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People seeking cosmetic surgery need mental health checks, says Royal Society's plastic surgeon

Published 1 month ago5 minute read

Cosmetic doctors should carry out mental health checks on patients who want aesthetic treatments, a top doctor has warned.

Dr Christopher Rowland-Payne is the first president of a new unit at the Royal Society of Medicine called the Section of Aesthetic Medicine and Surgery.

One of his first missions in the post is to improve the ability of plastic surgeons, dermatologists and other doctors working in the aesthetic field, to identify mental health issues amid a phenomenon he dubs “Helen of Troyism”.

In some instances, Dr Rowland-Payne says this could mean getting a patient psychological help instead of going ahead with a procedure.

“Some patients presenting with a request for cosmetic treatment may be better treated by psychological methods,” he said. “This year I would like renewed focus on that delicate area. As in all fields of medicine, we see so many patients who are stressed by job or family or life.

“Doctors need not only to be proficient in the treatments they perform and possessing of good judgement, they also need to possess skills in psychological diagnosis and treatment and consider carefully the whole patient before they embark on any aesthetic treatments.”

Dr Rowland-Payne, who is a consultant dermatologist at The London Clinic, said social media had fuelled the rise of “Helen of Troyism”, where young people become not only fixated by how they look but convinced they can never be beautiful enough.

“Helen of Troy was the most beautiful woman of all time: ‘The face that launched a thousand ships.’ Is that face now within reach of every woman?” he said.

He said insecurities were not always imagined and blamed the “selfie”, where a person takes a photo of themselves, for making people appear uglier than they are and “sowing the seeds of discontent”.

Helen of Troy, painted by Dante Gabriel Rossetti, 1863

Many modern women are on a ‘quest to emulate Helen of Troy’ - Alamy Stock Photo

At the same time people are faced with endless perfected images on social media where blemishes are filtered out, which when combined, can result in “insatiable yearning” to improve body image.

“The quest to emulate Helen of Troy and enhance and preserve one’s beauty is entirely natural and nearly universal. It is also usually rational. If it becomes irrational, we need to be looking out for body dysmorphic disorder (BDD),” he said.

BDD affects one to two per cent of people according to the charity, the BDD Foundation, which says the condition “sadly has one of the highest suicide rates of all mental health conditions with 1 in 50 making an attempt on their life”.

Conrad Colson, 34, was a charity worker in London that took his own life in 2022 after living with BDD that was primarily focused on the appearance of his skin.

He had not been receiving mental health support when he died, and his father said he had “spent thousands of pounds at a number of skin clinics in Harley Street where he tried to find a treatment to bring him relief regarding his own facial skin problems”.

BDD also disproportionately affects young women and girls, affecting about six per cent of females aged 17 to 19.

According to the NHS, symptoms include worrying a lot about a specific area of your body, particularly your face, spending a lot of time comparing your looks with other people’s, looking in mirrors a lot or avoiding them altogether, and going to a lot of effort to conceal flaws and picking at skin to make it smooth.

Dr Rowland-Payne summarised it as a female “feeling less beautiful than others would consider her to be”.

He said: “It may lead to repeated visits to many different dermatologists, plastic surgeons and other aesthetic doctors and dentists. Patients may seek procedures which are unlikely to result in patient satisfaction.”

The condition often presents alongside other mental health issues such as depression, anxiety or eating disorders.

“BDD may have its origin in insufficient self-confidence or obsessional compulsive disorder or depression or even, in rare cases, psychosis – at least six surgeons have been murdered by psychotic BDD patients,” the dermatologist said.

He said doctors should take a detailed medical history and examination with questionnaires to identify if there are any psychological problems that need treating.

It comes after a series of patients have died by suicide following botched cosmetic surgeries taking place in Turkey.

A 24-year-old Frenchman, Mathieu Vigier Latour, took his own life after a failed beard transplant in Turkey was performed by an estate agent posing as a surgeon.

His father, Jacques Vigier Latour, told French media that the procedure had been a disaster and his son had fallen into deep post-traumatic shock and suffered from severe BDD.

“When it started to grow out, it looked like a hedgehog, it was unmanageable,” he told BFM TV.

“He was suffering, he wasn’t doing well. He was in pain, suffered from burns, and he couldn’t sleep. He entered a vicious circle and couldn’t get out,” his father said.

Three months after the initial operation, Mr Vigier Latour Jnr took his own life in his student accommodation in Paris.

Jack Castell, a 24-year-old British man with Asperger’s and BDD also took his own life after being left with heavy scarring and in immense pain after multiple surgeries in Istanbul.

He had a series of operations including a jaw reduction, chin reduction, lower face lift, nose and hairline lowering with eye widening.

The NHS mental health chief said on Saturday night high-street clinics had a “duty of care” to spot body-image issues and that the health service “should not be left to pick up the pieces”.

Claire Murdoch, national director for mental health, said: “People are under increasing pressure to have an idealised perfect body, and the availability of ‘quick fix’ procedures on the high street without proper checks just adds further pressure.

“The NHS should not be left to pick up the pieces. Companies providing these procedures have a duty of care to their patients and should be trained to spot people with body-image or other mental-health issues.

“If you think you may be suffering from body dysmorphic disorder (BDD), or body dysmorphia, please reach out to your GP in the first instance – the NHS is here to help.”

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