Psych Yourself Out: Being Mindful About Plastic Surgery w/ Dr. Alan Goodwin

Doreen Wu (00:00):
Welcome to Park Avenue Plastic Surgery Class, the podcast where we explore controversies and breaking issues in plastic surgery. I'm your co-host, Doreen Wu, a clinical assistant at Bass Plastic Surgery in New York City. I'm excited to be here with Dr. Lawrence Bass, Park Avenue plastic surgeon, educator, and technology innovator. The title of today's episode is "Psych Yourself Out: Being Mindful About Plastic Surgery." This episode sounds a bit different. Usually we discuss technical aspects of plastic surgery, what's new, or technological advancements. What's the idea behind this episode, Dr. Bass?

Dr. Lawrence Bass (00:39):
That's true, Doreen. Our focus is on explaining which treatments address which aesthetic features. But I also like to spend time talking about decision making and how to think about your plastic surgery needs. That's a really important thing. Today's episode is an extension of that idea. We're fortunate to have a guest with us who is an expert in this area. Dr. Alan Goodwin is a psychologist in Los Angeles, California. He has spent the past 20 years as a psychotherapist and published his book, "Saving Face Without Losing Your Mind: Bringing Mindfulness to Your Cosmetic Procedure." And this book was published this past November of 2022. Dr. Goodwin, welcome to the podcast and thank you for joining us.

Dr. Alan Goodwin (01:33):
Thanks, Dr. Bass. I'm really happy to be here. Eager to talk with you about this.

Doreen Wu (01:37):
Wonderful. So, Dr. Goodwin, can you tell us a little about what experiences led you to write this book?

Dr. Alan Goodwin (01:44):
Well, you know, working in Los Angeles as a psychologist years ago, I began seeing clients who were preparing for or recovering from a cosmetic procedure. Initially, it just happened. They weren't looking for someone to help them with that, but it, the subject just came up in the therapy. And, you know, effective psychotherapy is often assisted by great self-help books. You know, books enable a client to continue the work between sessions. And I have shelves of them, but I don't have any book written by a psychologist, or I didn't until now that specifically directs the work toward helping cosmetic procedure patients. So, you know, a long, long, long time ago, <laugh>, I began writing this book, and that's what it's that's what it's about. That's what the focus is.

Dr. Lawrence Bass (02:36):
Yeah, I think there have been some books in the past that plastic surgeons have written discussing the experience and psychology and decision making of plastic surgery. But, you know, that's really from our perspective as surgeons, it's not an expert opinion of a psychotherapist with decades of experience. So hearing it from that perspective certainly fills an unmet need. The book has so many useful techniques and interesting human stories. I noticed you draw from cognitive behavioral therapy and meditation techniques. Can you tell our listeners a little bit about what they are and why they're useful?

Dr. Alan Goodwin (03:22):
Sure. So I do practice a form of cognitive behavioral therapy. It's solution focused, which means we get to work on key issues right away. It's integrative, which means it integrates ideas and practices that Buddhist and other eastern practitioners have been utilizing for centuries. Integrative cognitive behavioral therapy combines cognitive therapy with behavioral therapy, cognitive therapy. It is essentially the idea that if we change the way that we think that we'll have a direct impact on the way that we feel and behave. Behavioral therapy is similar, but it focuses on behaviors. If we change the way we behave, it will have an effect on the way that we think and feel. To combine the two, we focus on both. And so in the book, you'll, you probably noticed there's a triangular model that's just a triangle with cognitions and behaviors and thoughts and feelings on the different three corners with two-sided arrows connecting them.
(04:37):
And what it represents is the idea that the way that we think, the way that we feel, and the way that we behave are causally connected to each other. They're not just related. They cause each other. And so we work on from that fundamental idea in therapy. And the emphasis in the integrative aspect of the work is on the power of the act of mindfulness. Being aware of the way that we're thinking and the way that we're behaving, and how that's affecting how we feel. So the work is strengths based, it's empowerment focused. And, you know, we don't always associate compassion with strength and power, but compassion is really actually very empowering. And yeah, meditations are also a tool that's used.

Dr. Lawrence Bass (05:28):
You know, it's interesting because as you were explaining this, I'm reflecting, and if we change appearance and we feel good about our appearance, that's, that's part of that triangular double arrow interrelationship. So it's one mechanism for impacting the balance in some regard.

Dr. Alan Goodwin (05:55):
Sure. Yeah. And the reason that it becomes a problem at times, as I'm sure you're well aware, is some people after cosmetic procedures and before cosmetic procedures, some people are just way too demanding on themselves and on other people, and they're very difficult to please. And so that's one of the reasons. So a lot of people struggle with the process of preparing for and then recovering from a cosmetic procedure, but we could talk about some of those problems during the time we're talking.

Dr. Lawrence Bass (06:34):
Yeah, that's actually a really interesting point because something I often say to my patients, they'll show me some little feature and almost apologize. "I'm sorry, this is just a little thing." But to me, it's a big deal. And I usually tell them, "Listen, don't apologize." Plastic surgeons by temperament are perfectionists and plastic surgery patients by temperament are perfectionists. So it's a good meeting when we get together. but again, you have to avoid going overboard with that because you can work yourself into a frenzy over things that can't readily be changed. And you have to enjoy the things that can be changed and be satisfied on some level with that to avoid making yourself too preoccupied.

Dr. Alan Goodwin (07:30):
Yeah, and it's a great way of talking about this is to use the concept of perfectionism, because if we think of it in its purest form, perfectionism is more of a black and white concept. We humans are not perfect. And so if we're perfectionistic, we think of it as a way to do very, very well psychologically, because we're not perfect. Perfectionism is a way to ensure that we'll feel inadequate. So we want to strive, but we really don't want perfectionism.

Dr. Lawrence Bass (08:06):
Right. That's a good point. I mean, it's like the relentless pursuit of perfection, but we have to accept that we're never going to achieve it, and we have to find a way to live with that.

Dr. Alan Goodwin (08:18):
That's right. And that's a good example of what happens in psychotherapy. We might tease apart at times, what is this about, you know, first we identify the perfectionism, the next step is, so this is kind of self abusive because you are perpetuating this feeling inside you, this way of thinking about yourself that's connected to inadequacy and it's abusive. And where did this ever come from? And it's also a great example of how cognitive therapy is used. The objective in that kind of a situation isn't to convince the person to have low standards. The objective is to just tweak those standards a little bit so that they're more realistic and not abusive.

Dr. Lawrence Bass (09:07):
Yeah, I mean, I say over and over on the podcast that I really like people to be realist about what plastic surgery can do for them. We want try to represent those realities. And the notion of, as I said in the introduction, of how to think about your plastic surgery, is really important to being an effective, satisfied consumer of plastic surgery instead of not getting where you're trying to go. And now you speak a fair amount about a particular word, and it's in the subtitle of your book, mindfulness. Can you define what you mean by that in general, and specifically in the context of deciding to have plastic surgery?

Dr. Alan Goodwin (09:59):
Yeah, it's an important part of the aspect of the book, and I appreciate having the chance to describe how it's used in psychotherapy, because in some ways I talk about things a little bit differently than the Buddhists do. I give a lot of credit to them, but here's an example. Mindfulness is usually defined by Buddhist thinkers as awareness without judgment. In psychotherapy, I encourage clients to think of it as awareness without that qualifier, because what we're doing when we're mindful is we're being aware of the way that we're thinking and feeling in any given moment. And we do tend to be judgmental at times, at least at times, and we need to be aware of the judgment. and that's really one of the things that we work out in the therapy. So that's what mindfulness is about, it's about observing yourself.
(10:57):
And one way that clients can begin, oftentimes they say, you know, "how do I begin, how do I use this?" Is to think of this as a tool in your back pocket that you can pull out throughout any given day. And what you could start noticing is your own judgments, your judgments about how you appear, your judgments about other people, how they appear, about your performance, about how other people behave. Anything that you are evaluating throughout the day. And again, we're not, the objective isn't to become someone who has no opinion. The objective is to become more reasonable. And so I define compassion as viewing other people within the context of their struggle. And self-compassion would be viewing yourself within the context of your struggle. So you're not supposed to not see bad behavior in other people, but if you see the struggle that's fueling their bad behavior, you don't tend to personalize it as much. And if you don't personalize it as much, you're not as impacted by it, don't like it, but you're not deeply wounded by it.

Dr. Lawrence Bass (12:07):
That makes sense. And, and in the context of deciding about plastic surgery, how do you work around the concept of awareness with your patients?

Dr. Alan Goodwin (12:22):
Well, I think what one of the things that's important to look at is what they're expecting out of the procedure, but also whether the expectations are really rising above a mere expectation. You hear people casually talk about how we shouldn't have expectations. I don't know where that ever got started, but it sounds good, but it really isn't the problem. If I go to a movie, I should expect to enjoy it. If I'm really deeply disappointed and outraged if I didn't like the movie, what's happening that's the problem inside me is not that I expected to enjoy it, it's that I demanded that I enjoy it. So likewise, if someone is preparing for a plastic procedure and they have these rigid, narrow demands for outcomes, they're really setting themselves up for being really anxious during the recovery process and for being displeased at the end. Because as you know outcomes are somewhat unpredictable, somewhat predictable, but somewhat unpredictable. And the more rigid and narrow their demands are, the more likely they're not going to be pleased with the outcome.

Dr. Lawrence Bass (13:41):
That makes sense. So let's drill down a little bit to some specifics about plastic surgery. And, and we've started to talk about this with the concept of awareness and, and being demanding. But who's a good candidate psychologically for plastic surgery?

Dr. Alan Goodwin (14:02):
Yeah, I would say they're someone who knows what they like and what they dislike and what they want and what they don't want, but they're reasonable in their expectations about those things. They're not coming into the process with a sense of demand, the set of demands. They practice acceptance. Often this means they won't tend to overreact either to pleasant or unpleasant experiences in life. I guess we could say they tend to be more optimistic, not so cynical. they tend to be more compassionate and forgiving. These are the qualities that a patient would want to enhance in themself. And these are the kinds of things that the exercises in the book and what I do with clients in the office are aimed at achieving.

Dr. Lawrence Bass (14:54):
Is there a distinction between expectations of how you'll look after plastic surgery and expectations of how your life will be different after plastic surgery?

Dr. Alan Goodwin (15:10):
Well, they tend to be a function of each other. And you know, the good news is they do tend to be related to each other. You know, plastic surgery is achieving amazing things for people. The problem is people do need to keep themselves grounded and have realistic expectations. They're going to need to do some work in terms of changing their life. If their life is going to change, their appearance won't achieve it alone.

Dr. Lawrence Bass (15:45):
Right. I mean, let me give an example. If I do a breast augmentation almost for certain, you know, patient may like it, they may not like it or they may like it a little or a lot, but pretty much for sure their breasts are going to be bigger, but that's not necessarily going to change their relationship with their significant other. It might, but it might not. And appearance is a vehicle for improved life, but it doesn't necessarily connect linearly or in a direct linkage with making your life better, aside from the appearance, self-confidence aspect.

Dr. Alan Goodwin (16:32):
Sure, it's a great example of how complicated it can become, because if we just take that example, the woman might feel better about the way she looks and her partner may treat her differently, and that may cause the patient to resent that they were treated less well before. And that can create a whole other process thing issue for them to process together. So, you know, how people react to being treated differently is a whole other dynamic that you, you're probably aware of, but that we deal with in psychotherapy. One of the reasons it's hard to change in psychotherapy is you know who you are. You know, if I'm going to change and be more confident, one of the reasons it's difficult is I've never been confident in this or that setting. What would that look like? And that's some of the work that we do in therapy. What would it look like if you weren't concerned about this or that aspect of yourself if you were at a food court? You know it takes some time adjusting afterward. So this is why I thought the book was so important to write, because a lot of people don't think about that. They're not prepared for how am I going to interact in the world when the world is looking at me differently? I have practiced being who I've been.

Dr. Lawrence Bass (18:03):
Yeah. That's really interesting. I mean, I think it illustrates how psychotherapy and some of the techniques you discuss in your book can really amplify the benefit you get from having a plastic surgery because you'll understand better how to make use of it, how to react to it. That's really fascinating. You started to address this issue and talking about overly demanding people, but are there personality types or circumstances where in general, plastic surgery might be a bad idea?

Dr. Alan Goodwin (18:43):
Yeah, it's a touchy subject. You know, I try to deal with it carefully in the book because I am disinclined to tell someone that they should or should not have a procedure. And of course, I don't have a crystal ball, so we don't know whether a patient is going to have a real difficult time coping with the outcome. But yeah, there's some characteristics. There's a "P" test that I have in the book, which is a test for prickliness, and it's really about these qualities that I mentioned earlier. How reactive are we? I think prickly is a great descriptive for some people because they're like roses. You know, they remind you that if you rush to them without being careful, you're going to be injured. So these are people that we tend to walk on eggshells around because we just get a sense that they have pricks.
(19:46):
So that's one. Another is something that I call the appearance, self-consciousness measure, and it just lists a bunch of situations. I think there are nine, and asks you to rate how self-conscious you tend to be when you're, for instance, eating in public or when you see an attractive person, or how much of a tendency do you have to think about your own appearance and how you sort of stack up. So those are characteristics and a red flag that the patient or physicians could look out for are but patients who feel very intense needs for a particular outcome. What I discussed in the book is also the idea of a patient treating the surgeon like they are a savior. That should be a red flag. And it's difficult for psychologists to resist that.
(20:43):
It feels good when someone's treating you like you're a savior <laugh>, but you should have a voice inside you saying, you know, "danger, Will Robinson," because you aren't a savior. You know, you may be very helpful, I may be very helpful, but if someone's treating me like a savior, it's a sign that they tend to overreact, and those people tend to rebound in the other direction and feel abandoned or feel betrayed when really something just went wrong in spite of someone intending it to go well. And so we can work on these things in therapy. And that's really the important message that I keep wanting to make sure that I repeat effective psychotherapy can help people with these tendencies.

Dr. Lawrence Bass (21:35):
And you know, that's really interesting for me as a surgeon, because I went into my field to make people happy. I don't want to do procedures for people who aren't prepared properly, don't have the right mindset to have a good experience. And I meter patients very carefully and often tell patients, "no, it's not time," or "this is not a big enough issue, that it's worth what's involved in doing the surgery." And patients are often very taken aback by that. It's very hard to tell a patient no. but I tried to point out to patients, it's not good. I like operating, that's why I became a surgeon. It's good for my bank account when I operate. If I'm saying no there, there's nothing in it for me. It's all for the benefit of the patient. And a surgical experience, even in a field like plastic surgery where I spend much more time with my patients than other kinds of surgeons and where there's a lot more support and interpersonal dynamics in the doctor-patient relationship than with many other kinds of surgeons, it still doesn't really permit the kind of protracted analysis and reflection that psychotherapy will. So someone who's not ready or is not coming at it from a good perspective, probably would benefit from that approach rather than jumping ahead to a surgery.

Dr. Alan Goodwin (23:22):
Yeah, for sure. And one of the really positive things that is happening is these support groups are cropping up where patients online are talking amongst themselves. And of course there are problems with that, you know, misinformation can get passed from person to person. But one of the good things that's happening is people are talking about whether they're psychologically prepared for certain aspects of the process. And something that I've been exposed to is some patients saying, you know, I just don't understand why the plastic surgeon didn't help me with this. And a number of times I've said to them, well, okay, you know, I can understand, but you know, you have to remember that is not their field. You know, they can be compassionate, but they're not there to do psychotherapy. And so that's why it's helpful to see a therapist. And I'm hoping that the book will help, will give plastic surgeons more of an awareness of the need to encourage the patients to look out for these issues before the surgery. Because you've probably seen there are predictable reactions that people have in the recovery period. And they really do benefit if they prepare for the anxiety and what comes with that.

Dr. Lawrence Bass (24:53):
Yeah, it's interesting. you know, you're going to have bruising and swelling. You know, you may not look your best immediately after surgery, you know that in the abstract ahead of time, but when you actually see it looking in the mirror or on your own body, it feels very different than thinking about it abstractly in advance.

Dr. Alan Goodwin (25:15):
Yeah, there's a really simple idea that is intuitive, but I think we don't think about it enough. if you are in pain, anything psychological is more difficult to cope with, and pain should be defined broadly if you're in any form of discomfort. So that could even be itching, it could be restriction, you know when you're healing, you want, your doctor's probably going to tell you to move but the doctor's also going to tell you to rest and you may not want to be resting so much. So even resting can be unpleasant for people, but pain absolutely can be unpleasant. So in that context seeing the bruising and seeing the the swelling and, and whatever else can be more difficult to cope with.

Doreen Wu (26:06):
Next, let's imagine this scenario. I'm someone who is thinking about getting some plastic surgery done, but I'm not quite sure if it's the right decision. How should I decide if I have some doubt? Does that mean I shouldn't go through with this?

Dr. Alan Goodwin (26:20):
Yeah, it's a really good question. I mean, I think it's normal to have doubt because there's uncertainty. And so whether you should go through with it depends on a lot of factors. It depends how intense the doubts are. It depends on how intense the desired results are. Also depends on how disappointing the undesirable results might be for you. You know, all of these issues can be managed with effective psychotherapy. So the problem is there's no certainty with cosmetic procedures and there's especially no certainty because success is subjective. And so that's why you want to be careful to find a physician whose aesthetic matches your aesthetic. And just in general, this involves uncertainty and risk is scary but it's tolerable if we think in balanced, rational ways. And that's what the cognitive part of the work in psychotherapy is about.

Dr. Lawrence Bass (27:26):
You know, I have a yardstick that I use when I talk to patients because it is natural to have some doubt. It's different from trauma surgery where you're in an accident and bleeding to death and you have to do something. And people always ask the question,

Dr. Lawrence Bass (00:27:45):
"Should I really be doing this?" There's always a little bit of guilt. "Why am I doing something medical when I'm not forced to because of an illness?" So that's natural. That by itself shouldn't keep you from doing it. But what I ask patients to do is to think about the following: If there's a feature that they see and I see that's causing them distress, they don't like it, they want to change it, I have a good way to improve it that's reliable. Not a guarantee, exactly as Dr. Goodwin said, because nothing we do in life is a hundred percent guaranteed. This is no different. But if I have a good way to improve it and the goal of improvement is realistic, then I ask people, I say, "it's probably reasonable to go ahead." And I ask people to say, look, in your gut, you know, there's an impulse buy, if we had the magic wand, there might be 50 things you would change about your appearance, but we don't have a magic wand. We have to do it the real world way. So if there's something that bugs you every time you look in the mirror, every time you're getting ready to go out, every time you see a picture of yourself, you're probably not going to let go of that. You're probably going to do it sooner or later. So if it's one of those things that in your core really bothers you and we have a reliable way to improve it, then it's probably reasonable to go ahead.

Dr. Alan Goodwin (00:29:30):
I would just add that there was a study, I tried not to put too much research in the book, but there was a really interesting study I thought, out of Finland. I think the title of it was "A Second Youth." And it was kind of an ironic title because it was it involved interviews, it was qualitative research in Finland of about 2022, something like that. Individuals over 55 who had some sort of cosmetic procedure. I think they were all facial procedures. What was interesting about it was in interviewing these people they were not talking about wanting to look 30, they were talking about broader ideas, like wanting to remain relevant, wanting to remain professionally active, and wanting to counter some of the ways that ageism limits us socially and professionally.
(00:30:35):
They were wanting to eliminate the appearance of certain emotions that they felt were on their face, even though they didn't feel them. They were wanting to look optimistic because they felt optimistic and they were looking in the mirror and not feeling like they were looking the way they were feeling. They wanted to look energetic, and people were perceiving them to be tired. And so I just think it's interesting to add. one of the things we do in psychotherapy is, is validate that, you know, it isn't always in your head, you know, we can deal with the stuff that's in your head, but, but oftentimes what's happening is there's a reality basis to what you're experiencing. People are treating you a certain way. And so I don't talk people into or out of procedures, like I said, but I think this was a powerful study because it honors that there, there are understandable reasons why people would have procedures that are not just about vanity.

Dr. Lawrence Bass (00:31:45):
Yeah. And this happens to me all the time. It's very interesting that study. And it matches very closely, a a lot of clinical experiences that I have talking with patients. a lot of patients apologize for their vanity. And if there's one place, you really don't have to apologize for that. It's at the plastic surgeon's office because we're on board with it. But patients say to me, I say, "you know, I can't make you look 20 again." And they say, "oh, I don't need to look 20." But when they look exactly as you said, when they look worn, when they look like they don't have energy, that doesn't play well in your personal life. It doesn't play well in the workplace. It really doesn't matter who you are or what you do. In America, we like go-getters and people who are positive and upbeat, and if your appearance does not project that, that works against you, and that's very real, in the best of all possible worlds, it wouldn't be that way.
(00:32:51):
But definitively, this is the real world, not the best of all possible worlds, and it does work that way. So I tell patients, "We're trying to get you to this adult indeterminate stage. There are certain telltales in appearance that will peg you in a certain decade of life or at a certain decade or older. And if we can take some of those away, people may look at you and they know you're not 20, that's okay. But they can't say, 'oh, well, obviously they're in their sixties, or obviously they're a senior,' they just know you look good and you look like you, because rejuvenation and changing who you look like are both things we do in plastic surgery, but at different times for different reasons for different patients."

Doreen Wu (00:33:50):
Earlier, Dr. Goodwin, you brought up feelings of doubt related to uncertainty and the unknown, which makes me wonder, what is your take on patients getting a second opinion or even a third opinion from other providers? Is it worth the trouble?

Dr. Alan Goodwin (00:34:05):
Yeah, it's a great question. I think so, but in the book I described a way that, you know, second and third opinions and searches online for before and after photos can become counterproductive. They can reveal other underlying issues that we would look at in psychotherapy. Some things really should be resolved before the surgery because the recovery process is going to exacerbate and expose psychological vulnerabilities like I mentioned before. So second and third opinions are good, but at a certain point, you know, it's important to come to a decision. And sometimes people just feel like they're swimming in opinions by experts that are all expressing very strong opinions, but the opinions are not consistent with one another.

Doreen Wu (00:35:02):
So what if these recommendations don't match? Won't that only make the patient more confused?

Dr. Alan Goodwin (00:35:08):
Yeah, it may, that's the problem, and if it happens, the answer isn't necessarily to avoid the procedure. The answer may be to continue to consult, but to look for a different expert who can help them sift through the contradictory advice.

Dr. Lawrence Bass (00:35:25):
I see that very often. I think it's a good idea to see several surgeons. I like it when patients do that. I like patients who are consumerist and thinking about things I feel I work best with someone who tries to be informed that way. But I find very often patients are very confused and very anxious when the recommendations of the different surgeons don't match. And it's this notion of there's got to be one absolute best way of doing things. And in reality, most surgeons refine their techniques to where they can get an outstanding result in their hands based on their experience and their techniques. You know, there are techniques that are well outside the mainstream. I'm not suggesting going there, but surgeons who are experienced to do a procedure frequently are getting excellent results, can usually explain to you why they choose their technique, which doesn't mean that the other technique is wrong or bad.
(00:36:38):
It just means they can get great result with their technique. So looking at the technique is important, understanding it, being comfortable with it, and what it's going to mean in terms of recovery and so forth. But also looking at a surgeon who you feel comfortable with, who you feel you'll enjoy working with, who you feel is listening to you and hearing your concerns. Because if the surgeon hears your concerns, they can do whatever's humanly possible to try to address them, but if they're not listening to you or they have a cookie cutter approach, the chance that they're going to match up with what you're looking to have done is not, certainly not as good. So that's how I suggest patients try to deal with some of the confusion and anxiety when they get a few opinions and they're not matching up.

Dr. Alan Goodwin (00:37:40):
I think that's really great advice, especially finding a surgeon who you feel like is listening to you and is curious about what you're looking for.

Doreen Wu (00:37:49):
So now that leads me to my next question. I have made my decision to undergo plastic surgery, but how should I pick a surgeon? Is bedside manner more important, or should I focus on their technical skill and experience?

Dr. Alan Goodwin (00:38:04):
So I wonder what Dr. Bass would say. I would say you should definitely focus on bedside manner and technical skill and experience <laugh>. I just would think we need to find a balance among all of those. And of course, you know, the chapter that I addressed this in finding the right surgeon in that chapter, I talk about how it really is difficult. A lot of patients report that they have a really difficult time because they're not surgeons. And most surgeons will describe the work that they do with confidence. And so I like the idea of consulting a specialist who doesn't perform that kind of cosmetic work and asking them who they would recommend and what they think you should look for. So the example I give in the book is an ophthalmologist who doesn't do blepharoplasty might be a great person to consult because they've seen outcomes from people who do that work.

Dr. Lawrence Bass (00:39:18):
Yeah, I think it's challenging because there are a lot of people trying to deliver these services these days. And there's a very high noise level on the internet, on social media, on providers' websites. I mean, the marketing that's going on by the marketing professionals within the field of plastic surgery and aesthetic medicine is very aggressive. And it detracts from the key features, which are training, technical skill and experience, and bedside manner, really the doctor-patient relationship. What the way I think about it is I am looking to do A+ plastic surgery. This is elective. Patients don't have to do it. I have to be sure I can do it as reliably as possible, as safely as possible, because it's elective. There's no wiggle room. I can't, again, be perfect because that's not human, but I have to be as close as I can given the circumstances. And so that means everything, everything about how I work with patients, how my staff works with patients, how the office manages things and gets people through the experience, everything has to be a plus. There's no area that you can slack off in.

Doreen Wu (00:41:04):
Okay, so now that I followed the process, I picked a surgeon and I'm going for it. I'm getting a little nervous though about the surgery itself and the recovery and how I'm going to look at the end. Will I get a good result? Will I look like myself by the end? Will I like it or wish I'd never gotten into this in the first place? I thought I'd feel calmer once I decided, but now I'm more anxious than ever. What should I do?

Dr. Alan Goodwin (00:41:33):
It's a really important question. I mean, if there's one thing I would want listeners to take from this podcast, it's that there's a common set of reactions that patients have before and after procedures. And there are ways to prepare yourself for those reactions. You may not have all of them, you may not have them as intensely as other people, but if you prepare ahead of time, you're going to handle them better than you would if you didn't prepare. So that's why at the end of the book, I have a chapter that provides meditations, 14 meditations, one per day before the surgery, and 14 one per day for the 14 days after the day of the procedure. And I say in the book that you can do them in any order, but I present them in roughly the order that I expect a patient to need them.
(00:42:22):
Each meditation focuses on a different aspect of the experience. So fear, excitement, uncertainty, different things that people tend to experience and oftentimes struggle with. And so, you know, cognitive behavioral therapy really does work. If you've had that and it's been ineffective, try to trust that you do need to try again. No therapist is helpful for every client, but there are many therapists who are really very skilled and can help you learn some pretty simple and yet really effective tools that often help you to begin to feel better, feel more resilient and more hopeful, you know, very soon after beginning the work.

Doreen Wu (00:43:11):
Those are all great points. And that leads me to my final kind of overarching question. Is plastic surgery a good thing? Can it make me happy or should I just get over it and learn to love myself the way I am? I think essentially, I'm wondering what are the benefits of plastic surgery to me as a person?

Dr. Alan Goodwin (00:43:31):
Yeah, it's a good question, and I feel like I need to be careful because I really don't want to be seeming to be coming down on either side of, you know, whether this particular person should or shouldn't have a procedure. But you know, the fact is there's a lot of really positive research that's come out connected to plastic surgery. I mean, enhanced self-esteem, improved body image satisfaction with the decision to have the procedure is very high. Patients have reported seeking to appear more youthful, like I said, and then experiencing that and experiencing people treating them differently. So there really is no question that it can help, but, you know, there are complications and there are also people who are looking for things that plastic surgery isn't going to provide. And so that's where being mindful and either using a book like this or finding a therapist or doing both really is a prudent way to approach it and make it more likely that you're going to find what you're looking for.

Dr. Lawrence Bass (00:44:45):
I think that's a great way to look at it. I mean there's no doubt in my mind having done this for more than 25 years, that plastic surgery and the right individual can do a tremendous amount to enhance confidence, self-esteem. It really can be a tremendously positive thing. But being grounded, being realistic, kind of analyzing the realities and making sure it's a good fit for you is very important. And the saying about that is plastic surgery makes happy people happier, but it might more be said that plastic surgery for the right person can make you happier. But you have to ask yourself if what plastic surgery can deliver is, is going to fit that bill.
Dr. Alan Goodwin (00:45:49):
I think that makes a lot of sense.

Doreen Wu (00:45:51):
Finally, before we conclude, Dr. Goodwin, what should our listeners take away from today's episode?

Dr. Alan Goodwin (00:45:58):
Well, I'm not sure what to add other than there are methods for coping. We can't say that you're going to struggle, but we can say that struggling at different points of the process, choosing the procedure preparing for it, and then recovering from it struggling is common and there are tools for managing it. So I think that's the really the takeaway that I would want to keep emphasizing. And remember that you're going to be reacting within the context of physical discomfort. You know, it may not be a lot of pain but there will probably be some discomfort and there will also be limitations. And just remember that we do tend to have more difficulty coping when we have some kind of discomfort layered on top of something psychological going on. And we're going to be in a context of uncertainty about something that's important to us. So there are a number of things that are happening after a procedure, and that's why it's a good idea to prepare ahead of time.

Doreen Wu (00:47:13):
Dr. Bass, any parting words?

Dr. Lawrence Bass (00:47:15):
Well, in plastic surgery, we want to make people happy. We want, to the extent that it's possible, to try to give you the result that you want in a pleasant, comfortable, empowering experience. It can be very empowering to take control of your appearance and craft yourself image the way you wish. At the same time, you have to make a realistic assessment. You have to have realistic expectations about the experience and the result, and you're committing yourself to the necessary components of that experience. The recovery, the discomfort, the activity limitations exactly as Dr. Goodwin said. But it can give you tremendous self-confidence and positivity in both social and work interactions and a different sense of self. At the same time, if you're having difficulties leading up to or recovering from a procedure, I think as Dr. Goodwin pointed out, the ability of psychotherapy, the ability of various techniques that he discusses in his book to help you cope with those things and make the most positive experience out of it, is something important to remember that those tools are available.
(00:48:41):
There was a surgeon, Tagliacozzi, he was a pioneering plastic surgeon in the 16th century in nasal reconstruction, and his image appears on the seal of the American Board of Plastic Surgery on our board certificates. And to paraphrase him, he said, "we repair and restore, not so that it please the eye of the beholder, but so that it buoy the spirit of the patient." And I think that's really what we're trying to do in plastic surgery. It's almost more about the psychological impact on someone than it is about the physical alteration in their appearance.

Doreen Wu (00:49:29):
Definitely a very appropriate quote to close our discussion today. Thank you, Dr. Goodwin and Dr. Bass for sharing your insight and expertise on this fascinating aspect of how plastic surgery really impacts us psychologically.

Dr. Lawrence Bass (00:49:42):
And I'd like to thank Dr. Goodwin for joining us for this fascinating discussion. I think you know, so many really thoughtful, impactful points about how to be mindful approaching plastic surgery. If you enjoyed the discussion and want to learn more, you can read Dr. Goodwin's excellent book, "Saving Face Without Losing Your Mind: Bringing Mindfulness to Your Cosmetic Procedure." It's very thorough and has a very worthwhile discussion of this topic.

Dr. Alan Goodwin (00:50:16):
Yeah, I really appreciate the opportunity to be here and talk with you about this. It's been a pleasure.

Doreen Wu (00:50:23):
Thank you for listening to the Park Avenue Plastic Surgery Class podcast. Follow us on Apple Podcasts, write a review and share the show with your friends. Be sure to join us next time to avoid missing all the great content that's coming your way. If you want to contact us with comments or questions, we'd love to hear from you, send us an email at podcast@drbass.net or DM us on Instagram, @drbassnyc.