Self-esteem and Body Image - A growing social and community issue

Whilst it is difficult to estimate the percentage of Australians who undergo cosmetic procedures each year, as there is no obligation for health practitioners to share their figures, there is unanimity that Australians continue to spend up on cosmetic procedures¹. An annual spend on minimally or non-invasive cosmetic procedures topped the $1 billion mark for the first time in 2016, which is more than 40% higher, per capita, than in the United States².

Since achieving this concerning milestone, scantly efforts have been reported to protect the mental health of those seeking body-altering cosmetic procedures. The literature asserts that a significant number of patients who request cosmetic procedures also struggle with mental health problems associated to an increased psychological vulnerability to appearance concerns³. An independent review carried out by AHPRA and the Medical Board in August this year⁴ advised the guidelines about mental health evaluation ought to be “strengthened” and highlighted the relevance of healthcare professionals receiving further training to assess psychiatric disorders better.

If health practitioners who perform these treatments could recognise these issues early on, they would be in a better position to protect these patients and advise those for whom a body-altering medical treatment may not be the best clinical intervention⁵.

Key elements of psychological vulnerability to appearance concerns

• Low self esteem
• Heavy reliance on appearance for self-worth
• Lower mood
• Higher levels of perfectionism
• Greater internalization (buy-in at a personal level) to appearance ideals
• Greater susceptibility to messages in social media & advertising
• The Beauty Myths
• Greater susceptibility to pressure from peers, family, partners
• The tendency to engage frequently in unfavourable comparisons with others and to choose unrealistic targets for comparison (e.g., celebrities, supermodels, rather than peers)

Patient Assessment Tools (PATs)

Evidence based framework for assessment & follow-up designed to:

• Enhance assessment by facilitating a semi-structured interview between surgeon & prospective patient
• Inform appropriate patient management 
• Facilitate follow-up
• Provide a common framework for audit & research
• The PAT is about managing patients more effectively - not excluding them:
  • Majority of patients need no extra intervention
  • Most of those that do can be managed with extra    sessions, a longer cooling off period or information by the clinic
  • A small minority will benefit from psychological assessment/ intervention
  • Of these, a small number may not proceed to surgery/treatment

Benefits of rolling out the PATs

• Using the PAT routinely will help surgeons/practitioners to:
  • Identify psychological vulnerability and manage it appropriately
  • Meet the Medical Board of Australia Guidelines & key AHPRA recommendations re training & assessment
  • Enhance cosmetic practice by better meeting patients’ needs (Do No Harm)
  • Demonstrate duty of care (offering protection to surgeons & practitioners)
  • Demonstrate commitment to social responsibility agenda 

Challenges of rolling out the PATs

• Lack of regulation to date
  • Reluctance of professional bodies to ‘burden their members’
  • Reluctance of individuals to self-police
    • Reduce profits? Lose patients to competition? 
    • Lack of understanding re imperative to tackle BI
    • A fragmented industry; cooperation lacking
• The intention-behaviour gap 
  • Training
    • Investment of time by surgeons, clinic staff
    • Face-to-face is most effective in facilitating change
• Behaviour change is hard!
  • Road shows? (Hang-over from the pandemic)
  • Mingle events (surgeons/practitioners/nurses/psychologists
  • Facilitating access to support & advice to support change process

Relevant MIPS resources

• Telehealth: Injecting risk into cosmetic practice
• AHPRA commissions review into cosmetic surgery
• Major review of cosmetic surgery industry announced
• Botox lands doctor before committee hearing
• Do you undertake surgical placement of dental implants?
• Raising standards of clinical care and decision-making

¹ Sharp, G., Rumsey, N.  (2022) What’s the connection between cosmetic procedures and mental health? The Conversation.

²Australia's spend on cosmetic treatment tops $1 billion (2016) Cosmetic Physicians College of Australasia.

³Auer, D. (2020). Understanding body image from a psychosocial stance: how this connects with patients requesting cosmetic procedures. Journal of Aesthetic Nursing, 9(3), 128-131.

⁴Independent review of the regulation of medical practitioners who perform cosmetic surgery (2022). AHPRA.

⁵Maisel, A., Waldman, A., Poon, E., & Alam, M. (2020). Types of cosmetic procedures requested by different types of patients and the reasons for these preferences. Dermatologic Surgery, 46(12), 1728-1732.