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How Much?Why Some Things Should Not Be for SaleWisdom, Intuition and EthicsWithout ConscienceWomen and Borderline Personality DisorderWomen and MadnessWondergenesWould You Kill the Fat Man?Wrestling with Behavioral GeneticsWriting About PatientsYou Must Be DreamingYour Genetic DestinyYour Inner FishYouth Offending and Youth Justice Yuck!
Plastic surgery is a booming business, and Victoria Pitts-Taylor has investigated it in detail. Long before its popularity increased because of the media, namely television shows like "Extreme Makeover", there were people who had plastic surgery – perhaps improving on a crooked or hooked nose, or enhancing small breasts, and even those who had reconstructive surgery after something catastrophic, like breast cancer or a traumatic injury. There were (and are) also people who don't know when to quit, having surgery after surgery. There is now a psychiatric diagnosis for those who can't say "no" to more plastic surgery: Body Dysmorphic Disorder (BDD).
Surgery Junkies was interesting to me, as Pitts-Taylor offers tremendous details about various consumers of plastic surgery, including her. These people run the gamut, from mentally healthy people (like her) who decide to have surgery to enhance a particular feature (in her case: her nose), to those who have multiple surgeries, never seeming to reach satisfaction or satiety. Whether these patients suffer from a mental illness (BDD), or simply suffer from extremely low self esteem, or just have more disposable income, time, pain threshold and perhaps even self-loathing, is up for discussion.
It has come to pass (and is described in this book) that plastic surgeons are expected to be able to recognize mental illness (BDD specifically) as separate from someone with a healthy mental outlook who wants plastic surgery, and refuse to perform surgery on the person with a pathological mental status. Plastic surgeons however, are not necessarily learned in psychiatric medicine. Most plastic surgeons have a background in plastic surgery itself, or a general surgery or dermatology background, and they have subsequently specialized in plastics. As psychiatry is its own medical specialty, so is plastic surgery – each of these specialties may take several year for the practitioner to become expert. And physicians generally aren't expected to become expert in more than one field at once.
Having worked in a plastic surgeon's office, I have witnessed first-hand some of the different personalities that Pitts-Taylor describes. I don't recall any that would have been clearly diagnosable as suffering from BDD. I do recall the stereotypical patient as suffering from low self-esteem, apparently trying to soothe a weak ego with breast augmentation or abdominoplasty ("tummy-tuck"). I recall one who didn't receive the amount of attention at home that she desired, and breast augmentation was (in her mind) going to cure that problem. Certainly, it did for a while, as her partner was very enthusiastic at first. But would it last? We in the office were skeptical, but for other reasons, we would not find out whether she required further surgeries to maintain the level of attention she hoped for.
She certainly seemed a candidate to try another surgery to lift her spirits and another anatomical part when the added attention the enhanced breasts first brought dwindled to the usual attention of the relationship.
Victoria Pitts-Taylor includes some vivid descriptions of plastic surgery recovery, something that is apparently shared only minimally on television. Her description of her own recovery from rhinoplasty is clear and shares the pain. She describes other patients in their bandages and with their blood and their pain. In my opinion, this information should be more prevalent, shared more often. Some people tend to think that plastic surgery isn't a "real" surgery. Therefore, they act as if the pain from a plastic surgery either doesn't exist or isn't "real" either. Plastic surgery still involves (usually) general anesthesia, which of course comes with its own set of risks, and they are very real risks. And there are still incisions and movement of tissue and these things all tend to cause blood loss and pain. A plastic surgery consent form no doubt includes the potential complication of "death", as does the consent form for any other surgery. It is unlikely, but is possible.
Recently, I heard of a young woman, under thirty, who was on the operating table for breast augmentation when she suffered ventricular fibrillation. She was amazingly lucky as there was no lasting damage to her body and brain from the arrhythmia itself and the subsequent treatment (defibrillation). She awoke from sedation wondering why her breast augmentation had not been completed, and very upset that it had not.
There were some times while reading Surgery Junkies that I found myself thinking that what I was reading had already been covered. But in retrospect, looking at the book in its entirety, it is not redundancy, it is simply that Pitts-Taylor is looking at plastic surgery and those who are consumers of this (surgical) product, from several different angles. She is sharing information about the patients themselves, the procedures, the media, the surgeons and those who simply watch. Her style of writing is easy to read, although I imagine that one should have an interest in the topics of plastic surgery and/or mental status and stability in order to make the most of this book. I found it an interesting and comprehensive read.
© 2009 Margaret Riley
Margaret Riley, M.S., R.N. -- has been a Critical Care nurse in a highly acute ICU in the Denver Metro Area since graduation from nursing school. She continues to work occasionally in that setting, but now works full-time as a faculty member at her Alma Mater.
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