About Face

Procedures Menu

About Face

Are You a Good Candidate?

Introduction The Surbery of Happiness Choosing a Surgeon Are You a Good Candidate

Much of the current research has been done by Dr. Mary Ruth Wright, associate clinical professor of psychology at the Department of Otorhinolaryngology and communicative Sciences at the Baylor College of Medicine, in Houston. In 1982, Dr. Wright wrote that no single method of preoperative counseling or evaluation can be used with all patients, but conversely, all patient “difficulties” develop because a surgeon fails to fulfill the expectations of the patient. By difficulties, Dr. Wright means anything ranging from tears to litigation, but essentially, she means dissatisfaction with the results of facial cosmetic surgery.

The patient might be dissatisfied because a physical complication has arisen as a result of surgery. A minor example might be hematoma, where a blood vessel has leaked and a tiny pool of blood has collected under the skin. Fortunately, physical complications as a result of facila cosmetic surgery are rare occurrences and usually correctable by the performing surgeon.

But the most common cause of dissatisfaction is a patient’s unrealistic expectations in the first place. Such a patient is a poor candidate for facial cosmetic surgery. The problem is, some patients are very skillful at hiding their true expectations and motivations when they approach a facial cosmetic surgeon. Over the course of a couple of preoperative interviews, the surgeon can usually detect a poor candidate and either decline to proceed with surgery, or recommend that the patient take the time to work out personal problems first before undergoing surgery.

Dr. Wright has isolated a group of “troubled” patients with unrealistic expectations about what facial cosmetic surgery can do for them - patients who are psychologically unbalanced and should be counseled with extreme caution by facial cosmetic surgeons. She divides these patients into three broad groups: psychoneurotic, psychotic and those with a personality disorder.

I can generally recognize psychoneurotic patients by Dr. Wright’s guidelines: these patients show evident worry, anxiety and a tendency to sometime. A person who somatizes converts anxiety into physical symptoms. Patients with somatization disorder usually have a long list of physical complaints for which no physical causes can be found, and they often seek out unnecessary treatments or surgery - like facial cosmetic surgery. If I sense that I am dealing with a psychoneurotic, I will give him or her the benefit of the doubt at first and schedule one or two more consultation appointments. But ultimately, what this person needs is some counseling with a psychologist or psychiatrist, and I try to direct him or her that way.

Patients with a truly psychotic disorder display peculiar, disjointed thoughts and dizarre reactions to everyday occurrences. Facial cosmetic surgeons have a particular interest in identifying the psychotically disturbed patient: Dr. Wright cites two cases where patients suffered psychotic “breaks”, or breakdowns, following surgery and murdered their surgeons. The first case was detailed in the British Medical Journal in an anonymous editorial titled, “Hazards of Cosmetic Surgery”. The second case appeared in the Aesthetic Plastic Surgery Journal, in a story titled “Dr. Vazquaz Anon’s Last Lesson”. And so it was.

I should point out that both the patients who murdered their surgeons had had nose jobs; that is, they were Rhinoplasty patients. In a paper titled “The Psychology of Rhinoplasty”, Dr. Wright explains that authorities have observed more emotional turmoil following Rhinoplasty than with any other cosmetic surgery. Rhinoplasty produces more dramatic aesthetic improvement and a higher percentage of patient satisfaction than other forms of cosmetic surgery, but it also produces that highest level of dissatisfaction in patients inclined that way.

Male patients, of which there are an increasing number (up to fifty percent of all aesthetic patients wanting a Rhinoplasty), are more likely to be psychologically upset by what they perceive to be unsatisfactory nose jobs. Quite often, this dissatisfaction has to do with a deep-seated identity conflict, sexual or otherwise, as the nose ranks with the penis and breast as one of the most psychologically important body parts. The hapless facial cosmetic surgeon may end up taking the brunt of the patient’s frustrations.

The third troubled group noted by Dr. Wright - patients with a personality disorder - are the most difficult to identify. These patients tend to act out, to be manipulative, to have their pleasure at the expense of others, to disregard social mores and to be lacking in emotional depth. They are the group most inclined to sue a facial cosmetic surgeon for medical malpractice, no matter what the outcome of surgery might be. Frankly, their manipulativeness makes them hard to recognize because it often takes the form of flattery - hard for many doctors to resist! If you ask such a patient what he wants done to his face, his answer might be: “You’re the expert, doctor. You tell me.” This should set off warning bells for more experienced facial cosmetic surgeons.

Dr. Wright has identified the most troubled groups, but they are not the only people who go looking for facial cosmetic surgery when they shouldn’t. You might consider measuring your own motivation for seeking out facial cosmetic surgery against information published by the American Academy of Facial Plastic and Reconstructive Surgery. The Academy has put out a text called The Face Book in which four types of individuals are identified as having unacceptable reasons for wanting facial cosmetic surgery.

First, people with ill-considered reasons for wanting surgery, such as the twenty-three-year-old man who wanted a face-lift because his coworkers were ribbing him for being too old. Second, people who seem out of touch with reality, like the obese woman in her mid-thirties who came into a surgeon’s office wearing filthy clothes, a ton of makeup and with her hair dyed an unnatural color; she wanted her eyelids done in order to improve her appearance. Third, people who seek surgery at someone else’s instigation, like the sullen daughter brought in for nasal surgery by her beautiful mother or the wife whose husband is pushing her into doing something she doesn’t want to do. And fourth, people who have a secondary motive, such as the pathetic old man who wanted a face-lift because his family had kicked him out of the house and he thought a face-lift would make them want to take him back in.

[previous page] [next page]