This sounds like a contradiction in terms coming from a plastic surgeon, but I firmly believe that there is such a thing as too much of a good thing! In fact, plastic surgery is often times not a good thing. Here are some of my thoughts on the matter:

• If the surgery will not correct the problem that the patient comes in for, it’s not a good thing. I saw a woman in the office recently who had a fair amount of fat over her tummy. She wanted to have liposuction done, but the result she expected was a flat tummy. I pointed out to her that she would need to tighten her abdominal muscles and stand up straight after surgery if she was going to be flat, something that she did not want to do. For her, any plastic surgery would have been too much since it was not going to cure her problem.

• Plastic surgery costs! I’m not only talking about financial costs, but there is also cost in time off from work or social activities as well as time off from normal daily activities. If the benefit from surgery is outweighed by the cost, it’s too much plastic surgery. If a patient has to empty their life savings account or if they were going to have to miss their daughter’s graduation from college, it would seem that the cost of the plastic surgery is inordinately high. That’s a decision they must make, but if I sense that the cost seems to be excessive, I may suggest a less costly procedure or perhaps postponing surgery until a more convenient time.

• What if the medical risks of the procedure are significant? Although it makes sense to perform necessary surgery in the face of significant medical risks, I would hesitate to say the same thing about a cosmetic procedure. Now let’s face it – everything we do in life has some risk involved. Every patient of mine with medical problems must see their primary care physician prior to surgery for clearance. If the doctor believes that the medical risks outweigh the benefits to the procedure, we don’t proceed with surgery.

• What about the patient who has had multiple procedures and keeps asking for more? Several thoughts enter my mind. First of all, are we dealing with a patient who has Body Dysmorphic Disorder? These patients are preoccupied with correcting what is an imagined or minor issue with their appearance. A patient with this condition will continue to have surgeries to correct what they perceive as an imperfection and will never be satisfied with what is achieved with surgery. It is not appropriate to do surgery on this type of patient.

Other patients “worship” their appearance and are willing to sacrifice virtually everything they have to improve it. Although I can’t control what people worship, I can give advice and point out that other uses of their resources may give them more pleasure and be of more value to them.

Finally, some patients keep coming back for more surgeries, but perhaps at the rate of every 2 or 3 years. They have the time and financial resources to spend on plastic surgery and derive great pleasure from the results. Although this may not be the route everyone chooses, I personally find nothing wrong with this approach and am willing (gladly in most cases!) to help them.

What do you think? Feel free to send me your thoughts.

George Sanders, M.D.