Cosmetic Surgery, Proceed with Caution

I find it ironic that cosmetic procedures intended to improve a person's self-esteem too often lead to the opposite outcome.

A growing number of women in my practice express frustration for having paid dearly, both financially and emotionally, for procedures that leave them feeling uncomfortable and insecure. Is it that more women are undergoing surgery and speaking out about it? Or is the frozen, plastic look finally becoming passé? What I do know is that more women are feeling angst about looking oddly unlike themselves and regretful about it all.

Even women who feel surgery changed their lives or those who are simply satisfied with the results often say they were not prepared for the physical and psychological ups and downs involved in the whole process. Why does that happen? And how can it be prevented?

Take Tamra Barney, one of the most real of the Real Housewives, a woman who has gone public about her plastic surgery and speaks about it with regret. We were both part of a panel on the Today Show talking with Hoda Kotbe and Kathie Lee Gifford about the cultural pressures to look perfect. Tamra told us that insecurity led her to get breast implants in her 20s. At that age, like so many other young women, she believed that bigger meant better, and was convinced they would make her feel more confident.

Recently, Tamra had her implants removed. "It was a long time coming. I knew I kind of wanted to get rid of them, but I don't think I had the self-esteem to do it." It was only after being treated for cancer—and growing in other ways—that she said she had the courage to let go of what she calls her "fun bags." While a sense of humor seems to help Tamra, the women in my practice aren't laughing about the subject. And they rarely are as vocal about their experience—these are not reality show women—so they often suffer alone.

One woman (who I'll call Sally) came for psychotherapy following an eagerly anticipated Short Scar Face-Lift (SSFL), a procedure she was told had similar effects as a full one, with a shorter recovery and lower costs. She had hoped it would be the very thing that could get her on the right track, maybe even turn her life around. Divorced at age 30 and now in her 40s, she was worried about looking older and ending up alone. A guidance counselor at an all-girls' private high school, she thought long and hard about getting 'work' done, not only because it was expensive and required a break from school, but it went against the kind of role model she felt she provided to her young students. She said, "I give the right message to my girls—you know that 'beauty comes from the inside'—but with my jowls hanging and face wrinkled, I was just not feeling great about myself." It took her three years and several consultations before she found a plastic surgeon she trusted, who said, "don't worry, guys will love the face I create for you." That was all she needed to hear.

Then there was the 26-year-old professional tennis player who came for help after an upsetting experience with her dermatologist (I'll call her Heidi). A benign but pesky mole had to be removed from her forehead, which she was told would be a quick and simple procedure. While Heidi was at her doctor's office, she was asked if she wanted Botox to slow down the lines and crows feet cropping up on her face—something she heard other players on the tour talk about, but a concern she hadn't paid much attention to. She told me, "That's when I thought, why not?" Given the amount of time she spent outdoors playing tennis, with hopes that success would lead to more time in the spotlight, it seemed like a good idea.

While the mole removal was a simple procedure, the Botox was not. It wasn't that the injections hurt, nor was she disappointed with how she looked. It was what happened during her next tennis tournament that disturbed her. She said, "my skin feels so tight, so frozen. I can't really squint anymore," something she has to do when serving into the sun. She told me that just being aware of this odd sensation took her mind off her match and even this small distraction threw her off her game.

Heidi was devastated—winning matches meant more to her than anything else and she felt foolish for letting vanity get in her way. And she was angry—for letting the doctor talk her into a procedure she hadn't initiated herself, a feeling poignantly described in a recent off-Broadway play, Waiting for Dr. Hoffman. It portrays a character so enraged when her surgery fails to live up to her expectations that she shows up in the doctor's waiting room with a gun—out to have him feel as injured as she now felt.

I told Heidi that fortunately, Botox wears off and that she would eventually get used to the taut feeling around her eyes—little consolation to a young tennis pro whose every tournament contributed to her national ranking. I decided not to call attention to the woman in the news who claimed that a cosmetic procedure left her unable to close her eyes altogether! Instead, I talked about the consequences of cosmetic work that too often fails to be discussed with patients ahead of time—'hyper skin awareness' being one of them.

Sure, most doctors warn that the results and recovery from cosmetic surgery vary from patient to patient, but few are told that procedures can take up to a year for the worked-on parts to settle. We just don't realize how much we take the comfort of The Skin We Live In for granted until it's altered. Perhaps, in the end, Heidi's Botox experience served as a tough (and pricey) lesson; her body was precious and had served her well. Possibly, it would be best to leave it unaltered.

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Sally wasn't as lucky. Her surgery was more permanent and the consequences more emotionally disturbing. "I just don't see my face anymore." She couldn't put her finger on it, but she kind of missed the Sally she knew. Sure, she had fewer wrinkles and her jowls had disappeared, but she had no idea how attached she had been to her overall self-image until the "old her" was gone. "I thought this was a 'mini-lift,' no big deal," she said. When she caught a glimpse of herself, she felt a pit in her stomach. "Who is that?" she thought and "what have I done to myself?" She couldn't get past the feeling that she had betrayed herself, her students and fellow sisterhood, becoming just another victim of the anti-aging culture. She kept wishing she could turn back the clock—not on aging, but on acting on her desire to feel better by relying on external, rather than internal work.

Obviously there aren't only sad endings to cosmetic surgery stories. I hear from many women that the final results were well worth the bruising, swelling, and emotional adjustments that are part of it all. And of course, there are many responsible surgeons and dermatologists who properly prepare their patients for the wide variety of possible post-operative consequences. I even heard of a medical tourism company, Medaway, that includes reading material for each potential patient on the psychological issues related to cosmetic surgery—a wise way to ensure greater, long-term satisfaction.

The point here is, whether we are satisfied or not with the outcome of cosmetic work, we need to be attentive to all that's involved: choosing the right doctor, electing the proper procedure and recognizing the ramifications that go deeper than the glossy before and after photos that make it all look so promising. Opting for a cosmetic procedure, no matter how subtle or radical, in order to improve how we feel is backward—it's because we feel good about ourselves that we might even consider taking advantage of the cosmetic options currently available. Not the other way around.

Remember what Henry Higgins said about Eliza Dolittle: "I've grown accustomed to her face." Changing your own—or any other part of your body—with the intention of enhancing self-esteem can turn out to be more complicated than meets the eye. Think carefully. Choose wisely. And make sure you do the internal work necessary to enjoy who you are—before and after!

Have you had cosmetic work that led to positive (or negative) results? Share your story.