Cosmetic Surgery: Cure or Curse?
It’s a big and fast-growing business, but as with any other, it’s “buyer beware”

By Danielle Egan

“Feel this. It feels spongy, right? It almost doesn’t feel like my body,” says Leslie, exposing her lower back. The skin looks normal but feels like a foam pillow because Leslie had her backside, her hips and upper thighs liposculpted two months ago, along with a breast lift and facelift. It will take up to a year for the holes in her fat to heal and for the surgical scars to fade. “But I love myself now the way I should,” says the 45-year-old Vancouverite. “The surgeries helped create the Leslie I know was there—but would never come out before.”

Leslie’s “renovations” started at 40, when she had her lips plumped with a cosmetic injectable. At 42 she had a breast augmentation followed by upper and lower eyelid surgery a year later. “Once you start fixing yourself, the rest looks out of balance,” says the busy publishing sales executive. “It’s a wonderful thing to grow old gracefully and be happy with it. But I’m not that kind of person.” To date, Leslie says she’s spent over $20,000 on cosmetic procedures. “People go out and buy $40,000 cars. I chose cosmetic surgeries,” says Leslie. “Why not? Confidence is a wonderful thing.”

Cosmetic augmentation might seem like an extreme way to manage mid-life, but an ever increasing number of people—especially women between ages 35 and 50—are choosing cosmetic procedures.

“Every surgeon I know says there have been huge increases—up to three times what we used to do,” says Dr. Frank Lista, a Toronto-area plastic surgeon and past president of the Canadian Society for Aesthetic (Cosmetic) Plastic Surgery. “I’ve seen a 30-percent increase in patients just over the last year. Suddenly it’s commonplace to have cosmetic procedures. A decade ago it had to be a secret and was clearly only for rich people.” Costs haven’t changed—his patients spend an average of $5,000 to $8,000—“but now it’s accepted by normal, everyday people from students to soccer moms,” he says. “There’s no shame, and it’s already become like having dental braces.”

According to Medicard, a company that finances cosmetic and other elective surgery for Canadians, 42 percent of its clients are from Ontario, and Toronto has become the sixth biggest market for cosmetic surgeries per capita in North America. Medicard now services 3,750 Canadian clinics, approving financing for over 24,000 Canadians yearly—some 60 percent of them for cosmetic procedures.

Behind the number crunching is an age-old cultural fascination with beauty. “Many studies show that attractive people are more successful,” says Dr. Peter Adamson, a University of Toronto professor and facial plastic surgeon. Adamson cites everything from Plato to modern clinical polls as evidence. “Studies have shown that babies stare longer at beautiful faces; attractive people have a better social status, are more reproductively successful and have better sex lives—particularly beautiful women,” says Adamson. “My patients say this has been a most rewarding experience and one of the best investments they’ve ever made. [Post-op] they look like they feel—like the image they have of themselves.”

Other studies are less reassuring. A survey by the American Academy of Facial Plastic and Reconstructive Surgery has found that up to 15 percent of patients need corrective surgeries for their rhinoplasties (nose jobs), and an FDA study found that a third of Alabama women with breast implants required additional corrective surgery. Nearly half of those women learned that their implants had ruptured.

The psychological health of cosmetic-surgery patients has also gone under the microscope recently. A 2004 University of Pennsylvania comparison of cosmetic-surgery patients with those undergoing general surgery found that 19 percent of the cosmetic-surgery recipients had mental-health histories, and 18 percent were taking psychiatric medications, compared to five percent of noncosmetic patients. At the University of British Columbia’s Perfectionism and Psychopathology Lab—where perfectionism is classified as a maladaptive personality trait associated with crippling social and personal problems that can even lead to suicide—one recent study found that 79 percent of “extreme perfectionists” had had cosmetic surgery.

“I’m very busy with patients with perfectionism and body issues who consider cosmetic surgery,” says Calgary-based psychologist Natasha
Kutlesa, who has also mediated group-therapy sessions with perfectionists. “These patients have deep-seated feelings of inadequacy that typically develop in childhood with family issues. It’s difficult to convince them to put off the surgery because it seems like a quick fix, while therapy is longer term and harder work. They come back [post-op] and have the same issues. Deep down they think, I’m inadequate. I’m not good enough the way I am.”

Increasing cultural fixation on youthfulness and antiaging has also raised the bar on beauty standards. “Some of my patients just want to normalize their appearance with a nose job or a breast augmentation,” Kutlesa says. “But normal isn’t normal anymore. Some fear aging, wrinkles, their changing breasts. They see the celebrities and read the glamour magazines and can’t accept who they are now. Our culture doesn’t respect the wisdom of age, particularly of older women.”

Opting for cosmetic surgery, says Kutlesa, can actually worsen her patients’ psychological problems and become addictive. “They’re trying to run away from those problems by externally reinventing themselves.”

Just how addictive is cosmetic surgery? The Credit Medical Corporation, another Canadian company offering cosmetic-surgery financing, says that up to 15 percent of its customers return for more surgery financing. As Leslie admits, “once you start modifying, it’s an ongoing thing.” Her plastic surgeon weeds out people with body dysmorphic disorder (BDD), those who have an obsessive preoccupation with a real or imagined physical defect. (One percent of people have BDD, but among those seeking cosmetic surgery, as many as 15 percent have it, according to a 2005 St. Louis University study.)

But even if a reputable plastic surgeon turns a patient down, she may go elsewhere for a fix. Anyone with a medical degree can do cosmetic procedures—doctors, dentists, dermatologists, gynecologists; even nurses and estheticians do less invasive treatments such as injectables and “antiaging” treatments. The bottom line, say the experts, is buyer beware.

Lista, who turns away about 35 percent of prospective patients because they have “unrealistic expectations,” believes Ontarians are especially vulnerable because of a lack of legislation. “British Columbia’s and Alberta’s College of Physicians and Surgeons have passed certification rules for private facilities,” he says. “But the Ontario College has really let the public down. Any medical doctor can be a cosmetic surgeon if he wants.”

Any surgery is risky, but unnecessary, elective cosmetic surgeries have become risky business—particularly multiple procedures, which cut surgery costs to the patient but are more demanding on the body, mean more time under anesthesia and an increased risk of blood clots and blood loss. Lista recommends that any surgery over five hours in duration be done in a hospital.

Consider the tragic death in 2004 of Canadian media mogul Micheline Charest. The healthy, active 51-year-old went into cardiac arrest after multiple cosmetic procedures at a Montreal clinic a block away from Notre-Dame hospital. Both plastic surgeons at the clinic were hospital-affiliated members of the Royal College of Physicians and Surgeons of Canada.

 I felt like a filleted fish,” says Laura of her combined breast augmentation and tummy tuck in March 2005 at Montreal’s Lakeshore General Hospital. “I wasn’t prepared for the pain. It was brutal, and I thought, I’m so stupid, I’m going to die.” The 41-year-old happily married, stay-at-home mother of four hadn’t rushed into getting cosmetic surgery. “The decision was a long process, and I had to meet other goals first,” says Laura, who had gone from 132 pounds to 183 pounds since having her first child. She went on a low-carb diet and worked out for two years, losing 50 pounds and toning up. “But I had tube socks instead of boobs, and an ugly belly. That made me a little depressed,” says Laura. So she talked with her husband at length and consulted her cardiologist—Laura has a congenital heart defect—who gave her the green light as long as she had the surgery done in the hospital.

Post-op, it took at least four weeks before she felt “a little bit human.” But she’s thrilled to be wearing bikinis for the first time in her life, even though she had some loss of sensation in her left breast for more than eight months and it took her a while to adjust to her new shape. “Psychologically it’s a huge transition, and I’m a bit self-conscious,” acknowledges Laura. “But I feel better about the way I look. I look more like a woman and I’m getting used to being me.”

With the acceptance of cosmetic procedures climbing, plus financing options for lower-income people and the constant emergence of new technologies, more people may be tempted to have cosmetic surgery. Adamson even postulates that the desire to cosmetically augment is biologically rooted. “Cosmetic surgery itself may be an ongoing part of our Darwinian survival of the fittest adaptation,” he says. “With cosmetic surgery, someone might have a greater chance of passing on their genes than a less attractive person. And,” he asks, “is the courage required to have these surgeries reflective of someone with a more positive genetic makeup?”

But what about the courage it takes to choose not to modify your appearance? “People go too far,” says Ann Kaplan, founder of Medicard, which has gone through “astronom-ical growth” since starting in 1996. Considering that her business relies on this market and that she’s married to a cosmetic surgeon, Kaplan seems an unlikely critic. “Some people mutilate their bodies with extreme procedures,” says the 45-year-old Torontonian.

As a mother of six, she worries that future generations will be too accepting of invasive cosmetic procedures. “We’re always working on ourselves, and it’s great to feel good, but a line has to be drawn somewhere. There’s something to say about picking up a fishing rod and getting away. We can find a lot more inside ourselves than outside.”