Many patients seeing me for the first time for a cosmetic surgery consultation feel in some way guilty or ashamed for talking to me about their issue.  These feelings, I am sure, arise for various reasons in different people but, whatever their origin, the end result is the production of the same feelings when they consider changing the appearance of their bodies with surgery.   I start out by telling them that almost everyone has some critique of their form when they mentally compare themselves to their ideal. (I, for one, wish I had broader shoulders, but unfortunately, there is no ready solution for that problem.)  I then go on to mention that concern for our appearance is thought, in general, by our culture to be a good trait.  We busy ourselves for many hours during the week with activities to make ourselves physically attractive.  We bathe, cut and color our hair, shave, brush our teeth, work out, choose our clothing and jewelry carefully for each occasion, decide whether or not we will get a tattoo, etc.  We do this because we know that we will be judged by others, at least initially and for the largest part unconsciously, based on our appearance.  This trait, like it or not, is in all of us and relates in a primitive way to basic survival instinct.  We must readily ascertain if someone looks threatening or not (“friend or foe”) and the stage upon which these judgments are first formed is the stage of appearance. Very often, initial feelings of like or dislike are formed based on a subjective “sense” we get from someone’s appearance.  Additionally, we have excellent statistics that show how some human features and proportions are cherished as beautiful regardless of cultural background.  These would include things such as skin quality, facial symmetry and basic body shapes.  Furthermore, like it or not, studies show that individuals widely regarded as attractive in our society tend to be promoted more, make higher incomes and are less likely to get laid off in the event of a down-sizing.  Interestingly, it seems to be the opposite for attractive women in the legal profession who are less likely to make partner than a less attractive colleague of similar ability. 

When I point out how we are always concerned with our appearance and how we frequently go about changing the way we look, we begin to see cosmetic surgery as an inevitable technological extension of this powerful innate drive to enhance our feeling of self-satisfaction by adjusting our appearance. It is not so much that we have a problem changing how we look; it is the concept of using this technology to effect more profound changes at levels heretofore unattainable by traditional means.  It is important that making the step to cosmetic surgery as the next point in this continuum be safe.  If it were particularly risky, then it would be unreasonable. Fortunately, the advances of modern medicine, surgery and anesthesia techniques have brought the risks of life threatening complications down to levels that are significantly lower than the mortality risk for driving your car, an activity we engage in daily with the full knowledge that many people die behind the wheel daily in our country.  Driving is a very acceptable risk to us. For healthy individuals, the risk of serious or life threatening complications associated with cosmetic surgery is far below that for motor vehicle operation, bringing the risk profile to a level consistent with using surgical techniques for cosmetic enhancement. 

Often, by the time I get to this point in my explanation, the patient’s initial feelings of guilt have been assuaged as they have come to understand that the use of cosmetic surgery to alter appearance (when properly and ethically employed – see “Expectations and Patient Satisfaction” and “It’s OK, give yourself permission” blog posts) is just a technological extension of something human beings naturally seek to do; maximize their feeling of confidence by putting forth a physical appearance they feel represents their true selves in the best light possible.