In my job I am constantly having to battle against prejudices and preconceived ideas about cosmetic surgery.
Unfortunately we have it woven into the fabric of our society that cosmetic surgery is all about vanity and creating unnatural caricatures of previously beautiful people. This has led to the perception that all cosmetic surgery is unnecessary and so is a choice for the patient as to whether they have it or not. It is on these grounds that I frequently hear that patients have to take holiday or unpaid leave from their jobs as their employers will not allow them to take sick leave.
I saw someone this morning who approached their HR Department and asked how long they would be allowed off after surgery and the HR Department immediately asked if it is cosmetic, in which case no time would be allowed. I think this is unfair and should not be allowed to happen.
I tell all my patients that I am very happy to provide a sick note and I simply write on the sick note: Surgery, as the employer does not need to know the details of the patient’s medical condition since this is confidential. I think it is wrong for an employer to make a judgement on whether they are allowing a patient to have sick leave based on the reason for the sick leave. I do not know if it is legal, but I certainly do not think it is ethical for an employer to have a blanket policy that any cosmetic surgery would not qualify a patient to take sick leave. What are the grounds for this decision? Are the grounds that the surgery is not necessary and is the patient’s choice? Well in that case would a hernia repair, hip replacement, cataract surgery, surgery for gastric reflux or haemorrhoids necessary? I could go on.
Many operations, in fact, most operations that are the patient’s choice and they do not need to be performed but the reason for performing them is to improve quality of life and yet all of the above I suspect would be deemed perfectly appropriate for the patient to have sick leave after them.
So what makes cosmetic surgery different?
It can have a significant effect on quality of life and indeed studies have shown that the impact of cosmetic surgery on quality of life is more significant than most, if not all of the procedures above. So why do we not think it is as worthy as having your haemorrhoids fixed or your hip replaced?
I think it is because cosmetic surgery addresses psychological wellbeing rather than physical wellbeing. This is not always the case as there are often functional and physical improvements following cosmetic surgery.
Operations such as breast reduction and tummy tuck spring to mind. It is true to say a large part of the improvements the patient experiences following cosmetic surgery is in their psychological wellbeing and self-esteem.
We as a society do not value this. We do not treat psychological wellbeing with the same importance as physical wellbeing. If a work colleague goes off with stress or depression we do not know how to handle this and they are often thought to be shirking or weak, whereas if a colleague goes off with a painful back or a kidney infection we only have sympathy for them.
In today’s society psychological and mental health problems are an epidemic.
They are achieving a lot of exposure with the Royals and the Government backing campaigns to increase awareness and encourage people to speak up, but we are still a long way away from treating mental problems on the same level as physical problems. The particularly distressing fact about mental health is that it is a major cause of morbidity and mortality to our young people and because of the stigma attached to it people suffer in silence. When asked: How are you? You would probably have no problem saying: I’m fine but I have got a bit of back ache, or I have got terrible indigestion but you probably would not be quite so comfortable saying: I’m okay but I am feeling a bit low today, or: I cannot seem to stop crying.
I completely understand the public perception of cosmetic surgery. I see it myself on television and in the media. When you are only fed images of pumped up lips and enormous buttocks you would be forgiven for thinking that these people have no right to go off sick following this sort of surgery. However, these are not the people who are having surgery on a daily basis. Hospitals throughout the land are performing cosmetic surgery and changing people’s lives, not by inflating their lips or putting implants in their buttocks but by making subtle adjustments to the bump in their nose, by giving fullness back into their empty breasts or by removing the spare tyre from their tummy that they have had since having three kids.
Most people do not want to look like a caricature of themselves. They just want to look like themselves. I know we have all seen the woman who spent thousands of pounds wanting to look like Barbie and the man who wants to look like Ken. I am sure the media love these stories but the people I see in clinic are happy being who they are but they are unhappy about something, whether it be their tummy, their breasts, their nose, their ears. They just want to feel better about some part of their body.
The fact is that when it comes to improving symptoms and looking at the quality of life of patients before and after surgery, you can rank cosmetic surgery right at the top and it does as well if not better than any other operation, particularly when you make adjustments for age because cosmetic surgery is often performed in young people who have many years to enjoy the improved quality of life.
I do not think we are going to change the public perception overnight and employers will continue to look down on patients who go off sick following cosmetic surgery. I guess that will lead patients to simply not tell the employer what they are having done because after all, it is none of their business anyway. They can just say: Women’s problems.
I wish I could change the way these things are perceived and bring them on an equal footing with functional surgery and I will continue to try.