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Surgery of the Psyche: Why People Choose Aesthetic Facial Surgery

By Dr. Bryan C Mendelson
Posted: 4th June 2014 17:46
Aesthetic plastic surgery deals directly with the emotional wellbeing of the patient.  This is rarely written about, but it’s the underlying reality of the plastic surgery office and the reason people choose to have surgery.  ‘Surgery of the psyche’ as one surgeon called it, but his observation was not new.  These words, written over 400 years ago, hang in my surgery: ‘We restore, repair and make whole those parts of the face which nature has not given, or which fortune has taken away.  Not so much that they may delight the eye, but that we should buoy up the spirit and help the mind of the afflicted.’  The author was Gaspare Tagliacozzi, known as the ‘father of plastic surgery.’  He practiced in the Sixteenth Century.
This is a surprise to many, even to young surgeons who enter the specialty brandishing their newly honed surgical kills, and quickly learn that you cannot operate on someone’s face without operating on their emotional wellbeing and social persona as well.  You are dealing with the very core of a person; their identity, confidence and self-esteem.  As surgeons, they will spend a large part of every week listening to people, their life stories, the deep feelings they have about their appearance and the way they are affected by it. 
It goes to the very heart of why people choose to have aesthetic facial surgery in the first place.  In this article, we look at just one area of aesthetic surgery – facial ageing and rejuvenation surgery – to see more closely the relationship between facial ageing (a physical change), psychological health (affected by the change) and the (often reluctant) decision to have surgery. 
Firstly, and contrary to commonly held belief, people seeking rejuvenation are rarely denying their age, or hoping that surgery will miraculously return them to youth.  They tend to be healthy people involved in the world and often at the peak of their activity. 
Having spent their life not thinking a lot about the way they look, ageing has surprised them, revealing the importance of their face in daily life and to their sense of who they are.  For many, it’s a sudden confrontation with the idea that looks really do matter.  This is the psychological reality of facial ageing - invariably underestimated by those who have yet to experience it.
Let’s look at it more closely.  Facial ageing appears in middle age, or even earlier, bringing a look of tiredness or despondency.  This is due to sagging facial tissues and it is frequently described by people as being like a mask over their face, ‘the mask of ageing.’ It’s at this point that people begin to feel less certain that facial ageing can be shrugged off.
The loss of confidence which accompanies this is damaging to a degree that people could never have believed when they were younger.  Mostly, people liked the face which has now become obscured and its loss forms part of the grieving which can accompany the loss of youth.  They also lament losing a face which told people more about them than just their age: they start to notice other people speaking to them differently based on their appearance, and women commonly report feeling ‘invisible’ in social situations. 
We judge people by their face, whether we’re meeting someone for the first time at a party, or choosing a politician.  It’s a natural and human thing to do, and in the past was a key part of our survival.  Because our face presents itself first, before anything else is revealed, there are many situations and encounters where it may matter even more than what lies beneath.  When that face no longer reflects the real you, when you feel vital and happy but look tired or downcast, it’s a profound misalignment.
The mis-match between who people feel they are, and what they look like to others, frequently leads to despondency and loss of confidence over time.  Just as people with facial abnormalities struggle with the judgements of others, so people with facial ageing struggle, especially with comments that suggest they look tired, unwell, irritable or out of touch. 
But choosing surgery is a major step.  For many, it will require a re-evaluation of their beliefs about plastic surgery, the superficiality of appearances or their youthful conviction that they would age with equanimity – an easy notion to hold in youth, when our ideas about ageing are an abstract set of notions about a way- off future.  Many of us hope to ‘age gracefully’, a very desirable concept but sadly rarely achieved, as a quick glance around any street will demonstrate.  Facial ageing is an anatomical process and how well you do in that process is more a reflection of your genes than your state of wisdom or grace.
It’s commonly said, especially by younger people, that they would never have rejuvenation surgery because they wouldn’t want to ‘change their face’.  The reality is that with ageing, change has already occurred.  What people want is their face back, without the unattractive elements of ‘the mask’ and that is what good quality aesthetic surgery can offer them.
If you’ve started to notice that suddenly rejuvenation surgery is everywhere, you’re right.  Facial ageing is a result of the longer lives that most of us now lead; we live longer so we look old for longer.  In addition, we are working, socialising and maintaining a vital role in the world long past the age at which our parents decided to start taking it easy.  And because we’re fit, active and expect to live longer, we also expect our external appearance to match how we’re feeling in the decades of middle age and beyond. 
So there are the key reasons people have rejuvenation surgery.  They are overwhelmingly psychological and practical – the desire to get back into life without their face being an impediment.  It’s an act of life, not of vanity. 
This means that in the surgeon’s hands lies the future happiness of that patient, bringing us back to Tagaliacozzi’s insightful comment over 400 years ago.  Unless the surgery ‘buoys up the spirits’ it has failed, or, even worse, may actively damage that person’s life.  We can all think of examples of people who have suffered stretched, un-natural faces, which are the result of poor or outdated surgical techniques. 
There is no place for this sort of poor surgery – today’s modern aesthetic surgery can offer exactly what people seek – a natural looking rejuvenation which subtly removes the ‘mask’ and leaves them looking refreshed (and staying that way) without any visible trace of surgery.  But patients must do the work – they will need a qualified plastic surgeon who specialise in aesthetics and operates using the latest techniques which are deeper under the skin – in the support layer.  Aesthetic facial surgery should never be on the skin itself.  With those few rules, they will be on the right track.
Dr. Bryan Mendelson is a leading Australian plastic surgeon, recognised internationally for the quality of his surgical results, attained by utilising the most recent understanding of facial anatomy.  He is invited to perform ‘live’ surgical demonstrations of his facelift and eyelid surgery techniques at major plastic surgery conferences, workshops and teaching courses around the world, in addition to lecturing on the latest findings in anatomy.  He practices aesthetic facial surgery in Melbourne, Australia.  His recent book is In Your Face.  The hidden history of plastic surgery and why looks matter (Hardie Grant, Melbourne 2013). 
Dr Bryan Mendelson
The Centre for Facial Plastic Surgery
109 Mathoura Road
Toorak VIC 3142
T: +61 3 9826 0977
F: +61 3 9826 6342

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