic surgery.

Last month, Sarwer and his colleagues released a book on the psychological effects of plastic surgery on patients. While the title, "Psychological Aspects of Reconstructive and Cosmetic Plastic Surgery: Clinical, Empirical, and Ethical Perspectives," may be a bit of an eye-glazer, the book is the first scholarly text to detail the psychological aftermath of surgery.

The book notes, for example, that there have been few studies of postoperative changes among breast augmentation patients. And the two reports that used psychometric measures found mixed results: One found a decrease in symptoms of depression from preoperative status; the other reported increased symptoms of depression in 30% of patients in the immediate postoperative period.

It also suggests patient-screening guidelines that the psychologists say can help plastic surgeons determine which patients have acceptable expectations for their surgery and which ones need a reality check.

The American Society of Plastic Surgeons has also taken a keen interest in patients' psychological outcomes. The association has increased the amount of related training available to its members, educating physicians on how to screen patients and prepare them psychologically for life post-surgery. It also has devoted a substantial portion of its consumer website to a discussion of the issues.

The need has never been greater. Reality shows often portray cosmetic surgery as a quick fix, and more Americans than ever are turning to cosmetic procedures to change their features. More than 1.7 million surgical procedures were performed last year, according to the plastic surgeons group. And more than 7 million people sought less-invasive procedures such as Botox and laser skin treatments.

Doctors have long questioned, and occasionally cautioned, patients during the initial consultation about their expected goals of surgery, but some patients nonetheless expect a happier, more rewarding existence almost immediately. Many are subsequently dismayed by the weeks, maybe months, of healing.

"There is an emotional letdown," says Dr. Alan Matarasso, a cosmetic surgeon in New York City and a clinical associate professor of plastic surgery at Albert Einstein College of Medicine. "Patients anticipated this procedure for weeks or months or years, and that can have an emotional impact to it, and they should be prepared."

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