Cosmetic surgery – should surgeons be responsible for assessing a patient’s psychological profile?

Posted: 01/02/2018

Many researchers claim that it is of vital importance for a cosmetic surgeon to take into account a patient’s psychological needs when a cosmetic intervention is being considered.

Patients with body dysmorphic disorder are excessively worried about a specific part of their body, which they perceive to have a defect. They may be dissatisfied with any area of their body, but the majority of people with this condition are unhappy with parts or all of the face.

If body dysmorphia is suspected, a cosmetic surgeon may require a patient to undergo psychological evaluation. Ultimately, a reputable cosmetic surgeon will use his or her best judgment, perhaps in consultation with a mental health professional, to determine whether or not a particular patient can reasonably be expected to benefit from aesthetic surgery. More specifically, the patient’s prospects should be examined meticulously by the surgeon to be sure that the intervention is likely to meet the patient’s satisfaction, and if not, the patient should be advised accordingly and the procedure should not go ahead.

The British Association of Aesthetic Plastic Surgeons (BAAPS) has issued a checklist of eight warning signs to help cosmetic surgeons identify prospective patients with serious body image problems:

• a preoccupation with an imagined defect;
• excessive concern over a minor blemish or flaw;
• a perceived flaw causing significant distress and impaired social or working life;
• a preoccupation not accounted for by another mental disorder;
• multiple consultations for surgery;
• multiple surgical procedures;
• unrealistic expectations about the outcome of the surgery, such as wanting to look like a particular celebrity; and
• a lack of clarity about their goals for the procedure.

The guidelines also ask surgeons to stop and think before approving a patient for surgery. Although a surgeon may spend a long time in consultation with a patient and feel obligated to accede to their demands, or experience other financial pressures to approve a patient for surgery, if the patient is not a suitable candidate for that surgery, the outcome is highly likely to cause regret.

Alison Johnson, associate director in the clinical negligence team at Penningtons Manches LLP, says: “The patient’s mental health history is of crucial importance for a surgeon if he or she is to give proper advice in order to ensure that the patient is fully informed of and able to consent to the planned procedure. However, it may be questionable whether the surgeon is the right person to undertake this assessment alone, or whether the input and advice of a psychologist is required. At the very least, a surgeon with concerns should think about contacting the patient’s GP to gain a deeper understanding of his or her medical history and any relevant psychological issues. It could mean that those practitioners need to work collaboratively to perform a psychological assessment in the patient’s best interests. A failure to do so could lead to a patient being disappointed with the result of the cosmetic surgery, despite having received good medical care, due to poorly managed or unrealistic and unobtainable expectations.”

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