The psychology of surgery

The psychology of surgery – empowering patients to choose safer cosmetic surgery


A Q&A with Dr Eileen Bradbury 


Dr Eileen Bradbury is a consultant psychologist with extensive clinical and research experience in the area of Health Psychology. She has worked with surgeons, physicians and other health professionals. She is an affiliate member of BAPRAS and an honorary member of BAAPS. Here she discusses how anyone considering cosmetic surgery can make a safer, more informed choice.

What is the issue? 
I speak with someone every week who has experienced poor cosmetic surgery. When I hear about things going wrong, I am always struck by how little information that person felt a right to ask of their surgeon. There is an enormous need to educate people who have decided to have surgery, to ensure they can do so in a safe and considered way. 

How do I choose a surgeon or clinic?
It is not uncommon to get caught up in the sales process and professional-looking clinics, rather than stopping to ask questions or consider the decision fully. The criteria on which many people base their agreement to go ahead is sometimes founded on an impressive sales team and pressure to make a decision rather than receiving all the right information in terms of expectations, risk, competency of surgeon and aftercare provision. 

Many people just accept the person treating them is a qualified surgeon – with letters after their name that they don’t understand – and assume they know what they are doing. It is important to understand who a suitably qualified surgeon is and if they are the right person to operate on you. 

I always advise people thinking about cosmetic surgery to first speak to their GP and then go through an association like BAPRAS to find a professional member they can trust in their area. The clinics spend lots of money on good websites and publicity but that doesn’t mean they are the most appropriate for you. 

Am I entitled to ask questions of my plastic surgeon?
You need to understand your own expectations to be able to turn up with questions that make clear what you expect or hope for. A decent surgeon will have a long discussion and answer any questions fully and then give you all the time you want (at least two weeks) to think and come back with any other questions before you commit to the surgery. There can sometimes be a pressure to have it done quickly – I recently discussed this with one patient who was told that the clinic would knock off £200 if she had the operation the following week. If you feel pressured into making a decision, walk away.

Sometimes people are made to feel that they should not ask questions, that doctor knows best. It is important to feel empowered to ask questions on everything, from the qualifications and experience of the surgeon to the aftercare you will receive. It is not just about knowing what to ask, it is also important to recognise when you are not able to get an answer. 

What can be the impact of poor surgery?
Psychological injury can be really extreme following surgery. Anyone experiencing poor surgery may feel embarrassed and ashamed to have paid money and got a bad result – they feel distraught. It is vital to understand the possible outcomes of the surgery (the changes you can expect to see), as well as the risks. You also need to have confidence your surgeon is appropriately qualified and, between you, come to an understanding about what can and cannot be achieved.

What consideration should I make to my psychological need?
I don’t think everyone should be psychologically screened before surgery but everyone carrying out surgery should have an understanding of psychological issues that may be affecting their patient, and if the treatment is psychologically appropriate. Essentially, any cosmetic treatment is being conducted for psychological reasons, as it addresses the way you feel. Some people may feel that a cosmetic treatment will help them through a difficult period in their personal life for example, but you need to really consider if this is the right way to deal with that issue and if this is the change you really want. Your surgeon should be able to discuss with you if the treatment is appropriate and will meet your needs. However, before you even meet your surgeon, it is important you have taken time to consider the surgery and the change you want to see. You should also prepare yourself that a responsible surgeon may suggest a psychological review before committing to carrying out a procedure.