Sunday, March 24, 2013

Does plastic surgery make people happy?

Among my friends, I have taken a firm stance against cosmetic surgery. Most notably, when I was in college my very very best friend was hopelessly in love with a guy with a talent for infidelity. Due to modern methods of stalking, aka Facebook, my dear friend was intimately familiar with his most recent indiscretion, who happened to have impossibly perky double-D sized breasts. Thus, my gorgeous friend saved her waitressing tips for months to have enough for the down-payment on breast augmentation surgery. During those months I spent a great deal of energy trying to convince this friend that this guy was completely and utterly useless, and that this procedure wasn't going to change what a piece of scum he was. I was certain, without a shadow of doubt, that cosmetic surgery was not going to relate to any long-term satisfaction for my friend. On the morning her first payment was due, after countless hours on the phone throughout the night, she decided not to go through with the surgery. Not that it matters, but I am normally not the type of friend to bully others into following my advice. In this case, I was worried that my friend was going to drop thousands of dollars, undergo a painful procedure and eventually come to a realization that she and her cup-size were not the problem. She never got the surgery, and is now happily married to a man who worships her as she is and expecting her first baby.

As a woman, I can certainly see how having plastic surgery to change one thing about your physical appearance could be empowering. I know a lot of people who just "hate their nose" or can't seem to get rid of their "arm pit flab" or have Will Smith ears and won't wear their hair up. I can imagine that a quick fix might provide relief, and even a boost in that feeling, "nothing can stop me." On the other hand, I can see many people looking for quick fixes to problems that run deeper than physical appearances. In the case of my friend, that scumbag was unlikely to stop being a scumbag just because she had bigger boobs. Regardless of the outcome, 8.5 million people had cosmetic surgery in 2011, 18% of those people were in the US and 87% of them were women.  

While I hold personal biases against the notion of beautiful women changing their outward appearance to meet social standards, this experience begs a question that is entirely empirical.

Does plastic surgery lead to more happiness?

This month, a research article was published to address this very question. More specifically, they were interested in the psychological outcomes of undergoing cosmetic surgery, including depression and anxiety symptoms, life satisfaction, self-esteem, and feelings of attractiveness to name a few. In the study,  Professor Dr. J├╝rgen Margraf and his colleagues at the University of Bochum compared 544 patients who had cosmetic surgery and 264 patients who went in for a consult but chose not to receive the procedure. The patients ranged in age from 18 to 65 and were interested in procedures including: breast reduction, breast augmentation, liposuction, rhinoplasty, abdominoplasty, and eyelid surgery. They assessed patients on the day of their surgery, then 3, 6, & 12 months later to see the psychological impact. What they found was that one year after their cosmetic procedure, these individuals were more satisfied with their lives and bodies than the comparison group and that in general the psychological outcomes of going through with the surgery were positive. Thus the main message would appear to be that if you are motivated to change something about yourself enough to go in for the initial consultation, then you should go through with it because it will make you happier. However in taking a closer look at their findings, there is another story to be told indeed.

What's important to keep in mind about this study are the differences between the surgery and the non-surgery group; both of these groups of individuals sought out a cosmetic surgery consultation, but they were not the same (psychologically speaking) as one another. The group that decided not to have the surgery reported lower self-esteem, quality of life, and feelings of attractiveness and higher symptoms of anxiety and depression. So at the outset, these patients weren't doing as well. At the one year follow-up, these comparison individuals reported even lower self-esteem, much lower quality of life, and more problems with anxiety and depression. This has an important implication. These decreases make some of the improvements in psychological outcomes for the surgery group seem bigger than they actually are. In other words, had the comparison group remained stable in their depression symptoms, anxiety, and quality of life, there would have been little to no meaningful improvements in these outcomes for the surgery group.  Therefore, while the study claims that having cosmetic surgery increases happiness and mental health symptoms, it would be more accurate to say that choosing not to go through with a surgery that your feel strongly about may result in you feeling worse a year later. However, it's likely that whatever was making these patients worse off to begin with contributed to why their psychological functioning worsened over time, rather than merely choosing not to get cosmetic surgery.

Regardless, this type of research is important. At the very least they found that changing a specific part of your body that you find problematic actually does result in you appreciating your body more, or feeling more attractive. Any other benefits would have just been extra. And within the surgery group, most people did report more satisfaction with life and improved mental health a year after the surgery, so there is no evidence that cosmetic surgery has any negative psychological consequences. Yet, there is still much to learn about the relationship between the decision to get cosmetic surgery and happiness.

First, I expect that people who have cosmetic surgery are looking for longer-term gains than just a year after their surgery. What we know is that the surgery will lead you to be a little bit happier and healthier one year later, but what about after that? What about 5 and 10 years later? We just don't know. Second, there was a wide range of ages and procedures here. Overall, that gives the study more validity, but leaves us with a question of for whom are these benefits strongest? Perhaps people who get rhinoplasty are happier than people who get liposuction, or perhaps women in their 40s are empowered by getting these procedures while women who are in their 20s are less likely to see dramatic psychological gains. Are we creeping closer to being able to quantify someone should get a desired procedure based on when they will gain the most psychologically? What also remains to be seen regarding the choice to have cosmetic surgery and happiness is how this group might compare to individuals who have never been in for a surgery consult, or simply just a community sample of individuals, regardless of their interest in cosmetic surgery. And thus, we answer one question with several more.

Margraf, J., Meyer, A. H., & Lavallee, K. L. (2013). Well-Being From the Knife? Psychological Effects of Aesthetic Surgery. Clinical Psychological Science.

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