By Dr. Philip Solomon and Nancie Heiber

Nowadays, we have incredible access to other’s personal lives on social media. People share their experiences, celebrities post intimate photos and surgeons document their work daily. But often, we see only the final outcome, not the process leading up to it. And, as many images in the media are modified and filtered, what appears online is not always a reflection of reality—but it can still have a big impact on what we think is achievable. Expecting immediate perfection is something cosmetic surgeons are seeing more and more, but even the most excellent surgeon can’t promise a perfect result and certainly not right away. So, what is a cosmetic perfectionist and why are they on the rise? When is perfection something to strive for and when does it go too far? Dr. Philip Solomon MD, FRCSC, Otolaryngology, Head and Neck Surgeon, practising Facial Plastic Surgery in Toronto, discusses how to identify and confront perfectionism in cosmetic surgery.

DR. SOLOMON, LET’S START WITH HOW YOU DEFINE A PERFECTIONIST. IS IT A POSITIVE TRAIT IN COSMETIC SURGERY?

I would define a perfectionist in the world of cosmetic surgery as someone who has a very specific vision or image of what they want their result to look like. What can be challenging for this personality type is that they may have a difficult time if the immediate outcome does not align definitively with their vision. A perfectionist may also have a degree of OCD (obsessive-compulsive disorder) and may obsess over the most minor imperfection, which can lead to a lack in self-esteem or even depression.

Working with a perfectionist patient can become a challenge if the perfectionism impacts their ability to manage or cope with the recovery phase when swelling plays a role and the result doesn’t look “perfect” right out of the gate. Surgery is not 100 percent predictable as results can vary, which can be challenging for both the surgeon and the patient.

SO HOW DO YOU DETERMINE DURING CONSULTATION IF A PATIENT IS A PERFECTIONIST AND HOW DO YOU NAVIGATE THAT AT AN EARLY STAGE?

The consultation is a meeting between the patient and the surgeon where we learn about each other. From our perspective, we are interviewing the patient to ensure they are a candidate for surgery in all capacities—physically, emotionally and psychologically. We like to know what their motivation is for surgery and determine if it’s reasonable. We also use this opportunity to educate the patient about the procedure of interest and what the recovery entails. We can often get a sense if a patient is a perfectionist at this early stage. Quite often, the patients who want the slightest or most minimal change are those seeking perfection.

HAVE YOU SEEN A CHANGE SINCE COVID WHEN IT COMES TO THE DESIRE FOR COSMETIC SURGERY AND THE NEED FOR PERFECTIONISM?

Absolutely. There was a significant rise in plastic surgery during COVID as people worked from home and had the downtime to recover from surgery. What often drove people to want surgery was videoconferencing, as people saw themselves from a different vantage point. This was known as the “zoom boom.” Not all cases were driven by the perfectionist mentality. However, there is no question that we live in a time when selfie photos and videos impact how people see themselves.

WHEN DOES THE QUEST FOR PERFECTION GO TOO FAR?

The last thing we want is for a patient to struggle in any way after having had cosmetic surgery. We want the experience to be positive and fulfilling. Setting realistic goals is critical with all patients but especially with patients who are predisposed to being perfectionists. Michael Jackson is a perfect example of someone whose perfectionism led to multiple surgeries that inevitably damaged his nasal structure and its appearance. There was also the New York socialite Jocelyn Wildenstein, known in the media as the “cat woman,” who underwent multiple plastic surgery procedures that led her to look somewhat unnatural and “cat-like.” The desire for the perfect cosmetic surgery result often comes from a place of deep dissatisfaction with a physical trait and wanting to perfect its appearance. It’s normal to want to change something you don’t like about yourself, but it can become unhealthy if you disregard the limitations of what is realistic and attainable with surgery.

WHAT IS YOUR ADVICE TO PATIENTS SEEKING PERFECTION WITH COSMETIC SURGERY?

Ensure you have an open and honest relationship with your surgeon and that your goals are realistic and achievable. Educate yourself on what the healing process looks like, and be sure you can manage what is required. Plastic surgery can be a fabulous experience for those looking to improve rather than wanting to perfect.