Perfectionism as a contraindication for cosmetic surgery: a reply to Clodius (2007)

Abstract

Millions of individuals undergo cosmetic surgery every year [1]. However, little is known about the extent to which, or the ways in which, personality traits or selfpresentational styles influence cosmetic surgery. Therefore, we welcome Clodius’ commentary and encourage further dialogue on the role of personality processes in cosmetic surgery. We have contributed to this dialogue by asserting that perfectionism is a personality trait likely to influence the entire cosmetic surgery process, from interest in, to satisfaction with, cosmetic surgery [8, 12–14]. Although we applaud Josef [9] and Clodius [2] for highlighting the importance of personality processes in post-surgical outcomes, a central issue with their interesting typology is whether it aids cosmetic surgeons in identifying and in understanding “hyper-” or “para-aesthetic” patients before surgery. In our view, the Josef–Clodius typology appears best suited to helping cosmetic surgeons categorize dissatisfied patients after surgery. In contrast to Clodius, we now outline a model describing both identifiable features of perfectionism and mechanisms through which perfectionism creates surgical dissatisfaction (SD). By so doing, we intend to explain why, as asserted in our prior work [12], perfectionism represents a contraindication for cosmetic surgery. Before describing this model, evidence linking perfectionism to cosmetic surgery is reviewed. Cosmetic surgery patients are viewed by others as being perfectionistic [3]. Case histories also suggest that perfectionism may fuel an insatiable appetite for cosmetic surgery [4], and both surgeons [11] and psychologists [8] have nominated perfectionism as a contraindication for cosmetic surgery. Furthermore, empirical research suggests that perfectionism is related to contemplating cosmetic surgery [13, 14] and that perfectionism is elevated among female cosmetic surgery patients compared to carefully matched controls [12]. Overall, this literature suggests that perfectionism is relevant to understanding the process of cosmetic surgery and that perfectionism may influence SD. We now outline a model expressing the manner in which we believe perfectionism is likely to produce SD. Our model (see Fig. 1) proposes that perfectionism engenders SD via multiple pathways. Prior studies [12–14] using the Hewitt–Flett multidimensional perfectionism model [6, 7] indicate that three perfectionism dimensions are particularly relevant to cosmetic surgery: socially prescribed perfectionism (i.e., viewing other people as demanding perfection of oneself), perfectionistic selfpresentation (i.e., promoting a public image of perfection), and nondisplay of imperfection (i.e., concern over behavioral displays of imperfection around other people). In our model, perfectionism is understood as a distressing preoccupation with perfection as reflected in high levels of one or more of the above perfectionism dimensions. Perfectionism is not only believed to exert a direct influence on SD, it is also hypothesized to bring about SD through interpersonal hypersensitivity (see dotted black Eur J Plast Surg (2007) 29:357–359 DOI 10.1007/s00238-007-0111-4