Speaker 1: Welcome to another episode of Plastic Surgery and Centered. I'm
Speaker 1: your host, as always, doctor Rider Raban, and I am
Speaker 1: excited about today's episode because we're going to tackle and
Speaker 1: talk about kind of a very important subject matter, which
Speaker 1: is body dysmorphia and the distinction between it and the
Speaker 1: regular normal desire to improve something. Because it's a sliding spectrum,
Speaker 1: and the word is thrown around very loosely. It's a
Speaker 1: real entity, a very concerning entity, an entity on the rise,
Speaker 1: but we have to define it and make sure that
Speaker 1: we don't mislabel people as having body dysmorphia when in
Speaker 1: reality they don't, and then identifying those that have it
Speaker 1: to make sure that we don't worsen their condition any rate.
Speaker 1: They always say that plastic surgeons, in order to be incredibly,
Speaker 1: incredibly successful and good, they need to be essentially psychologist,
Speaker 1: which is actually very true. I have no formal training
Speaker 1: in psychology, but I actually consider myself very very knowledgeable
Speaker 1: in the under the underbelly of the human psychologic condition.
Speaker 1: Because remember, at the end of the day, it is
Speaker 1: insecurities that drive much of what we do. And while
Speaker 1: that's absolutely okay, absolutely normal and absolutely treatable, there are instances,
Speaker 1: as in the instance of body dysmorphia, where we cannot
Speaker 1: correct them, we worsen their conditions, and we are actually
Speaker 1: adding fuel to the fire. So let's dive right in
Speaker 1: and let's talk about what's going on. Well, body dysmorphia
Speaker 1: has been around forever. It's basically an unrealistic it's an
Speaker 1: unrealistic preoccupation with a flaw. It has certain elements about
Speaker 1: it that make it very distinct. Number one, the flaw
Speaker 1: is usually very, very minor, almost I've had instances where
Speaker 1: you can't even see it or it doesn't even exist.
Speaker 1: It's compulsive, so in other words, it's repetitive. It's repetitive.
Speaker 1: It's repetitive. It's part of an OCD component of psychologic issues.
Speaker 1: There's constant comparison of well, look at this as compared
Speaker 1: to that look at me. I should be that there's
Speaker 1: there's my friend doesn't have it, look at so and
Speaker 1: so angela jo only doesn't have it, et cetera. And lastly,
Speaker 1: it's it's a psychologic issue. It's not a physical issue.
Speaker 1: There is no physical issue there. It's a process in
Speaker 1: the way we perceive our physicality. So it for sure
Speaker 1: is an issue. It's always been around, but it's a
Speaker 1: little bit on the rise. Why is it a little
Speaker 1: bit on the rise, Well because of social media. And
Speaker 1: what does social media have to do with body dysmorphia. Well,
Speaker 1: what it does is now we have young people whose
Speaker 1: minds and their and their psychology and their their sense
Speaker 1: of self is incredibly malleable, vulnerable and naive, seeing hundreds,
Speaker 1: if not thousands of images a day of people who
Speaker 1: not look good, because that in and of itself causes insecurity,
Speaker 1: but of people who don't even look like themselves. We
Speaker 1: keep going back to the same issue over and over again,
Speaker 1: which is this idea of comparing yourself to a filter,
Speaker 1: a morph and ai perfect jaw, perfect skin, perfect pecs,
Speaker 1: perfect nose, perfect brows, and now the idea of influencerism.
Speaker 1: This never really was present during the developmental phases of
Speaker 1: young adults in the past. So while body dysmorphia OCD,
Speaker 1: all these things existed. Is definitely on the rise, and
Speaker 1: now young adults can go and get plastic surgery, whereas
Speaker 1: many years in the past that was never an issue.
Speaker 1: So if you had body dysmorphia, you'd have to wait too,
Speaker 1: your grown adult to really do anything about it. Now
Speaker 1: you have sixteen year olds getting lip lifts and eighteen
Speaker 1: year olds getting rhinoplasts and liposuction and all kinds of
Speaker 1: things in a very very very very unscrupulous, dishonest landscape.
Speaker 1: And as much as I love plastic surgery and I
Speaker 1: love plastic surgeons and I love esthetic surgery, we are
Speaker 1: the wild wild West. And there is absolutely, unarguably tons
Speaker 1: of providers who will one hundred percent take advantage of
Speaker 1: dysmorphic people and deliver the so called procedure that's being
Speaker 1: requested and then sort of kick the can forward. Okay,
Speaker 1: so let's go over the red flags. These are the
Speaker 1: red flags. So there's two reasons why as a surgeon,
Speaker 1: I want to identify body dysmorphia. Body dysmorphia. The reason
Speaker 1: I want to identify this for two reasons. Number one, Selfishly,
Speaker 1: I want to not get stuck in this web because
Speaker 1: at the end of the day, because this is a
Speaker 1: psychologic condition or a perception condition, it's an unwinnable puzzle.
Speaker 1: In other words, there's nothing you can do surgically structurally
Speaker 1: that will alleviate or eliminate the problem and make this
Speaker 1: patient happy. That's the idea. Our goal is to make
Speaker 1: patients happy, and we do so by doing something surgical, structural,
Speaker 1: making something better, and therefore patients are happy. When a
Speaker 1: patient is unh I call it insatiable, unable to be
Speaker 1: made happy. It's a whin. It's an unwinnable or un
Speaker 1: unwinnable game. So what are the red flags? Number one
Speaker 1: is when a patient comes to me. And by the way,
Speaker 1: I can tell you literally every week, every week I
Speaker 1: can count the two to four patients that I see
Speaker 1: that fall in this category. And back up for a second.
Speaker 1: The second reason, of course, that we want to do this.
Speaker 1: The second reason we want to do this, of course,
Speaker 1: the selfish reason was I don't want to get stuck
Speaker 1: with this patient and then be they're miserable and they
Speaker 1: make us miserable. The second is we don't want to
Speaker 1: worsen their condition, because every time someone operates, or every
Speaker 1: time someone gives into this person's compulsion, they're worsening their condition.
Speaker 1: And because surgery is irreversible, they can push them further
Speaker 1: and further into a dark space and when reality, what
Speaker 1: they need is psychiatric care, medications, and therapy. So every
Speaker 1: week I see patients and every week. I know exactly,
Speaker 1: like right now in my mind as I was thinking
Speaker 1: about this episode, I can remember the two patients that
Speaker 1: I saw last week that fall into this spectrum. Remember
Speaker 1: it's a spectrum, and it's like a very it's a
Speaker 1: very difficult spectrum. Obviously they sort of classic beaded. The
Speaker 1: body dysmorphic disorder patients are easy, right, They're so easy
Speaker 1: to identify. And obviously the healthy patient who's normal is
Speaker 1: easy to identify. That's not the nuance. The nuances what
Speaker 1: about the person who's in the middle, who sounds like
Speaker 1: they're gonna be challenging but at the same time probably
Speaker 1: will be okay. If I didn't operate on every person
Speaker 1: that I was a little worried with, I probably do
Speaker 1: a third of my cases. It's just the truth. So
Speaker 1: what I do with every consult in addition to analyzing
Speaker 1: their anatomy looking at who they are, is I'm constantly
Speaker 1: taking data points of their psychologic readiness to figure out
Speaker 1: if I want to get involved in this because I'm
Speaker 1: like selling them a purse, I'm like cutting their hair,
Speaker 1: I'm like doing their makeup, I'm like taking care of
Speaker 1: their taxes. Once I operate on them, I marry them.
Speaker 1: I am forever bound to that person. It is literally
Speaker 1: like we had children together and I cannot escape them.
Speaker 1: You better damn well bet that I'm going to do
Speaker 1: everything in my power to try to flush out. Are
Speaker 1: you just kind of a nitpicky person or are you
Speaker 1: really a BDD person on the spectrum? So what are
Speaker 1: the things that I look for? First thing I look
Speaker 1: for is that the person has seen multiple consults. So
Speaker 1: I always ask, so is this your first consult? And
Speaker 1: when the patient's like, no, this is my ninth consult,
Speaker 1: ninth consult, ninth consult for this wrinkle that's right next
Speaker 1: to your nose. So the fact that they've seen nine
Speaker 1: people is a red flag. Yes, seeing zero, seeing one
Speaker 1: doctor is not ideal. A reasonable number of doctors two, three,
Speaker 1: maybe four because your condition is very complicated. But once
Speaker 1: you've seen nine doctors, there's a problem. There's a real,
Speaker 1: real problem. That's a red flag. The second your issue,
Speaker 1: the thing you're here for is so minor, so minute,
Speaker 1: so inconsequential that there's no way on earth anyone would
Speaker 1: be able to deliver it. So I have had patience
Speaker 1: come to me and they're dead serious, They're very very
Speaker 1: like sure of it. And they're like, hey, doc, do
Speaker 1: you see you see how there's a little bit of
Speaker 1: They don't even say the word little bit. You see
Speaker 1: this major irregularity or asymmetry in my lip? You see
Speaker 1: how the other side this and the other And I
Speaker 1: swear to God, I stare and I go no, I
Speaker 1: just don't see it. So right, there is a huge problem,
Speaker 1: like I can't fix something I can't see right, I
Speaker 1: don't see it. I can't fix it. Secondly, when the
Speaker 1: margin of error is so small, I don't want to
Speaker 1: be involved. Right if you people are always like listen,
Speaker 1: I just want my nose made just just just a
Speaker 1: little bit better. I want to have nothing to do
Speaker 1: with that nose. Whereas if you have a horrible nose,
Speaker 1: huge nose, I'll have everything to do with it every day. Well,
Speaker 1: I understand that knows is ten times more difficult than mine. No, no, no, no,
Speaker 1: that person has a million iterations of their nose. That
Speaker 1: it will make them happy. You have like zero point
Speaker 1: oh one percent probability that the thing that we'll do
Speaker 1: is right. What if I overdo it, you'll be unhappy.
Speaker 1: So I don't want to do anything that is so
Speaker 1: minor or I can't tell the fact that they're hyper
Speaker 1: focused on it and constantly keep pointing to it and
Speaker 1: showing you, and is a problem they when they bring
Speaker 1: in tons of photographs. I can tell immediately when I'm
Speaker 1: doing a consult we have virtual consults, or when I
Speaker 1: do in person consults and the patient brings a folder
Speaker 1: with them, not because they're prepared, not because that they're
Speaker 1: doing homework, because they bring a laptop and they start
Speaker 1: showing me images and diagrams and profiles and arrows and
Speaker 1: schematics and let me show you a power point. It's
Speaker 1: not it's a red flag. I am an incredibly thorough person,
Speaker 1: so trust me, I am all for it, and if
Speaker 1: I needed something to get done, I would be prepared.
Speaker 1: But I sure as hell won't bring fourteen diagrams and
Speaker 1: images of like a slight contour of my nose. That's
Speaker 1: a major concern. The words they use really matter, And
Speaker 1: one of the most common red flag words is this
Speaker 1: is ruining my life. What your droopy tip is ruining
Speaker 1: your life? Yeah, doctor Remont, I can't even leave the house. Honestly,
Speaker 1: It's like I'm having a hard time getting a job
Speaker 1: when your esthetic issue is ruining your life. You have
Speaker 1: a psychologic issue. Of course, noses make insecurities, It makes
Speaker 1: you harder to date, Saggy breasts makes you not want
Speaker 1: to maybe take your clothes off. I get all that,
Speaker 1: there's a normal amount of that, But when you are
Speaker 1: telling me that this problem, whatever medical problem you came
Speaker 1: in for, is ruining your life, we know it's a
Speaker 1: huge psychologic issue, not a physical problem. The last thing
Speaker 1: is multiple revisions. Hey, doctor Bond, this is my fourth,
Speaker 1: my sixth revision rhinoplasty. And then I look at the
Speaker 1: nose and it's like I'm here because the last four doctors.
Speaker 1: And then they start bad mouthing to doctors. We're terrible.
Speaker 1: You know they're horrible. And I research you and then
Speaker 1: love bombing you're the best. You're the only one that
Speaker 1: can fix me. I know you're the right person for me.
Speaker 1: I just pray you will take on my case. No, no, no, no,
Speaker 1: I want to have nothing to do with your case
Speaker 1: because there's no way on earth I'm going to be
Speaker 1: able to help you and I'm going to be able
Speaker 1: to get you to your destination. Okay, well, then, so
Speaker 1: if all that is red flags, what are you actually
Speaker 1: looking for? Because everyone's coming with an issue, everyone has
Speaker 1: an insecurity, Everyone something bothers them. Remember it's a spectrum,
Speaker 1: and what we're looking for is somebody that has a
Speaker 1: very very specific concern, right specific concern, very realistic expectation,
Speaker 1: and are emotionally stable. Hey doctor vroon, Hey, how's it going?
Speaker 1: So tell me what's bothering you? Well, you know, I
Speaker 1: got a big bump on my nose and my tip
Speaker 1: is a little droopy and fat. I just kind of
Speaker 1: want to make it a little bit better and cleaner,
Speaker 1: and yeah, I think it'll be good. You do know
Speaker 1: that it won't be perfectly straight. Yeah, yeah, of course.
Speaker 1: If it's better, just a little better than this is
Speaker 1: going to make me much happier. And what does your
Speaker 1: life partner say? They don't think I need it. They
Speaker 1: if they makes me happy, they're happy to do it.
Speaker 1: So that is a patient I'm here for every single day.
Speaker 1: What they're looking for. I can see what they're expecting
Speaker 1: is within reason, and they're not coming here because they're
Speaker 1: emotionally unstable. It's ruining their lives. Their life partner hates them,
Speaker 1: and they're about to get a divorce and I have
Speaker 1: to do this surgery. So those are very very very
Speaker 1: important psychologic distinctions that are important. The biggest concern today
Speaker 1: are the young adults. The reason I'm concerned about the
Speaker 1: young adults is they have now access to things they
Speaker 1: never had access to before, and they are the most
Speaker 1: vulnerable part of our society because their brains are not
Speaker 1: fully developed. And it's not a DIGGD young adult, it's
Speaker 1: just the truth. The frontal lobe and all the development
Speaker 1: and emotional stability and mistakes and all the errors that
Speaker 1: we make. Everything usually happens prior to twenty five. Trust me,
Speaker 1: there's a lot of stupid people after twenty five, but
Speaker 1: a lot of your vulnerability as a sense of self
Speaker 1: occurs earlier. So, as I mentioned, you got all these
Speaker 1: young adults historically just physiologically developmentally, are still vulnerable. Then
Speaker 1: you add some gasoline. That gasoline is all the social
Speaker 1: media images of like hot women, hot men, chiseled men,
Speaker 1: money cars, and then you you you add to that
Speaker 1: to that dys morphia, you add the social media. It
Speaker 1: was something else I was going to add to that,
Speaker 1: and I'm trying to remember what I was just thinking,
Speaker 1: and my brain just had an infar. You have young adults,
Speaker 1: the social media teens, and what was the last thing? Oh,
Speaker 1: I know now, yes, it just took a second. And
Speaker 1: then before so you had this person who's vulnerable, right
Speaker 1: then you add all these images makes them really insecure,
Speaker 1: and then you light the match. What's the match surgery?
Speaker 1: They go do something about it permanently. Before you were
Speaker 1: you had body dysmorphia and you were putting on makeup
Speaker 1: and you were Now you go, you literally go down
Speaker 1: the street to a strip mall and doctor Kavorkian nurse
Speaker 1: Jackie does something to you permanent or near permanent or whatever,
Speaker 1: and you act on that dysmorphia. And the notion that
Speaker 1: anyone gives a shit, or there's gonna be a watchdog
Speaker 1: or some surgeon or someone's gonna have some ethical moral
Speaker 1: grounds is zero. I'm sorry to tell you that. Yes,
Speaker 1: of course there are good doctors and good nurses and
Speaker 1: of course, but there are so many unscrupulous people that
Speaker 1: you walk in, they're barely making ends meet. Some young
Speaker 1: person comes in and says, oh, do you see this
Speaker 1: that the other like, oh, of course, and then they
Speaker 1: literally light the match, and then what happens poof this person,
Speaker 1: this young adult who is already vulnerable and mostly unstable,
Speaker 1: not in the right mind, does something surgical. In no
Speaker 1: universe does that fix their problem, because their problem was
Speaker 1: psychologic and it always makes things worse. Yeah, it makes
Speaker 1: them better for a little while. Oh oh my god,
Speaker 1: I feel better, and then starts the obsessions, press, the perseverations,
Speaker 1: the picking, the OCD, and then whatever they did filler, rhinoplast,
Speaker 1: the pinning, live destruction, blah blah blah just gets worse
Speaker 1: and worse and worse, and then now they're so unhappy,
Speaker 1: and then in many instances it leads to major things
Speaker 1: like drug addiction, depression, suicide, et cetera. So the real
Speaker 1: issue that we have is we have this epidemic going
Speaker 1: on where social media, young adults, and cosmetic surgery all collide.
Speaker 1: And the truth is that it really falls on the gatekeeper, right,
Speaker 1: it falls on the gatekeeper. So who's the gatekeeper? It's us.
Speaker 1: So the vulnerable people are psychologically born vulnerable. The images
Speaker 1: fall on social media. But you know who's gonna who's
Speaker 1: gonna who's gonna patrol the social media. Who's gonna be like, oh,
Speaker 1: you can't put this image on it's filtered. Oh, like
Speaker 1: that's what they should be doing. I think in other
Speaker 1: countries they're starting to do that, like filtered images sho
Speaker 1: gonna be allowed? But whatever, So who's the ultimate gatekeeper?
Speaker 1: So the guy comes to me, He's like, hey, doctor,
Speaker 1: I want to do my nose. Mm no, how about no?
Speaker 1: So that's the gatekeeper. Ultimately, the gatekeeper is the person
Speaker 1: who holds the keys to the kingdom. Right that they think.
Speaker 1: And so the problem is that you can only you know,
Speaker 1: there's only a handful of us that are still ethical
Speaker 1: and willing to help the patient. So I try. So
Speaker 1: what do I do? How do I walk them off
Speaker 1: the ledge? If I feel that the person is reasonable
Speaker 1: and can be talked to, I will actually take the
Speaker 1: full duration of the console, bring the mirror, take some photos,
Speaker 1: draw some pictures, and try to walk them off the ledge.
Speaker 1: Explain to them why I don't see the asymmetry. Explain
Speaker 1: to them that if I try to fix the asymmetry,
Speaker 1: I'll create a new asymmetry. Explain to them that the
Speaker 1: anatomy is such that if I cut here, then the
Speaker 1: blood supply. I'll really do my very best to hope
Speaker 1: that I can unlock some of this dysmorphia with academics, education,
Speaker 1: and real reality. Believe it or not, I have been
Speaker 1: successful many times because I am in a very unique position.
Speaker 1: I am not a therapist, and I am not a
Speaker 1: family member or a loved one. I am a doctor
Speaker 1: who makes money from doing it. So when I am
Speaker 1: telling them, and I'm telling them why they shouldn't do
Speaker 1: it in a weird way, it's really powerful. It just
Speaker 1: takes time, and you know, in a busy schedule, the
Speaker 1: guy comes in or gal comes in immediately within ten minutes,
Speaker 1: you're like, oh, this person's not all here, and it's
Speaker 1: just easier to just be like, I can't help you
Speaker 1: and then move on. But you have a very unique
Speaker 1: window where you'll probably never get it and that person
Speaker 1: will never be sitting in that seat again, So I
Speaker 1: really try to help. I'm not gonna not make them
Speaker 1: body dysmorphic, right, I can't change their underlying psychologic condition
Speaker 1: in a twenty minute consult by the excuting in a
Speaker 1: one hour consult. They need, they need therapy, and they
Speaker 1: need medications. Despite everyone's ridiculous statements, I'm not gonna get
Speaker 1: them in a one hour console. When they come in
Speaker 1: to do a rhinoplasty, to go see a therapist. Hey,
Speaker 1: you know, I don't think your nose needs it. And
Speaker 1: by the way, maybe you might want to see a therapist. Yeah, okay,
Speaker 1: that's gonna go Overwhell. That's never gonna go Overwhell. I'm
Speaker 1: sorry to break it to you. They're not gonna be like, oh, thanks,
Speaker 1: doctor Rebond, thanks for suggesting a psychologist and getting on
Speaker 1: some OCD medications. But what I can do is, in
Speaker 1: regard to that particular battle, that particular issue, I can
Speaker 1: help slowly walk them back. But one thing I can
Speaker 1: do for you're sure is not operate on them. I
Speaker 1: can one hundred percent not make matters worse. So I
Speaker 1: do that, and I say, listen, I'm so sorry. I
Speaker 1: just don't think you can fix this, and I'm not
Speaker 1: the right and I and I suggest you be careful. Now.
Speaker 1: If they're really far gone and they're not going to
Speaker 1: listen to anything I say, then of course I'm not
Speaker 1: gonna sit there and educate them when they're just looking
Speaker 1: at me like I'm crazy. But I certainly again won't
Speaker 1: operate on them. And that's ultimately what I think is
Speaker 1: our industry responsibility. I don't think you can change the
Speaker 1: under genetics of some people who have BDD. I don't
Speaker 1: think that's gonna happen. I don't think it's gonna be
Speaker 1: eons before we get social media to take any responsibility,
Speaker 1: and I don't think that'll ever happen. So at the
Speaker 1: end of the day, the only place that we can
Speaker 1: capture these people is at the gates of the providers.
Speaker 1: Whether or not that's gonna happen to each provider on
Speaker 1: their own, they're gonna have to sort of sit with
Speaker 1: their own self and decide whether what their moral ethical
Speaker 1: compasses and how they want to make a living. But
Speaker 1: for me, it's pretty straightforward and pretty easy. I don't
Speaker 1: want to make matters worse. And again, as I said,
Speaker 1: from a selfish standpoint, I want to avoid these things
Speaker 1: because it only we only get entangled in this very
Speaker 1: very unwinnable, difficult situation. So anyways, that's my sort of
Speaker 1: overall take on body dysmorphia. I do think the word
Speaker 1: is thrown out left, right and center. Oh my god,
Speaker 1: did you see you know your patient has body myosmorphia?
Speaker 1: Why she got a no job and a breast augmentation?
Speaker 1: And then pined your ears. She doesn't love herself. She's
Speaker 1: definitely no. She had huge ears, she had no breast issue,
Speaker 1: and she had a big nose, very finite issues. She's
Speaker 1: totally normal, loves herself, super confident now, her family loves her,
Speaker 1: and was very realistic. Her breast is still a l
Speaker 1: asymmetric and one of her ears sticks out, and she's
Speaker 1: happy as a clam. So we have to be very
Speaker 1: careful as we use these labels, and obviously in the
Speaker 1: instances where it's real. I think as a total we
Speaker 1: have a responsibility any rate that's a rap. As always,
Speaker 1: I hope you enjoy the show. I hope that you
Speaker 1: find it helpful. I always ask two favors. I ask
Speaker 1: favor number one. Please go write a nice review. It
Speaker 1: makes a huge difference to the team. As a matter
Speaker 1: of fact, just pause it right now. It takes two seconds.
Speaker 1: You're gonna I'll go later, I'll do it. You're not
Speaker 1: gonna do it later. Let's be honest. Just pause this,
Speaker 1: go write the review, come back, hit click. It makes
Speaker 1: everyone so happy. The second thing is if you can
Speaker 1: share this with two people, you know, just two people forward, Hey,
Speaker 1: check out this episode, because at the end of the day.
Speaker 1: So many people only realize after they've done something foolish
Speaker 1: that they wish they had done a little more homework,
Speaker 1: and so we always try to get ahead of it together.
Speaker 1: All right, guys, that's a rap. I will see you
Speaker 1: guys next week. Have a wonderful week. Doctor Rabon on
Speaker 1: plastic surgery on censored