The New York Post released an article titled, “The most dramatic body transformations of 2017,” highlighting cases from massive weight loss to truly bizarre transformations requested by patients. “Dramatic” is an interesting term to describe these transformations, as dramatic can be used in both and positive and negative manner to describe them. Massive weight loss is dramatic in the physical sense and in a positive sense; not only did the patients succeed to vastly lowering their weight, but their overall health – specifically mental – also saw dramatic improvement. Perhaps on the other side of the spectrum, some of the transformations were also dramatic physically – and potentially dramatic negatively in a host of ways.
Plastic surgeons are used to dramatic bodily changes and use a variety of tools to affect these changes per their patients’ wishes. In the latest episode of No Spin Live, board certified plastic surgeons discuss the Post’s article and what it means in the national conversation about body transformation.
Body Transformation + The Media = Sensationalism
The point of such articles is usually fairly obvious: capitalizing on sensationalism. Even with the positives of massive weight loss procedures and outcomes, the article points to the absurd end of examples – notably a man who lost over 600 pounds, but whom is still 400 pounds overweight. While this is in deed an example of massive weight loss, it isn’t the kind typically seen in the offices of physicians in the field. Instead of looking to speak broadly about the idea of massive weight loss and the corrective aesthetic and function-improving procedures following success, the article rather points to the outliers – those stories steeped in sensationalism.
“The bottom-line is, the media loves sensationalism,” shares board certified plastic surgeon Dr. Jason Pozner. “A guy who goes from 1200 pounds to 600 pounds, he’s still 400 pounds overweight – that’s sensationalism. A lot of these stories were re-imaginations of the same old thing that we’ve heard for years and years and years.”
The conundrum for aesthetic plastic surgeons and the media is sensationalism defines the cases rather than the median. Outliers provide communal understanding of aesthetic surgery, which significantly hampers perception as the vast majority of cases seen by plastic surgeons are patients looking to achieve something that places them in the middle of what’s normal and natural, not on the edges.
“What do we do as plastic surgeons? We make things bigger, we make things tighter, we make things smaller,” says Pozner. “For us, a lot of these transformations are pretty much what we see on a daily basis.”
Dramatic and Natural Transformation – Massive Weight Loss
Since it was thoroughly discussed in the article, massive weight loss patients and plastic surgery are very common. The plastic surgeon is not responsible for the overall weight loss; this part of the process is managed either through a strict diet and exercise regimen and/or surgical weight loss methods. Gastric bands, gastric bypass, etc… These are procedures and regimens performed by family physicians, nutritionists and weight loss surgeons to help patients achieve their weight goals.
When that goal has been met, then enter plastic surgeons to finalize the transformation. While a 1200 pound man going to 600 certainly will create conditions of extreme excess and loose skin, even patients losing a few hundred will see similar negative changes. “I see a lot of patients who’ve had weight loss surgery,” begins board certified plastic surgeon Dr. Charles Messa. “They were 3-400 pounds over weight, had a gastric sleeve or gastric bypass, then they come in with all of this redundant skin that needs to be removed. That’s a very common scenario for most plastic surgery practices.”
Lower body lifts and body contouring procedures are aimed at these patients who wear diet and exercise-resistant excess skin. The only way to treat this issue is via surgery excision, or removing the skin and making sure that the contour that follows is aesthetically pleasing and accurate to a patient’s wishes. These types of procedures are very common in plastic surgery offices, with some devoting significant parts of their practices to the effort. For these patients, having their journey completed by a final recontouring of their bodies is indeed dramatic and transformative. Many plastic surgeons will say that these kinds of procedures – helping patients achieve their final goals to be both healthy and normal – is the reason they got into the field in the first place.
The Weird, One of Society’s Current Fixations
A patient asking to have excess skin removed after their multi-year weight loss journey is quite different than a patient asking to look like somebody else. Body modifications have been around for millennia, things such as gauged ears, split tongues, implanted brows, and artificial cranial deformation. These modifications seem and can certainly be extreme, but, typically, the individual is preserved and only “enhanced.”
The kinds of body transformations that involve plastic surgeons in this context are somewhat different. These patients are looking to dramatically, and sometimes permanently, change their looks to appear as someone else, change gender identity, or, in the most extreme of cases, perhaps even to look unnaturally human. The best of plastic surgeons see these things as more than wanting to look better and younger, but to look different entirely. Because the request is defiant of all sorts of social and natural norms, it opens many doors as to what the patient is actually attempting to accomplish – and whether or not the risks involved with surgery merit intervention.
“Some of these other stories they’re talking about – where they’re transforming their bodies and faces to look like a different person – I think that’s where we as plastic surgeons have to draw the line,” shares Messa. “A lot of these patients are having these surgeries because of self-esteem issues. Cases where patients are having multiple procedures, then you have start considering the fact that there may be some kind of body dysmorphia going on. We really have to be careful about who we’re operating on, what their ultimate goals are – and can we make them happy. Or is there something more internally that’s really bothering them that we’re not going to be able to fix?”
Dr. Messa shares a seemingly forgotten truth about plastic surgeons – they are still, and foremost, physicians looking to help patients. When a would-be patient comes to a consultation and describes that they’re unhappy with their looks and what to look like someone else entirely, this is problematic for a physician. The businessman who comes in looking for a neck lift at 55 isn’t trying to alter who he is, he’d just like to get back a little of his youth and “trim up” who he is later in life. This is the normal for plastic surgeons, patients who just want to enhance or reset who they are and do some touch-ups where time hasn’t been so kind. Clearly, a desire to fundamentally change you appearance is above and beyond this request.
When questions regarding mental state arise, this is a warning sign to the best plastic surgeons because of their basic training as physician’s looking to help others. If someone is young and making large, often irreversible decisions, perhaps that patient is better off seeing a counselor before their plastic surgeon consultation. This is already done in many offices who offer transgender procedures, such as removing implants in a woman transition to a man or adding implants to a man transitioning to a woman. The surgeons who perform these procedures make sure that patient has undergone hormone therapy, as well as extensive counseling to verify this is what they want to do.
“They’re asking for things that are so outside of what’s normal, and there’s so much education sometimes that I have to do,” shares board certified plastic surgeon Dr. John Diaz. “I explain to patients, ‘Listen, I’m a plastic surgeon, but at the end of the day I’m still a doctor. My goal is to make things look natural and make things look aesthetically pleasing.’ [Some of these patients’ goals] are not going to look aesthetically pleasing; it’s going to look abnormal. As Dr. Messa said, we have to draw the line there.”