Why cosmetic surgery may not always be for you

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Psychological issues may be driving many of us into the clinics of plastic surgeons, prompting renewed calls for clinicians to consult openly with us about our reasons for seeking cosmetic surgery.

According to a new survey, there is widespread under-diagnosis of body dysmorphic disorder (BDD) and researchers say psychological challenges regarding body image should be always be up for discussion before any procedure takes place.

And it's not just cosmetic surgery sufferers are seeking. BDD may also be a driving force for some people considering botulinum toxin, dermal fillers or other less invasive procedures.

The lack of correlation of the figures is alarmingly, with two thirds of aesthetic practitioners saying they had encountered up to five patients with BDD in their practice but studies reporting that 10% of those seeking cosmetic procedures suffer with it.

Whilst body image problems were touched upon during consultations, only 7% of practitioners covered it as a matter of course, with less than half saying they worked alongside a psychologist or psychiatrist.

Comparethetreatment expert Deborah Sandler is a psychotherapist with a background in philosophy of aesthetics and is the first cosmetic surgery counsellor.

In January 2000, together with clinical psychologist Dr Art Anderson, she set up Cosmeticsupport.com offering professional emotional support for pre- and post-op cosmetic surgery patients.

Deborah also launched cosmeticsurgerycounselling.com supported by Prof Windy Dryden.

Deborah has struggled with BDD all her life and has had benefit from two cosmetic surgery procedures.

Her cosmetic surgery counselling is an independent service designed to support and provide information to pre- and post-operative cosmetic clients as well as to their friends, family and loved ones. This service allows patients to get the best out of their cosmetic consultation time by focusing on one thing at a time.

She says: ‘The need for awareness and understanding of BDD by cosmetic professionals is a relatively recent recommendation introduced by the Health Education England’s new Qualification Recommendations (HEE–QR), based on the Keogh Review of Cosmetic Interventions.

‘The HEE recommendations clearly show that, while the focus on screening for BDD is important, it is not the only psychological issue that has a bearing on a patient’s suitability for treatment. The integration of psychology education for cosmetic practitioners is still in its infancy. As a result, cosmetic practitioners using the consultation time to explore the patient’s body image and/or psychological issues are not yet meeting the needs of either the HEE–QR, the Keogh Review or the patient. It is recommended by the HEE that psychology training in the relevant issues be undertaken by all modalities at all levels for qualification.’

She adds: ‘The HEE–QR Learning Aims and Outcomes on psychology recommend that practitioners “encourage patients to use independent emotional support to foster realistic expectations, enhance safety and make best use of their consultation time and results”. This illustrates the growing recognition that psychological issues, not limited to BDD, are often the driving force for patients seeking cosmetic treatment.’

It is widely considered that BDD can be a contra-indication for cosmetic procedures. Sufferers who undergo treatments are often unhappy with the results and therefore seek further surgery.

In the study, some 16% of cosmetic professionals had reported verbal altercations, while 6% had received legal threats.
Ask our Expert Dr Deborah Sandler a question

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