At the recent ASAPS conference in Sydney, Dr Ewa Siolo, a Plastic and Reconstructive Surgeon from South Africa, stresses the importance of psychologically assessing aesthetic surgery patients.

The desire to look a certain way comes from different forms of pressure, from the mass media, corporate consideration and personal expectation, leading to degrees of self-dissatisfaction and body dysmorphia.

The mass media, flaunting beautiful, airbrushed faces, leads to unrealistic expectations from the general public. Constantly fed these perfect images as normal, it is not difficult to understand how body dysmorphia develops. Unfortunately, it is often young females who fall victim to this condition and seek methods of attaining their perceived ‘normal’ but it certainly pertains to older women and also men.

It is interesting that Kate Winslet has recently declared that her contract with L’Oréal Paris will specify that her photos are not to be retouched, in order to be a ‘real’ role model for younger women.

Dr Siolo explains that it is important to look for signs of BDD and to refer the patient to a psychologist if required. She stresses that plastic surgery is a self-inflicting surgery, not a life- saving surgery.

“Eighty to 90 percent of my cosmetic patients are on anti- depressants. I make sure that they are coming in for the right reason, not to feed their illness,” says Dr Siolo.

Psychology & motivations

It’s important for the doctor to understand the motivation for aesthetic surgery. Is the patient purely motivated by vanity or social pressure? Are they having surgery for themselves? Or are they doing it for their partners, thinking that it will save their relationship?

“I always try to get behind the psychology of my patients,” says Dr Siolo. “From the beginning I try to see why they want it – if it’s just pure vanity or social pressure, then I am reluctant to do more. When this happens, I try to be honest and talk them out of the surgery.”

A psychological assessment of the motivation is vital. Cosmetic intervention will not solve problems and, as health care professionals, doctors need to be aware of this and consider both the physical and psychological state.

“Plastic surgery won’t solve their problems,” Dr Siolo says. “I think too many doctors do not think that way and I don’t think they look too much into the psychology of the patient.”

Understanding the female psyche is crucial to ensuring plastic surgery is undertaken for the right reasons. It is up to the doctor to recognise inappropriate motivation and advise accordingly. Conversely, Dr Siolo says males seem less philosophical, more pragmatic about their surgery. “Men just want to fix this or get rid of that,” she says.

“Sometimes saying no to a patient requesting plastic surgery is the answer. I’m a doctor first, not a businesswoman. I think you have to keep that in mind when you are working in a cosmetic practice. You should always maintain the standard that you are a doctor first,” Dr Siolo concludes.

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