Cosmetic Beauty Directory - Great Expectations

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Johanssen's breasts. Like a woman going to her

hairdresser with a magazine to show her stylist a

new hairstyle, many prospective patients take a picture of

the celebrity look they covet to their cosmetic or plastic

surgeon. 'Many of those desiring cosmetic surgery will be

influenced by a celebrity's look although not necessarily

want to be a celebrity lookalike,' comments social worker

Roberta Honigman, co-author of Living with your Looks

(UWA Press).

To most plastic and cosmetic surgeons, this comes as no

surprise and the majority of patients listen when told that their

desired result may not be the most suitable for their unique

features, or the surgery may not result in them mirroring the

celebrity look they long for. Instead the patient usually works

with the surgeon to discuss the best possible outcome from

their cosmetic surgery so their expectations (and satisfaction)

with the procedure are realistic and positive.

According to Honigman, a review of a range of studies

of psychosocial outcomes following cosmetic surgery

suggest most patients were pleased with the outcome and

felt better about themselves. Factors identified with

unsatisfactory outcomes included being male, being

young, suffering from depression or anxiety and having a

personality disorder or psychiatric disorder including body

dysmorphic disorder (BDD).

'The patient's expectation of the outcome appears to be

important,' says Roberta Honigman. 'It has been

suggested that a distinction can usefully be made between

expectations regarding the self (such as improving body

image) and expectations relating to external factors (such

as enhancing a social network or getting a job). Some

evidence points to externally directed expectations being of

more concern. If the person views the procedure as a

panacea for his or her life problems, the outcome is likely

to be poor.'

According to Honigman, a cosmetic specialist can

ascertain a patient's expectations from their surgery by

asking some pertinent, common sense questions during

consultation. 'First, the individual's attitude towards the

cosmetic problem and the distress and disability

associated with it should be assessed. If the cosmetic

specialist perceives the patient's cosmetic problem to be

much more trivial than the patient believes it to be,

suspicion should be aroused,' Honigman continues. 'It is

illuminating to assess the patient's expectations in terms of

the outcome of the proposed procedure in both cosmetic

and psychosocial terms. A person's motivation for having

the surgery can be significant in whether the patient

believes whether the procedure has been successful.'

It is useful to review past cosmetic interventions,

including the number of previous procedures and their

cosmetic and psychosocial outcome as perceived by the

patient as well as by family and friends. The cosmetic

It's important patients have

realistic expectations of their

chosen cosmetic procedure prior

to surgery.

Kerrie Davies reports.

AUSTRALIAN COSMETIC SURGERY

N icole Kidman's nose. Angelina Jolie's lips. Scarlett

specialist should be most concerned about people who

have had numerous procedures performed by many

practitioners and particularly those who report the outcome

of such procedures to have been unsatisfactory. Any

history of legal procedures or threats should obviously be

considered very worrisome.

Honigman recommends that all cosmetic specialists

take into account a psychiatric history and assessment of

the patient's mental state during consultation, although

those who have a mental illness should not be

automatically excluded from surgery. A social history

assessment - such as a recent relationship breakdown - is

also advisable so the cosmetic specialist is mindful of these

issues and motivations when ascertaining the patient's

suitability for surgery.

'A cosmetic specialist can

ascertain a patients expectations

from their surgery by asking

some pertinent, common sense

questions during consultation'

But when Honigman and co-writer David Castle's paper,

'Does cosmetic surgery improve psychosocial wellbeing?'

was published in the Medical Journal of Australia , Sydney

cosmetic plastic surgeon Dr Darryl Hodgkinson replied in his

extensive letter to the journal's editor that such an in-depth

routine psychological assessment was easier said than

done, and the expectation that the result may have a positive

effect on their life is not necessarily an unrealistic one.

'The warning given that cosmetic specialists should be

concerned about patients who have had numerous

procedures, in particular patients who have previously sued

physicians, is a poignant one,' he wrote. 'Psychological

testing of patients who wish to have plastic and cosmetic

surgery is not routine, and plastic or cosmetic surgeons

cannot be expected to carry out such testing. Liasion with

psychologists or psychiatrists can be conducted on a

case-specific basis but not routinely. The aim is to screen

for body dysmorphic disorder but this can be quite difficult,

as the presentation is often obscure.

'In reality we live in a world where appearance is very

important and self-esteem is related to appearance. Age

discrimination is a reality, and cosmetic surgery has been

shown to improve a patient's psychosocial well-being.'

The delicate balance of achieving a satisfactory surgery

outcome for both the cosmetic specialist and the patient

seemingly lies between achieving the desired aesthetic

outcome and the patient's great expectations within

a realistic and healthy physical and psychological

framework. acsm

AUSTRALIAN COSMETIC SURGERY