Plastic Surgery Won’t Solve Self-Esteem

Although most people are happy with the outcome of plastic surgery, existing studies back what therapists say: The change doesn’t address self-esteem issues.

Perhaps your teenage daughter wants a nose job, and you understand why. Her nose gives her less-than-average looks. Feeling sympathetic, you might decide to give her a boost in a confidence. Maybe her nose isn’t a big problem, in your opinion, but since it’s making her unhappy you want to help.

There isn’t much sophisticated science — randomized, with control groups — about the psychological effects of optional cosmetic surgery. The existing studies, however, back what therapists say: It doesn’t address fundamental issues of self-esteem.

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At least at younger ages, one large study found, cosmetic surgery patients are a more troubled group — and the procedure doesn’t help. This study is important because it followed more than 1,500 teenage girls for 13 years, and the researchers didn't know who would actually have surgery in that time. The 78 girls who did were more likely to be anxious or depressed and had a greater increase in those symptoms over the period than non-patients.

"I think this is one of the best studies out there," says Viren Swami, an expert on body image and a psychologist at Anglia Ruskin University in Cambridge, United Kingdom. "And their findings seem quite clear: Those who chose to have cosmetic surgery tended to have a history of poorer mental health to begin with but having cosmetic surgery did not result in a positive outcome."

In studies of older patients, people tend to be happy with the outcome of the surgery and have higher self-esteem about their looks for as many as five years but not necessarily higher self-esteem overall.

There seem to be three kinds of patients, according to anecdotal reports and small studies. One group is pessimistic, shy, and insecure. Others are impulsive, novelty-seekers — people who are likely to take drugs or have wild escapades. A third group are confident people who aren’t especially impulsive but chose to invest in their appearance.

A good bit of evidence shows that, as you move up the looks scale, both men and women do better in the workplace, says Dan Hamermesh, author of “Beauty Pays: Why Attractive People Are More Successful.”

Patients who were dissatisfied with previous surgeries or who have a history of depression or anxiety are less likely to be pleased with the outcome, a research review concluded. It’s also a bad sign if a patient hopes the procedure will save a relationship or if there’s disagreement within a couple over whether the surgery is a good idea.

Women who augment their breasts may be more likely to be pleased than those who alter their noses or get face-lifts to look younger, the review found. Nose reshaping, eyelid surgery, facelifts, and liposuction, however, have become more popular than breast augmentation, which once topped the list.   

About 5 to 15 percent of plastic surgery patients have body dysmorphic disorder, an obsession with nonexistent or slight defects in appearance. These patients are most likely to ask for nose jobs, and they usually aren’t happy with the results.

Procedures that alter female genitalia to enhance pleasure or appearance have become more popular, though there isn’t much research on long-term benefits or harms. Are you afflicted with a flat rear end? You can have your buttocks surgically lifted as in a facelift, or boosted with an implant or your own fat.

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