It’s not beautopia, get real about cosmetic surgery

The Gulf region has become a “beautopia”, a global hotspot for cosmetic surgery and related appearance-enhancing procedures. A recent study undertaken among 596 Saudi college women, published in the Journal of Taibah University Medical Sciences, reported that around 2.2 per cent of the participants had already undergone cosmetic surgery, while 11 per cent were considering doing the same. Perhaps the most troubling aspect of this study is that the average age of the participants was just 20.

Beyond cosmetic surgery, the rates of bariatric (weight loss) surgery in the Arabian Gulf region are among the highest in the world. Once the preserve of the morbidly obese, today, even moderately obese individuals might elect to undergo the procedure. No doubt there are benefits: remission of type 2 diabetes, better liver functioning, and most people would argue, improved physical appearance. However, there are two faces to bariatric and cosmetic surgery, and the second can be particularly miserable if left unchecked.

Beyond the obvious changes to physical appearance, both interventions have psychological and social consequences. In weight-loss surgery, for instance, an important psycho-social implication appears to be an elevated rate of post-operative divorce. A research study published in Social Work Today, suggests that the two-year, post-operative, divorce rate among bariatric patients can be as high as 85 per cent. This phenomenon is so common as to have given rise to the phrase “bariatric divorce”. But, does this happen in the Gulf region? Is bariatric divorce a thing here, too? Unfortunately, limited regional research prevents us from answering this question.

But why should weight-loss surgery be linked to divorce? One reason offered is related to the interrelated notions of lifestyle changes. When both partners are obese and only one partner undergoes the surgery, the lifestyle changes can tax the relationship. The partner, having undergone the surgery, may become more energetic and outgoing, and begin to attract more attention. Furthermore, old habits that gave the couple a shared identity, such as eating junk food while binge-watching TV, may no longer appeal to the post-operative partner. Such lifestyle divergence can put a considerable strain on a longstanding relationship. A couple once unified by obesity is now divided by slimness.

With cosmetic surgery too, there are often unforeseen

Surgery offers little hope of relieving appearance anxiety; the correction of one imagined defect is quickly replaced by a preoccupation with another

psychological consequences. While people typically elect to undergo cosmetic interventions to feel better about their appearance, the effects can be short-lived. Post-intervention, some people only find fresh disappointments and renewed appearance anxieties. If this cycle goes on long enough, a psychiatrist might diagnose body dysmorphic disorder.

In body dysmorphic disorder (BDD) the distress associated with imagined flaws and minor physical defects is massively disproportionate to the reality of the situation. For example, a relatively attractive young woman, believing herself to be grotesque, might avoid social interaction from fear of humiliation and embarrassment. If forced to interact, she might resort to camouflaging her imagined defects – oversized glasses, excessive make-up, and baggy clothes. If this sounds familiar, it might be because a mild form of body dysmorphic disorder has become the norm in some societies.

An article from the journal, Plastic and Reconstructive Surgery, suggests that between 7 and 15 per cent of all individuals seeking cosmetic interventions are experiencing BDD. In this context, surgery offers little hope of relieving appearance anxiety; the correction of one imagined defect is quickly replaced by a preoccupation with another.

The answer to such a problem isn’t more surgery; it is access to psychologists and psychotherapy. Screening for BDD should be standard practice before offering cosmetic surgery. Similarly, in the context of bariatric surgery, access to psychological support before and after surgery should be standard practice. International best practice guidelines for bariatric surgery strongly recommend that psychological evaluations and psychological support are essential aspects of the bariatric care-pathway.

Poor quality bariatric and cosmetic surgery programmes might take a tick-box (superficial), approach to psychological assessment and support; the worst ones don’t do it at all. With the popularity of bariatric surgery in the Gulf on the rise, there is an urgent need for well-enforced regional guidelines that include the vital psycho-social support element. Regional research and higher compliance with existing evidence-based best-practice would also help inform and protect the large numbers of individuals considering such procedures in the region. Justin Thomas is Associate Professor of Psychology,

Zayed University, Abu Dhabi