The Many Faces Of Cosmetic Surgery
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Cosmetic Surgery: What’s The Truth?
In Tuesday’s newsletter, we asked you your opinion on elective cosmetic surgeries, and got the above-depicted, below-described, set of responses:
- About 48% said “Everyone should be able to get what they want, assuming informed consent”
- About 28% said “It can ease discomfort to bring features more in line with normalcy”
- 15% said “They should be available in the case of extreme disfigurement only”
- 10% said “No elective cosmetic surgery should ever be performed; needless danger”
Well, there was a clear gradient of responses there! Not so polarizing as we might have expected, but still enough dissent for discussion
So what does the science say?
The risks of cosmetic surgery outweigh the benefits: True or False?
False, subjectively (but this is important).
You may be wondering: how is science subjective?
And the answer is: the science is not subjective, but people’s cost:worth calculations are. What’s worth it to one person absolutely may not be worth it to another. Which means: for those for whom it wouldn’t be worth it, they are usually the people who will not choose the elective surgery.
Let’s look at some numbers (specifically, regret rates for various surgeries, elective/cosmetic or otherwise):
- Regret rate for elective cosmetic surgery in general: 20%
- Regret rate for knee replacement (i.e., not cosmetic): 17.1%
- Regret rate for hip replacement (i.e., not cosmetic): 4.8%
- Regret rate for gender-affirming surgeries (for transgender patients): 1%
So we can see, elective surgeries have an 80–99% satisfaction rate, depending on what they are. In comparison, the two joint replacements we mentioned have a 82.9–95.2% satisfaction rate. Not too dissimilar, taken in aggregate!
In other words: if a person has studied the risks and benefits of a surgery and decides to go ahead, they’re probably going to be happy with the results, and for them, the benefits will have outweighed the risks.
Sources for the above numbers, by the way:
- What is the regret rate for plastic surgery?
- Decision regret after primary hip and knee replacement surgery
- A systematic review of patient regret after surgery—a common phenomenon in many specialties but rare within gender-affirmation surgery
But it’s just a vanity; therapy is what’s needed instead: True or False?
False, generally. True, sometimes. Whatever the reasons for why someone feels the way they do about their appearance—whether their face got burned in a fire or they just have triple-J cups that they’d like reduced, it’s generally something they’ve already done a lot of thinking about. Nevertheless, it does also sometimes happen that it’s a case of someone hoping it’ll be the magical solution, when in reality something else is also needed.
How to know the difference? One factor is whether the surgery is “type change” or “restorative”, and both have their pros and cons.
- In “type change” (e.g. rhinoplasty), more psychological adjustment is needed, but when it’s all over, the person has a new nose and, statistically speaking, is usually happy with it.
- In “restorative” (e.g. facelift), less psychological adjustment is needed (as it’s just a return to a previous state), so a person will usually be happy quickly, but ultimately it is merely “kicking the can down the road” if the underlying problem is “fear of aging”, for example. In such a case, likely talking therapy would be beneficial—whether in place of, or alongside, cosmetic surgery.
Here’s an interesting paper on that; the sample sizes are small, but the discussion about the ideas at hand is a worthwhile read:
Does cosmetic surgery improve psychosocial wellbeing?
Some people will never be happy no matter how many surgeries they get: True or False?
True! We’re going to refer to the above paper again for this one. In particular, here’s what it said about one group for whom surgeries will not usually be helpful:
❝There is a particular subgroup of people who appear to respond poorly to cosmetic procedures. These are people with the psychiatric disorder known as “body dysmorphic disorder” (BDD). BDD is characterised by a preoccupation with an objectively absent or minimal deformity that causes clinically significant distress or impairment in social, occupational, or other areas of functioning.
For several reasons, it is important to recognise BDD in cosmetic surgery settings:
Firstly, it appears that cosmetic procedures are rarely beneficial for these people. Most patients with BDD who have had a cosmetic procedure report that it was unsatisfactory and did not diminish concerns about their appearance.
Secondly, BDD is a treatable disorder. Serotonin-reuptake inhibitors and cognitive behaviour therapy have been shown to be effective in about two-thirds of patients with BDD❞
~ Dr. David Castle et al. (lightly edited for brevity)
Which is a big difference compared to, for example, someone having triple-J breasts that need reducing, or the wrong genitals for their gender, or a face whose features are distinct outliers.
Whether that’s a reason people with BDD shouldn’t be able to get it is an ethical question rather than a scientific one, so we’ll not try to address that with science.
After all, many people (in general) will try to fix their woes with a haircut, a tattoo, or even a new sportscar, and those might sometimes be bad decisions, but they are still the person’s decision to make.
And even so, there can be protectionist laws/regulations that may provide a speed-bump, for example:
Take care!
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Loss, Trauma, and Resilience – by Dr. Pauline Boss
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Most books about bereavement are focused on grieving healthily and then moving on healthily. And, while it may be said “everyone’s grief is on their own timescale”… society’s expectation is often quite fixed:
“Time will heal”, they say.
But what if it doesn’t? What happens when that’s not possible?
Ambiguous loss occurs when someone is on the one hand “gone”, but on the other hand, not necessarily.
This can be:
- Someone was lost in a way that didn’t leave a body to 100% confirm it
- (e.g. disaster, terrorism, war, murder, missing persons)
- Someone remains physically present but in some ways already “gone”
- (e.g. Alzheimer’s disease or other dementia, brain injury, coma)
These things stop us continuing as normal, and/but also stop us from moving on as normal.
When either kind of moving forward is made impossible, everything gets frozen in place. How does one deal with that?
Dr. Boss wrote this book for therapists, but its content is equally useful for anyone struggling with ambiguous loss—or who has a loved one who is, in turn, struggling with that.
The book looks at the impact of ambiguous loss on continuing life, and how to navigate that:
- How to be resilient, in the sense of when life tries to break you, to have ways to bend instead.
- How to live with the cognitive dissonance of a loved one who is a sort of “Schrödinger’s person”.
- How, and this is sometimes the biggest one, to manage ambiguous loss in a society that often pushes toward: “it’s been x period of time, come on, get over it now, back to normal”
Will this book heal your heart and resolve your grief? No, it won’t. But what it can do is give a roadmap for nonetheless thriving in life, while gently holding onto whatever we need to along the way.
Click here to check out “Ambiguous loss, Trauma, and Resilience” on Amazon—it can really help
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- Someone was lost in a way that didn’t leave a body to 100% confirm it
How Useful Are Our Dreams
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What’s In A Dream?
We were recently asked:
❝I have a question or a suggestion for coverage in your “Psychology Sunday”. Dreams: their relevance, meanings ( if any) interpretations? I just wondered what the modern psychological opinions are about dreams in general.❞
~ 10almonds subscriber
There are two main schools of thought, and one main effort to reconcile those two. The third one hasn’t quite caught on so far as to be considered a “school of thought” yet though.
The Top-Down Model (Psychoanalysts)
Psychoanalysts broadly follow the theories of Freud, or at least evolved from there. Freud was demonstrably wrong about very many things. Most of his theories have been debunked and ditched—hence the charitable “or at least evolved from there” phrasing when it comes to modern psychoanalytic schools of thought. Perhaps another day, we’ll go into all the ways Freud went wrong. However, for today, one thing he wasn’t bad at…
According to Freud, our dreams reveal our subconscious desires and fears, sometimes directly and sometimes dressed in metaphor.
Examples of literal representations might be:
- sex dreams (revealing our subconscious desires; perhaps consciously we had not thought about that person that way, or had not considered that sex act desirable)
- getting killed and dying (revealing our subconscious fear of death, not something most people give a lot of conscious thought to most of the time)
Examples of metaphorical representations might be:
- dreams of childhood (revealing our subconscious desires to feel safe and nurtured, or perhaps something else depending on the nature of the dream; maybe a return to innocence, or a clean slate)
- dreams of being pursued (revealing our subconscious fear of bad consequences of our actions/inactions, for example, responsibilities to which we have not attended, debts are a good example for many people; or social contact where the ball was left in our court and we dropped it, that kind of thing)
One can read all kinds of guides to dream symbology, and learn such arcane lore as “if you dream of your teeth crumbling, you have financial worries”, but the truth is that “this thing means that other thing” symbolic equations are not only highly personal, but also incredibly culture-bound.
For example:
- To one person, bees could be a symbol of feeling plagued by uncountable small threats; to another, they could be a symbol of abundance, or of teamwork
- One culture’s “crow as an omen of death” is another culture’s “crow as a symbol of wisdom”
- For that matter, in some cultures, white means purity; in others, it means death.
Even such classically Freudian things as dreaming of one’s mother and/or father (in whatever context) will be strongly informed by one’s own waking-world relationship (or lack thereof) with same. Even in Freud’s own psychoanalysis, the “mother” for the sake of such analysis was the person who nurtured, and the “father” was the person who drew the nurturer’s attention away, so they could be switched gender roles, or even different people entirely than one’s parents.
The only real way to know what, if anything, your dreams are trying to tell you, is to ask yourself. You can do that…
- by reflection and personal interrogation (see for example: The Easiest Way To Take Up Journaling)
- or by externalising parts of your subconscious (as in Internal Family Systems therapy)
- or by talking directly to your subconscious where it is, by means of lucid dreaming.
The idea with lucid dreaming is that since any dream character is a facet of your subconscious generated by your own mind, by talking to that character you can ask questions directly of your subconscious (the popular 2010 movie “Inception” was actually quite accurate in this regard, by the way).
To read more about how to do this kind of self-therapy through lucid dreaming, you might want to check out this book we reviewed previously; it is the go-to book of lucid dreaming enthusiasts, and will honestly give you everything you need in one go:
Lucid Dreaming: A Concise Guide to Awakening in Your Dreams and in Your Life – by Dr. Stephen LaBerge
The Bottom-Up Model (Neuroscientists)
This will take a lot less writing, because it’s practically a null hypothesis (i.e., the simplest default assumption before considering any additional evidence that might support or refute it; usually some variant of “nothing unusual going on here”).
The Bottom-Up model holds that our brains run regular maintenance cycles during REM sleep (a biological equivalent of defragging a computer), and the brain interprets these pieces of information flying by and, because of the mind’s tendency to look for patterns, fills in the rest (much like how modern generative AI can “expand” a source image to create more of the same and fill in the blanks), resulting in the often narratively wacky, but ultimately random, vivid hallucinations that we call dreams.
The Hybrid Model (per Cartwright, 2012)
This is really just one woman’s vision, but it’s an incredibly compelling one, that takes the Bottom-Up model and asks “what if we did all that bio-stuff, and then our subconscious mind influenced the interpretation of the random patterns, to create dreams that are subjectively meaningful, and thus do indeed represent our subconscious?
It’s best explained in her own words, though, so it’s time for another book recommendation (we’ve reviewed this one before, too):
Enjoy!
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Seriously Useful Communication Skills!
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What Are Communication Skills, Really?
Superficially, communication is “conveying an idea to someone else”. But then again…
Superficially, painting is “covering some kind of surface in paint”, and yet, for some reason, the ceiling you painted at home is not regarded as equally “good painting skills” as Michaelangelo’s, with regard to the ceiling of the Sistine Chapel.
All kinds of “Dark Psychology” enthusiasts on YouTube, authors of “Office Machiavelli” handbooks, etc, tell us that good communication skills are really a matter of persuasive speaking (or writing). And let’s not even get started on “pick-up artist” guides. Bleugh.
Not to get too philosophical, but here at 10almonds, we think that having good communication skills means being able to communicate ideas simply and clearly, and in a way that will benefit as many people as possible.
The implications of this for education are obvious, but what of other situations?
Conflict Resolution
Whether at work or at home or amongst friends or out in public, conflict will happen at some point. Even the most well-intentioned and conscientious partners, family, friends, colleagues, will eventually tread on our toes—or we, on theirs. Often because of misunderstandings, so much precious time will be lost needlessly. It’s good for neither schedule nor soul.
So, how to fix those situations?
I’m OK; You’re OK
In the category of “bestselling books that should have been an article at most”, a top-tier candidate is Thomas Harris’s “I’m OK; You’re OK”.
The (very good) premise of this (rather padded) book is that when seeking to resolve a conflict or potential conflict, we should look for a win-win:
- I’m not OK; you’re not OK ❌
- For example: “Yes, I screwed up and did this bad thing, but you too do bad things all the time”
- I’m OK; you’re not OK ❌
- For example: “It is not I who screwed up; this is actually all your fault”
- I’m not OK; you’re OK ❌
- For example: “I screwed up and am utterly beyond redemption; you should immediately divorce/disown/dismiss/defenestrate me”
- I’m OK; you’re OK ✅
- For example: “I did do this thing which turned out to be incorrect; in my defence it was because you said xyz, but I can understand why you said that, because…” and generally finding a win-win outcome.
So far, so simple.
“I”-Messages
In a conflict, it’s easy to get caught up in “you did this, you did that”, often rushing to assumptions about intent or meaning. And, the closer we are to the person in question, the more emotionally charged, and the more likely we are to do this as a knee-jerk response.
“How could you treat me this way?!” if we are talking to our spouse in a heated moment, perhaps, or “How can you treat a customer this way?!” if it’s a worker at Home Depot.
But the reality is that almost certainly neither our spouse nor the worker wanted to upset us.
Going on the attack will merely put them on the defensive, and they may even launch their own counterattack. It’s not good for anyone.
Instead, what really happened? Express it starting with the word “I”, rather than immediately putting it on the other person. Often our emotions require a little interrogation before they’ll tell us the truth, but it may be something like:
“I expected x, so when you did/said y instead, I was confused and hurt/frustrated/angry/etc”
Bonus: if your partner also understands this kind of communication situation, so much the better! Dark psychology be damned, everything is best when everyone knows the playbook and everyone is seeking the best outcome for all sides.
The Most Powerful “I”-Message Of All
Statements that start with “I” will, unless you are rules-lawyering in bad faith, tend to be less aggressive and thus prompt less defensiveness. An important tool for the toolbox, is:
“I need…”
Softly spoken, firmly if necessary, but gentle. If you do not express your needs, how can you expect anyone to fulfil them? Be that person a partner or a retail worker or anyone else. Probably they want to end the conflict too, so throw them a life-ring and they will (if they can, and are at least halfway sensible) grab it.
- “I need an apology”
- “I need a moment to cool down”
- “I need a refund”
- “I need some reassurance about…” (and detail)
Help the other person to help you!
Everything’s best when it’s you (plural) vs the problem, rather than you (plural) vs each other.
Apology Checklist
Does anyone else remember being forced to write an insincere letter of apology as a child, and the literary disaster that probably followed? As adults, we (hopefully) apologize when and if we mean it, and we want our apology to convey that.
What follows will seem very formal, but honestly, we recommend it in personal life as much as professional. It’s a ten-step apology, and you will forget these steps, so we recommend to copy and paste them into a Notes app or something, because this is of immeasurable value.
It’s good not just for when you want to apologize, but also, for when it’s you who needs an apology and needs to feel it’s sincere. Give your partner (if applicable) a copy of the checklist too!
- Statement of apology—say “I’m sorry”
- Name the offense—say what you did wrong
- Take responsibility for the offense—understand your part in the problem
- Attempt to explain the offense (not to excuse it)—how did it happen and why
- Convey emotions; show remorse
- Address the emotions/damage to the other person—show that you understand or even ask them how it affected them
- Admit fault—understand that you got it wrong and like other human beings you make mistakes
- Promise to be better—let them realize you’re trying to change
- Tell them how you will try to do it different next time and finally
- Request acceptance of the apology
Note: just because you request acceptance of the apology doesn’t mean they must give it. Maybe they won’t, or maybe they need time first. If they’re playing from this same playbook, they might say “I need some time to process this first” or such.
Want to really superpower your relationship? Read this together with your partner:
Hold Me Tight: Seven Conversations for a Lifetime of Love, and, as a bonus:
The Hold Me Tight Workbook: A Couple’s Guide for a Lifetime of Love
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- I’m not OK; you’re not OK ❌
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Getting antivirals for COVID too often depends on where you live and how wealthy you are
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Medical experts recommend antivirals for people aged 70 and older who get COVID, and for other groups at risk of severe illness and hospitalisation from COVID.
But many older Australians have missed out on antivirals after getting sick with COVID. It is yet another way the health system is failing the most vulnerable.
CGN089/Shutterstock Who missed out?
We analysed COVID antiviral uptake between March 2022 and September 2023. We found some groups were more likely to miss out on antivirals including Indigenous people, people from disadvantaged areas, and people from culturally and linguistically diverse backgrounds.
Some of the differences will be due to different rates of infection. But across this 18-month period, many older Australians were infected at least once, and rates of infection were higher in some disadvantaged communities.
How stark are the differences?
Compared to the national average, Indigenous Australians were nearly 25% less likely to get antivirals, older people living in disadvantaged areas were 20% less likely to get them, and people with a culturally or linguistically diverse background were 13% less likely to get a script.
People in remote areas were 37% less likely to get antivirals than people living in major cities. People in outer regional areas were 25% less likely.
Dispensing rates by group. Grattan Institute Even within the same city, the differences are stark. In Sydney, people older than 70 in the affluent eastern suburbs (including Vaucluse, Point Piper and Bondi) were nearly twice as likely to have had an antiviral as those in Fairfield, in Sydney’s south-west.
Older people in leafy inner-eastern Melbourne (including Canterbury, Hawthorn and Kew) were 1.8 times more likely to have had an antiviral as those in Brimbank (which includes Sunshine) in the city’s west.
Why are people missing out?
COVID antivirals should be taken when symptoms first appear. While awareness of COVID antivirals is generally strong, people often don’t realise they would benefit from the medication. They wait until symptoms get worse and it is too late.
Frequent GP visits make a big difference. Our analysis found people 70 and older who see a GP more frequently were much more likely to be dispensed a COVID antiviral.
Regular visits give an opportunity for preventive care and patient education. For example, GPs can provide high-risk patients with “COVID treatment plans” as a reminder to get tested and seek treatment as soon as they are unwell.
Difficulty seeing a GP could help explain low antiviral use in rural areas. Compared to people in major cities, people in small rural towns have about 35% fewer GPs, see their GP about half as often, and are 30% more likely to report waiting too long for an appointment.
Just like for vaccination, a GP’s focus on antivirals probably matters, as does providing care that is accessible to people from different cultural backgrounds.
Care should go those who need it
Since the period we looked at, evidence has emerged that raises doubts about how effective antivirals are, particularly for people at lower risk of severe illness. That means getting vaccinated is more important than getting antivirals.
But all Australians who are eligible for antivirals should have the same chance of getting them.
These drugs have cost more than A$1.7 billion, with the vast majority of that money coming from the federal government. While dispensing rates have fallen, more than 30,000 packs of COVID antivirals were dispensed in August, costing about $35 million.
Such a huge investment shouldn’t be leaving so many people behind. Getting treatment shouldn’t depend on your income, cultural background or where you live. Instead, care should go to those who need it the most.
Getting antivirals shouldn’t depend on who your GP is. National Cancer Institute/Unsplash People born overseas have been 40% more likely to die from COVID than those born here. Indigenous Australians have been 60% more likely to die from COVID than non-Indigenous people. And the most disadvantaged people have been 2.8 times more likely to die from COVID than those in the wealthiest areas.
All those at-risk groups have been more likely to miss out on antivirals.
It’s not just a problem with antivirals. The same groups are also disproportionately missing out on COVID vaccination, compounding their risk of severe illness. The pattern is repeated for other important preventive health care, such as cancer screening.
A 3-step plan to meet patients’ needs
The federal government should do three things to close these gaps in preventive care.
First, the government should make Primary Health Networks (PHNs) responsible for reducing them. PHNs, the regional bodies responsible for improving primary care, should share data with GPs and step in to boost uptake in communities that are missing out.
Second, the government should extend its MyMedicare reforms. MyMedicare gives general practices flexible funding to care for patients who live in residential aged care or who visit hospital frequently. That approach should be expanded to all patients, with more funding for poorer and sicker patients. That will give GP clinics time to advise patients about preventive health, including COVID vaccines and antivirals, before they get sick.
Third, team-based pharmacist prescribing should be introduced. Then pharmacists could quickly dispense antivirals for patients if they have a prior agreement with the patient’s GP. It’s an approach that would also work for medications for chronic diseases, such as cardiovascular disease.
COVID antivirals, unlike vaccines, have been keeping up with new variants without the need for updates. If a new and more harmful variant emerges, or when a new pandemic hits, governments should have these systems in place to make sure everyone who needs treatment can get it fast.
In the meantime, fairer access to care will help close the big and persistent gaps in health between different groups of Australians.
Peter Breadon, Program Director, Health and Aged Care, Grattan Institute
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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5 ways to naturally boost the “Ozempic Effect”
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Dr. Jason Fung is perhaps most well-known for his work in functional medicine for reversing diabetes, and he’s once again giving us sound advice about metabolic hormone-hacking with dietary tweaks:
All about incretin
As you may gather from the thumbnail, this video is about incretin, a hormone group (the most well-known of which is GLP-1, as in GLP-1 agonists like semaglutide drugs such as Ozempic, Wegovy, etc) that slows down stomach emptying, which means a gentler blood sugar curve and feeling fuller for longer. It also acts on the hypothalmus, controlling appetite via the brain too (signalling fullness and reducing hunger).
Dr. Fung recommends 5 ways to increase incretin levels:
- Enjoy dietary fat: this increases incretin levels more than carbs
- Enjoy protein: again, prompts higher incretin levels of promotes satiety
- Enjoy fiber: this is more about slowing digestion, but when it’s fermented in the gut into short-chain fatty acids, those too increase incretin secretion
- Enjoy bitter foods: these don’t actually affect incretin levels, but they can bind to incretin receptors, making the body “believe” that you got more incretin (think of it like a skeleton key that fits the lock that was designed to be opened by a different key)
- Enjoy turmeric: for its curcumin content, which increases GLP-1 levels specifically
For more information on each of these, here’s Dr. Fung himself:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- Semaglutide for Weight Loss?
- Ozempic vs Five Natural Supplements
- How To Prevent And Reverse Type 2 Diabetes ← this was our “Expert Insights” feature on Dr. Fung’s work
Take care!
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Imposter Syndrome (and why almost everyone has it)
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Imposter Syndrome (and why almost everyone has it)
Imposter syndrome is the pervasive idea that we’re not actually good enough, people think we are better than we are, and at any moment we’re going to get found out and disappoint everyone.
Beyond the workplace
Imposter syndrome is most associated with professionals. It can range from a medical professional who feels like they’ve been projecting an image of confidence too much, to a writer or musician who is sure that their next piece will never live up to the acclaim of previous pieces and everyone will suddenly realize they don’t know what they’re doing, to a middle-manager who feels like nobody above or below them realizes how little they know how to do.
But! Less talked-about (but no less prevalent) is imposter syndrome in other areas of life. New parents tend to feel this strongly, as can the “elders” of a family that everyone looks to for advice and strength and support. Perhaps worst is when the person most responsible for the finances of a household feels like everyone just trusts them to keep everything running smoothly, and maybe they shouldn’t because it could all come crashing down at any moment and everyone will see them for the hopeless shambles of a human being that they really are.
Feelings are not facts
And yet (while everyone makes mistakes sometimes) the reality is that we’re all doing our best. Given that imposter syndrome affects up to 82% of people, let’s remember to have some perspective. Everyone feels like they’re winging it sometimes. Everyone feels the pressure.
Well, perhaps not everyone. There’s that other 18%. Some people are sure they’re the best thing ever. Then again, there’s probably some in that 18% that actually feel worse than the 82%—they just couldn’t admit it, even in an anonymized study.
But one thing’s for sure: it’s very, very common. Especially in high-performing women, by the way, and people of color. In other words, people who typically “have to do twice as much to get recognized as half as good”.
That said, the flipside of this is that people who are not in any of those categories may feel “everything is in my favor, so I really have no excuse to not achieve the most”, and can sometimes take very extreme actions to try to avoid perceived failure, and it can be their family that pays the price.
Things to remember
If you find imposter syndrome nagging at you, remember these things:
- There are people far less competent than you, doing the same thing
- Nobody knows how to do everything themselves, especially at first
- If you don’t know how to do something, you can usually find out
- There is always someone to ask for help, or at least advice, or at least support
At the end of the day, we evolved to eat fruit and enjoy the sun. None of us are fully equipped for all the challenges of the modern world, but if we do our reasonable best, and look after each other (and that means that you too, dear reader, deserve looking after as well), we can all do ok.
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