Non-invasive cosmetic procedures or ‘tweakments’ have become commonplace over the last five or so years, which in turn, has normalised more invasive cosmetic procedures. The latest global survey from ISAPS reports a continuing rise in aesthetic surgery worldwide, with cosmetic surgeries rising by more than 5% year on year. 

This rise in cosmetic treatments begs the question, with surgeries more widely accepted and accessible, and the medical beauty industry booming, can you rely on your doctor to tell you when not to go ahead with a procedure and, if needed, recommend psychological support instead?

Doctors, consultants and aestheticians have a duty of care to all patients, but when a procedure is purely cosmetic and not being carried out to sustain or improve physical health, this duty of care becomes a specious one. Cosmetic surgery and cosmetic procedures are costly and let’s not forget that private practices are also businesses. 

Twenty years ago it might have been possible to undergo a procedure like a rhinoplasty (nose job), liposuction or a breast augmentation under the care of the NHS. The UK’s National Health Service offered life changing cosmetic surgeries on the basis that for those living with debilitating body dysmorphic disorder, cosmetic procedures combined with mental health support would save lives. 

Now, in 2021, the NHS is under enormous strain and it would take a near miracle to receive a new set of boobs if no medical need for them were apparent. And so, the private medical aesthetics industry has grown exponentially, and continues to do so. 

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Butt Jobs Are 77% More Popular Than They Were Five Years Ago 

Breast augmentation is still the most popular cosmetic procedure in the world. Many people with breasts opt to undergo this procedure for a variety of reasons – some elect for a reduction because of back pain, some for reconstruction after mastectomy and some for fat transfer to address uncomfortable disparities in symmetry. But people also undergo breast augmentation because they’re simply dissatisfied with the appearance of their breasts. 

Şirin Atçeken, MFT, an EMDR Europe Accredited Consultant at WeCure says, “Studies show that increasingly more people are dissatisfied with the way they look and consider having surgical and non-surgical cosmetic surgery. And the cosmetic surgery industry and its methods are evolving rapidly. Of course, there are people seeking operations due to medical reasons and for rehabilitation after injuries but most are carried out on a voluntary basis to improve appearance.”

To date, the most popular procedures globally are breast augmentation, rhinoplasty or nose job, blepharoplasty or eyelid aesthetics, facelift, browlift, hair transplantation, cosmetic dental operations, liposuction and tummy tucks. But it’s buttock augmentation that has seen the greatest spike in popularity in the last five years. The number of ‘butt jobs’ being performed have increased by 77.6% since 2015. 

In addition, labiaplasties AKA designer vagina procedures have increased by 73.3% since 2015. It’s fairly obvious that no one is receiving a butt lift or breast implants for physical health reasons, and a labiaplasty is often a procedure more associated with sexual confidence, rather than a medical issue. Of course, if it’s your body and it’s your choice, but are clinics all too keen to accept payment for these increasingly common confidence-boosting procedures when a course of talking therapy might benefit the recipient far more in the long term? 

Şirin Atçeken says, “The main reasons to consider these types of cosmetic operations include improving self esteem and confidence, reversing the effects of aging, increasing self-fulfillment and pleasure in daily life. Social media showing photos of curvy celebrities looking ‘perfect’ has a big influence in the desire to be a better version of oneself and to emulate these body types.”

Are You Struggling With Your Confidence? 

It’s normal to feel insecure. The human brain isn’t wired to feel positively all the time and being critical of oneself is part of life. But if you begin to feel that cosmetic surgery is your only route to happiness, undertaking a course of therapy before a butt lift or breast implant consultation, may benefit you. You may find you still want to pursue cosmetic surgery or a non-surgical treatment but you should also be looking for indicators of dysmorphic thinking, low self esteem and obsessive behaviours.

“Even though many people are satisfied with the results of cosmetic surgery, there are many others who are not.” Says Şirin Atçeken. 

“Unfortunately, if someone has a deeper need for self confidence or has issues of unworthiness, they will find it difficult to feel satisfied with themselves and continue being disappointed with surgical results. 

More elaborate psychological counselling is needed for people who are very preoccupied with their physical appearance. People who have very high or unrealistic expectations about the way they will look after surgery, are often experiencing underlying mental health issues. 

Signs and indicators of this might be compulsive and repetitive behavior such as checking one’s appearance in a mirror, excessive grooming, skin picking and seeking reassurance, or mental acts like constantly comparing one’s appearance with that of others or obsessing about certain areas of one’s body to the point where all other thoughts are affected or dominated by this.

Clinically significant distress or impairment associated with physical appearance is known as BDD or Body Dysmorphic Disorder and this condition is found to be highly common in cosmetic-surgery-seeking patients with major depression, social phobia, eating disorders and obsessive compulsive disorder. Some of those patients change their minds about surgery after psychological or psychiatric support for their symptoms, or set more realistic goals for themselves for the surgery they seek.”

How Often Will A Medical Professional Recommend Therapy Over Surgery?

At the end of the day, a clinic is a business so being self aware and looking out for the signs and symptoms of BDD is essential. If you’re finding it difficult to advocate for your own mental health, speak to friends, family, loved ones, your GP or a counsellor or therapist. Often, a good practitioner will go through your reasons for wanting a cosmetic procedure and will discuss these in detail. They’ll talk about your general mental health and suggest talking therapy if there are any red flags. Some practitioners will simply refuse treatment if a procedure seems ill advised, unnecessary or is being requested for the wrong reasons. However, there are plenty of practitioners who don’t take their duty of care to patients as seriously as others. 

Surgery is totally your choice but you need to be self aware and sure that you’re pursuing it with a healthy frame of mind, and that you’re consulting with professionals who’ll put your mental health first, rather than simply accepting your business. Surgery won’t make any underlying problems with self acceptance disappear. It could make you feel great, but be aware that looking slightly different isn’t a fix for mental health issues. 

“If a client of mine decides to have cosmetic surgery I would help them process their reasons, motives and expectations for the surgery.” says Şirin Atçeken. “Setting realistic goals is very important to prevent disappointment as well as understanding the unconscious dynamics behind the decision.

If medical professionals are aware of the possible psychological risks of cosmetic surgery for particular patients, for example, the heightened risk of suicide among women following breast augmentation surgery and the high prevalence of BDD and the associated psychiatric comorbidities, they should refer those patients to appropriate psychological assistance before the surgery and explain the pre and post-operation processes as well as limitations of the operation in detail.”

If you’ve been thinking about having a procedure for a long time, ask yourself why. Make a list of the reasons you’d like the procedure and why it’s important to you. Make a list of other things you’d like to change in your life too. Consider how high on your list of priorities this treatment or surgery is. Next, start a diary. Record how you feel about yourself, your body, the things you’d like to change, how often you think about the treatment, your general mood and anything else you think is relevant. Keep this diary for at least a month and once the month is up, reflect on the signs and symptoms of BDD and your feelings and behaviours. 

If you’re certain you want a surgery or treatment and are feeling healthy and focused,  the next step is finding the right practitioner. Never opt for someone because they offer cheaper procedures. Always carry out in-depth research, check accreditation and qualifications, read reviews and testimonials, look at before and after images and if possible, speak with previous patients. 

Once you’ve contacted your doctor, nurse or consultant, arrange an initial chat. Take your time and make sure you feel comfortable and listened to. Discuss the realistic goals you have set for yourself and the positive and negative outcomes of the procedure. Ask questions and feel free to book more than one consultation to ensure you’re completely confident before you go ahead. 

If you feel you may be struggling with issues around body image, self esteem and self worth but want to book a treatment or surgery anyway, that’s your choice. However, ensure that you’re not using the procedure like a band aid. Apply the same research and self awareness techniques to find a therapist or counsellor that you feel comfortable talking with and address those issues. Surgery isn’t a substitute for therapy and won’t help you to really process what’s bringing you down.