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Psychology of cosmetic surgery: fear and desire

The most immediate impression one has of a person is that of their external image.

It is only later, and in a progressive manner, that all other characteristics emerge.

In history, men and women have always sought to improve their physicality.

However, in this historical moment, we are surrounded by more or less explicit messages pushing to qualify "beauty" and a youthful appearance as primary values and/or objectives to be achieved by everyone. In modern society, the use of cosmetic surgeons is becoming increasingly common.

The psychology of cosmetic surgery is certainly a sensitive subject, but there is nothing wrong with wanting to change one's appearance.

Behind the need to change and eliminate characteristics perceived as flaws, there are psychological dynamics linked to the need for approval and self-esteem. Sometimes, what is perceived as a physical defect can cause considerable discomfort and dissatisfaction. Sometimes, the discomfort is so great to affect the person's everyday life.

This is where the fundamental role of pre-operative counselling comes in. An attentive professional will carefully assess the deep-seated motivations that drive patients to request an operation. This psychological analysis makes it possible to create a picture of the patient's needs and expectations, direct him/her towards the safest tailor-made solution, and prepare him/her for change.

Surgery with achievable expectations can contribute to emotional and mental well-being, restoring confidence and self-esteem. But the psychology of cosmetic surgery can be much more delicate. Indeed, in some cases, the discomfort behind a request for surgery may be linked to deeper motivations and existential dissatisfaction. And woe betides the illusion that plastic and cosmetic surgery can really solve them.

the role of body image

Each of us has our own body image, a perception of how we look and how we present ourselves to others. People who have a positive body image tend to feel more confident in relationships with others and in all social activities and feel comfortable in most relationships.

On the other hand, for those who are dissatisfied with their appearance or parts of it, interactions with others are often somewhat more complicated. Cosmetic surgery stimulates and promotes a strong and positive self-image because small outward improvements can turn into big inner changes that give people renewed self-confidence and, not infrequently, a new zest for life.

Bearing in mind that cosmetic surgery induces often permanent and sometimes major changes, it is essential to be clear about the benefits one expects from the procedure, both physically and psychologically.

Even before consulting the surgeon, the patient should reflect on his or her current condition and expectations.

Below are a few considerations that seem important to us in order to underline the psychological aspects of cosmetic surgery, which is a 'surgery of the soul', much more often than one would think.

The ideal candidate for cosmetic surgery

If you are thinking of undergoing cosmetic surgery, be honest with yourself.

  • Why do you want to have surgery?

  • What are the goals you would like to achieve?

  • what are your expectations regarding the results?

For cosmetic surgery, there are (broadly speaking) two types of 'good' candidates:

  • The first group includes people with firm self-esteem but bothered by certain physical aspects they wish to change. After the operation, these patients are satisfied with the result, which only reinforces the positive image they already had of themselves.

  • The second group includes patients with more or less important physical characteristics that have diminished their self-esteem over time. These patients find it more difficult to adapt to the post-operative results and the recovery of a positive body image is a somewhat longer process. However, even in this case, after a period of adaptation, the self-image is strengthened by the surgical experience.

Sometimes it may be important for the patient to undergo a psychological assessment to help them explore their motivations, of which they are not always aware.

This indication, which at first sight may seem superfluous, is instead very useful in preventing post-operative frustrations.

With due exceptions, it is possible to draw a brief portrait of patients who should not have surgery without having considered therapy:

  • people in crisis, for instance on the verge of divorce, after the loss of a spouse or job. These individuals may in fact be aiming at goals other than improving their physical appearance and therefore exceed those achievable with plastic surgery.

  • those who want to resemble someone else in one or more details of their appearance, who wish to acquire the "style" or identity of another person, for example, a star; people who are trying to regain perfect physical condition after a serious accident, or who are chasing the look they had decades ago; the eternally dissatisfied, those who consult one surgeon after another in the frantic search for an answer they will never get.

In general, these situations imply an effort to solve, by acting on the body, problems that have little or nothing to do with the physique.

  • Also unsuitable for cosmetic surgery are people suffering from BDD ( we spoke about Body Dysmorphia a few weeks ago, you can read the article here).


During the initial consultation, the surgeon will ask you to indicate the imperfections you would like to correct and the results you would like to achieve. Sincerity is a must. Freely express your wishes and concerns, uncertainties, doubts, and ask any questions you may have.

You will be asked how long you have had this desire to change something about your appearance and the motivation behind it. At the end of the meeting, you should have the feeling that you have been understood and that you have developed a quiet trust in the surgeon.

Do not insist on the correction of a functional defect (e.g. poor breathing) if your goal is primarily aesthetic (having a prettier nose).

Choosing the ideal moment

Surgery always causes some stress and can interfere with the rhythm of daily activities. Therefore, the choice of the period during which you undergo the operation should ideally fall on times when you are not too physically or emotionally tired.

Sincerity, once again, helps to choose the 'right' period with the surgeon, after considering together the various aspects of the patient's personal and professional commitments.

Getting used to the change

Getting used to one's new appearance is not immediate, especially if the changes have been intense; even if desired, these alterations require some adaptation - a period of time during which a new self-image is reformulated.

Cosmetic surgery procedures can change one's appearance to a more or less perceptible extent and it is possible that for a few days or weeks the image reflected in the mirror may not be very familiar...

Post-operative depression

Immediately after cosmetic surgery, some patients experience a transient feeling of loss or sadness. This temporary condition can develop into post-operative depression, which is very rare.

The melancholy often manifests itself from the third day after the operation when the patient has at least partially resumed his or her normal activities, the final result is still a long way off and the image reflected in the mirror is altered by swellings or small bruises.

This psychological state may last for a few days or a few weeks depending on the patient's basic psychological condition. Generally, contact with the surgeon in the post-operative period alleviates this phase of sadness and prevents the condition from worsening. In addition, short walks in the open air, and especially the closeness of loved ones, help to resolve the problem more quickly.


In the post-operative period, the emotional closeness of loved ones, relatives or friends, is very important. During the first few days or weeks, depending on the extent of the operation, it is easy to feel anxious and worried, and good company really helps. On the other hand, stay away from negative, hypercritical people and those who do not tolerate the sight of stitches, etc.

How to cope with criticism

The more visible and radical the surgery, the easier it is to receive comments such as 'I preferred you before' or 'you didn't need surgery'.

The motivations for this type of criticism are the most diverse and are often unconscious; this does not detract from the fact that they can add additional and completely unnecessary stress to convalescence.

Don't expect compliments - people are generally more generous with criticism than with good words - don't rush to defend your choice to have surgery, remember that immediately after the operation the results you see are not the definitive ones and that the negative comments that are addressed to you concern a transitory aspect, inevitably destined to improve.

Be patient, remember that you had the operation to do good for yourself and not to please or surprise others, and seek help and comfort from the people who love you and are emotionally close to you.

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