I’ve spent a lot of time engrossed in social media sites covering plastic surgery. While I was recovering from my body lift I thought deeply about the body image held by many of the patients I’d interacted with online, as well as my own image of my body. What are the emotional implications of plastic surgery post bariatric surgery?
We found our bodies unattractive, or even ugly, after losing 100 pounds or more. We were left with excess sagging skin that could not be exercised or dieted away. Body contouring plastic surgery was the only way to restore the body’s normal shape. Read, “Body Image after Weight Loss.”
Having body image issues about breasts, thighs, and tummy being deflated and sagging is quite understandable. Wanting the sexy body you have always wanted is normal. If you can afford plastic surgery, I encourage you to follow your heart. Read, “Female Body Image and Sexuality.”
Distorted Body Image
However, obsessive worry about your body or some part of your body is not normal or healthy. The American Psychiatric Association reports that as many as 7-15% of patients undergoing plastic surgery have Body Dysmorphic Disorder, or dysmorphophobia. Body Dysmorphic Disorder is a psychiatric illness affecting 2.4% of the population and is more common than bipolar or schizophrenia. Read, “Mental Health Support for Bariatric Patients.”
According to Mayo Clinic, “When you have Body Dysmorphic Disorder, you intensely obsess over your appearance and body image, often for many hours a day. Your perceived flaw causes you significant distress, and your obsession impacts your ability to function in your daily life. You may seek out numerous cosmetic procedures or excessively exercise to try to “fix” your perceived flaw, but you’re never satisfied.”
The American Psychiatric Association reports that people who have had Body Dysmorphic Disorder and plastic surgery are generally unhappy with the results and often become concerned about another body part. Hence, many cite Body Dysmorphic Disorder as an additional contraindication for plastic surgery.
Plastic surgeons have sometimes been victims of violence and even murder by patients with Body Dysmorphic Disorder who despair about their outcomes.
Body Dysmorphic Disorder and Plastic Surgery
A prospective study was done to evaluate the effect of plastic surgery on stabilizing patients with a Body Dysmorphic Disorder diagnosis. Patients selected for the study had a minimal defect in appearance, and there were groups with and without a diagnosis of Body Dysmorphic Disorder. They are followed five years after their request for plastic surgery.
Researchers conducted phone interviews to re-evaluate 24 patients, 10 with Body Dysmorphic Disorder (BDD) and 14 non-BDD. Seven of the patients had had Body Dysmorphic Disorder and plastic surgery versus 8 non-BDD. Patient satisfaction with the intervention was high in both groups.
Nevertheless, at follow-up six of the seven patients who had Body Dysmorphic Disorder and plastic surgery still had a BDD diagnosis. They also had higher levels of handicaps and psychiatric comorbidity compared to their non-BDD counterparts. Three non-BDD patients also developed Body Dysmorphic Disorder at follow-up.
Plastic Surgery Post Bariatric Surgery
Drs. Seth Thaller and Mimis Cohen discuss the psychological evaluation of the post bariatric patient in their book, “Cosmetic Surgery after Massive Weight Loss.” Bariatric surgery patients may suffer from a particular dysfunction in body image whether or not they have a diagnosis of Body Dysmorphic Disorder. These people will experience little change or an actual worsening of their dysmorphophobia symptoms post operatively.
Patients with massive weight loss who are undergoing reconstructive plastic surgery procedures have neither slight nor imagined physical deformities. Therefore, it is difficult to apply the diagnosis of Body Dysmorphic Disorder to them. However some studies of such patients have reported symptoms consistent with BDD. Therefore, patients undergoing pre-operative evaluation for plastic surgery after weight loss may present with dysmorphophobia symptoms, and should be counseled appropriately. Read, “Realistic Expectations of Plastic Surgery.”
Living larger than ever,
My Bariatric Life
Photo by bigjom @freedigitalphotos.net