What motivates people to go under the knife?

Trying to get a fix on the psychology of cosmetic surgery is a bit like looking through a kaleidoscope. Shift the focus a bit and the whole picture changes. Is surgery empowering, enabling women – and, increasingly, men – to change their looks as they see fit or is it simply indulging vanity? It depends who you ask.

“There’s no question that cosmetic surgery is far more acceptable,” says Rajiv Grover, consultant plastic surgeon and president of the British Association of Aesthetic Plastic Surgeons (BAAPS). “But the vast majority of my patients still prefer to see me discreetly and avoid anyone knowing. People do feel judged.”

It’s a no-win situation. On the one hand, there’s the fixation with the youthful, clear-skinned, super-slim look paraded by models and actresses; on the other, there is still an undercurrent of disapproval for those so bold to admit they take active steps to pursue this ideal.

We know from the 2012 report from the All-Party Parliamentary Group on Body Image that half the UK public suffers from negative body image and for the majority of patients, who have been through a through consultation and are in the right frame of mind, cosmetic enhancement can change that in a positive way.

I would not advise surgery if a patient has very high expectations

As Norman Wright, a psychotherapist who works with cosmetic surgery patients, points out, given the numbers of people suffering with body dysmorphic disorder – 600,000 cases diagnosed and many more, surely, undiagnosed – the likelihood of prospective cosmetic surgery patients having underlying emotional or psychological issues is high, which is a problem for surgeons.

He encourages doctors and surgeons to “see the person behind the patient”. He says: “What I’m trying to do is not to talk people out of having cosmetic surgery, but to get surgeons to give patients the chance to explore the emotional and psychological issues of the procedure that they have chosen to have.”

So who shouldn’t have surgery? Research among BAAPS members shows they already turn down around 35 per cent of prospective patients. “I would not advise surgery if a patient has very high expectations beyond that of surgery, if the person is going through a major life event such as a divorce or has an underlying psychological condition,” says Dr Julian De Silva, a cosmetic surgeon based in central London. “Identifying these conditions can be challenging as often patient’s may not be aware themselves.”

Psychological screening for prospective patients would seem a vital move. The Centre for Appearance Research at the University of the West of England has come up with a user-friendly psychological screening tool to identify which patients might be at risk of post-operative dissatisfaction. It is currently being trialled by BAAPS surgeons. In the meantime, surgeons must keep their professional antennae attuned for potential problems.