Body image, the manner in which the body is evaluated by one’s self, holds a significant contribution to expression of intimacy, sexuality and an overall sense of feeling lovable. For example, when shame is associated with one’s body, sex becomes an emotionally painful experience and can leave the partner in states of confusion and rejection. Self-consciousness surrounding one’s body can prevent interpersonal initiatives and lead to social isolation and loneliness.

Due to the increased accessibility to plastic and reconstructive surgery, many options are available for one to modify parts of their body according to various standards. Frequently, the surgery can help to elevate one’s body image. However, usually this occurs in tandem with a reasonably strong overall sense of self worth and situating the body in a context of one’s overall personhood.

For example, undergoing breast augmentation surgery in an attempt to regain a lost relationship or expectations that the surgery can make one more desirable when other obstacles to intimacy are present usually leads to disillusionment. When standards are particularly harsh, repeated surgeries can exacerbate self esteem issues.

Body Dysmorphic Disorder, characterized by perceived distortion of a minor defect or no defect at all, is marked by persistant obsessive thinking and compulsive acts to camouflage the defect. Focus can be on facial features, beasts, buttocks or thighs, for example, or targeted on muscle development or skin tone. The rate of plastic and reconstructive surgeries in this population is very high with low satisfaction outcomes.

So despite the rapidly expanding technology and marketing of plastic and reconstructive surgery, an individualized exploration of the feelings behind body dissatisfaction and expectations for change need to be explored. This could involve a combination of traumatic experience involving the body, neurobiological proclivity for obsessive thinking and longings for an unattainable relationship. Age consideration, especially adolescence, when the body has not reached its maximum growth is also a consideration as is a the development of ways to assess cultural mandates for beauty perfection. All in all, surgery to enhance beauty involves thorough emotional decision making as well as physical risk and cost.

Ellyn Freedman PsyD, LCSW

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