Beauty, Obsession and Reality TV

The trail of plastic surgery devotees in Hollywood is growing faster than sequels to the movie Saw. From aging musicians and film makers to young actresses on the rise, Tinseltown is awash with everyone getting nips and tucks.  While an occasional tweak or two may be the norm, some ‘ stars’ are becoming more mannequin than human in their quest to turn back the hands of time.

Most recently, Heidi Montag of ‘The Hills’ fame,  underwent a second round of extensive plastic surgery procedures. The 23-year-old reality TV star, who had a rhinoplasty and breast augmentation in 2007, confessed to having ten plastic surgery procedures in one day according to People magazine. By her own admission, she admits to being addicted to plastic surgery. In her quest to be “the best of me”, she had  liposuction on her neck, waist, hips, and thighs, a buttocks augmentation, revision of a prior breast augmentation, an ear pinning, a “mini” brow lift, chin reduction, Botox in her forehead as well as fat injections in her cheeks and around her mouth.

Ms. Montag represents the ‘extreme’ plastic surgery patient.  Low self-esteem, combined with easy access and large amounts of disposable income and an insatiable need for attention, can create this perfect storm with the end result what we now see on the cover of People magazine.  

Heidi Montag’s situation is definitely the exception.  But real addiction can and does occur outside of reality TV  and mainly affects those that suffer from Body Dysmorphic Disorder. (BDD) In this condition, there is a never-ending unhappiness with changes that keeps the person affected with it coming back for more. Most repeat plastic surgery patients, however, are not ill and are motivated by what I call ‘accomplishment feedback’, a normal psychological response that creates a desire for further benefits after a previous positive experience. Every retail business thrives to create that outcome. That is a far cry from a BDD illness or a ‘plastic surgery addiction’. The sheer reality of economics prevents most  people from ever crossing the line into either of these behaviors.

Ms. Montag’s plastic surgeon has also been the target of criticism.  When should plastic surgeons tell patients no? How much is ‘enough’? While many people are appalled by what Heidi Montag did and felt she did more than she should have been ‘allowed’, the answer is not so straightforward. Should McDonald’s be selling those 80 grams of fat in a burger and fries meal to anyone overweight or should home mortgages or debt consolidation services be tendered to people whose finances knowingly don’t support them?

Elective plastic surgery is medicine mixed with a good dose of business and marketing. While the safety of the patient is the number one limiting factor to the number of procedures that should be performed at a given time, it’s impossible to remove the component of ‘personal responsibility’ from the equation.  Defining what is reasonable for someone to want is akin to you telling me what I should like. While beauty may be in the eye of the beholder…what is needed to get there is most certainly in the mind of the beholden.

Dr. Barry Eppley