Medically Reviewed April 2023, by Claire Clarke - Head of Surgical Services for The Harley Medical Group
With more than a quarter of UK women (29%) feeling unhappy about the way they look and over half (51%) considering having a Cosmetic Procedure, it’s interesting to look at the psychology behind cosmetic surgery.
How does a surgical procedure impact on our self-esteem and confidence and if it does, how long does that last?
What are we looking for when we embark on a cosmetic surgery procedure and are there some procedures that are of more psychological ‘value’ than others?
The cosmetic surgery industry is certainly evolving. Breast augmentation remains the most popular procedure, even though the percentage of women having boob jobs has dropped significantly in the last few years. What we are seeing in recent years is a steady rise in anti-aging procedures such as facelifts and eyelid surgery, while less radical procedures such as liposuction have seen an increase, year on year. In general, we are looking at a pattern that involves tweaking rather than tucking, implying that people are becoming more aware, educated and giving more consideration to surgical procedures than ever before. This is all very positive news, and as a psychologist, anything that encourages more thought and caution before undergoing any procedure, is a very good thing.
Firstly, it’s important to recognise the difference between those two attributes. Confidence is effectively the outward manifestation of self-esteem, which is our inner most feelings about ourselves. If a client were in physical discomfort because of a concern such as overly large breasts, from a psychologist perspective, I would have no hesitation in recommending a breast reduction. If someone feels that they would feel better about their personal and professional lives if they could keep age at bay, then having a face or neck lift or eyelid reduction may well bring them pleasure and fulfilment. I am in no way against plastic surgery – it can have a long-term and positive impact on both confidence and self-esteem. However, if there is a deeper dissatisfaction with their life in general, or they have unrealistically high expectations of how their lives will change post surgery, then I believe that further psychological investigation is necessary. Cosmetic surgery whether for aesthetic or physiological reasons – especially without other counselling – is rarely the answer to deeper issues.
With two in five (43%) women revealing they are unhappy with their breasts, breast augmentation, is a bit of an anomaly psychologically. It doesn’t involve the kind of physical discomfort that might make someone seek a breast reduction, nor the psychological issues of wanting a nose job or a tummy tuck to make us feel better. It is perhaps the most ‘cosmetic’ of any of the procedures and as such understanding someone’s motivations and expectations of a breast enlargement is especially important. As indeed is surgical and psychological advice on the actual intended cup size of the increase. A good surgeon is a responsible surgeon, who will talk through your body confidence issues with you in some detail – or recommend you to a psychologist – before considering the size of your implants.
We’ve all seen celebrities and possibly known people closer to home that have countless cosmetic surgery procedures in an attempt to transform themselves into a much younger version of themselves or perhaps someone quite different, or celebrities who have their boobs enlarged, reduced and then enlarged again at a dizzying rate. Not only do constant surgical procedures carry physical risks, the psychological impact of this kind of body dysmorphia, can never lead to lasting to fulfilment. And undoubtedly social media, with its constant bombardment of celebrities looking perfect in every way, highly influences our decisions to undergo certain treatments. Reacting to images of celebrities, by wanting the same thing yourself, without due consideration and caution is not something to be recommended – and any responsible plastic surgeon will tell you the same thing.
As with any voluntary operation, we should seek the counsel of friends and family as well as researching your choice of clinic in order to make an informed and wise decision. Whether it’s a long-term, well-considered desire for change or a knee-jerk reaction to a ‘fashion’ – and there are plenty of them in cosmetic surgery – talking to a psychologist or a counsellor is recommended. A good psychologist won’t talk you out of your intent, unless they feel that it’s really counter-productive to your life, but they will talk you through why you want a certain procedure, how long you have wanted it and what your expectations are of the results.
If you appreciate what you hope to achieve from cosmetic surgery, have realistic expectations of how it will change your life and fully understand the process involved, both surgically and post-surgery, then the whole experience can be a positive one, making you feel more body and psychologically confident and more self-accepting of the way you look and present themselves to the world. It is also important to understand that cosmetic surgery procedures are not designed to be a quick fix for self-esteem issues, but are part of a bigger picture of self-acceptance. The more you are equipped with knowledge, options and due consideration, the more likely your procedure will be successful psychologically.
© Jo Hemmings, January 2016
 The Harley Medical Group independent survey conducted by OnePoll of 2,000 respondents