Psychosocial Factors Within the Psychosocial Factors Within the Realm of Aesthetic Plastic SurgeryRealm of Aesthetic Plastic Surgery

Hilary McCord, PA-SHilary McCord, PA-S

hilarymccord@uky.eduhilarymccord@uky.edu

Advisor: Professor PowdrillAdvisor: Professor Powdrill

Spring 2008Spring 2008

My Audience My Audience

Plastic SurgeryPlastic SurgeryPsychiatryPsychiatryDermatologyDermatologyPrimary CarePrimary Care

Growth of the IndustryGrowth of the IndustryAmerican Society of Plastic Surgeons reports American Society of Plastic Surgeons reports

~ 11 million aesthetic procedures were performed ~ 11 million aesthetic procedures were performed in 2006.in 2006.

NONSURGICALNONSURGICAL

Botox

Restylane

Microdermabrasion

SURGICALSURGICAL

Breast Augmentation #1Breast Augmentation #1

RhinoplastyRhinoplasty

LiposuctionLiposuction

Breast Augmentation #1Breast Augmentation #1

330,000 in 2006330,000 in 200655% increase since 200055% increase since 2000Expected to increase in the future due to Expected to increase in the future due to

the FDA reapproval of silicone implants the FDA reapproval of silicone implants Invention of the “Gummy Bear” implantInvention of the “Gummy Bear” implant

Growth of the industry: Why?Growth of the industry: Why?

Sociocultural theories emphasize the Sociocultural theories emphasize the interaction of the mass media and cultural interaction of the mass media and cultural ideas of beauty with notions of Self-Ideal ideas of beauty with notions of Self-Ideal Discrepancy and Social Comparison Discrepancy and Social Comparison Theory.Theory.

Growth of the Industry: Why?Growth of the Industry: Why?The most recent example of mass media influence The most recent example of mass media influence

is the explosion of aesthetic surgery Reality T.V.is the explosion of aesthetic surgery Reality T.V. Extreme Makeover Extreme Makeover

(ABC)(ABC) The Swan (FOX)The Swan (FOX) I Want a Famous I Want a Famous

Face (MTV)Face (MTV)

Plastic Surgery: Plastic Surgery: Before and After Before and After (TLC)(TLC)

Miami Slice (Bravo)Miami Slice (Bravo) Dr. 90210 (E!)Dr. 90210 (E!)

Influence of Reality T.V.Influence of Reality T.V.

Crockett (2007) Crockett (2007) concludes 4 out of 5 concludes 4 out of 5 patients reported patients reported plastic surgery Reality plastic surgery Reality T.V. directly T.V. directly influenced them to influenced them to pursue an elective pursue an elective cosmetic procedure.cosmetic procedure.

Didie (2003) reports Didie (2003) reports 70% of cosmetic 70% of cosmetic breast augmentation breast augmentation patients studied, patients studied, endorsed T.V. as a endorsed T.V. as a significant source of significant source of knowledge for the knowledge for the procedure.procedure.

Influence of Reality T.V.Influence of Reality T.V.

In 2005, the American Medical Association issued an In 2005, the American Medical Association issued an amendment to its constitution and bylaws addressing amendment to its constitution and bylaws addressing

concerns arising from reality television programs’ concerns arising from reality television programs’ influence on patient expectations regarding medical influence on patient expectations regarding medical care and standards to guide physicians’ participation care and standards to guide physicians’ participation

in such programs in such programs

Breast AugmentationBreast Augmentation

Psychiatric Disorders: yet, another Psychiatric Disorders: yet, another prevalent factor: prevalent factor:

Sarwer (2003) reports 40% of women Sarwer (2003) reports 40% of women seeking breast augmentation were under seeking breast augmentation were under the care of a mental health provider.the care of a mental health provider.

Meningaud (2001) similar resultsMeningaud (2001) similar results

Assessment of the Breast Assessment of the Breast Augmentation Candidate: Augmentation Candidate:

the PA’s Rolethe PA’s Role

Identify the motivating factors for the Identify the motivating factors for the intervention and expectations of the intervention and expectations of the surgical outcomesurgical outcome

Recognize Body Dysmorphic Disorder and Recognize Body Dysmorphic Disorder and consult with Mental Health Servicesconsult with Mental Health Services

Elicit a psychiatric history to determine risk Elicit a psychiatric history to determine risk for post-operative suicidefor post-operative suicide

Identify Motivating Factors to have Identify Motivating Factors to have Breast AugmentationBreast Augmentation

Body Image Body Image Dissatisfaction Dissatisfaction may be the may be the primary primary motivational motivational factor (Cash factor (Cash 1996)1996)

Identify Motivating Factors to have Identify Motivating Factors to have Breast AugmentationBreast Augmentation

Valence is the measure of the importance Valence is the measure of the importance of body image to a person’s self-esteem.of body image to a person’s self-esteem.

Value is the degree of dissatisfaction with Value is the degree of dissatisfaction with one’s appearance. one’s appearance.

Breast augmentation patients have high Breast augmentation patients have high valence and high value. (Sarwer, 1998b)valence and high value. (Sarwer, 1998b)

Body Dysmorphic DisorderBody Dysmorphic DisorderDSM-IV (ICD-10:F45.2)DSM-IV (ICD-10:F45.2)Extreme body image dissatisfactionExtreme body image dissatisfactionA psychiatric illness of perceived uglinessA psychiatric illness of perceived uglinessAbsolute contraindication for breast Absolute contraindication for breast

augmentation or any cosmetic surgeryaugmentation or any cosmetic surgeryAvoid litigationAvoid litigation

Body Dysmorphic Disorder: Body Dysmorphic Disorder: Recognize It and Recognize It and

Consult Mental Health Consult Mental Health Frequent mirror gazingFrequent mirror gazingPerform repetitive time consuming Perform repetitive time consuming

behaviors regarding the imagined defectbehaviors regarding the imagined defect ““Doll-like” appearanceDoll-like” appearanceExtreme rituals of camouflageExtreme rituals of camouflageSurgery JunkySurgery Junky

Body Dysmorphic Disorder: Body Dysmorphic Disorder: Recognize It and Recognize It and

Consult Mental Health Consult Mental Health

15% of cosmetic surgery patients15% of cosmetic surgery patients2% general population2% general population57% of BDD patients attempt suicide57% of BDD patients attempt suicidePatient’s treatment of choice: mo’ surgeryPatient’s treatment of choice: mo’ surgeryPsychiatrist’s treatment of choice: SSRIs Psychiatrist’s treatment of choice: SSRIs

and Cognitive Behavioral Therapyand Cognitive Behavioral Therapy

Post-operative Suicide: the Post-operative Suicide: the importance of a psychiatric historyimportance of a psychiatric history

Six international epidemiological studies Six international epidemiological studies have found an unexpected relationship have found an unexpected relationship between cosmetic breast augmentation between cosmetic breast augmentation and suicideand suicide

(Brinton, 2001) (Koot, 2003) (Pukkala, 2003) (Jacobson, 2004) (Brinton, 2001) (Koot, 2003) (Pukkala, 2003) (Jacobson, 2004) (Brinton, 2006) (Villeneuve, 2006).(Brinton, 2006) (Villeneuve, 2006).

Designed to investigate overall mortality in Designed to investigate overall mortality in women who underwent breast women who underwent breast augmentation. augmentation.

Death by suicide associated with:Death by suicide associated with:

Breast augmentation vs. other forms of cosmetic Breast augmentation vs. other forms of cosmetic surgerysurgery

Older age at implantation >40 years oldOlder age at implantation >40 years old Women who had their implants for longer Women who had their implants for longer

periods of timeperiods of time History of psychiatric hospitalization with breast History of psychiatric hospitalization with breast

augmentation vs. other forms of plastic surgeryaugmentation vs. other forms of plastic surgery Suicide rate approximately twice that expected Suicide rate approximately twice that expected

from estimates of the general populationfrom estimates of the general population..

ConclusionConclusionThe aesthetic plastic surgery PA: The aesthetic plastic surgery PA:

must be aware of the influence television must be aware of the influence television and western culture has on a patient’s and western culture has on a patient’s desire to invasively alter their appearance desire to invasively alter their appearance

has the duty to ameliorate the patient’s has the duty to ameliorate the patient’s body dissatisfaction with surgical body dissatisfaction with surgical intervention while providing info on intervention while providing info on benefits and risks of the procedure.benefits and risks of the procedure.

ConclusionConclusionThe aesthetic plastic surgery PA:The aesthetic plastic surgery PA:

should decide the appropriateness for should decide the appropriateness for surgery on a case-by-case basis and surgery on a case-by-case basis and include collaboration with Mental Healthinclude collaboration with Mental Health

should consider results of existing studies should consider results of existing studies on suicide’s link to breast augmentation. on suicide’s link to breast augmentation.

ConclusionConclusion

The plastic surgery physician assistant The plastic surgery physician assistant has the right to refuse a surgical has the right to refuse a surgical intervention if it is perceived as causing intervention if it is perceived as causing future harm to the patientfuture harm to the patient

PRIMUM NON NOCEREPRIMUM NON NOCERE

For FunFor Fun

Association of Plastic Surgery Physician Association of Plastic Surgery Physician Assistants Assistants www.apspa.net

BDD VIDEO BDD VIDEO http://www.youtube.com/watch?v=KfcohewREYc

Reality TV and Cosmetic Surgery VIDEOReality TV and Cosmetic Surgery VIDEO

http://www.msnbc.msn.com/id/20068105/

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