CHILDHOOD ABUSE, BODY SHAME, AND ADDICTIVE PLASTIC SURGERY

A plastic surgeon presents insights into patients’ motivations based on his practice and empirical research.

In this medical book, Constantian (Rhinoplasty, 2009) analyzes patients who have undergone multiple cosmetic surgeries and are unsatisfied with the results, finding that their reactions can often be connected to disturbing childhood experiences. The author combines anonymous anecdotes from his patients with peer-reviewed research into the lasting impacts of traumatic events in childhood to show that many cases are the result of patients’ reactions to family dysfunction or abuse. He argues that the pursuit of elective cosmetic surgery—rhinoplasties, or nose jobs, in Constantian’s practice—should be understood in that context. The deeply researched book (each chapter includes several pages of endnotes, and full credit is given to existing rubrics like the Mellody model) takes readers through existing literature on human psychology, including body dysmorphic disorder, an exploration of how behaviors related to body image can be a response to trauma, and the physiological effects of painful experiences. He concludes that patients can be best served by developing a sense of resilience and dealing with the underlying issues as opposed to going to surgeons who simply accede to requests to lengthen or shorten their nose tips by a few millimeters. The author urges physicians to understand the “intensity of emotion” that may be involved in a case and to acknowledge the connections between emotional state and physical health. The writing here is strong, though certainly technical, and it is clear from the opening pages that the book is intended as a professional reference rather than casual reading material. The target audience is surgeons, and understanding that keeps the authoritative narrative tone from becoming overbearing (“Physicians see the effects of this neglect in patients who become childlike following surgery, or in Internet conversations where patients give medical advice to each other or pose questions that should be directed to their surgeons—or not even asked”). Although the patients who appear in the work’s many anecdotes may appear extreme (one’s “six-page letter read like the Unabomber Manifesto”), Constantian provides a level of detail and empathy that renders them entirely plausible, allowing readers to see how domineering parents, the lasting effects of physical abuse, or other childhood traumas can shape patients’ enduring unhealthy relationships with their bodies. The volume’s conclusions are based on solid science, and the author acknowledges socio-economic factors that may further shape patients’ responses. The occasional bits of humor (“If I were marooned with her for three days, she could probably turn me into Prufrock”) add a distinctive touch without detracting from the treatment of a serious subject. The concrete and actionable information provided gives readers useful takeaways, like comparisons of satisfaction rates between patients correcting real deformities and those having features that appear normal to a casual observer. There is some discussion of how patients can develop the resilience that seems to be the most effective way of managing these disorders, but the book remains focused on its readers, providing surgeons with guidance on improving their interactions with troublesome patients.

A solid, well-researched, and well-argued analysis of the behavior of plastic surgery patients.