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Psychosomatic Medicine 12:345-355 (1950)
© 1950 American Psychosomatic Society

Psychodynamic and Esthetic Motivations for Plastic Surgery

GERALD HILL M.D.1 and A. GILBERT SILVER M.D., F.A.C.S.2

1 Neuropsychiatric Institute, Ann Arbor, Michigan
2 New York City

In this study of 48 consecutive patients in private practice who voluntarily underwent plastic surgery of either the nose, face, or breast, evaluations of the motivational dynamics are presented based on careful psychiatric interviews.

In general the motivation was almost always overdetermined and usually followed prolonged frustration in significant interpersonal relationships. Almost without exception the final decision was made after some acute event had altered the previously adequate ego defenses. Most often actual events in adolescence involving rejection because of some disfigurement were elaborated in fantasy to involve preadolescent and preoedipal problems. In few cases fantasy alone responded to instinctual or structural conflicts, focusing upon some aspect of the body image.

Our case material is arbitrarily divided into adolescence and early unmarried adulthood, young and middle-aged married individuals, and late middle life and early senility. Illustrative cases are presented of specific dynamic motivations in each division.

The value of plastic surgery in carefully selected cases as an adjunct to psychotherapy is indicated. Several cases are described in which the surgery was esthetically successful but in which the emotional response was either negative or revealed greater intrapsychic conflict.

Since it was the exception to find the wish for cosmetic surgery a wholly rational response to realistic ugliness, the actual consultation of the plastic surgeon by the patient, for reasons other than trauma, should be considered as an overt symptom of neurosis. This consultation of the surgeon should be sharply differentiated in its significance as a symptom from the mere wish to look better. As a symptom of neurosis its import can vary from negligable to critical. In our series this symptom was presented by only one psychotic individual.

In general if the psychic energy bound to the unpleasing aspect of the body image has been of little defensive value to the ego and has given little secondary gain, the prognosis for the emotional response to the surgery is favorable.

Surgical problems in the esthetics of rhinoplasty are considered.






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Copyright © 1950 by the American Psychosomatic Society