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:

Thinking about cosmetic surgery? New standards will force providers to tell you the risks and consider if you’re actually suitable

Take care!