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Depression and Cosmetic Surgery

Does Plastic and Cosmetic Surgery Cure the Blues?


CosmeticSurgery.com Staff Report

Some studies have surfaced showing that a few surgical rejuvenation procedures can stop depression and mood disorders. While physicians are not yet prescribing a face lift or a nose job for depression, some operations are reported to be relieving serious cases of the blues. The bottom line is that all psychological states are an important part of rejuvenation surgery.

When Sheena Person, then 23, developed breathing problems a decade ago, she choose a surgeon to perform her rhinoplasty at the medical center where she worked. However, she checked no other credentials nor training and that lead to a botched surgery.

Depression and Cosmetic Surgery

"Everything that could go wrong, did go wrong," Sheena told CosmeticSurgery.com. "I had terrible reactions to the anesthesia and I suffered pain during and after the procedure which left my nose bent and disfigured."

So misshapen, in fact, Sheena went out of her way to hide the bad side of her nose. She rearranged her office so that visitors only sat on her good side. At social events, she carefully planned how she would enter a room and where she would stand so the disfigurement was harder to see.

Botched Nose Job

"I hated mirrors and made sure I retouched every photo of me ever taken," Sheena says. "But the worst was staring. People were always looking, not in my eyes, but at my nose."

Sheena was so spooked by the surgery, she procrastinated for ten years about repairing the botched nose job. She just couldn't bring herself to go near a plastic surgeon again.

A little over a year ago, Sheena summoned her courage and found a plastic surgeon qualified to handle the revision.

Depression Treatment

However, she did not get an immediate date for surgery. The first thing Sheena's surgeon did was present her with an unusual RX that said: wait a year before surgery while seeing a mental health therapist monthly about your depression.

"Plastic surgeons are trained to ask questions to screen out potential patients who may have a psychological condition," says Anthony Brissett, M.D., an assistant professor and director of the Baylor Facial Plastic Surgery Center at The Methodist Hospital in Houston. "Sheena was upset and crying during our interview because her appearance had thrown her into a cesspool of depression.

"Post-traumatic stress disorder -- it was once called "shell shock" -- comes in many shapes and forms."

Cosmetic Plastic Surgeries

Sheena completed the year of therapy and finally went under Dr. Brissett's knife for a revision rhinoplasty which, when healed, lifted her dour mood and changed her life. (We'll learn more about Sheena later on.)

Among the psychological states and conditions surgeons are trained to be on the lookout include patients suffering from a condition known as body dysmorphic disorder or "imagined ugliness syndrome." Sufferers imagine their appearance is flawed so endless cosmetic plastic surgeries can never be enough. Consequently, reputable plastic surgeons turn down requests for surgery because those patients' expectations are so unrealistic they can never be met.

Because plastic and cosmetic surgeons are so attuned to patients' psychological states, the connection between mood, self-esteem and depression has been widely studied by plastic surgeons, psychologists and other scientists.

Depression

"About 100 scientific studies and surveys have explored the plastic surgery - depression connection," says Henri P. Gaboriau, M.D., an expert in psychological matters related to plastic surgery. "The landmark study in this area -- a survey of depressed breast reduction patients -- showed 70 percent of the subjects had relief of their depression after the breast reduction."

Body Dysmorphic Disorder and Cosmetic Surgery

In his professional life, Dr. Gaboriau currently writes the questions that plastic surgeons use to screen patients for various psychological states.

The British Journal of Plastic Surgery reported a psychosocial survey of 33 breast reduction patients at the University of Manchester in England. The overall improvement in health status and psychological functioning were so good, the authors recommend the National Health Service -- Britain's taxpayer supported health plan -- provide the operation to women who needed it.

In most cases, rejuvenation surgery is expected to cause temporary blues. According to Vasdev Rai, M.D., a plastic surgeon in Dallas, post-operative depression often sets in about three days after the procedure.

"With radical changes, it may be a while before you are comfortable with your new appearance," says Dr. Rai. "The other unexpected event is when others close to you become upset or critical about your surgery. That relates back to envy on your friend's part."

Depression Test

If you were to visit a plastic surgeon to ask about rejuvenation procedures, here are some of the typical questions the surgeon might pose:

Why do you want surgery now?

Surgeons and psychologists agree that major life changes like death, divorce, bankruptcy or other life-altering events should be over before you before take on plastic surgery.


How do you imagine surgery will affect your life?

If you think plastic surgery will get you a better job or a hefty raise, reinvigorate your marriage or attract a trophy mate, you have what surgeons call unrealistic expectations. A facelift can only make you look better, not land you the hand of the daughter of the company president.


Are you depressed, anxious or having difficult sleeping?

If the answer is yes to any of the above, you probably need to see a different type of doctor -- one specializing in questions of mental health. Having surgery in those states could possibly worsen your condition. Consider: A high percentage of the most mentally stable patients typically experience depression, anxiety or insomnia after cosmetic surgery. Even plastic surgeons who have just had rejuvenation surgery get the blues.

Some of the other danger signs surgeons look for include:

  • Preoccupation with an imaginary facial or body defect
  • Many consultations for rejuvenation surgery and having undergone multiple surgical procedures
  • Wanting to look like a particular celebrity

Some of the current studies about cosmetic plastic surgery and psychological states show the following:

Treatment for the Blues?

Botox in Frown Lines Helps Patients with Major Depression

Dermatologist Eric Finzi, M.D., Ph.D. and psychologist Erika Wasserman, Ph.D., treated 10 clinically depressed patients with Botox in the glabellar area, (the "worry lines" between the eyes) and got rid of most of the subjects' depression. Ten women patients who had been diagnosed and treated for major depression received Botox. Two months later, nine patients were no longer depressed while one experienced no improvement in mood. The researchers think there is a direct feedback between the frowning muscles in the face and the depression center in the brain.

Says Dr. Finzi: "I developed this idea and only wanted to see if it warrants further testing. I think it absolutely does."

(The editor of Dermatological Surgery, the journal that printed the study, noted that Botox for depression would be an entirely new use for the wrinkle remover and that the study was largely anecdotal, meaning it only discussed a few cases and proved nothing in the eyes of science.)


Plastic surgery, a Natural Mood Enhancer?

Bruce Freedman, M.D., medical director of Plastic Surgery Associates of Northern Virginia, studied 362 cosmetic plastic surgery patients, 61 of whom were taking antidepressants at the time of surgery. Six months later, only 42 patients were still taking anti-blues medications, creating a 31 percent decrease in cases of depressed subjects. Not too surprisingly, 98 percent of patients said the surgery had markedly improved their self-esteem.


Breast Surgery Linked to Boost in Self-esteem and Libido.

University of Florida nurse Cynthia Figueroa-Haas, a clinical assistant professor studied 84 women, 21 to 57 years old who were undergoing breast augmentation. The womens' levels of self-esteem and sexual activity were assessed before surgery and again at the two and three month points after surgery. Results? "Improvements in the women's self-esteem and sexual satisfaction were directly correlated with having undergone breast augmentation," writes Professor Gigueroa-Haas who also noted that the rates of sexual desire, arousal and satisfaction were "substantial."

Creative Thinking

Sheena Pearson found a different type of satisfaction in life with a newly repaired nose. All the scheming and mental energy that formerly went into concealing her misshapen nose was freed for more creative thinking. Three months after the procedure, she noticed her nose was looking much better and felt her confidence growing by leaps and bounds. She was already tolerating a bad situation in her marriage, so she ended the relationship, knowing she would have to double her income to keep her home and lifestyle.

"Having a presentable nose has a huge impact on me and made me a stronger person," Sheena says.

She completed the divorce, left the medical field, created two businesses and is well on her way to seeing the rest of her dreams come true.

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