To answer this question about plastic surgery, we must analyze the concept of body dysmorphic disorder. This is a psychiatric or mental condition whereby certain individuals:
- See themselves as ugly.
- Spend hours analyzing flaws in their body.
- Miss work or school fearing others will see them.
- Avoid family and friends.
- Seek endless plastic surgery to improve these defects.
Fortunately, this is a very rare condition. In addition, there are certain medical conditions, for example, blood thinners, severe heart conditions, possibly metastatic cancers, or other medical conditions that put the patient at risk for general anesthesia.
The general anesthesia risks for patients who should not have plastic surgery are different from those patients who are basically physiologically healthy and could withstand hours of general anesthesia but emotionally and behaviorally are problematic.
For example, we’ve seen a patient who brought to us a paper-mâché model of his nose. He then presented different aspects of his nose related to this model that he would like improved. On physical exam, he had full open Airways bilaterally and no large hump no wide nasal base or middle third. In essence, I was not sure what he wanted to be improving.
This combination of factors is in my opinion a patient not suitable for cosmetic surgery. Then there’s the patient who’s had surgery elsewhere and does have a degree of improved ability which presents with numerous pages and drawings and enlarged photos indicating their desires. This patient may have improvability but emotionally can the patient handle less than optimal improvement and even possibly complications?
As doctors, we feel obligated to help as many people as possible. If we believe someone has an improbable aspect of their body, we must assess their psychiatric, psychological and mental state before we accept them as patients.