Key points to the debate

 According to BBC press, seven different epidemiological studies, women who

have breast enlargement have a suicide rate that is two to three times higher than
the rest of the population. It seems likely that there is an underlying
dissatisfaction that makes women decide to have breast surgery and that the
operation does not resolve. There is a known psychological condition called
dysmorphic disorder, and several studies suggest that about 10% of people who
seek cosmetic surgery have this condition, showing up women are not feeling
well after surgeries.

 In the same way, Nahàs and Medrano have demonstrated to a study were Eighty-
six patients participated: 13 men (15.1%) and 73 women (84.9%), aged between
15 and 67 years (mean 40, standard deviation 12.75) in a cosmetic treatment in
order to measure up the results of the procedure practiced over them, obtaining
results that consistent with the work of Wengle and Young et al, who in general
terms argue that people who have had cosmetic surgery have shown an increase
in their levels of satisfaction, but only for a short period of time. In other words,
the observed increase in psychological well-being is not long-lasting.

 The results obtained suggest in general terms that there are no differences in
levels of well-being between people who have received aesthetic treatment and
people who have not, in accordance to Nahàs and Medrano.

 In this manner, Arango et al (2023) although this type of procedure may appear
to be a solution to various insecurities that people have, the risks and negative
impacts are rarely socialised, let alone the great influence that society's standards
of beauty have on the decision making of those who decide to undergo cosmetic
surgery.

 It is also concluded that the participants have a good perception of cosmetic

surgery as a tool to raise self-esteem and improve self-concept, however, most of
them are aware that it is a matter of care due to the expectations that patients
may have or in cases of pathologies such as body dysmorphia and the
development of an addiction to cosmetic procedures. The participating plastic
surgeons, for their part, recognise the psychological impact of cosmetic surgery,

 - However, it is important to note that cosmetic surgery is not a panacea for

stress. If the motivation to undergo cosmetic surgery comes solely from external
pressure or a desire to please others, the results may be unsatisfactory and the
stress persistent. In addition, the post-operative recovery process and adjustment
 to the new appearance may generate additional stress for some people.

 Nonetheless, authenticity in relationships is critical, and relying solely on

appearance can undermine genuine emotional connections. Realistic
expectations are also essential to avoid disappointments that may indirectly
affect relationships. Ultimately, while cosmetic surgery can contribute to
personal confidence, relationships must be based on authenticity, communication
and genuine acceptance.

 Notwithstanding, it is important to address the relationship between body image

and mental health in a balanced way. If improved appearance becomes the sole
basis for self-esteem, it can lead to emotional vulnerability if the results do not
meet expectations.

 One of the consequences of cosmetic surgeries is postoperative depression,

sometimes called post-surgical depression, is the feeling of overwhelming
discomfort that can accompany post-surgical recovery. It shares the same
characteristics as other forms of depression, but its occurrence is related to the
surgery itself.

 A 2009 study published in the Journal of Evaluation in Clinical Practice

examined 56 patients undergoing hip or knee replacements. It concluded that of
those 56 patients, approximately 50% of them experienced depression ‘at some
point’ before being discharged from hospital. Similarly, a 2012 study in the
Journal of Geriatric Cardiology noted that approximately 50% of cardiac surgery
patients experience depression during recovery.

 The link between cosmetic surgery and predisposition to psychological problems

is, in fact, well documented. A 2007 study in Psychiatry carefully traced the
relationship between depression, body dysmorphic disorder (BDD) and cosmetic
surgery. It concluded that patients who have sought or undergone cosmetic
surgery were more likely to suffer from these or similar psychological
conditions, putting them at greater risk of continued psychological distress and
low self-esteem.

 No two people are exactly alike and one person's response to a breast
augmentation or breast lift will not necessarily mirror that of another person who
has undergone the same cosmetic procedure. While anyone can be a victim of
post-operative depression, regardless of their medical history, some people are
definitely more at risk than others. A 2004 study published in Plastic &
Reconstructive Surgery took a close look at the psychological outcomes of
 plastic surgery. The study concluded that ‘factors associated with poor
psychosocial outcome’ include:
 History of depression or anxiety
 History of body dysmorphic disorder (BDD)
 Age (youth)
 Gender (female)
 Surgeries motivated by the hope of improving a relationship

 A study was carried out with 24 adult subjects, with medium or higher
education, medium-high cultural level, without any type of psychiatric or
neurological disorder, who wished to voluntarily undergo cosmetic surgery. All
subjects were informed of the type and characteristics of the aesthetic procedure
they were undergoing and all signed the informed consent form, both for the
procedure and for the study. Of the 24 study participants, 20 are women and 4
are men. They ranged in age from 35 to 66 years. Previously, salivary cortisol
was considered to be associated with high levels of psychosocial stress, whether
due to problems with work, social relationships, mood, excessive worry, quality
of life problems, etc. (Maina et al. 2009). Other studies have also linked salivary
cortisol levels to high levels of social anxiety (Shirotsuki et al. 2009), so that the
measurement of salivary hydroepiandrosterone secretion has been considered an
important marker in studies on biological markers of psychosocial stress and
anxiety problems (Hellhammer et al. 2009).

 And, although the patients after the cosmetic surgery manage to slightly reduce
the levels of anxiety, these after the cosmetic surgery do not manage to reduce
the levels of Cortisol in saliva, possessing the social stress that preceded the
surgery, which indicates an almost null improvement of the procedures and even
more if it is taken into account that the majority were women.

In most cases, cosmetic surgeries take approximately 6 weeks to heal. This period of
time often triggers or worsens psychological disturbances in women's perception of
their bodies.
SUMMARY
Body Dysmorphic Disorder (BDD):
Excessive Dissatisfaction: Individuals with BDD obsess over perceived flaws in their
appearance and are often dissatisfied with the results of cosmetic surgery, leading to
repeated procedures.
Increased Obsession: Surgery can exacerbate the obsession with physical flaws,
potentially worsening the disorder.
Narcissistic Personality Disorder (NPD):
Unrealistic Expectations: Individuals with NPD may have unrealistic expectations of the
outcomes of cosmetic surgery, believing it will garner admiration and solve deeper
issues.
Chronic Dissatisfaction: They may remain perpetually dissatisfied with surgical results,
leading to repeated surgeries and increased psychological distress.
Anxiety and Depression:
Post-Surgery Depression: If the results don't meet expectations, it can lead to worsened
anxiety and depression, possibly exacerbating feelings of inadequacy and low self-
esteem.
Factors associated with the actual decision to undergo surgery were related to changes
in psychological health and patients' evaluation of the outcome of surgery.
Some studies have found that body dysmorphic disorder (BDD), narcissistic personality
disorder, and histrionic personality disorder are more common in patients seeking
cosmetic surgery than in the general population. BDD is reported in 7–15% of cosmetic
surgery patients, compared to 1% in the general population. Histrionic personality
disorder is reported in 9.7% of cosmetic surgery patients.
The mental illness most commonly associated with plastic surgeries is body dysmorphic
disorder (BDD).
https://pubmed.ncbi.nlm.nih.gov/21866003/
Overview of Body Dysmorphic Disorder (BDD)
BDD is a psychiatric disorder where individuals are preoccupied with a perceived defect
in their appearance that is either minimal or non-existent. This concern causes
significant distress or impairs their daily functioning.
Symptoms:
• Excessive concern about the perceived defect, often spending hours each day
obsessing over it.
• Behaviors include seeking reassurance, frequently checking their appearance in
mirrors, skin picking, and using clothing, makeup, or accessories to conceal the
perceived flaw.
Prevalence:
6%-15% of patients in cosmetic surgery settings have BDD.
About 12% of patients in dermatology settings have BDD.
Challenges:
• Ineffectiveness of Cosmetic Procedures: Cosmetic procedures are typically not
helpful for individuals with BDD. Most patients report dissatisfaction with the
outcomes and do not experience reduced concerns about their appearance.
• Potential for Negative Outcomes: Some patients with BDD may resort to legal
action or exhibit violent behavior towards their healthcare providers if the procedures do
not meet their expectations.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1851945/
• Focus on Flaws: Post-surgery, patients might shift their focus to new or different
aspects of their appearance that they perceive as problematic, a phenomenon known as
"shifting preoccupations."
• Lack of Improvement: Even if the surgery is technically successful, individuals
with BDD may not experience the anticipated relief from their distress. This persistent
distress can lead to a worsening of BDD symptoms as they continue to seek unattainable
perfection.
Narcissistic personality disorder
As defined in the DSM-IV-TR™, narcissistic personality disorder is “a pattern of
grandiosity, need for admiration, and lack of empathy”. Fifty to seventy-five percent of
those diagnosed with narcissistic personality disorder are men (5). The prevalence
ranges from 2% to 16% in the clinical population and less than 1% in the general
population (5).
Negative Consequences of Cosmetic Surgeries:
- Individuals with NPD may pursue cosmetic surgery to enhance their appearance
and seek admiration from others. This can lead to an unhealthy focus on physical
appearance and external validation.
- People with NPD may have unrealistic expectations of the outcomes of cosmetic
surgeries. They might expect these procedures to bring them admiration and solve
deeper psychological issues, which they do not.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6263231/
A separate study of Norwegian adolescents also found that symptoms of depression and
eating problems worsened in those who’d had cosmetic surgery compared to those who
hadn’t. Even patients with little to no depressive symptoms don’t report experiencing a
boost in their psychological wellbeing after cosmetic surgery.
In other words, there’s a risk cosmetic surgery may worsen existing mental health
problems for some people. This is especially concerning as some research shows people
who seek out cosmetic surgeries are more likely to have experienced mental health
problems compared to the general population.
Many factors can determine what outcome you might experience after having a
cosmetic procedure.
One of these is the degree of post-operative complications. A study of women who’d
undergone breast augmentation found that those who’d experienced post-operative
complications – such as leaking implants and infections – had smaller improvements in
body image following surgery. Healing time may also be important, with studies finding
patients who took a long time to heal often show only small improvements in wellbeing.
Likewise, patients who are experiencing high levels of psychological distress –
including severe symptoms of depression and anxiety – may not experience any benefit
from cosmetic surgery.
https://theconversation.com/cosmetic-surgery-boosts-some-peoples-mental-health-but-
for-others-it-makes-problems-worse-214517#:~:text=Even%20patients%20with
%20little%20to,health%20problems%20for%20some%20people.

Cosmetic surgery is a frivolously used resource that is becoming more normalised, more
accessible and more acceptable as time goes by thanks to the media that contribute to
spreading the idea that cosmetic operations are a superficial matter. In addition, there is
a pressure imposed by society to look more beautiful, especially on women, who are
still judged by their physical appearance, with 85% of people who have undergone
cosmetic surgery being women. And it is true that on the one hand these surgeries may
be necessary to make women feel good either for health or acceptance issues. However,
plastic surgery should not be wanted as a substitute for efforts to boost self-esteem. It is
a matter of psychological balance, security and self-confidence.

People who want cosmetic surgery as a quick fix for deep-seated self-esteem issues may
face emotional challenges after the procedure if they do not address the underlying
causes of their dissatisfaction. In addition, unrealistic expectations about results can lead
to disappointment and affect emotional well-being.

This phenomenon leads to addiction or dependency to cosmetic treatments. Some

people, when they overcome their fear of change, become obsessed with the
pathological need to repeat over and over again every possible surgical procedure,
wanting the perfect body, in other words, individuals may become overly dependent on
plastic surgery to feel good. Behind the addiction to cosmetic surgeries there is a type of
anxiety that deserves to be addressed, due to its negative effects on self-concept.

There is also a pathology that must be correctly diagnosed, such as body dysmorphism,
where the person sees negative aspects in their image that are not real.

Cosmetic surgery can have positive effects, but it also carries risks and is not a
permanent, but a temporary and superficial solution to deep emotional or self-esteem
problems. As mentioned above, social and media pressure to achieve certain standards
of beauty are causes for undergoing these surgeries, which can promote a limited and
unrealistic view of female beauty.
In addition, there are risks of medical complications and side effects, especially with
invasive procedures, which can contribute to mental health problems such as anxiety
and depression, negatively impacting their self-esteem. Surgeries can have
complications and risks associated with them, such as:

• Bleeding: During any type of surgery, there is a risk of excessive bleeding.

While this is rare, it can be dangerous if not controlled.
• Infection: Any type of surgery can increase the risk of infection. It is important
to follow post-operative instructions carefully to minimise this risk.
• Reactions to anaesthesia: General anaesthesia is commonly used in cosmetic
surgery, and there is a risk of adverse reactions to anaesthesia. This can include
breathing problems, nausea and vomiting.
• Scarring: All surgical procedures can leave scars, and cosmetic surgery is no
exception. While cosmetic surgeons make every effort to minimise scarring, some
people may be prone to more prominent scars.
• Procedure-specific complications: Each procedure has its own specific risks. For
example, liposuction can cause perforations to internal organs, and breast surgery can
cause breastfeeding problems in the future.

Ultimately, beauty stereotypes and canons of beauty can influence our decisions about
cosmetic surgery. However, it is important to remember that beauty is subjective. Rather
than trying to conform to society's standards of beauty, it is better to choose to be
comfortable with yourself and want to find ways to improve your self-esteem that are
not solely dependent on your physique.

Disagreement on Cosmetic Surgery:

1. Media Influence and Societal Pressure:
- Media exposure, including advertisements and reality TV shows, plays a significant
role in shaping perceptions and influencing individuals to undergo cosmetic surgery[1]
[2].
- Societal norms and expectations, driven by media glamorization of beauty,
contribute to the pressure individuals feel to conform to certain physical standards[2].

2. Personal Experience and Self-Esteem:

- Individuals may resort to cosmetic surgery due to low self-esteem, attributing their
dissatisfaction to their physical appearance and seeking alteration as a solution[2].
 - Studies suggest a negative association between self-esteem and the likelihood of
undergoing cosmetic surgery, emphasizing the psychological aspect of these procedures.

3. Health Risks and Unrealistic Expectations:

- Cosmetic surgery can have health risks, and some patients may develop body
dysmorphic disorder (BDD), which renders cosmetic surgery ineffective for addressing
underlying issues.
- Unrealistic expectations from cosmetic procedures can lead to dissatisfaction and
potential mental health concerns, highlighting the importance of managing expectations
and considering the risks involved.

Impact on Self-Esteem and Society:

1. Body Confidence and Mental Health:
- Cosmetic surgery can help improve body confidence, self-esteem, and mental health
conditions like anxiety and depression, potentially enhancing overall quality of life[4].
- However, unrealistic expectations and societal pressures can lead to dissatisfaction
and negative psychological outcomes, emphasizing the need for a balanced approach to
cosmetic procedures.

2. Cultural Perceptions and Societal Norms:

- The societal obsession with youth and beauty, particularly for women, can create
unrealistic beauty standards and contribute to the normalization of cosmetic procedures
as a solution to body dissatisfaction.
- Embracing a wider range of body types in media and entertainment can promote
diversity and challenge conventional beauty norms, fostering a more inclusive and
accepting society.

In conclusion, the debate on cosmetic surgery involves a complex interplay of media

influence, personal experiences, societal pressures, and health considerations.
Understanding these diverse perspectives is crucial for engaging in a meaningful
discussion on the implications of cosmetic surgery on individuals' self-esteem and
societal perceptions of beauty.

Reference:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3513261/
https://www.bbc.com/news/magazine-35380469
https://www.getdoc.com/the-cosmetic-surgery-debate-to-do-or-not-to-do/
https://www.medicalnewstoday.com/articles/is-plastic-surgery-good
https://www.oupchina.com.hk/elt/holiday-pack-22/oe2e/simplified-reading/
oe3bu6_p40_sim_reading_2.pdf