The day after plastic surgery

Nearly 11.9 million cosmetic procedures were performed in the United States last year.
By STEPHEN G. HENDERSON
SPECIAL TO THE BALTIMORE SUN
Elisabeth Reed, a writer in Santa Fe, N.M., is an attractive 59-year-old who looks perhaps a decade younger. This, she believes, is because she never smoked, eats well and plays tennis regularly. Oh yes, there's one other possible explanation. Five years ago, she had a face-lift.
"Someone showed me a picture of myself, and I saw a little droop in my neck that I'd had since I was 28. I thought it was high time to get rid of it," she explained. "What I hadn't realized, though, is that there are politics involved in cosmetic surgery. It created some resentment."
Once a secret pursuit of the rich and famous, makeovers not only have hit Main Street, but in the last few years there's been a steady uptick in nip-tucks. Nearly 11.9 million surgical and nonsurgical cosmetic procedures were performed in the United States last year, according to the American Society for Aesthetic Plastic Surgery (ASAPS). This represents a 44 percent increase over 2003, and a whopping 465 percent increase since 1997.
While patients are typically overjoyed by their new appearance, these statistics don't reveal that they're also sometimes saddened by judgmental responses from families and friends. Reports of jealousy, strained relations, even breakups are not uncommon. Beauty, it seems, can create beasts.
Quotable
"There is still a stigma, a lingering Calvinist ethic that says 'you don't change what God gave you,'" Reed said. Although the majority of her friends were supportive of her face-lift, several were emphatically not. "Some people create drama about a quote-unquote dishonest decision to represent yourself to the world as younger than you are."
Dr. Patrick J. Byrne, director of the Division of Facial, Plastic and Reconstructive Surgery in the Johns Hopkins Department of Otolaryngology-Head and Neck Surgery, is well aware of this phenomenon.
"Our faces are how we identify ourselves and others identify us. When facial changes occur, then, it's only to be expected there will be psychological adjustments," he said. "The real challenge is helping a patient to be prepared mentally for what they'll go through, post-operation. I often bring up the concept of 'buyer's remorse.' Some people question, 'Why did I do this?' Others feel anxiety and stress. This doesn't get enough media attention."
The ASAPS reports that the top five surgical procedures are -- in descending order of frequency -- liposuction, breast augmentation, eyelid surgery, rhinoplasty and face-lift. And, before electing to have one or more of these, many more women and men chose nonsurgical procedures such as Botox and collagen injections, chemical peels or microdermabrasion.
"We find patients are coming in earlier, looking for smaller procedures, rather than radical," said Mark Jewell, ASAPS president. "When you get to a point where these don't work, though, it's time to consider a surgical procedure that can improve what's wrong. Everyone who considers aesthetic surgery is standing on the edge of a diving board. They are nervous. Do they make the leap?"
Physical pain
In their initial consultations, most patients tend to focus exclusively on the physical pain involved in cosmetic procedures. (Will it hurt, and exactly how much?) It is the doctor who usually raises any question of emotional pain, or how surgery may affect interpersonal relationships.
"I feel sometimes like I am half-psychiatrist, half-surgeon," said Dr. Randolph Capone of the Facial Plastic Surgicenter in Pikesville, Md.
Capone says his first concern is assessing a patient's narcissism to discern if the patient has sufficient ego strength to weather criticism he or she may receive as a result of a cosmetic procedure. A particularly fraught scenario, he said, is when a patient is getting surgery on a facial feature that's considered part of an ethnic identity. Capone cites instances of Asians wanting to alter their distinctively shaped tear ducts, or Italians, their "Roman nose."
"In cases like these, patients sometimes can get quite a bit of heat from their families," he said.
Even when the so-called problem area isn't a family trait, friction can still be caused by its alteration. Those getting liposuction, for example, are sometimes accused of taking the easy way out, rather than losing weight through diet and exercise. Women with implants tell of being approached by complete strangers and asked if their breasts are "real." The shock of such unsolicited comments, they say, can be nearly as uncomfortable as the surgery itself.
"Believe me, if I could have done it without anyone knowing, I would have," said Robert Schloss, 50, an employee benefits professional in San Francisco. He recently underwent blepharoplasty to remove "bags" from under his eyes that he dreaded seeing each morning while he shaved. Despite his family trying to convince him that he was being silly and overreacting to a minor physical defect, Schloss proceeded and is extremely pleased with the results.
What he didn't foresee, however, was all the gossip among his co-workers. "For a while there, it was kind of disempowering, especially around other men at the office," he admitted. "I'm sure there was talk-talk-talk behind my back, but I just had to tough it out."
Complicating such decisions, of course, is that no one else sees what we see in the mirror. Nonetheless, doctors say they are wary when a patient expresses excessive concern with a body feature that appears normal to them. Another red flag is when a patient seems to be less motivated by his or her own wishes, than to be acting on pressure from a spouse or romantic partner.
"When you feel better about yourself, you will feel better about everyone around you," said Dr. Robert Weiss of the Maryland Laser, Skin & amp; Vein Institute in Hunt Valley, Md. "But if you start off as a basically unhappy person and you expect surgery to change that, it won't."
Young people may be better at handling conflict caused by a surgical procedure, said Byrne. "Those we call the 'aging face patient' are trying to recapture something they once had, but a younger patient is a different dynamic. They're just starting out; they are moving life forward."
Good and bad
Such, at least, appears to be the case with Karen Karas, 27, a district adjudicator for the Department of Homeland Security in Baltimore, who recently asked Byrne to perform cosmetic surgery on her nose. The result, she says, was altogether life-changing, both for good and bad.
"I am Polish and everyone in my family has a widow's peak" -- her expression for a bump -- "in the nose. It was a barrier for me. I couldn't get over it. Before I had the surgery, I didn't date. I didn't see myself as an attractive person. Afterward, my self-esteem increased and I had a better outlook on life. I didn't even try to, but I lost weight. Now I have a boyfriend, and we recently bought a house together."
After completing this breathless recap of her rhinoplasty, Karas exhaled with a heavy sigh. "My new nose actually ended two of my friendships. I no longer speak to them. These girlfriends didn't view it as self-improvement, but self-absorption."
She paused again.
"I think it was jealousy," Karas concluded. "All women want to change things about themselves, but some just won't take the initiative."