S05E82 - Depression after Plastic Surgery: When Beauty Comes with an Emotional Cost

Discover the unspoken truth behind the glitz and glamor of plastic surgery, as hosts Dr. Sam Jejurikar @samjejurikar, Dr. Salvatore Pacella @sandiegoplasticsurgeon, Dr. Lawrence Tong @yorkvilleplasticsurgery, and Dr. Sam Rhee @bergencosmetic unravel the emotional battles waged in the aftermath of cosmetic procedures.

Our conversation sheds light on the surprising prevalence of post-plastic surgery depression, a journey filled with anxiety, sadness, and sometimes regret, even when the results meet or exceed expectations. This episode peels back the curtain on the immediate postoperative changes—swelling, bruising, and the stark reality of an altered body image—that can send patients into an emotional tailspin. By recounting the stories of those who've traversed this rocky terrain, we offer a candid look at the psychological toll of elective surgeries and the resilience needed to emerge stronger on the other side.

Navigating the delicate intersection of patient aspirations and the realities of recovery, our panel shares their expert insights on the critical role of trust and communication. We delve into the nuanced approach required to manage expectations, from strategic daily check-ins during the initial week after surgery to the discernment of patient motivations and readiness to face their new selves. Our discussion also highlights the red flags that may signal deeper issues, like potential body dysmorphia or the unrealistic desire to keep surgeries secret from loved ones. This episode is a must-listen for anyone considering plastic surgery or those supporting someone through the process, offering a profound understanding of the emotional implications and the importance of setting realistic recovery expectations.

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S05E82 - Depression after Plastic Surgery: When Beauty Comes with an Emotional Cost

TRANSCRIPT

[00:00:00] Dr. Sam Rhee: Welcome to another episode of Three Plastic Surgeons and a Fourth. We have Dr. Sam Jejurikar, as always, from Dallas, Texas. Dr. Salvatore Pacella from San Diego, California. Our newest host, Dr. Lawrence Tong from Toronto, Canada. And I am Dr. Sam Rhee from Paramus, New Jersey. And this episode is going to talk about something that we don't talk about very often.

This was from a popsugar. com article recently that Depression is a side effect of plastic surgery that we don't talk about. This is something that was very interesting to all four of us as we were discussing it before the broadcast. And, uh, before we get into it though, let's, uh, go ahead and start with our disclaimer as always.

[00:00:50] Dr. Salvatore Pacella: This show is not a substitute for professional medical advice, diagnosis, or treatment. This show is for informational purposes only. Treatment and results may vary based upon the circumstances, situation, and medical judgment after appropriate discussion. Always seek the advice of a surgeon or other qualified health provider with any questions you may have regarding medical care.

Never disregard professional medical advice or delay seeking advice because of something in the show.

[00:01:13] Dr. Sam Rhee: Now, cosmetic surgery, especially elective plastic surgery, is something that you would think any patient who undergoes would be thrilled to have when it goes well. Uh, however, there is a phenomenon that I'm sure all of us have seen called post plastic surgery depression, which is more prevalent than you may think.

And this And recent studies have shown that a significant number of patients will have depressed feelings after either going, undergoing a breast augmentation, facelift, rhinoplasty, or other cosmetic procedures, where they feel anxious, sad, or depressed initially. After having had a procedure done, regardless of how great that outcome is, and this is something that seems a little, uh, you know, not, it doesn't seem to make, yeah, counterintuitive.

I was going to say counter something, counterintuitive. And, uh. And so let me ask all three of you, what are you, what is your experience with post plastic surgery depression and, and how do you approach that?

[00:02:20] Dr. Sam Jejurikar: Uh, I'll, let me start cause I, I actually want to ask you guys. Two questions. Um, uh, one, how prevalent do you think this is? And how long do you think it typically lasts? I'll say that in my patient population, I think that probably 60 or 70 percent of my patients that don't have pre existing anxiety or depression experience considerable emotional, um, changes.

In about a six week span, up to about six weeks after surgery. That's what my experience is, but I've never asked any other plastic surgeon what they, what they will see,

[00:02:56] Dr. Lawrence Tong: How do, how do you define that? I guess if you, if you say patient's feeling anxious after surgery, yeah, that's a very high number and I think that it's sort of natural because it's not something that they're used to you know going through having a surgical procedure. I think it's not maybe limited to that.

Just cosmetic surgery, any kind of surgery, you're going to have some anxiousness, maybe some depression. So I, I would agree with you. Maybe like 60 percent people feel that way, but what, how do you define that? And what are you seeing?

[00:03:34] Dr. Sam Jejurikar: you know, people, um, being tearful, um, being, um, you know, just being emotionally exhausted. Um, you know, where, where, you know, there's some minor degree of buyer's remorse where they can't believe they made decisions, um, That got them into the situation where they couldn't move around well after surgery, or their face looked so swollen after surgery.

Where even though they knew that they would probably get the outcomes that they were going to want and before and after pictures that they would want, that they have some emotional, emotionally strong reaction that at least for a transient period of time made them regret that decision. I see that a lot.

[00:04:13] Dr. Salvatore Pacella: I mean, I wouldn't, I don't know if I'd say 60 or 70%, but definitely a good half, I would say. Uh, this is particularly, I think, in my patients who I do eyelid or facelift surgery. Um, because I think they're not, regardless of the teaching we do, my nursing staff is exceptional. Um, I think we do, I do a really good job of trying to explain and set expectations about the recovery.

Um, quite honestly, they're just not prepared for it sometimes, or, or they're not hearing what we're saying. And, you know, Oh, I'm going to be, you tell me it's going to be three months before I look normal. I'm going to be the exception. I've always healed well. You know, and this is particularly problematic, I think, in patients who are type A or control or in control of their, the, their environment quite a bit.

Um, definitely see that very commonly.

[00:05:05] Dr. Sam Rhee: For me, I would agree somewhere in the half to two thirds range of patients. And you're right. I think there are two sort of aspects to this. The first one is as Larry. Had mentioned, um, and, and you, Sam, that, you know, you have these initial post surgical changes with the swelling, with the, you know, all these, uh, initial changes where you're all, you look all jacked up, honestly, initially, and those are hard to deal with right after a procedure, even though you know, intellectually, that these are transient changes and recovery will happen, and you will look better.

Um, a lot of people are anxious about that. Um, the second part, which I think is actually more interesting to me sometimes, is that acceptance of change of body image. And this happens, one, because people get plastic surgery to change something about their body, whether it's their face, their breasts, their, their belly, whatever it is.

And changing that can psychologically affect people in a pretty dramatic way. Um, you have to, you have to gain acceptance of that new image. You have to reconcile that with the fact that you made that choice to change that image. You might feel guilty that you changed your image and, and you decided to do this, as Sam mentioned.

And, and so dealing with that brings a lot of depressive feelings. You can have insomnia, you can have sadness, you can have self doubt, you can, you can be looking at yourself saying, is this me now? Especially, um, patients who've had, I've seen that in rhinoplasty, I've seen that in breast augmentation, where they're looking at themselves and being like, wow, look at me, like, is, is this, I chose this, is this what I wanted?

Is this what I'm supposed to look like? And, and that kind of, wrestling with your self is can, can be challenging. That can take months for some people to either learn to accept. And, and I don't know if, if you've ever seen anyone not fully accepted, uh, I think I've seen maybe one or two or a couple in my career, but, but those are dramatic changes that people have to accept.

[00:07:20] Dr. Lawrence Tong: Yeah, it's, it's usually on the face. If you're going to get that kind of thing, that's what I found. You know, you'll do like a rhinoplasty on somebody and it looks perfectly fine and they look better, but, and when what they notice sometimes is so minor. Um, that nobody else can see it except them, and sometimes it just makes it very difficult to, um, to, to manage.

Um, I think that with time, like you said, they eventually will accept, you just have to support them, uh, through that. I don't, I don't know if I've had anybody who's never, uh, accepted it, but yeah, occasionally that does happen, I agree with you.

[00:08:00] Dr. Salvatore Pacella: I, I see it a bit in, uh, fat transfer. Um, you know, it's such a dramatic postoperative recovery for the first couple weeks that, uh, you know, patients just wonder what they signed up for. But,

[00:08:11] Dr. Sam Jejurikar: That transferred to the face.

[00:08:13] Dr. Salvatore Pacella: to the face, yeah. You know, the temple, the cheek. And, and I think, um, you know, I, I, I over or under promise and over deliver and I, I tell them how bad they're going to look, how bad, how bad, how bad, how thick, how thick their skin is going to look, how puffy it's going to look.

And. You know, it's just, unless you're experiencing it, I think it's very difficult for, for patients to grasp.

[00:08:38] Dr. Sam Jejurikar: Yeah, I mean I, I like, um, I like Sam's explanation about sort of just the People having to accept the way that they look now because I've never really thought of it that way. I've always sort of associated it with the sort of the temporary dysfunction or the temporary, um, you know, pain or loss of income and that sort of stuff.

But yeah, that that on the face in particular, I think that change and. The way your appearance is going to be, um, can really, can really sort of contribute to that. So I guess my question then is, do you guys deal with anything special to try to support people during this time? Or what advice do you guys give to patients to try to get through this period of time?

Because, you know, I, I tell people that I think it's going to happen. We spend some time talking, but we even have a handout in our office that we've given people the entire time I've been in practice that talks about emotional reactions after surgery. But I have yet to actually come up with any strategies to eliminate this from happening in people.

Have you guys had any success with anything that you do?

[00:09:35] Dr. Sam Rhee: Some of it depends on how, how deep you're willing to. Get to know a patient and how willing a patient is, is to open up to you. So, um, I, uh, you know, patients will come to you for all sorts of different reasons why they're having procedures done. And sometimes they're willing to disclose exactly like truthfully what those reasons are, and sometimes they're not.

And so what their motivations and what their expectations are. It's sometimes opaque to us. I mean, we can see if they're physically ready, if we believe that we can affect the change that they want, like what they're describing to us, but without really sort of digging into their underlying motivations for why they're doing these things, sometimes it's really hard to prepare them for what they're going to expect afterwards.

And so I think. I try to not be too invasive in terms of their privacy, but I do look for, you know, red flags. Maybe their motivation is not something that comes from within, but is external. Maybe this is something that wasn't fully Um, reasoned out for a long period of time, but is more of a snap judgment, uh, type of situation.

Those are the type of, um, situations where I might have more of an open dialogue. I might talk to them a little bit more. I might try to find out more of their underlying reasons why they're considering a procedure. Uh, but you're right. This is something that I think we don't address Proactively enough, Sam.

And I think you're a hundred percent right with that.

[00:11:13] Dr. Salvatore Pacella: I, you know, I, I try, um, one strategy I think that's helped at least for my face patients is, you know, I, my normal operating room days are Mondays and Tuesdays, give or take a few days. And, um, so when I do one of these face procedures earlier in the week, I, I try to see them. Every day, the first week, so Tuesday, Wednesday, Thursday, Friday, and I think, you know, if we can get a handle on.

You know, showing them that they're going to be okay, telling them that they're going to be okay, and doing that repeatedly and checking in with them repeatedly, I think that's exceptionally helpful. It does take a lot of resources and, and holding, holding hands, but I think it's absolutely worth it.

[00:11:58] Dr. Lawrence Tong: You're just referring to patients who exhibit those. More extreme symptoms that you would see them

[00:12:02] Dr. Salvatore Pacella: No, no, I, I, I prophylactically do that for every single facelift patient or,

[00:12:08] Dr. Sam Jejurikar: see them every day of the week

[00:12:10] Dr. Salvatore Pacella: Yeah, I see them pretty much every day, you know, either myself or my nursing staff, you know,

[00:12:16] Dr. Sam Jejurikar: and they're okay coming in every single day.

[00:12:18] Dr. Salvatore Pacella: yeah, for the most part. And, uh, you know, by the end of the week, so let's say we do this on a Monday. By the time I've seen them on Wednesday, you know, they're, I think they're pretty much okay by what I'm telling them we, oh, if you feel, if you don't, if you're not feeling up to it, we could see again on Friday, check in with you before the weekend, or happy to see you tomorrow.

And I think just the willingness to get them through this is a, is a Big, big plus for them. So, um, I think it's helpful.

[00:12:48] Dr. Sam Rhee: What, uh, are there any warning signs or, or things that you identify is eight, like will as particular age, uh, be more likely to potentially have post plastic surgery, depression, you mentioned certain procedures, which might sort of tend to trip it off, like, like face type procedures. Are there any other things that, that might sort of make you think I really need to.

Um, be more aware in this particular situation of, of an issue potentially.

[00:13:19] Dr. Lawrence Tong: I think like what you had said, Sam, um, you had alluded to a lot of, you know, patient selections, speaking to them, getting to know them. So if, you know, if somebody comes in and thinks that some procedure is really going to change their life, I think that's, that's a warning sign. Somebody who has a history of, you know, body dysmorphia is probably, Higher risk, uh, for that, you know, patients who have cosmetic surgery are self selected to be conscious about their appearance.

So I think that maybe, you know, cosmetic surgery patients might have a higher likelihood of, um, you know, of having these, uh, symptoms, but it is, I think it is difficult, but I think that, you know, as you get experience speaking to a lot of patients, sometimes you can just tell that. This patient might not be able to handle a complication, you know, if it happens, or if the surgery isn't perfectly done, they might not handle it.

And you just have to be honest and just say, you know, maybe I, I'm not going to be able to help you the way that I want, uh, that you would want me to help you. Um, but it is, I think it's hard. Sometimes it just comes out of the blue, you know, people who you would never think would have this do, do have these symptoms.

I

[00:14:36] Dr. Sam Rhee: I've seen is if, if a patient has very poor communication with those around them, you know, I've, and I'm sure you've seen that patient's like, I don't want my husband to know, I don't want my friends to know, I don't want anyone to know. I want this to be a complete secret and hide it.

That to me, I always, I want to ask them, why is that? Why are you not owning this? Why are you not being, you know, disclosing this to others, especially those close to you? Not to everyone, but those close to you. Um, what is

[00:15:06] Dr. Lawrence Tong: just tell them that's not, that's not possible. How are you going to hide something from your husband that you live with?

[00:15:12] Dr. Sam Rhee: It is, I mean, the, I'm not saying it's, I'm not saying it's reasonable, but just that intention or that emotion that they have about it. To me, that's a warning sign that maybe they're not emotionally ready or maybe their expectations are not met. Realistic. As you said, how, how can you literally hide some of these types of procedures or the effects of some of these procedures?

[00:15:35] Dr. Sam Jejurikar: You know, we all, we all had a mentor, um, named Hack Newman, who, uh, none of our, uh, none of our listeners or very few of our listeners would know who that is, but all had a pretty big impact on us. And I remember. People would ask him, uh, how long it would take, um, you know, before they'd be recovered from their surgery, you know, the facelift, for instance, and he would sort of say, well, um, well, you'll be socially acceptable, um, in like three weeks.

And, and the thing is, is I think that's what I always will try to tell people is you're going to be socially acceptable after your facelift to go out in three ish, two or three weeks. But you're not going to look like you didn't have had surgery. Like people are going to know that you look different.

It's impossible for you to hide this unless you go to a third world nation where nobody knows you. You convert to a very traditional form of Islam where you're wearing like a full, you know, burqa and your face is covered, but it's impossible to hide this and you just need to get over it. Like, you know,

[00:16:34] Dr. Salvatore Pacella: my, uh, one of my friends and colleagues, Lou Buckey, out of Pennsylvania. He has a different way of saying this. He, he tells patients, um, you know, after three weeks you can go to your third favorite restaurant. And I think, I think, uh, that's really, you know, his point is that, you know, they're not going to remember if I say three weeks, five weeks, six weeks, but they'll remember the restaurant comment.

I thought that was brilliant. I mean, it's, uh, I've

[00:17:00] Dr. Sam Jejurikar: that's amazing.

[00:17:01] Dr. Salvatore Pacella: since I heard it.

[00:17:02] Dr. Sam Rhee: Oh, I'm going to steal that one for me for sure. Yeah,

[00:17:05] Dr. Sam Jejurikar: Yeah, me too. I love that.

[00:17:07] Dr. Sam Rhee: Um, some of the other suggestions from this article include trying to get patients back into their normal routine as, as. Fast as is reasonably possible in terms of eating, talking to people. They might, uh, they suggest other kind of foofier things like journaling, um, or deep breathing, which might help some people in terms of coping during the acute post op period. Ultimately, I think, As plastic surgeons for me, it's really about them placing their trust in me and having confidence that we're going to see this through. And as long as I feel, I feel like they had a good vision and goal to begin with. And that's really the hard part. I think as plastic surgeons is weeding out people whose plans or goals are not sort of in concert with mine, then, or what I can technically achieve, then You know, then generally things will, will go well.

It's, it's, uh, but it can be very tricky sometimes with some people.

[00:18:12] Dr. Lawrence Tong: Have, have any of you guys ever sent any of these patients to like other mental health care professionals?

[00:18:21] Dr. Sam Jejurikar: Other, are you calling us mental health care professionals? Like, like, yeah, no, no. I, I, I've never sent anyone to like a psychiatrist or a psychologist, but going back to what you were saying, Sam, in terms of doing things to try to get people back to their routine a little bit faster, I send kind of all of my patients, both body and facial ones, To, to try to, you know, to, to estheticians postoperatively for lymphatic massage, for instance, even for like face and neck lift patients, I find that lymphatic massage is helpful to get their swelling down faster.

Estheticians can talk to them about camouflage makeup, you know, cause I think once people can at least go to their third favorite restaurant afterwards, they see that there's a light at the end of the tunnel. And, um, and then the trust aspect that you're talking about is a lot easier. It's not, you know, they, they can actually.

Trust us with some sort of tangible evidence that they can trust us. So I do, I do that. And that usually helps quite a bit. And that's who I usually send almost all of my patients to.

[00:19:21] Dr. Sam Rhee: I think one of the things that I always try to keep in mind is, is that it takes a tremendous amount, it takes a leap of faith to say, I'm going to let this person take a knife and cut on my face or on my body. And in most circumstances, in every other circumstance in life, It either has to be a life threatening or a very serious circumstance, right?

You have a cancer, you have heart disease that, you know, blocked arteries, a tumor. Like, we are the only ones where someone will come to us and say, I don't like the way I look. I trust you to cut on me and make it better. And that takes a certain mindset, you could call it a crazy mindset, you could call it a leap of faith mindset, you could call it, but whatever it is, these people have decided that the benefit of doing something outweighs the risk, okay?

And so that is a huge responsibility that we have, but it also means that these are people that are also at risk for being upset afterwards for any reason, because if you take that leap of faith and you go for it for whatever reason, results, aren't what you expected. There's a lot of, you know, that, that it's a really rocky recovery.

You, you know, you look different than what you might've envisioned yourself to be, or even that the fact that you just look different period. Those are huge issues that these patients have to confront.

[00:20:49] Dr. Salvatore Pacella: Just to, um, to shift gears a little bit here, I want to ask you three a question. know, you're, you're doing these operations all the time. You're in your office, you're kind of in a zone, whatever. You ever just sit back during an operation and look to yourself and say, holy crap, I just peeled this entire person's face apart and now I'm about to put it back together.

Do you ever just like sit back and say, wow. Like it's rare that like, I feel that or notice that every once in a while, I just kind of sit back and say, Wow, I can't believe we just did that.

[00:21:26] Dr. Sam Rhee: Absolutely.

[00:21:27] Dr. Sam Jejurikar: that, I noticed that at the end of the case, yeah. Like when they're all done, I think about that.

[00:21:31] Dr. Sam Rhee: know. I, I absolutely. And it, um, And I

[00:21:34] Dr. Salvatore Pacella: cool feeling.

[00:21:35] Dr. Sam Rhee: I can't think that too long because then it's like, it's too overwhelming. I'm like, Oh shit, I better just keep moving here because if I just stop and dwell on it, it's, it's gonna, it's gonna freeze me up. Like anything, like if you're in the middle of something and you're in flow state, you can't stop and be like, Oh man, I am dunking this basketball.

Or I, you know, I'm hitting a frigging awesome shot, like in golf, like the more you, you have to almost like push. Conscious thought out and and stay in the unconscious and let that flow state take take you back over because you're right when I do That and it does happen. I'm like Yeah, I'll I'll freeze. I can't I can't think about that anyway Thank you very much gentlemen. That was an amazing conversation I really enjoyed that and I hope that that does benefit people and In terms of, uh, how they might be feeling after surgery and also to prepare for it a little bit and, and think about that. Um, as always, you can check out our website, uh, 3 Plastic Surgery Podcast, where you can get all our episodes.

We're on all the big podcast sites. And you can check out all of our, uh, our Instagram accounts. Dr. Lawrence Tong is at Yorkville Surgery. Dr. Sal Pacella is at San Diego Plastic Surgery, right? And, um, Surgeon, San Diego, uh, Plastic Surgeon. And Dr. Sam Jejurikar is at Sam Jejurikar. I did those all by, by memory, so I'm very proud of myself right now.

Uh,

[00:22:59] Dr. Lawrence Tong: Okay, well you got mine wrong, it's

[00:23:01] Dr. Sam Jejurikar: And, uh, and Dr. Rhees is at Burton Cosmetic.

[00:23:04] Dr. Sam Rhee: mine's at Burning Cosmetic. What is yours, Larry? What is it?

[00:23:07] Dr. Lawrence Tong: Yorkville Plastic Surgery. You, you were pretty close.

[00:23:09] Dr. Sam Rhee: Thank you very much. So until next time, thank you very much, gentlemen. Have a great day.