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Specialist Plastic Surgeons on the front line against body image issues

Posted on Monday, 29 October 2018

Body image issues

Dr Naveen Somia PhD., FRACS, Specialist Plastic Surgeon and President of the Australasian Society of Aesthetic Plastic Surgeons (ASAPS) writes the phenomenal growth and universal acceptance of social media have disrupted traditional industries and wholly redefined how the public engage and influence political debate, social issues, and online sales of goods and services including professional medical services like cosmetic surgery.

As social media marketing continues to evolve rapidly, there will be a corresponding boom in many areas including cosmetic surgery.  The traditional referral process for cosmetic surgery that was GP facilitated has been totally disrupted, and now it is patient-driven as consumers do their own research online and self-refer to a Surgeon’s practice.

While this disruption increased consumer choice and allowed unfettered access to abundant information online, it bypassed a potential mental health gatekeeper namely the primary health care physician or General Practitioner enabling direct access to a surgeon’s practice.  Not surprisingly Specialist Plastic Surgeons now encounter people with body image issues more frequently than any other medical group.

ASAPS recognised this escalating issue some time ago and have been working with its members to help deal with such patients ethically using scientifically validated and evidence-based methods.  Specialist Plastic Surgeons are actually ahead of the curve, but as surgeons we always follow the principles of evidence based medicine.  The inclusion of a body session at the recent Breast Masters Symposium with three well-known experts addressing the audience was yet another effort to equip Specialist Plastic Surgeons with the latest evidence and thinking on the topic.

During the session Professor Nicola Rumsey (OBE, BA(Hons), MSc, PhD) from the UK, Ms Roberta Honigman (Accredited Mental Health Social Worker) from Melbourne, and Dr Michelle Roesler B.Soc.Sc, BPsych(Hons), DPsych (Organisational Psychology), Phd (Health Psychology) from the Gold Coast shared their views and strategies to help Specialist Plastic Surgeons identify and effectively manage people with body image issues when they present for cosmetic surgery.

Specialist Plastic Surgeons are looking for solutions and have adopted technology and screening tools to identify and manage patients with body image issues.  Blaming Specialist Plastic Surgeons for the body image problem that confronts society is based on personal opinions dressed up as scientific evidence.  It ignores many other factors such as global multinational corporations with massive marketing budgets and powerful social media influencers with millions of followers who regularly promote cosmetic products manufactured by the multinationals.

Ms Honigman gave an update about her questionnaire that has been scientifically validated, peer-reviewed which was made available to ASAPS Members two years ago, to help identify patients with body image issues.  Dr Michelle Roesler spoke about her online pre-operative screening tool specifically developed to assist in the identification of such patients.  She detailed how the tool was supporting Specialist Plastic Surgeons during their consultations with patients.

Dr Roesler said while an optimal solution would be to have a Psychologist work within the Specialist Plastic Surgeon’s practice, as part of a multi-disciplinary team, this was not necessarily practical.

“Given the proportion of patients requiring intervention is actually quite low, a more efficient approach is the use of a screening program to identify at-risk patients.  The screening process allows not only examination of potential risk for poor psychological outcomes but also provides pre-operative prompts to help Specialist Plastic Surgeons with an individualised consultation roadmap.  It also provides a referral pathway for more intensive psychological assessment, support, and intervention if appropriate,” Dr Roesler said.

Presenting to the audience of Specialist Plastic Surgeons, Dr Roesler said that patient selection is a critical component of any cosmetic surgery practice.

“Patient dissatisfaction with cosmetic surgery outcomes is more often the result of patient selection error than a technical error.  Patients who have a disconnect between a perceived and actual outcome cause disproportionate frustration and angst within a Plastic Surgery practice.  Evidence showed that even experienced Surgeons with well-developed “filters” can be caught out by patients with body image issues.

“This has not been an easy process.  Predictive modelling is complicated.   Even for someone with a PhD in the field it took many years of research and 1000’s of patients to develop and then validate this model,” Dr Roesler said.

If a Specialist Plastic Surgeons feels the patient has unrealistic expectations, hasn’t the right motivations or is battling with Body Dysmorphic Disorder, the screening tool will identify these issues, and the patient may be asked to seek psychological support before treatment.

Specialist Plastic Surgeons have a duty of care to patients and adhere to strict Codes of Conduct as set out by the Royal Australasian College of Surgeons, the Australian Medical Council and the Medical Council of New Zealand.  These Codes outline the responsibilities of doctors and surgeons to ensure patients are mentally and physically fit for surgery.

After all, Specialist Plastic Surgeons are on the front line in the battle against unhealthy body image.  We hear first-hand the negative opinions people have of themselves, sometimes these views are at odds with reality.  However, the use of a screening tool provides an independent and unbiased way to identify patients with body image issues.

This is the standard of quality care you can expect from a Specialist Plastic Surgeon.

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