‘Make Peace with the mirror and watch your reflection change.’

For many the mirror is a friend. Not just a literal mirror but its social media counterpart the ‘selfie’ the Instagram post. We look in wonder at ourselves gazing out from the Retina display. We check in several times a day to see how the likes are mounting up. Yes! Everybody shares your opinion of yourself, you look good, you are worthy of approval.

But suppose, just for a moment, that the image you see in your bedroom mirror every morning repulses you. You see a hideous, bloated body that would not even fit on an Instagram post let alone gain likes and shares. Your brow is too wide for your face, your nose barely humanoid and forget those size 10 jeans they won’t get over your ankles. But what you are seeing is not the you that the world sees it is ‘Fake News’ a dysmorphic illusion of the actual you. Unfortunately, this is your reality. Can you battle your way out from it?

Our identity-driven world offers a seductive solution to the dysmorphic personality in the form of the cosmetic surgeon who can pass the ‘knife of truth’ across you skin and reveal the beauty hidden beneath. So you set off for Beverly Hills or Gungam in Seoul or Istanbul or Harley Street to find that medical genius who can reconcile your truth with the mirror in your bathroom. Should you be visiting a cosmetic surgeon or should your first port of call be a psychotherapist? The renowned psychologist David Sarwer who is an expert on the psychological aspects of physical appearance has grave doubts on the ethical problems that arise when a patient presents at a cosmetic clinic. He explains that the vast majority of dymorphic disorder people who get cosmetic surgery procedures end up feeling no better or even worse having spent time and money getting the surgery. Whereas, he say “Whereas with psychotherapy, in combination with pharmacotherapy, patients can experience improvements and relief from their symptoms.”

Plastic surgeons are not required to screen candidates for body dysmorphic disorder or any other psychological problems . Plastic surgeons are also not trained to detect such psychological issues either. It isn’t really their professional skill set and also in this money-driven age a paying client is ‘king’. Because the client is vey often left disappointed by the surgical outcome they may demand additional surgery after the initial surgery. Such patients are more likely to be litigious and aggressive when dealing with surgeons than other patients.

The diagnosis by psychologist David Sarwer was body dysmorphic disorder. This is a mental illness that is characteristic of obsessive perception about a supposed bodily flaw that may not even be visible to others. The solution was not plastic surgery but rather, psychotherapy.

Sarwer is now the associate dean for research and directs the Center for Obesity Education at Temple University’s College of Public Health. Sarwer says that “The evidence is pretty conclusive that greater than 90 percent of people with body dysmorphic disorder who get these procedures either report no change or worsening of symptoms, which means they’re spending time, energy and money seeking a treatment that ultimately isn’t going to benefit them. Whereas with psychotherapy, in combination with pharmacotherapy, patients can experience improvements and relief from their symptoms.” Not only is the patient’s life affected by body dysmorphic disorder, it affects the plastic surgeons that are consulted for help says Lisa Ishi professor of head and neck surgery at John Hopkins . Such patients are more likely to call the surgeon more often and make unnecessary demands on their time and, in some cases be more willing to bring legal action against the surgeon.

Ishi has an impressive background and a plastic surgeon and is a renowned authority for her research in ‘Facial Perception’. In her major 2016 study of dysmorphia and plastic surgery she discovered that cosmetic surgeons were mostly incapable of recognizing these patients through their regular conversations. Out of a total of 402 people evaluated for body dysmorphic disorder through an objective screening process and using a surgeon, 43 or 10.7 percent were determined to be positive in the analysis. The reviewing surgeons were only able to identify only two people with the disorder. It is not just invasive surgery that comes under scrutiny but also the easy access to Botox-type treatments and chemical peels – a market driven by the ever-present ‘celebrity culture’ and the reality television shows.

The other soaring trend in cosmetic surgery that is closely related to dysmorphia is in ‘Ethnic’ cosmetic surgery where people with Asian or black heritage seek to eradicate the physical hallmarks of their race. Double-eyelid surgery for example is very popular for women of Asian descent who lack the western crease in the eyelid and pay thousand of dollars to fix that. Rhinoplasty surgeons can change an African nose into a Caucasian nose and bone shaving in Korea can make an Asian chin look more like Western chin through a highly invasive and sometimes dangerous surgery known as ‘bone shaving’ euphemistically referred to as ‘facial contouring’ in the glossy brochures and websites.

Yet our perceptions of beauty are inextricably tied to dominant cultures especially in our social media world and it is understandable that people who are predisposed psychologically to be unhappy with their appearance will seek out solutions in the marketplace. Cosmetic surgeons play a great role in helping people stay youthful and enjoy increased self-esteem but I feel that there should be more filtering by trained psychologists to prevent clients suffering from body dysmorphia to choose cosmetic surgery before exploring other options that might provide a long-term resolution to the nemesis in the mirror. Plastic surgeons like Ishii believe, however, that although such assistance from psychologists is a must. It is nearly impossible for plastic surgeons to regulate the situation without any bias, since they believe they can help every patient that approaches them.

Author's Bio: 

David Miller is the founder of https://bestcosmeticsurgeons.com and a writer on issues of self-identity.