The genesis of this book was strongly influenced by the work of Milton Edgerton, who wrote the Foreword. Any book on the psychology of plastic surgery would be neither credible nor complete without making clear his many contributions to the field.

Edgerton cultivated his interest in, and knowledge of, the psychological aspects of plastic surgery from the earliest stages of his career at Johns Hopkins University in the 1950s and through his long tenure at the University of Virginia Medical Center. He and his colleagues published scores of papers on a wide range of psychological topics over five decades. These include, but are not limited to, pioneering descriptions of the motivations for breast augmentation (1, 2), rhinoplasty (3), and rhytidectomy (4, 5). Presciently, Edgerton et al. also described the psychological characteristics of the “minimal deformity” (6) and “insatiable” patient (7), which are likely the first descriptions of plastic surgery patients who are now believed to have body dysmorphic disorder and are discussed at length in the cosmetic surgery section of this book. Edgerton and his colleagues also illuminated the unique psychological characteristics of male (8) and adolescent patients (9). They provided what are now classic descriptions of distinct patterns of psychological motivation for surgery (10, 11), as well as, some of the earliest discussion of patients with factitious wounds (12). He certainly appreciated the crucial role of body image in understanding plastic surgery patients (13). Many of his papers were the first formal investigations of these patient groups and were catalysts for much of the subsequent scientific work discussed throughout this book.

Edgerton’s compassion was evinced by his deep commitment to understanding the psychological experience of his patients. Over five decades of practice, he spent countless hours in extended clinical consultations learning to empathize with a patient’s experience of deformity as “dis-ease” (14). He discerned a core clinical truth of plastic surgery—namely, that having a deformity, either real or perceived, causes great emotional distress (“dis-ease”) and that treating this psychological suffering is the heart of the plastic surgeon’s work.

Throughout his career, Edgerton’s courage was evident in his willingness to treat many patients who suffered greatly but who were often shunned by colleagues. These patients included transsexuals (15, 16, 17, 18, 19) and persons with particularly severe forms of psychopathology. Often, other plastic surgeons looked askance at his persistent willingness to help these uncared for individuals. Despite the resistance, he continually stressed “the plastic surgeon’s obligation to the emotionally disturbed patient” (20) and explored just how far the healing powers of plastic surgery could be stretched to reduce patient unhappiness and to enhance quality of life. He collaborated closely with a series of mental health colleagues over the span of his career, setting the standard for how to improve clinical and scientific understanding of plastic surgery patients (21, 22, 23).

The plastic surgeon-psychiatrist team of John and Maria Goin embodied the integration of surgical and psychiatric perspectives. Their collaborative research covered a wide range of topics (24, 25, 26, 27, 28, 29, 30) and offered informative perspectives on such critical issues as a patient’s psychological reactions while under local anesthesia (27) and the psychological experience of tissue expansion (30). Among the Goins’ many insights were that a substantial number of facelift patients experienced a period of postoperative
depression that was associated with preoperative depressive symptoms (24) and that some reduction mammaplasty patients experienced negative postoperative psychological adjustment reactions not routinely detected by the plastic surgeon (26). The Goins are particularly well-known for their informative text, Changing the Body: Psychological Effects of Plastic Surgery (31). The book was the only resource of its kind for over two decades and provided a foundation on which this book was built.

Several other books over the past decade have directly or indirectly touched on the psychological issues in plastic surgery. Sander Gilman has written two books, Making the Body Beautiful (32) and Creating Beauty to Cure the Soul: Race and Psychology in the Shaping of Aesthetic Surgery (33), which discuss the relationship between cosmetic surgery and psychology against the larger historical backdrop of race and culture. Elizabeth Haiken’s (34) Venus Envy: A History of Cosmetic Surgery touches on similar themes. Kathy Davis’s Reshaping the Female Body: The Dilemma of Cosmetic Surgery (35) and Dubious Equalities and Embodied Differences: Cultural Studies on Cosmetic Surgery (36), as well as Virginia Blum’s Flesh Wounds: The Culture of Cosmetic Surgery (37) all look at the evolution of cosmetic surgery in relation to cultural influences. Although not specifically focused on plastic surgery, Marilyn Yalom’s The History of the Breast (38) and Nancy Etcoff’s Survival of the Prettiest: The Science of Beauty (39) are also helpful in understanding of the psychology of physical appearance.