The American Society of Plastic Surgeons

“Tell me what you don’t like about yourself. ” The opening line to many episodes of the popular television series Nip/Tuck. It is likely that most individuals have one aspect of their physical appearance they would like to change. Changing appearance can be as simple as joining a gym or going on a diet to lose weight, or as drastic as multiple cosmetic surgical procedures to achieve perfection. From face lifts and tummy tucks, breast augmentation and liposuction, to laser hair removal and Botox injections, there is a procedure out there that can repair, remove, lift and smooth just about every inch of the human body.

A single cosmetic procedure to correct a problem area may not always be a bad thing. When a patient constantly seeks surgical treatment and is never satisfied, it may be a sign of a deeper rooted problem. In a society so focused on physical appearance, it is not hard to see how an individual could become obsessed or addicted to the idea of physical perfection. It is important to understand the science behind addiction to determine how an individual may become addicted to plastic surgery.

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Humans engage in behaviors that are rewarding; the pleasurable feelings provide positive reinforcement so that the behavior is repeated (NIDA, 2007). The natural reward pathway of the brain allows the feeling pleasure when eating, drinking, procreating, and being nurtured. The experience is pleasurable because of the increased release of dopamine in the reward pathway (NIDA, 2007). When the reward pathway is stimulated by something other than a natural action or substance, addiction can occur.

“Addiction is a state in which an organism engages in a compulsive behavior, even when faced with negative consequences. The reward pathway may be even more important in the craving associated with addiction, compared to the reward itself (NIDA, 2007). ” In the case of drug abuse, an addict will continually seek drugs because of the feeling associated with the drug, and not necessarily because of the drug. A similar situation can occur with plastic surgery. The initial surgery makes an individual feel better about their physical appearance.

After the first surgery, it may be easier for the individual to justify additional surgeries because the reward pathway in their brain is telling them it feels good. The field of cosmetic surgery has seen an extreme amount of growth in the past decade. In 2006 188% increase in women and 400% increase in men having cosmetic consultations (Anderson, 2009). The American Society of Plastic Surgeons (ASPS) estimates that more than 333,000 cosmetic procedures were performed on patients 18 years of age or younger in the United States in 2005, compared to approximately 14,000 in 1996 (Zuckerman & Abraham, 2008).

According to Dr Richard Anderson, two of the main contributing factors to this growth are the focus on beauty, fitness, and anti-aging in all ages, and because of the economy of beauty that we live in (Anderson, 2009). Consumer demand has driven many advancements in the field of cosmetic surgery. Individuals with money do not want to invest their time into diet and exercise, when a quick fix is available. New procedures offer faster recovery, less down time, and lower morbidity rates (Anderson, 2009). These advances could be a contributing factor to patients becoming addicting.

Two-thirds of cosmetic surgery patients are repeat patients (Higuera, 2006). If procedures have less risk involved, a shorter recovery time, and an over-all positive outcome, an individual may be more inclined to seek multiple treatments. In a beauty-centered society, one could point a finger at television and movie industries for the increased number of plastic surgeries. People perceive beauty by what they see in magazines and on television. If they don’t feel that they fit the standards of beauty, they may take drastic steps to ensure they do.

Cosmetic surgery addiction can be caused by a medical condition called body dimorphic disorder (BDD). “BDD affects both men and women and manifests as a preoccupation with an imagined physical defect or an exaggerated concern about a minimal defect (Pruitt, 2007). This can lead the patient to a plastic surgeon in an attempt to try to change the perceived defect. However, turning to a doctor for more surgery is rarely successful because that patient will never be happy with these changes (Pruitt, 2007). Plastic surgery proves no benefit because it is never good enough, and the obsession is still present.

In many cases symptoms get worse after the cosmetic procedure or a person becomes obsessed with another part of their body (Gorbis, 2007). No matter how much cosmetic surgery a patient receives, they will most likely never be happy with the results. Mentally, they would still see themselves as flawed, even if the rest of society did not. What should be done when a patient seeks excessive cosmetic procedures? A greater level of expertise, caution and accountability is required in cosmetic surgery (Anderson, 2009). Accountability is the key word.

What happens when BDD sufferers or those who rely on cosmetic surgery for the wrong reasons, turn to a doctor for even another procedure? Is it that medical professional’s responsibility to intervene? “When a physician encounters a patient that desires surgery but clearly has already had enough, it is time for a very frank discussion with the patient. It is important to recognize the point at which either nothing more can be done or nothing more should be done (Pruitt, 2007). ” Addiction is a treatable disease of the brain (Wyatt et al, 2005, and needs to be viewed as such.

Plastic surgeons need to be able to recognize these addicted patients and advise they seek medical and psychological treatment instead of surgery. BDD is not always recognizable by surgeons and general practitioners, so it is suggested that all medical providers have a basic understanding and ability to recognize psychological conditions. Practitioners from various disciplines, including physicians, nurses, pharmacists, dentists, social workers, psychologists, and other allied health professionals, are essential participants in national efforts to deal with these problems (Wyatt et al, 2005).

It takes a collaborative effort to treat these patients, starting with the surgeon. Some plastic surgeons are doing their part to ensure cosmetic procedures are being done for the right reasons. As cosmetic procedures have become much more pervasive, advertised in the mass media and the subject of numerous prime time television programs, it has become increasingly difficult for health professionals to agree on when it is appropriate or necessary (Zuckerman & Abraham, 2008). Mental health screenings have become more mandatory as part of initial consultations.

In a study conducted to determine if certain patients were good candidates for cosmetic surgery, cases requiring greater surgical intervention, patients’ requests for cosmetic correction of disliked features invariably involved more complex decision making and patients that did not meet all the psychological requirements prior to surgery are often rejected as surgery candidates. (Cook et al, 2007). To combat these addictions, it is important for practitioners and surgeons to remain consistent.

In a survey of cosmetic surgeons, 13 percent of the surgeons replied that they treat patients with BDD, 51 percent do not, and 36 percent do it sometimes (Gorbis, 2007). If some surgeons are still willing to treat patients with psychological disorders, the patients will just seek surgical treatment from those few surgeons instead of treating the underlying condition. Addictive behaviors can be viewed as a result of personal choice, instead of a disease, which can hinder a patients’ decision to seek needed treatment.

Despite emerging scientific evidence that substance abuse alters neurotransmitter patterns, many still stigmatize smokers, alcoholics, and drug abusers for having made unwise choices (Schroeder, 2005). Because of this strong theme of respect for choice and individual freedom in the United States culture, family and friends that recognize a loved one has a problem may not confront them about it. Clinicians find it hard to care for patients with abuse problems (Schroeder, 2005). This may be because the initial behavior that led to the addiction was a choice, and the patient needs to choose when they are ready to start treatment.

The stigmatization of addiction in the medical realm is not as prominent as it is socially. Addiction is viewed as a “disease to be addressed by treatment and prevention (Grossman et al, 2001). ” There has been a lot of research conducted to study the brain and addictive behaviors for drug abuse. Research funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA) has identified the primary receptors for every major class of abused drug (including alcohol), identified their genetic code, and cloned the receptors.

Researchers have mapped locations of these receptors in the brain and determined the neurotransmitter systems involved. They have demonstrated activation of these regions during addiction, withdrawal, and craving; identified and separated mechanisms underlying drug-seeking behavior and physical dependence and developed animal models for drug self-administration (Wyatt et al, 2005). If such extensive research has been done for people suffering from drug abuse problems, the same approach could be taken for patients that suffer from other addictive behaviors.

Other studies have been done researching genetic predispositions for addictive behaviors. Imaging and neurochemical techniques have identified pathways of dopamine neurotransmission and specific brain areas that change with addiction. The role of specific genes in predisposing to addiction or protecting against it is under active exploration (Schroeder, 2005). Such advances have provided a clear understanding that substance abuse is a preventable behavior and that addiction is a treatable disease of the brain (Wyatt et al, 2005).

If the medical field is able to recognize that these behaviors are not just about personal choice, perhaps the general population can do the same. Medical and psychological treatment of cosmetic surgery addiction would be of greater benefit to the patient than just accommodating their behavior with multiple surgeries. An even more effective course of treatment would be ensuring these behaviors do not occur in the first place by placing an emphasis on prevention.

Being aware of environmental factors such as sun exposure and smoking, as well as education about proper diet and exercise at a young age may reduce the need for cosmetic treatments in the future (Anderson, 2009). Socially, it may be beneficial to encourage the idea for teenagers that beauty is subjective. There are many forms of beauty, and what they see in magazines and on television are not the only ways it can be expressed. When making a life changing decision, such as cosmetic surgery, one must weight out the possible risks as well as the benefits.

Although a surgery is for aesthetic purposes, it is still, in fact, a major surgery and should not be taken lightly. The field of cosmetic surgery is the only area of medicine where physicians can make well patients unwell (Anderson, 2009). It is important for an individual to evaluate the reasons for which they desire to change their appearance. Cosmetic surgery is a nice addition to one’s quest for bodily satisfaction and most patients will probably never become addicted. A cosmetic procedure can be a good thing, but just like anything in life, too much of a good thing can cause unfavorable outcomes.

Cosmetic surgery addiction can affect an individual the same as any form of dependency. Through proper cross-training of medical professionals to identify these addictive behaviors, it can become the moral obligation of a responsible plastic surgeon to recognize when a patient needs treatment more extensive than what they can provide. It is also important for a patient to realize that there is no shame in admitting to being addicted and that their behavior is a treatable disease of the brain, and not just a result of personal choice. References Anderson, R. L. (2009). Address given to BSH 5000 Students.

University of Utah. Salt Lake City. Cook, S. A. , Rosser, R. , James, M. I. , Kaney, S. , & Salmon, P. (2007). Factors Influencing Surgeons’ Decisions in Elective Cosmetic Surgery Consultations. Medical Decision Making. 311-320. Gorbis, E. (2006). Addiction to plastic surgery. Westwood Institute for Anxiety Disorders, Retrieved April 11, 2009, from http://www. hope4ocd. com/downloads/gorbis_plastic0703. pdf Grossman, M. , Chaloupka, F. J. , & Shim, K. (2001). Illegal drug use and public policy. Health Affairs. 21 (2), 134-145. Higuera, V. C. (2006). Plastic Surgery Addiction - A Body Image Problem within Our Society.

Associated Content, Retrieved April 24, 2009, from http://www. associatedcontent. com/article/52092/plastic_surgery_addiction_a_body_image_pg2. html? cat=69. Murphy, R. (Creator). (2003-2009). Nip/Tuck [Television series]. Los Angeles: Warner Brothers Entertainment Inc. National Institute on Drug Abuse, (2007). The Neurobiology of Drug Addiction. Retrieved April 25, 2009, from National Institute on Drug Abuse Web site: http://www. drugabuse. gov/pubs/teaching/Teaching2/Teaching3. html Pruitt, E. (2007-2009). Cosmetic Surgery Addiction: What's the Doctor Got to Do With It? PlasticSurgery.

com, Retrieved April 13, 2009, from http://www. plasticsurgery. com/breast-augmentation/cosmetic-surgery-addiction-a763. aspx Schroeder, S. A. (2005). An agenda to combat substance abuse. Health Affairs. 24 (4), 1005-1013. Wyatt, S. A. , Vilensky, W. , Manlandro, Jr, J. J. , ; Dekker, M. A. (2005). Medical Education in Substance Abuse: From Student to Practicing Osteopathic Physician. Journal of the American Osteopathic Association, 105 (6), 18-25. Zuckerman, D. , ; Abraham, A. (2008). Teenagers and Cosmetic Surgery: Focus on Breast Augmentation and Liposuction. Journal of Adolescent Health. 42, 318-324.