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Letters
Cosmetic surgery
Darryl J Hodgkinson
MJA 2002 177 (8): 461-462
To the Editor: It was most enlightening to read the articles
on cosmetic surgery in the 17 June 2002 issue of the Journal.
In particular, the Clinical Update by Castle et al on psychosocial
wellbeing and cosmetic surgery1 is pertinent to everyday practice.
The warning given that cosmetic specialists should be concerned
about patients who have had numerous procedures, in particular
patients who have previously sued physicians, is a poignant one.
Psychological testing of patients who wish to have plastic and
cosmetic surgery is not routine, and plastic or cosmetic surgeons
cannot be expected to carry out such testing. Liaison with psychologists
and psychiatrists can be conducted on a case-specific basis, but
not routinely. The aim is to screen for body dysmorphic disorder,
but this can be quite difficult, as the presentation is often
obscure.2
In reality we live in a world where appearance is very important,
and self-esteem is related to appearance. Age discrimination is
a reality, and cosmetic surgery has been shown to improve a patient's
psychosocial wellbeing.3 The issue of advertising of cosmetic
surgery services is a vexed one, as is the issue of where cosmetic
surgery should be performed. As it is usually not performed in
public hospitals, it has been relegated to the private sector
in Australia, and private hospital appointments that might include
cosmetic surgery have been vigorously protected by special-interest
craft groups in Australia. Misconceptions by the general medical
community are rife, due to both the lack of exposure to cosmetic
surgical procedures and the lack of information on the subject.
The assistance of the general practitioner, together with a thorough
patient history, is very valuable in determining whether cosmetic
surgery is likely to have a positive psychosocial outcome. Unfortunately,
the generally poor attitude of the Australian medical community
towards cosmetic surgery has led to patients being afraid of a
negative response when asking their GPs about cosmetic surgery.
Often referrals are either not made or are made by an anonymous
practitioner, which is not an ideal situation.
Liaison with surgeons who have previously treated a patient is
ideal, but cooperation in this area is not always forthcoming,
as some surgeons fear litigation from former patients.
With most cosmetic surgeons being shut out of the medical mainstream,
access to potential patients comes through normal commercial means,
such as advertising in the Yellow Pages and in magazines. It is
to be hoped that in future there will be more contact between
cosmetic surgeons and other medical practitioners so that the
true benefits and risks of the procedures can be understood by
the general medical community, who, in turn, can counsel their
patients in a sympathetic manner as to whether cosmetic surgery
is advisable.
References
Castle DJ, Honigman RJ, Phillips KA. Does cosmetic
surgery improve psychosocial wellbeing? Med J Aust 2002; 176:
601-604. <PubMed> <eMJA full text>
Hodgkinson DJ. Imagined ugliness: a symptom which can become a
disorder [letter]. Med J Aust 2001; 174: 156. <PubMed>
Macgregor FC. Social and psychological studies of plastic surgery:
past, present and future. Clin Plast Surg 1982; 9: 283-288. <PubMed>
(Received 25 Jun 2002, accepted 24 Jul 2002)
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