Plastic Surgery Ad Nauseum

Two items about plastic surgery have been in the news recently, as a result of recent studies about the topic. The first looks at “reality” television and plastic surgery.

Crockett RJ, Pruzinsky T, Persing JA. The influence of plastic surgery “reality TV” on cosmetic surgery patient expectations and decision making. Plast Reconstr Surg. 2007 Jul;120(1):316-24.
Who was included: 42 patients seeking their first plastic surgery at the the Yale Plastic Surgery Clinic. Patients were excluded if they were under 18, had any previous cosmetic surgery or consultations for cosmetic surgery, or couldn’t communicate in either English or Spanish.

What was done: Participants completed a survey, the first part of which was done prior to their consultation with the surgeon, and the second part completed afterward. The survey was intended to “examine the knowledge, perceptions, and decision making of patients seeking cosmetic surgery.” The study was conducted over 4 months in early 2005.

What the survey asked: In addition to demographic information, participants were asked about their familiarity with television shows such as Extreme Makeover (ABC), The Swan (Fox), I Want a Famous Face (MTV), Plastic Surgery: Before and After (TLC), Dr. 90210 (E!), and Miami Slice (Bravo). Based on how familiar they were with these shows and how often they watched them, participants were classified as “high intensity” or “low intensity” viewers. Participants rated how knowledgeable they thought they were about cosmetic surgery, including “benefits, risks, costs, length of procedures, recovery times/discomfort, and other alternatives.” They were also asked how much they thought the shows had influenced their decision to seek cosmetic surgery. Finally, they completed a standard questionnaire intended to gauge how realistic their perceptions of their own bodies were.

What they found:
-95% of participants were female. Average age was 35.9 years. Latin-Americans made up the largest ethnic group (38 percent), followed by European-Americans (33 percent), African-Americans (24 percent), and Asians (5 percent).
-”Fifty-seven percent of patients were high-intensity viewers, meaning they were “very familiar with” and “regularly watched” at least one of the shows. Overall, only 12 percent of subjects reported never having seen plastic surgery reality television shows.”
-”There were statistically significant differences in viewing intensity based on ethnicity (p < 0.05). Whereas 75 percent of Hispanic or Latino subjects were high-intensity viewers and 70 percent of African-American or black subjects were high-intensity viewers, only 36 percent of European-American subjects were high-intensity viewers. No Asian or Pacific Islander subjects were high-intensity viewers.”
-High-intensity viewers were more likely to think the shows were similar to “real life.”
-”79% reported that television/media influenced their decision to pursue a cosmetic surgery procedure by coming into the clinic for consultation. Thirty-one percent of patients reported that they were very much or moderately influenced, forming a category of “large-influence” patients. Of these large-influence patients, 85 percent were high-intensity viewers.” In other words, people who watched plastic surgery tv more were more likely to say the shows influenced their decisions to seek cosmetic surgery.
-There was no difference in intent to proceed with surgery or body image disturbance between high- and low-intensity viewers.

What does it all mean? Nothing really surprising here. People who are interested in getting cosmetic surgery by and large have been watching cosmetic surgery reality tv. They say the shows influenced their decision, but how much they watched didn’t make much difference in whether they decided to follow through or how warped their own body image was. Overall, they had a more disturbed body image than what is considered “normal.” Shocking, no? I’m guessing people interested in cosmetic surgery are more likely to watch these shows, and the shows are not so much influencing people to have the surgery. The study did not address whether those who watched a lost of cosmetic surgery tv were more or less satisfied with their results after surgery.

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The second study suggests that women who get breast implants for cosmetic reasons are more likely to commit suicide.

Lipworth L, Nyren O, Ye W, Fryzek JP, Tarone RE, McLaughlin JK. Excess Mortality From Suicide and Other External Causes of Death Among Women With Cosmetic Breast Implants. Ann Plast Surg. 2007 Aug;59(2):119-123.

Who was included: First, this study was conducted using national registries in Sweden. Your mileage may vary for other populations. They identified 3527 women who had cosmetic breast implants for the first time between 1965 and 1993, alongside cause of death data.

What was done: The number and causes of death for women with cosmetic breast implants was examined and compared with the number expected for the general population of women in Sweden.

What they found:
-175 deaths among the women with implants, compared to 133.4 expected deaths.
-Women with implants were 3 times more likely to die of suicide than the general population.
-Death from mental illness was 2.6 times higher in women with implants, mostly due to alcohol/drug dependence.
-22% of all deaths among those with implants “were associated with suicide, psychologic disorders, and/or drug and alcohol abuse/dependence.”
-Elevated suicide risk did not become apparent until 10 years or more after the implants.

What does it all mean? Not that much, really. The number of deaths due to mental illness/suicide were pretty small (24 deaths by suicide), although they were higher than the general population. What the study can’t tell us is the mental status of these women prior to cosmetic surgery – it’s possible that there was an elevated rate of mental illness in the women seeking surgery to begin with. It doesn’t imply that all women seeking implants are suicidal, because they obviously didn’t all kill themselves. It’s not at all likely that breast implants cause mental illness, but the study suggests that women seeking this procedure may be at risk for future (or current but unrecognized) mental illness. It doesn’t seem like too much of a stretch to suggest that some women seeking the implants may have self-esteem problems or other issues, and the cosmetic surgery is simply a sign of that. Would that really surprise anyone?