Thursday, July 02, 2009

Drive-thru Plastic Surgery and Michael Jackson

Like many people around the world, I've been giving some thought to all the coverage of the recent untimely death of pop superstar, Michael Jackson. Among the controversies in his life has been criticism of the number and extent of facial cosmetic procedures Mr. Jackson endured over his career. What's bothered me, though, is that most often the scorn and ridicule has been directed at Michael Jackson himself. Surprisingly little of it has been directed at his surgeon(s) and dermatologist(s).

Remember, Michael Jackson did not do this to himself. Never once did he himself operate on his own nose, or eyelids, or chin. He had to find willing accomplices in his doctors. Which brings me to the following point:

Plastic Surgery is not a McDonald's Drive-Thru!

Now, I don't mean any disrespect to the McDonalds restaurants [as my staff will attest, I probably eat there more often than most Americans]. My point is that as doctors we have a different responsibility to our patients than simply filling their order. If a 400 pound person orders a couple of Big Mac Meals at McDonalds, when he pulls up to the drive through he'll be given two Big Macs, large fries, and drinks. It is not the duty of the McDonalds staff to say, "Wait a minute, buddy. We're not going to give you these Big Macs. You're overweight and you really would be better off just having a small side salad and a diet soda."

As surgeons, however, our duty is to evaluate whether patients will be properly served with what they're requesting. If we feel that their desires are inappropriate or their expectations are unrealistic, we need to advise them against surgery, against an injection, against a prescription.

Body Dysmorphic Disorder

In fairness, I have never examined Mr. Jackson as a patient, so my analysis is necessarily limited by what I've seen in the media about him. But in all likelihood, the pop star suffered from Body Dysmorphic Disorder, a psychiatric condition in which patients imagine themselves as ugly and obsess about minor or nonexistent flaws. Its treatment is medication and psychotherapy, not plastic surgery. It's like the anorexia nervosa patient who thinks she needs to lose more weight.

Why Michael Jackson's surgeons didn't say no to him is beyond me. Money is a reasonable guess. Physicians and surgeons—regardless of speciality—need to be the guardians of reality for our patients, lest the Oath of Hippocrates become regarded by the public as the Oath of Hypocrisy as far as plastic surgery is concerned. Again, Michael Jackson didn't act alone.

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