Fiona MacCallum on cosmetic surgery and body image

Fiona MacCallum

This is the second in a series of posts about the complex relationship between cosmetic surgery and body image. Here Fiona MacCallum, Associate Professor in the Department of Psychology at the University of Warwick, and Co-Investigator of the Beauty Demands project, gives her thoughts. If you would like to contribute to this discussion please email your response to Jan Kandiyali.

Question: Cosmetic surgery is regarded by some as a 'quick fix' for more deep rooted problems of self-esteem and body-image. How far do you agree with this assessment of elective cosmetic surgery? If surgery is undertaken for reasons of self-esteem and/or body image do you think this is problematic?

There can be a range of motivations for requesting cosmetic surgery procedures. Dissatisfaction with body image is unsurprisingly a major driving force, and is often feature-specific, i.e. a potential rhinoplasty patient who is unhappy with their nose, rather than their general appearance. A recent review (Brunton et al., 2014) identified several other associated psychosocial factors in potential cosmetic patients, including self-esteem and self-confidence issues. The question of whether these motivations make cosmetic surgery problematic depends partly on the outcomes – does surgery actually “fix” these problems? For some patients, this does seem to be the case in relation to body image, with post-operative improvements seen. The effects on other aspects of well-being, such as self-esteem or mental health, are less clear-cut. Findings have shown a mixture of improvements, no change, and even worsening of these aspects after surgery. Therefore, “fixing” your nose may make you happier about your nose but won’t necessarily make you happier in general and could actually make some people less happy.

One group who are especially at risk are those with Body Dysmorphic Disorder, a clinical diagnosis relating to preoccupation with imagined defects in appearance that causes severe distress and/or impairment. Individuals with BDD are relatively common in cosmetic surgery populations, with varying estimates up to about 15% of patients (compared to around 2.5% prevalence in the general population). However, they are typically dissatisfied with the outcome and BDD symptoms may even increase in severity post-operatively. For these patients, cosmetic surgery is definitely problematic, and many practitioners agree that BDD should be screened for and alternatives to surgery offered, such as therapy or medication. It’s not only those with BDD who are vulnerable though; Brunton et al identified multiple factors that are associated with poor psychological outcomes following cosmetic surgery. Key facets are the expectations of the patient, and the extent to which these are realistic. Trained mental health professions should discuss motivations and anticipations with all potential patients, and consider alternatives in the way that they do for BDD.

Perhaps the important question though is why some feel that cosmetic surgery will fix their problems. Expectations are heightened by the adverts used by cosmetic surgeons (as discussed previously on this blog), suggesting that their procedures will not just change your appearance but also make you feel good. More generally, internalisation of the beauty ideals to which we are constantly exposed leads to more positive attitudes towards cosmetic surgery, and an increased likelihood of requesting it. Surgery in itself is not so much problematic as reflective of the wider societal problem; that so much of our self-esteem and supposed happiness is bound up with how good we think we look, and how much effort we think we should be putting in to look better.