How common is plastic surgery addiction?

The media often portrays examples of people who suffer from body dysmorphia and who become "addicted" to plastic surgery procedures - so much so that it gives the impression that it's actually quite a common thing.

Some of these people obviously have gender issues (ex: the guy who wants to look like Kim Kardashian http://www.mirror.co.uk/tv/tv-news/see-male-kim-kardashian-wannabes-8591385), while others are obsessed with physical defects that they may or may not have.

How common are such cases? Have you seen many throughout your career? What do you say to people who come in to your practice with expectations and behaviours that suggest underlying personality issues?

9HopeHarp

F, 54, New York

In my opinion true surgery addiction mental disorders are quite rare. We see thousands of patients annually for breast augmentation, breast reduction, tummy tucks and other standard plastic surgery procedures. These procedures have an obvious, rational benefit to physical appearance. We also perform many minimally invasive and non-surgical procedures, from fat transfers to Botox. In every case our patients' aesthetic goals are simple, rational and understandable.

If I believe a prospective patient's goals represent an unnecessary or dangerous level of risk or is clearly indicative of an underlying mental disorder, it’s my professional responsibility to refuse this patient.

On the other hand, it's not a plastic surgeon's role to question the aesthetic choices of a patient, so long as these are the rational choices of a mature adult. If a man wants to look like Kim Kardashian (to use your example) that’s his choice. If a young woman of normal weight wants 8 ribs removed because she thinks she's too fat, then the answer is "no".

In my practice there are many procedures we simply will not perform because we consider them unethical. Some extreme surgery addicts like Heidi Montag or the famous "Human Barbie Doll" have undergone several rare procedures which can be extremely dangerous.  In one instance Montag supposedly underwent 10 procedures in a single day. In my opinion these types of cosmetic surgery binges cross an important ethical line in the sand which shouldn't be crossed.

As you have probably seen in "extreme plastic surgery" stories and television shows, patients suffering from obsessive-compulsive disorders and other psychological issues compulsively undergo excessive procedures. While these stories often get enormous publicity, they are far from common.

Plastic surgery should be a positive, life-changing, empowering decision for mature adults. I have seen patients make remarkable, rapid transformations from low self-esteem to self confidence after cosmetic surgery.  Patients should do diligent research into the risks and benefits of any procedure and make rational decisions based on improving their aesthetic appearance and quality of life.

For our part, the professional responsibility of a plastic surgeon is to carefully discuss the associated risks of any procedure with our patients. In the event a patient asks for procedures which violate the basic ethics of health and safety, a plastic surgeon should refuse the patient on those grounds.

The first point I have to make is that plastic surgery addiction is a serious issue and should not be disregarded. It's a psychological rather than physical addiction and requires the attention of a mental health professional. In many if not most cases addiction to surgery is the result of body dysmorphic disorder (BDD) or an irrational belief that one's body is "wrong" or "flawed" in some way.

When it comes to plastic surgery addiction, the important question surgeons must ask is: Where does one draw the line between a healthy desire to aesthetically improve oneself and an unhealthy obsession which goes too far?

From my personal experience, a true psychological addiction to surgery is actually a very rare condition. Because sufferers of cosmetic surgery addiction are often visually striking (looking like 'plastic dolls' or even anime characters), their stories tend to attract millions of viewers online and their photos frequently go viral on social networks. The resulting overexposure on websites and in television shows can make the disorder seem more widespread than it is.

I’ve seen thousands of patients in my practice, and in my experience people carefully research both procedures and doctors. Our patients are mentally balanced adults who are making rational decisions in the effort to improve their physical beauty and health. For most surgical procedures like tummy tucks, breast lifts, eye lifts, chin augmentations and brow lifts, the top concern of my patients is that the results look natural.

Plastic surgeons do need to remain cognizant of potential surgery addiction, but it isn’t a common condition. That being said, if one of my patients started making deeply irrational or unsafe requests, I would refrain from performing these procedures.

Body Dysmorphic Disorder, fortunately, is not as common as it is portrayed in the media. Most plastic surgery patients are well grounded individuals who have realistic expectations about what surgery can and cannot do for them. I have seen a number of patients in my career whom I thought had unrealistic expectations ("I want celebrity X's nose") or who thought one of their features was horribly awful when in reality it was barely perceptible. When it comes to these folks, I believe honesty is the best policy. As a surgeon, it is ok to say "I don't think you need ANY surgery". They may not like that answer and find someone else who will. I feel its best to be honest and ethical and sometimes that means not operating on someone who may have other more pressing issues.