On the effectiveness of aesthetic surgery

Plastic surgery is often understood as being divided into two extremes: aesthetic surgery and reconstructive surgery. It is easy to find examples of reconstructive surgery that are primarily important for the patient's physical survival, such as cancer surgery and burn surgery.

Based on current knowledge, it is very difficult to find aesthetic surgical procedures that only affect the patient's appearance without any other effects. All plastic surgery procedures shape not only physical but also mental health; the procedures form an overlapping continuum in which procedures considered aesthetic are mixed with corrective procedures and vice versa. Surgery can affect the physical or psychological side in varying degrees. The difference between cosmetic and corrective surgery is like a line drawn in the water.

In his doctoral thesis, Dr. Kai Saariniemi demonstrated that the impact of breast reduction surgery on patient well-being and quality of life can be compared to that of joint replacement surgery. The study also showed that the effect lasts for years and a so-called "honeymoon effect," where the initial joy quickly fades into the gray of everyday life, does not appear.

In our own study, we monitored the impact of breast implants on women's well-being. During the six-month follow-up period, it became apparent that breast implants significantly boosted women's self-esteem. Satisfaction with their own bodies also improved, while susceptibility to eating disorders and depression decreased significantly.

Another very common procedure is abdominoplasty, or tummy tuck surgery, which is performed on women whose stomachs have become loose and saggy due to pregnancy or weight loss. We monitored the effects of surgery on sagging stomachs: women's quality of life improved, their self-esteem increased, their feelings of inefficiency and powerlessness decreased, their satisfaction with their bodies increased, their depression decreased, their bulimia decreased, their sex lives improved...

Surgery on the face has also been found to have similar positive effects, and it is likely that all surgeries considered aesthetic have a positive impact not only physically but also psychologically. A satisfied person radiates their satisfaction to their environment. Surgery primarily affects conscious thinking, which is reflected in unconscious thinking. The changes are visible in the patient's satisfaction and improved quality of life. It is noteworthy that the changes are not limited to the patient but are also reflected positively in their immediate environment.

A surgeon's knife is a powerful instrument and must be used with caution and skill.

In an American study, 100 patients with varying degrees of psychiatric disorders and some kind of physical ailment, minor or major, underwent surgery. It turned out that almost all of the patients' psychological symptoms improved after the surgery. The degree of improvement was not proportional to the severity of the physical defect, as one might expect. It may be that surgical correction of a minor defect achieves better psychological recovery than correction of a major defect. The intention is not to change current treatment practices from psychotherapy to surgery, but to remind us of the power of the surgeon's knife, not only as a corrector of physical defects, but also as an influencer of the mind. For better or for worse.

Just as complications are bad, so is the frivolous marketing of surgeries or treatments. Therefore, the ethics of cosmetic surgery should be the same as normal medical ethics: listen to the patient and help to the best of your ability. Refer the patient elsewhere if your own skills are not sufficient. To help and support. Simply seeking financial gain is unacceptable and will not get you very far in the long run. Reducing a doctor's work to a means of making money is spiritual poverty.

Aesthetic surgery is not sales work, but consultation. At the same time, it includes the obligation to provide as objective information as possible about the treatments and options available. If you don't know what to do, think about what you would do if your patient were your wife, child, sister, father, or mother. Would you operate or not? Would you treat them yourself or refer them to a more qualified colleague?

Unfortunately, we do not live in an ideal world, and aesthetic surgery has been overshadowed by incidents such as the PIP scandal, in which silicone implants were filled with industrial silicone, endangering the health of around half a million women. It is also not uncommon for patients to be given implants that are different from those they were led to believe they would receive. Unprofessionalism, indifference, and outright quackery are also on the rise. There are operators in the field whose ethics are questionable. 

Legislation should be clarified and tightened, and supervisory authorities should be given better tools for monitoring and addressing shortcomings. Quackery should be prohibited. Young doctors should be provided with training and job opportunities in aesthetic surgery. Aesthetic surgery is here to stay; its future lies in sincere enthusiasm, ironclad professionalism, uncompromising self-reflection, and research that separates the wheat from the chaff: belief-based treatments from actual treatments.

Happy summer to all our readers!

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Asko Salmi

Specialist in Surgery and Plastic Surgery