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Mind and Body, Elevate, Winter 2001
By: Susan Williamson

You've got money good health and you know what you want - so when a surgeon says no, what's the problem?

During the consultation process, a big part of the esthetic surgeon's task is to determine whether or not you are psychologically ready for surgery. A facelift and new breasts can make you look better and feel more confident, but they're no guarantee you'll snag a lover or land that new job you're after. The best candidates for cosmetic surgery want to improve their appearance; they don't expect it to give their life meaning where it didn't exist before.

"Sometimes the best advice I can give a prospective patient is not to do it," states Dr. Peter Adamson, a cosmetic facial surgeon with a clinic in downtown Toronto. "Maintaining a patient's self-respect may mean informing him or her that it's not in their best interests to have the surgery." He estimates that he turns down approximately 10 per cent of his perspective clients for psychological reasons.

In some cases, the client wants surgery earlier than needed. In others - depending on patient motivation - Dr. Adamson may suggest other rejuvenate techniques like botox injections or laser surgery. But where he really makes up his mind is during the assessment process.

QUESTIONING THE PATIENT MOTIVES

The purpose of consultation is to get an overview of the patient's history, to discover why he or she wants surgery and to discuss what their expectations may be. "Ideal patients are those who are physically healthy and psychologically stable," says Dr. Adamson. "They want to improve a particular concern of long standing and are not unrealistic about the outcome." Using a specific set of questions, he determines the psychological and emotional maturity of a patient, and decides whether or not expectations are realistic.

"If you're 50, I can refresh you, but I can't turn you into a 20-year-old," explains Dr. Adamson. "And I can't make you look like a model you've seen in a magazine either." A surgeon deals with the unique make-up of an individual - the bones, tissue and cartilage - and these genetic factors, in combination with the healing process, determine the outcome.

Dr. Mitchell Brown, a plastic surgeon specializing in esthetic and reconstructive breast surgery at Sunnybrook and Women's College Health Sciences Centre, also relies on the assessment process to help him filter out clients with unrealistic expectations. "I often caution patients not to make a decision right away," he says. "And I insist on at least two consultations so we're both certain that surgery is the right route to take."

ASPIRING TO PERFECTION

Neither surgeon has seen a clear-cut case of body dysmorphia, the pathological obsession with a body part that others just can't understand. But both doctors agree that a patient's desire for perfection raises a red flag for them, mainly because they just can't guarantee it. "Perfectly symmetrical breasts are not natural," says Dr. Brown, remarking that even beautiful natural breasts are asymmetrical. "When a patient gives me a millimeter by millimeter description of what he or she expects to happen, that's not someone I feel comfortable operating on," adds Dr. Adamson.

Another concern for doctors is the patient who thinks he or she is the exception to the rule and can speed up the way nature works. Dr. Adamson tells Type-A personalities who expect to me ship-shape in just a few days, that their job for two weeks after the surgery is to stay home and heal. And if they think they can beat the odds, he suggests putting surgery off until they are prepared to recover properly.

"Some people look to cosmetic surgery to kick-start their life after a death or divorce," continues Dr. Adamson. "The surgery might be right for them, but the timing isn't." In cases like these he recommends that prospective clients seek counseling so they can understand what is behind their need for esthetic surgery, and what they hope to gain from it. He also encourages depressed patients to seek therapy. While there may be an initial 'up' after a facelift, for instance, if there's a chronic underlying problem, sooner or later the patient will slide back into a depression. And that's not something he's prepared to deal with.

GOOD MENTAL HEALTH IS KEY

Overall, doctors want you to me in good mental shape before surgery. "Even though it's elective, it's still surgery and it's stressful," explains Dr. Adamson. "We have to make sure that a patient has the psychological reserves to heal well afterwards."

Psychotherapist Marcia Beck often sees clients with body image issues in her Toronto practice. "I don't like the fact that women get the message from society that if we're beautiful, we're valuable," says Beck. "But we live in a world where we have to make decisions about how to live best." If you think changing your body will suddenly result in being treated properly though, think again.

The key to having a good experience with cosmetic surgery is to know yourself really well - to clarify what your goals are and to discover what's motivating you. "If surgery helps you to feel better about yourself, then it can be a good thing," Beck believes. "Where it's a bad move is when your desire for it waxes and wanes because this is a decision that's impossible to go back on."

In the final analysis, a cosmetic surgeon is always looking for a good fit. When patients have an overactive sense of entitlement, or turn to their surgeon for a new identity, they're only going to be disappointed. "If you don't deliver it, you're the anti-hero," remarks Dr. Adamson, choosing instead to operate on client with whom he has a rapport. And Dr. Brown echoes that sentiment. "If expectations are well-founded and the client seems mature, it's usually a "go"; we're a team and we can deal with everything that comes up as smoothly as possible.

EDITORIAL SOURCES: Dr. Mitchell Brown, MD, Sunnybrook and Women's Collage Health Sciences Centre, 416-323-6336

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