"I worked for a plastic surgeon. This is why I left after seven months."

It was only for seven months of my life, but I found the experience of working in a plastic surgeon’s rooms profoundly unsettling.

I’ve spent a great deal of time mulling over the reasons why. And if I had to bundle them into one word, it would be ‘betrayal’. I worked in an industry which exploited women’s, and increasingly men’s, insecurities at every touch point. I was also betraying myself. How could I claim to be a feminist whilst being involved in the promotion of cosmetic surgery as a means of overcoming those insecurities?

When I first started, I was staggered at the amount of money people willingly parted with for cosmetic procedures – thousands and thousands of dollars for thinner thighs, a flatter tummy, or a perkier butt. In addition to annual leave or sick days spent convalescing from surgery, what were they giving up? A family holiday, a gap year, a more secure financial future?

I started to wonder at what point the sacrifice became too great. And then, as I watched one patient sell her only asset, a car, to pay for breast augmentation surgery, I no longer had to wonder. She’d had several invasive cosmetic procedures, and was planning more. With nothing left to sell, there was only debt, and she was not isolated in her willingness to plunge into it for the sake of her appearance.

In retrospect, I’d been naive about many aspects of cosmetic surgery, but none more so than how addictive it was for some. These were the patients booking in for, or planning more procedures whilst in the early stages of recovery from previous surgery. Whilst I’ve no training in mental health, it wasn’t difficult to see they were obsessive about their appearance, and their use of anti ageing treatments and cosmetic surgery had veered into the problematic.

Watch: The Mamamia Out Loud team debate the ethics of plastic surgery. Post continues after video. 

If I had my way, all patients would visit a mental health professional prior to undergoing cosmetic surgery. In my experience, I’m not convinced current screening tools are robust enough. A psychological questionnaire is only of value if the results are analysed, and those in need of help pointed in its direction. (A 2016 study published in JAMA Facial Plastic Surgery indicates about 10% of cosmetic surgery patients have Body Dysmorphic Disorder and, crucially, that plastic surgeons are not adept at identifying it in casual conversations).

To be sure, it wasn’t just those afflicted with poor mental health returning for subsequent surgeries. Unsurprisingly, a rejuvenated face can often highlight an aged neck. And a newly lifted neck might lead to laser treatment of a sun damaged décolletage. It’s the sort of lucrative, decades-long relationship a cosmetic or plastic surgeon might be keen to cultivate with a prospective patient.

And if a person were feeling vulnerable following a break-up, divorce, or retrenchment, well, it’s easy to see how that relationship might begin. If effective pre-surgery evaluations were conducted, a patient’s motives could be teased out prior to them embarking on a costly and painful journey, as well as determining whether they hold realistic expectations for life afterwards. Cosmetic surgery is no panacea for a failing marriage or depression, nor indeed for much of what life throws at us.

On a daily basis we’re bombarded with images of unattainable and unrealistic beauty. And no where is this more apparent than on the Instagram feeds of some of Sydney’s most high profile plastic surgeons. There, scantily clad, oftentimes naked patients showcase their newly acquired breast implants in bed, on the beach, in the shower. It’s a depiction of the female form that can lead women, especially young women, to conflate sexualisation with success and confidence. When, in fact, there’s evidence to suggest those who seek out breast augmentation surgery for cosmetic reasons have an elevated risk of suicide.

Though it may sound otherwise, I’m not categorically against cosmetic surgery. At the right time of life and for the right reasons, it can lead to a positive outcome. But I want those considering it to have a full understanding of their reasons, the trade off they’re making, and what they expect to gain. It’s a conversation that might just lead to money more wisely invested in ongoing psychological treatment rather than on the operating table.

In the end I couldn’t reconcile my beliefs and values with the job I was doing. I no longer wanted to peddle images of the sort of beauty obtained with a surgeon’s scalpel, when what we really need is more honest and diverse representations of women and men.

Mamamia reached out for comment from the President of the Australian Society of Plastic Surgeons, Professor Mark Ashton. He responded as follows.

“As Specialist Plastic Surgeons it is not our role to make moral judgements about choices individuals make in the pursuit of happiness – whether it be to spend their money on clothes, a new car or cosmetic surgery.

We do, however, have an ethical responsibility to protect patients from harm and warn them about risks involved in surgery as well as provide them with a clear understanding of the likely outcome of their procedure.

The Australian Society of Plastic Surgery recognises there are some people for whom cosmetic surgery may not be appropriate: those who may have an unrealistic expectation of the benefit it will bring; those who may be placing themselves in unreasonable debt; and those who may have underlying psychological issues (such as body dysmorphia).

In a perfect world risk assessment tools and questionnaires would provide a foolproof solution. While these are valuable and necessary tools, there will always be those patients, however, who may not be completely candid in answering the questions involved, or who will simply ‘doctor shop’ until they find someone who is willing to do the procedure another surgeon may have advised them not to have. This becomes risky as we know that the law offers limited protection as doctors with only a basic medical degree can and do perform cosmetic surgery in Australia, without the many years of rigorous surgical training accredited by the Australian Medical Council that Specialist Plastic Surgeons undergo.

However, if a psychologically and physically healthy and well-informed individual makes the decision to have a cosmetic procedure, the Australian Society of Plastic Surgeons’ priority is to ensure our members are trained to the highest standards to deliver the best possible outcomes in a safe environment.”

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