Warning Signs of Narcissism and Appearance Obsession

Most plastic surgeons develop a sixth sense when talking to new patients. We size up the body language, how comfortable patients seem, how willing they are to discuss their hopes and fears and how realistic their expectations are. Certain key phrases are giveaways that these patients might be better served by a competent therapist than a surgeon.

"I need this done. I have to have this procedure."

Whenever I hear that, I gently explain that cosmetic surgery is called elective for a reason. It's not necessary from a medical standpoint. No one will die without this procedure.

At that point, I'm looking for more cues that a patient might be suffering from depression. Few come out and admit that they are. They might not list antidepressants on their medical form if they don't want me to know. So I'll try to steer our conversation toward acknowledging that depression might be an issue, and I make it clear that I won't operate on them unless they see a therapist first.

"I need a guarantee that I'm going to look like this."

I'll explain that cosmetic surgery (and medicine in general, for that matter) is not an exact science and that everybody is different. Some people heal well after complicated surgery, and some don't. If patients still demand a guarantee, no matter what the procedure, then I'll just say that I can't help them. 

"I only want a correction of 1.2 millimeters."

Anyone who has measured any part of their body down to a fraction may be suffering from body dysmorphic disorder, which is a fixation on perceived "deformities" that in reality are absolutely normal. Body dysmorphic disorder can become dangerous if not treated with therapy, as sufferers can continue to demand surgery and other procedures from less-than-ethical surgeons or physicians, to the point where the damage cannot be undone. 

"I want to look young again, like when I was a teenager."

Having unrealistic expectations of what surgery can do to make you look younger is a typical warning sign of narcissism. It is also one of the most common comments I hear from patients who expect to erase decades from their appearance. Not only is this impossible, it is a warning sign to me that there are deep-seated psychological issues to address. Sure, we all want to turn back the clock a little, but expecting to look like a college freshman when your granddaughter is a college freshman is not going to happen!

I also notice this right away with someone who immediately talks about extremes, such as an especially petite woman who wants incredibly large breasts. She's likely to already have a high standard of self-esteem and knows she already looks good. She just wants to do something to be noticed, not for her, but for an external quality. That's crossing over the line into narcissistic thinking.

How to nurture healthy vanity