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Why your plastic surgeon won't operate on you
September 6th, 2011
12:07 PM ET

Why your plastic surgeon won't operate on you

Anthony Youn, M.D., is a plastic surgeon in Metro Detroit. He is the author of “In Stitches,” a humorous memoir about growing up Asian American and becoming a doctor.

I make my living operating on people, but I don’t accept everyone.

I turn down one out of every five patients who consult me for cosmetic plastic surgery. Mostly I say no because of a patient’s unrealistic expectations.

“Dr. Youn, I’ve had five children. I’ve breastfed all of them and now my breasts droop down to my waist. I want my breasts lifted and perky. I want them to feel as firm as they did when I was 16. Oh, and no scars, please.”

Sometimes the risk of surgery simply outweighs the benefit.

“Dr. Youn, I’m 80 years old. I have end stage emphysema, two stents in my heart, and uncontrolled diabetes. I want a facelift. And could you tighten up my butt?”

And sometimes a patient’s request is just weird.

“Dr. Youn, I want liposuction on my kneecaps and surgery on my belly button so it looks exactly like Paris Hilton’s.”

As a board-certified plastic surgeon, I almost never turn down a patient for reconstructive surgery. But when it comes to cosmetic surgery I feel obligated to be more selective. In general, cosmetic surgery patients display a higher degree of psychological problems than reconstruction patients. The condition I find most concerning is BDD - body dysmorphic disorder.

BDD is a psychiatric condition in which the affected person demonstrates an excessive preoccupation with a minor defect in either a facial feature or localized part of the body.

To someone with BDD, a small bump on the nose looks like Carrot Top’s head. Sometimes these patients undergo repeated plastic surgeries to correct imaginary defects. Yes - defects that don’t exist. The result can be a vicious downward spiral making the affected individual look more and more, well, plastic.

Researchers estimate that BDD exists in approximately 1% of the general population and 10-20% of plastic surgery patients. A recent study in Plastic and Reconstructive Surgery found a 33% incidence of BDD in patients presenting for cosmetic rhinoplasty (nose jobs).

When I encounter patients with BDD, I encourage them to seek counseling and to avoid plastic surgery. Unfortunately, most BDD patients don’t believe they have the disorder and refuse to see a therapist. I remember a patient I’ll call “Jane.”

Jane was a librarian in her mid-40s who consulted with me for eyelid surgery. It didn’t take long to diagnose her BDD.

“So what would you like to talk about today?” I asked her.

“Don’t act like you don’t know, Dr. Youn. I see you staring at my eyes. Just like everyone who comes into the library. They pretend to read books or go through the card catalog, but the moment I look away they stare at me. I catch them doing it all the time. I need you to fix my hideous eyes.”

“What’s wrong with them? I think they look fine.”

“Don’t patronize me. You know what’s wrong with them! I’ll pay you $5,000 cash to fix them. I hear you’re the best. I want you to make them perfect.”

I spent an hour trying to convince Jane that she didn’t need surgery and that she should seek professional counseling instead. She wouldn’t listen. She became increasingly agitated. Finally she said if I didn’t operate on her, she would take a scalpel and perform the surgery on herself in my office right then!

Cue creepy horror film music here.

I would never operate on Jane, who clearly seemed mentally imbalanced. But I wanted to say no to her as tactfully as possible. I pulled out my trump card. When things get ugly and I can’t convince the patient to see a therapist, I go to the one excuse that always defuses a situation. It’s guaranteed to prevent a patient from having surgery without making her upset.

Sadly, it’s the same excuse countless women used on me during high school and college.

“Jane, it’s not you, it’s me. I’m not ready to do your surgery. I don’t think I’m a skilled enough surgeon to make you happy.”

“Really?”

“Yes. Jane, I’m not good enough for you.”

Don’t laugh. It’s the truth. And she bought it.

Editor’s Note: The patient’s identifying details have been changed to protect her privacy.


soundoff (25 Responses)
  1. Manolo

    As a brother in the medical profession all I can say is "Amen". I've used the "I'm not your guy" denial and it works.

    September 6, 2011 at 13:16 | Report abuse | Reply
  2. Roxanna

    Really? I think he's pretty cute, and I'm a part-time model from MI. Love his sense of humor and wit. Interesting article

    September 6, 2011 at 13:56 | Report abuse | Reply
  3. Bubba

    I walked into a plastic surgeon's office the other day and he turned white and started saying he wasn't a miracle worker. Man, was he relieved when I told him I was there to fix his computer.

    September 6, 2011 at 16:18 | Report abuse | Reply
    • R

      Good one! Needs no "work" done on it either!

      September 7, 2011 at 10:36 | Report abuse |
  4. tldixon

    A doc I worked with was relentlesly harassed to do a procedure on a patient when the patient was in such poor condition the anesthesia would certainly have killed him-when I say "harassed" I mean menacing phone calls,threats and crackpot letters to the editor of the local paper-in the advent of web md people(whack-jobs) think they know more than their surgeon

    September 6, 2011 at 17:55 | Report abuse | Reply
  5. Mrs. R

    I wanted eyelid surgery a few years back and all the plastic surgeon had to say was "Why." When someone who can change you drastically won't, it's time to take a different look at yourself. I may still do it in a few years – I will probably need it one day, but I won't forget the one day someone told me I didn't.

    September 6, 2011 at 22:26 | Report abuse | Reply
  6. Elise

    I think this article is a little bit callous in addressing mental health issues. BDD can be a mild or a very serious disorder, and therapy isn't always enough to treat it (nor are psychiatry and medications always enough). There is a lot we still need to learn about the most severe forms of the disorder - there are people who cannot work or really live their lives with a flaw that most of us would consider insignificant (or even a limb! - yes, it happens). They will perform surgery on themselves - it's the only thing saving them from disabling psychological/psychiatric pain. If psychiatry isn't advanced enough to treat them and plastic surgery is, then why not alleviate their suffering?

    I agree that many (if not most) cases should be turned down and are amendable to counseling, but for the severely untreatable BDD patient who has found no solace in psychiatry, plastic surgery may be the best hope they have for a life not consumed by pain.

    September 7, 2011 at 02:12 | Report abuse | Reply
    • L

      This article was NOT about BDD. The doctor is not a psychologist – as why he refers the patients to them. You also can't force a person into counseling.

      September 7, 2011 at 07:55 | Report abuse |
    • Kate

      "If psychiatry isn't advanced enough to treat them and plastic surgery is, then why not alleviate their suffering?" Because it won't relieve their suffering. BDD patients will believe the doctor botched their surgery, maybe making them even more disfigured than before. They wouldn't be able to "see" the improvement, even or especially if the improvement was barely necessary.

      September 7, 2011 at 09:38 | Report abuse |
    • Elise

      Maybe I'm actually thinking of Body Integration Disorder. I agree that some people with BDD will never be satisfied (like someone with anorexia thinking that no matter how much weight they lose they always need to be skinnier). Still, there is another disorder I remember discussing in a medical ethics class where people feel like a limb (a leg for instance) does not belong to them and should be amputated (even though it's perfectly "healthy"). It's a psychiatric disorder, but psychiatrists don't have a good means of curing it. And the disorder can be very disabling - psychologically distressing, sometimes keeping these people from holding down jobs, creating interpersonal problems, an eroding the quality of their life. In some cases, these people even threaten to amputate the limbs themselves (risking their lives) if a doctor doesn't do it. Should a surgeon operate in this situation? (I concede this isn't the situation contemplated by the article, but it's an interesting thought experiment.)

      True, operating would make this person disabled for life (e.g. put them in a wheelchair). However, it would make them LESS disabled in the sense that they would be less distressed, possibly able to work again, and able to maintain relationships. I'm not sure what a surgeon should do, but they can't ignore the situation just because it's a "psychiatric" problem. ALL doctors are responsible for alleviating suffering, and psychiatrists and surgeons would have to work together in such an instance to decide what the best course of action is - which course of action could restore the most function and good health to the patient.

      September 7, 2011 at 14:42 | Report abuse |
  7. R

    If a plastic surgeon can't make an ethical, rational, objective decision easily, upon examination, that a patient is in no need of cosmetic surgery and advises them so, then maybe the doctor needs some therapy.

    September 7, 2011 at 10:34 | Report abuse | Reply
    • Marwa

      Through tears, I am praying for you and beneivilg God, who is the GREAT physician will guide all involved in your care. Praying mostly for your precious daughters they are amazing Jane, and I know God has matured them beyond belief through this time, but they are still so young. Asking God to reveal Himself to them in such a powerful way that they will always know Him throughout all of their lives. Kinda like in the Old Testament when the Israelites would get through something or God showed Himself in some new way they would build an altar really a pile of stones. I'm praying that they will have a new rock to add to their collection of how God has revealed Himself to them.. I hope this makes sense because I certainly do not have the gift of writing that you do, but so want to canvey this message Much love to you my friend!!

      September 14, 2012 at 01:07 | Report abuse |
  8. jillmarie

    Hysterical! I can believe he sees a lot of people with unrealistic expectations. His response to this woman? Priceless and clever!

    September 7, 2011 at 13:08 | Report abuse | Reply
  9. Brian

    I need a skilled surgeon to fix my nose. Another surgeon really messed it up years ago. It's really unfortunate that there are in fact shady plastic surgeons out there.

    September 8, 2011 at 13:03 | Report abuse | Reply
  10. tatatoothy

    The body in that photo does NOT need any plastic surgery!

    September 8, 2011 at 13:25 | Report abuse | Reply
  11. rena graham

    i think are instances that doctors say no to some patients because it would be dangerous for this patient. that is why there's what they called intensive pre-consultation before the patient is allowed to have the cosmetic surgery. My sister had heart problem history and she wanted to have lipo, the doctor in http://www.EsteemStudio.com.AU/ says no. which i think is fair enough that they don't permit my sister to have it.

    September 12, 2011 at 00:38 | Report abuse | Reply
  12. sandra

    Would it be so bad for a doctor to say I don't want to do the procedure because I don't want to get sued if something goes terribly wrong? Is it possible for a doctor to be that direct?

    February 14, 2012 at 01:45 | Report abuse | Reply
  13. Jhen

    I do believe that plastic surgeons should say no to patients who are displaying an addictive behavior to the procedure or a symptom of a serious health risk. This is what my breast enhancement surgeon in Riverside did when I scheduled an appointment.

    June 10, 2012 at 23:12 | Report abuse | Reply
  14. Ana

    Pangolin / As far as the anesthesia goes, it isn't going to make any dcfferenie. We use opioid medications as part of the anesthetic, and detoxing isn't going to change his tolerance to the medications. It also isn't going to give him more pain tolerance I don't think that opioid-induced hyperalgesia (junkies feeling more pain than normal people do) is reversible. He will also (depending on the surgery) require opioids for pain control after the surgery, and may very likely relapse when he has access to the drugs legally.It may be a good idea to get him into drug treatment, and have an addiction counselor available for consultation and support throughout the peri-operative period.I wouldn't be surprised if the surgeon wanted an excuse not to operate on an addict.

    September 12, 2012 at 05:15 | Report abuse | Reply
  15. Tenisha Viale

    Rhinoplasty is generally more common among asian women because they like taller noses. –

    Most up-to-date write-up on our own blog
    http://www.foodsupplementdigest.com/benefits-of-yerba-mate/

    November 17, 2012 at 21:06 | Report abuse | Reply
  16. Greg Takashima

    The ancient Egyptians and Romans also performed plastic cosmetic surgery. The Romans were able to perform simple techniques, such as repairing damaged ears from around the 1st century BC. For religious reasons, they did not dissect either human beings or animals, thus their knowledge was based in its entirety on the texts of their Greek predecessors. Notwithstanding, Aulus Cornelius Celsus left some surprisingly accurate anatomical descriptions.;-

    Most recent write-up on our blog site
    <http://www.caramoan.co

    April 30, 2013 at 04:58 | Report abuse | Reply
  17. Lisabeth Jezierski

    Deciding to have cosmetic surgery isn't a decision that should be taken lightly. Cosmetic surgery can be expensive and time consuming. The results are often variable and can't be guaranteed. Therefore it's important that you give careful thought and consideration when deciding to have cosmetic surgery. It's a good idea to discuss your plans with your GP before going ahead with private treatment. If you decide to have surgery, be absolutely sure about your reasons for wanting to have it...-^'

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    June 16, 2013 at 21:19 | Report abuse | Reply
  18. Chiquita Franceski

    lastic surgery is always a growing trend even though there are studies that says that it is plateauing or declining. Even if that is the case, in the future, more people will try it, most especially the non-invasive kind because almost anyone can afford it already.;;';

    Our personal web page <http://www.healthmedicinejournal.com/

    July 1, 2013 at 10:41 | Report abuse | Reply
  19. Arla Rimple

    The nose, nasal dorsum, or tip can be revised substantially and improved tremendously, by injecting these cosmetic fillers. A recommended combined approach for Rhinoplasty or Revision Rhinoplasty using Juvederm or Restylane are to use these fillers as an ancillary procedure during the Rhinoplasty rather than operate on a certain part of the nose, which can be difficult and not as predictable.^^';

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    July 2, 2013 at 10:08 | Report abuse | Reply

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