A new review looks at the relationship between body image dissatisfaction and the aesthetic surgeries, including abdominal liposuction and abdominoplasty, meant to improve body contour. Among other things, it reveals that while these patients tend to report after their procedures that they are less self-conscious about their appearance and are more satisfied with their shapes, the reality is they’re not necessarily healthier because of those procedures, says review author David B. Sarwer, Ph.D., associate dean for research and director of the Center for Obesity Research and Education, College of Public Health, Temple University in Philadelphia, Penn.
The disconnect is this: Consumers, in general, often think that liposuction removes a significant amount of fat, which could dramatically change what they see on the scale and potentially improve their health, according to Dr. Sarwer.
Demand remains high for surgical liposuction, which is the only surgical procedure to have a place in the top 10 cosmetic procedures overall, according to American Society for Aesthetic Plastic Surgery (ASAPS) 2015 Statistics on Cosmetic Surgery.
Tummy tuck is the third most popular surgical procedure, after liposuction and breast augmentation, according to ASAPS stats.
“The evidence that we reviewed suggests that the typical weight loss seen with liposuction is quite modest. Also, there is limited evidence to suggest that it leads to significant improvement in health,” he says. “Liposuction is well designed for individuals with pockets of fat around their waistlines, but the procedures are not necessarily appropriate for individuals who are 30, 50 or 100 pounds or more overweight.”
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The Corner of Obesity & Body Contouring
Dr. Sarwer says that his 20 years of research on psychological aspects of cosmetic procedures as well as the etiology and treatment of obesity, has taught him that the two fields intersect.
“There is probably the greatest degree of overlap now, given the scope of the obesity epidemic and the desire of people struggling with their weight to find a treatment that works to control their weight,” Dr. Sarwer says.
Providers of all types are always quick to remind their overweight patients and the public that obesity is a recognized disease, associated with severe comorbidities. But what providers might not realize, according to Dr. Sarwer, is that many overweight people are not driven to lose weight because of health concerns.
“For many individuals the primary motivation for weight loss is to feel better about how they look. When they come in for their follow-ups, they’re more excited to talk about how much weight they’ve lost or how their clothes fit. They’re far less excited to talk about decreases in their blood pressure,” Dr. Sarwer says. “At the same time, there are people who will seek body contouring procedures who think that those interventions are recognized treatments for obesity. We wrote this paper as a way to provide some clarity around the intersection of obesity and cosmetic procedures.”
Plastic and other surgeons who do body contouring need to pay attention to the psychological motivations and expectations of the patients who present for these treatments, Dr. Sarwer says.
“I would make the argument that in most, if not all specialties of medicine, providers under-assess psychological status and history when doing a history and physical,” he says. “Because of the psychological component of all cosmetic procedures, it should be a much more central part of the history and physical than for other medical specialties.”
Whether it’s the plastic surgeon, a nurse or a nurse practitioner who is collecting the history and physical, a thorough assessment of psychological history and current function is recommended, he says.
Understanding Patient Motivations, Expectations
Since many of today’s surgeons are affiliated with hospitals or major medical centers, the data they collect on their patients could fuel needed research on these patients in the form of big data. But beyond its potential to improve research, better understanding patient knowledge and expectations about (and motivations for) a body contouring procedure improves patient selection and, potentially, patient satisfaction, he says.
In fact, it’s likely that patients, including liposuction, abdominoplasty, and body contouring post bariatric surgery patients, differ from their surgeons in what they think these procedures are designed to do and what they can do.
“Therefore, it’s important that patients and providers have a thorough and informed discussion about how these procedures can help individuals feel better about themselves,” Dr. Sarwer says.
Asking a patient about motivations for body contouring can reveal whether a person is having a procedure to address a body image issue or their self-esteem, or if they’re doing it in hopes of saving a marriage or finding a new job.
Asking a patient about his or her expectations is the next step. For example, do patients appreciate the reality that the changes made from liposuction or even a tummy tuck might not be noticeable to most people when that patient is clothed (or not in a bathing suit)?
“Do patients have realistic expectations about how these changes will impact their appearance, and, just as importantly, impact their social relationships?” Dr. Sarwer says. “The success of our social relationships is determined by many different factors. Our physical appearance can be one of them. Having a different body shape isn’t necessarily going to make people like you better or help them get a promotion that’s eluded them for a period of time.”
Plastic and other surgeons who perform body contouring procedures on bariatric surgery patients who have had massive weight loss should know that these patients often come to the surgeon carrying a significant psychosocial burden from their extreme obesity. For some patients, the degree of distress warrants management by a mental health professional, he says.
For example, Dr. Sarwer says that between 30% and 40% of bariatric surgery patients are in treatment for depression, and some 60% to 70% have a history of depression.
“Sometimes, these episodes of depression can come back after surgery. Just because an individual has lost a large amount of weight with bariatric surgery and is now presenting for body contouring procedures, that doesn’t necessarily mean that their depression has been successfully treated or has resolved,” he says. “So, the plastic surgeon is well served to ask about how the patient’s mood is and ask about whether a patient is still in treatment of some form.”
NEXT: Research Gaps
The review revealed the need for more research about psychological aspects of surgical body contouring procedures, Dr. Sarwer says.
“I would anticipate that given the scope of the obesity problem in the United States, we’ll likely see more individuals coming forward for these procedures, which would give us the opportunity to collect the strongest possible data to demonstrate the psychological benefits of these procedures,” he says.
There also is little evidence on how some of the newer body contouring interventions — from the sculpting devices to injectable treatments — impact patients psychologically.
“One of the main arguments that we make in the paper is the need for additional research on the psychological benefits of cosmetic procedures more generally. As cosmetic surgery continues to grow, it will be important to provide the strongest possible evidence for the efficacy of the procedures — not only with respect to improving an individual’s appearance but also documenting the psychological benefit, as well,” he says.
Disclosure: Dr. Sarwer has consulting and research relationships with Allergan, BaroNova, Enteromedics, Ethicon Endo-Surgery and Galderma.