Six months ago, a woman in her late 40's walked into Dr. Navin Singh's office requesting a thigh lift. The plastic surgeon, director of breast reconstruction and assistant professor of plastic surgery at the Johns Hopkins University School of Medicine, had already performed a breast augmentation with lift and a tummy tuck on the patient—and Singh's partner had performed a facelift, eyelid surgery, and rhinoplasty on her, as well—but she wanted more.
The procedure would leave a sizeable scar, Singh warned her, but she remained eager to pursue it. The surgeon got the feeling that the woman was "seeking the thrill" of the procedure, and "just didn't have a reasonable expectation of what a thigh lift involved." She was the classic plastic surgery addict, out for body-altering surgery for all the wrong reasons, he explains. So he turned her down.
"She became irate," he recalls. "Typically the answers we provide are, 'I don't think I'm the right surgeon for you.' It's the classic 'It's not you, it's me.'"
Another patient, a young man in his late 20's who was "well into the double digits" of facial procedures, approached Singh for eyelid surgery. Reconstructive rhinoplasty earlier in his life was his "gateway" procedure—a hallmark for those dependent on plastic surgery—to an alarming roster of aesthetic surgeries that, one by one, wouldn't signify an issue, but "in aggregate, symbolized to me a problem," he says.
"It starts with [the gateway procedure] and creeps onto the rest of their body," he says. "They're insatiable."
Again, Singh refused to do the surgery.
"I told him honestly that I thought he was starting to look too synthetic and that I thought he needed to be evaluated by a mental health professional," he says. "Oftentimes, a young plastic surgeon will just do it and validate it to themselves by saying, 'If I don't do it, someone else will.' But you never want to be the last person to have operated on a person like that."
But sometimes, "no" just doesn't cut it, and patients will try to convince a plastic surgeon to perform the operation anyway—something that confounds Singh.
"Imagine you've got a car and the mechanic says, 'I'm not really the right guy for this.' Would you really leave him your car?" he asks. "But yet, when it's your body . . . it's amazing how much they'll negotiate with you to get you to do something."
Cosmetic surgeon Dr. Hema Sundaram has also seen her share of "over-enhanced" patients, but the 46-year-old woman who recently walked into her office definitely took her by surprise.
The woman had already had a laundry list of facial procedures—various implants, lifts, and fillers—but it was her lips that shocked the doctor.
"They were grossly over-enhanced," Sundaram recounts. "She came to me because she wanted more."
"I just want them totally pumped up," the woman told her. "As big as they can be."
Sundaram, who has offices in Rockville and Fairfax, Virginia and is the author of the book Face Value: The Truth About Beauty—and a Guilt-Free Guide to Finding It, explained to the prospective patient that her look had surpassed natural—and that she refused to inject her lips with anything else until they went down to a normal size.
"To me, the best cosmetic surgery is undetectable, and her lips absolutely walked in the room before she did," the surgeon says. "Chances are, she went to another cosmetic surgeon and got what she wanted."
The experience of turning someone away who has gone overboard with plastic and cosmetic surgery is a familiar one to doctors like Singh and Sundaram. With faster recovery times and a seemingly endless array of procedures to modify just about any body part that needs "fixing," plastic surgery is more popular than ever in America. According to the American Society for Aesthetic Plastic Surgery (ASAPS), there were nearly 11.5 million surgical and nonsurgical procedures in the United States in 2006 alone, including 4.1 million injections of Botox—a neurotoxin used to temporarily smooth facial lines that can even be available at some certified day spas, or "medi-spas." All that nipping, tucking, and injecting equals big business; Americans shelled out nearly $12.2 billion on cosmetic surgery last year, ASAPS reports. Of course, our celebrity culture is driving this phenomenon. More and more celebs are being "outed" as plastic surgery indulgers—and we want to look as great, as young, as nipped and tucked, as they do.
It's not only women going under the knife, either. Since 1997, nonsurgical cosmetic procedures among men have increased a whopping 722 percent, and men accounted for nearly 1 million cosmetic procedures in 2006 (liposuction was the most popular procedure for men, followed by rhinoplasty, eyelid surgery, breast reduction to treat enlarged male breasts, and facelift).
As lips and breasts continue to swell, faces mysteriously tighten, and celebrities quietly remodel their entire bodies, it doesn't come as a surprise that people often go overboard with plastic surgery. When it comes to a plastic surgery "addiction," though, one's friends and neighbors don't usually come to mind. Instead, we think of the freakish Michael Jackson, or "Lion Queen" socialite Jocelyn Wildenstein, or self-proclaimed plastic-surgery expert Cindy Jackson (commonly known as the "Human Barbie"), not the person standing behind you at the supermarket.
But everyday people addicted to plastic surgery? The answer is yes, according to area plastic and cosmetic surgeons.
Although he admits it is truly rare, Dr. Adam Basner—division head of plastic surgery at Sinai Hospital with a private practice in Lutherville—does turn patients away who seem like candidates for plastic surgery addiction.
"In a very, very small percentage of patients I'll say, 'I don't think I can help you,'" he explains of a surgery-seeker who has unrealistic expectations of what cosmetic procedures can achieve, a warning sign of an addiction to—or at least a dependence on—plastic surgery. If Basner is unsure about a cosmetic surgery candidate, he may recommend that a psychologist be involved to determine whether the patient has reasonable expectations.
A person who can't be convinced that surgery might be futile, or who comes in requesting to look like someone else, definitely rings a warning bell in the minds of most plastic surgeons.
"As a plastic surgeon, you have to be able to recognize what can be fixed," adds Dr. Michael Cohen of the Towson-based Cosmetic Surgery Center of Maryland. As for turning away a patient? "It's a service that you owe to the patient. It doesn't do you any good, it doesn't do the patient any good, and it's not worth the money."
But what about Hollywood's portrayal (perpetuated through shows like Nip/Tuck) that plastic surgeons are strictly in it for the narcissism and the money?
"I do believe that most plastic surgeons actually have a great deal of care and concern for their patients," Basner says.
Singh agrees, but admits that true "addicts" find ways to manipulate some surgeons into performing procedures they're hesitant about. "They will play into our own narcissism," by showering them with compliments about their work and reputation, he says. "Females will also play the 'damsel in distress,'" role, Singh continues. "'I've been butchered,'" the women will say. "'I should have come to you in the first place.'"
"As men, we're trained to jump at that," Singh admits. "Patients themselves can be very good psychological manipulators."
For some patients, no amount of surgery will ever satiate their needs. Fifteen percent of patients seeking plastic surgery have what is called body dismorphic disorder (BDD), Sundaram says, an obsessive-compulsive disorder that creates a distorted self image, usually when there's nothing noticeably wrong to outsiders.
"By and large, [those with BDD] don't feel better when they get the surgeries . . . or if they do, they pretty much switch to another part of the body," explains Dr. Christopher Welsh, addiction psychiatrist and assistant professor at the University of Maryland Medical Center. He is careful to distinguish between people with BDD and those simply obsessed with plastic surgery. "Body dismorphic disorder is deeper-rooted psychologically. It's a fixed feeling that something is wrong," versus someone who is preoccupied with looking younger, Welsh says. "With body dismorphic disorder, you act like there's something wrong with you. . . . Because your nose is 'too big,' it just destroys your life. It's qualitatively different than someone who just wants to look younger."
In the case of BDD, "it's a need, not a choice," Sundaram says. Similar to an alcohol or drug addiction, "your whole life revolves around it," and those suffering from BDD may go far into debt to finance their extensive procedures.
BDD aside, the need to look younger—or have bigger breasts, smaller thighs, a streamlined nose, or more enhanced muscles (for men)—can indeed take over someone's life if they have the means for the often costly procedures.
This is not only a danger for adults, but for children, too, says Dr. Shreya Patel Hessler, a Bel Air psychologist specializing in children and adolescents. She is now seeing girls as young as 7 with body image issues, already mapping out future plastic surgery procedures and counting calories. She sees teenagers who request cosmetic surgery as graduation gifts. Hessler has also counseled three young male patients with eating disorders within the past year, one of whom wanted pectoral implants to make his chest more defined. "Without appropriate intervention, [their self-esteem issues] could get worse," she warns.
The psychologist recommends that parents listen closely to what their children are saying about their appearance, making special note of whom their children are comparing themselves to, how they respond to compliments on their physical appearance, and if they make self-deprecating statements.
But parents are often to blame themselves, she states, giving in to their children's desires to have plastic surgery because they are so desperate for them to feel not only good about themselves, but accepted amongst their peers. Sometimes a procedure such as rhinoplasty can truly boost an adolescent's self-esteem, Hessler says, but if your child has a "laundry list" of cosmetic procedures he or she wants to have done, it's time to worry.
Even with these concerns, plastic surgery still has its cheerleaders. Christine Schwab, a California-based fashion reporter and author of The Grown-Up Girl's Guide to Style: A Maintenance Bible for Fashion, Beauty and More, isn't shy about her love of plastic surgery and cosmetic dermatology. She's had her share of both and is quick to admit how easy it is to become addicted to something that, in her opinion, isn't all that painful and has such immediate payoff.
"It just turns back the clock so rapidly," she says. "If you have the money and looks are important to you, it's a very good investment. There's not a lot of pain. It's almost like a little vacation. [Often] the results are so good that you get greedy. I think the problem and the important thing is to have some restraint and not to get greedy."
After one successful procedure, "you start noticing other areas of your face and body that might not match," she explains. "It's very easy [to get addicted]. I really had to put the brakes on myself."
But even a dyed-in-the-wool cosmetic surgery fan like Schwab knows the dangers.
"I always look the best I can without looking foolish, and that's a very fine line to cross," she says. "I don't want to look like Joan Rivers."
She also notes Melanie Griffith's "duck lips." "I'm sure when Melanie Griffith looks in the mirror, she thinks her lips look like Angelina Jolie's. But she doesn't look like Angelia Jolie. Angelina Jolie's are natural. Nobody close to a celebrity tells them the truth."
A veteran of the fashion industry, Schwab, who is in her 50's, is all too familiar with the pressure to look perfect in today's beauty-obsessed world, and finds celebrities who deny having had plastic surgery to be woefully irresponsible. She recalls watching former supermodel Christie Brinkley on a recent talk show. When asked how she stays so young looking, she responded with "'Oh, I drink a lot of water. I exercise and get enough sleep,'" Schwab recounts. "And I'm thinking, 'how dishonest!' They're doing everything that's available to them. They set the bar really high for the average person."
As for people denying that they had cosmetic surgery? Dr. Basner isn't surprised. "It's the one thing nobody talks about," the surgeon says. "We still condemn women who have cosmetic surgery. We're scared of our own mortality. As a society, we don't have the social mores that we're mortal and are going to die."
Terry Goodwin, for one, isn't ashamed to talk about the cosmetic surgery she's had, but her post-op agony will prevent her from getting any other procedures—and leaves the 34-year-old wondering how people can get addicted at all. The Westminster native had a breast augmentation in 1998, going from an A cup to a C. She's thrilled with the results—"I never felt proportionate," she says. "I never felt I could wear clothes that fit well"—but had to go back under the knife just days after her surgery because one breast implant was higher than the other.
"It was extremely painful," Goodwin says of the ordeal. "It wasn't anything like [the surgeon] said it was going to be. He said it would feel like I had done 100 push-ups. I felt like I'd been beaten. I could not sit up or get out of bed by myself. I was miserable. It was definitely more uncomfortable than he had prepared me for."
The worst part? Her implants, like all others, will eventually need to be replaced.
"I'm absolutely dreading it," she says with a sigh. "I don't want to ever go through that again."
Goodwin feels the media coverage of plastic surgery didn't sufficiently prepare her for her ordeal. Many doctors agree. Plastic-surgery-themed television shows, such as Dr. 90210 and Extreme Makeover, "glorify and glamorize" cosmetic surgery, Dr. Cohen says. "I don't think they're terribly realistic or informative," he states. "They're more glamorized. People don't realize it takes a lot of recuperation—ups, downs, hills, and valleys. The transition isn't really overnight. It can take quite a long time."
Just ask Terry Goodwin.
"Whenever I see something on TV about how people are addicted to [plastic surgery], I don't know how they can be," Goodwin sighs. "For some reason, it must be like having a baby because you forget the pain and the misery and you're ready for that next round."