Cosmetic Medicine: Friend or Foe

5/20/2022 9:26:05 PM

Cosmetic Medicine: Friend or Foe?

A true story:When I was a bachelor’s student, I had a friend named Leila, who was beautiful but wanted to undergo rhinoplasty to be more attractive.

I remembered that I traveled to a one-week conference, and when I was back to the dormitory, I noticed that a newcomer was there in our room. I warmly greeted my friends and welcomed the newcomer. All of a sudden, everyone burst out laughing!

Didn’t you recognize me? The newcomer said. That moment I noticed that the newcomer was Leila from her voice!

Leila had become more attractive but unrecognizable too, and this was the start only. In later times, Leila experienced some cycles of depression and grandiosity interchangeably, which put her in an unpleasant psychological situation.

Demand for cosmetic procedures is increasing globally as people are getting more interested in improving their appearance (1). In fact, the request for cosmetic services becomes an emotional or psychosocial motivated need (2). The desire to rejuvenate is the main reason for doing cosmetic procedures (3) and the media constantly reminds us to care about such needs and shape our mindset (2). The advertisements in the media use jargon and deceptive wording to persuade the public to buy new beauty products (4).

Cosmetic Medicine is a high-profit industry and therefore follows marketing rules (2). Cosmetic industries present their products with exaggerated claims in order to capture the consumers’ attention and guide them towards obtaining their products.

Have you ever watched a cosmetic product ad? They usually claim that the positive results of their product are coming from extensive clinical trials; however, to be clear serious doubts are present when it comes to the cosmetic industry’s trials and this field is deeply involved with conflict of interest (4).

The number of consumers considering cosmetic treatment is rapidly growing (5), much more than what we thought. In the past, beauty culture was practiced by women, but now men are attracted to this industry and even some special products are available for men too (2). In addition to gender differentiation, the site and type of cosmetic surgeries vary based on country and culture. Facial osteotomy, for example, is more popular in the Far East (1); however, in western societies other aesthetic procedures are more popular, such as Botox injection (6). Interest in nonsurgical procedure services is growing and it is estimated that 65% of all cosmetic procedures are now nonsurgical (2).

Now a question; what is the problem with cosmetic medicine? The cosmetic marketplace is so attractive and each year, many practitioners from outside the field of plastic surgery join such highly competitive markets (2, 7), while patients with actual skin diseases are waiting for their entitled services (4). In order to control the market and industry, some countries and regions have tried to regulate this market, its players and policies and increase the safety of cosmetic products (8).

But still, there are some concerns! This market and its science work based on emotional factors. It can be inferred that the main consequence of having cosmetic procedures is psychological effects; satisfaction or dissatisfaction with appearance. Although there are many concerns about psychological disorders related to cosmetic procedures, there are also some positive effects on increasing the quality of life, patient self-esteem, and satisfaction following cosmetic procedures (3).

This creates an ethical dilemma on this issue that aesthetic surgery is a business guided market or a medical intervention that is seeking better health conditions for patients? (2), because sometimes it really helps patients to feel better about themselves, but it also can be inferred that the aesthetic market inducing demand for more and occasionally unnecessary need for cosmetic procedures. 

Furthermore, using cosmetic procedures may have some benefits, but it may also have some adverse effects, which are considered less than what they really are (9). In reality, some cosmetic surgeries potentially put patients in danger and have serious side effects (2).

Psychological disorders might be of the most impact of such procedures; studies have shown some sort of psychological disorders related to undergoing cosmetic procedures. Some studies suggested that 30% to 70% of patients who sought plastic and cosmetic surgery had some psychiatric problems (1). Its a considerable rate!

It seems there are two main patterns for the development of psychiatric disorders in cosmetic surgeries; patients who suffer from psychiatric problems before surgery and those who have postoperative psychiatric disorders. In the latter group, there is a wide gap between the expectations of patients before surgery and the results after surgery (1). But who is shaping the expectations? Media? Practitioners? Society?

 Probably all factors incorporate each other.

Some patients may suffer from psychological disorders like body dysmorphic syndrome, dysmorphophobia, or heightened narcissism, which cant be cured by surgery (2), and even getting worse, but plastic surgeons are not psychiatrists and may fail to understand their patient has such problems (1). So regardless of the surgical outcome, probably the patient may not be happy after surgery (2). And the bad thing is that patients with psychological disorders are at risk of frequent cosmetic surgeries (1).

Psychological disorders are not the only problem in cosmetic medicine. Nowadays, many ethical issues have surrounded cosmetic medicine; does the aging skin really need rejuvenation? (4) Is cosmetic surgery suitable for teenagers? (10).

In fact, it is impossible for a surgeon to say if this type of surgery should or should not be done, and its a hard job to control conflict of interest in such situations (2).

Cosmetic surgeons should be very careful about their professional obligations and their duties to patients and the public. Their prescription on aesthetic issues is far different from other specialties that save lives (4). Actually, surgeons should help people to have a more realistic attitude towards themselves (2).

What should be done to reduce problems in such conditions?

Maybe it can be recommended to refer patients who are seeking cosmetic surgery (at least those who are repeating such surgeries) to a psychiatrist to be examined in terms of psychiatric problems and to prevent unnecessary surgical procedures. And if there is a strong will to reduce unnecessary cosmetic surgeries, mandatory psychological consultations may help. Such processes are done routinely in some countries. In the presence of good psychological consultations, sometimes patients understand their psychiatric problem is not related to their appearance and accept to stop unnecessary cosmetic surgeries (1).

Some suggest informed consent for invasive cosmetic procedures because, most of the time, there is no medical indication for plastic surgery (2).

Media advertisements have a very important role in shaping peoples mindsets; therefore, there should be guidelines on cosmetic surgeries advertisements in the media (2). 

 Pharmaceutical manufacturers should disclose information on the effectiveness of their cosmetic products (4)

Written By: Masoomeh Gholami

Poster Design: Alireza Bagheri


1. Hayashi K, Miyachi H, Nakakita N, Akimoto M, Aoyagi K, Miyaoka H, et al. Importance of a psychiatric approach in cosmetic surgery. Aesthetic surgery journal. 2007;27(4):396-401.

2. Atiyeh BS, Rubeiz MT, Hayek SN. Aesthetic/cosmetic surgery and ethical challenges. Aesthetic plastic surgery. 2020;44(4):1364-74.

3. De Aquino MS, Haddad A, Ferreira LM. Assessment of quality of life in patients who underwent minimally invasive cosmetic procedures. Aesthetic plastic surgery. 2013;37(3):497-503.

4. Cantor J. Cosmetic dermatology and physicians’ ethical obligations: more than just hope in a jar. Dermatologists, Why Cosmetic. 2005;24:155-60.

5. Maisel A, Waldman A, Furlan K, Weil A, Sacotte K, Lazaroff JM, et al. Self-reported patient motivations for seeking cosmetic procedures. JAMA dermatology. 2018;154(10):1167-74.

6. Sarwer DB, Crerand CE. Body image and cosmetic medical treatments. Body image. 2004;1(1):99-111.

7. Camp MC, Wong WW, Mussman JL, Gupta SC. The battle for hearts and minds: who is communicating most effectively with the cosmetic marketplace? Aesthetic Surgery Journal. 2010;30(4):614-7.

8.Cornell EM, Janetos TM, Xu S. Time for a makeover‐cosmetics regulation in the United States. Journal of Cosmetic Dermatology. 2019;18(6):2041-7.

9. D’Amico RA, Saltz R, Rohrich RJ, Kinney B, Haeck P, Gold AH, et al. Risks and opportunities for plastic surgeons in a widening cosmetic medicine market: future demand, consumer preferences, and trends in practitioners’ services. Plastic and reconstructive surgery. 2008;121(5):1787-92.

10. Singh K. Cosmetic surgery in teenagers: To do or not to do. Journal of Cutaneous and Aesthetic Surgery. 2015;8(1):57.

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