By Nifemi Akingboye
When you hear the word plastic surgery, I’m sure the first thing that pops into your head is Kim Kardashian or Kylie Jenner. And you're not wrong, but there is so much more to this sector of medicine than meets the eye. I partly blame social media for the representation of plastic surgery as ‘plastic’. It’s in the name too, it does throw you off.
I’ve always wanted to study medicine, but it wasn’t till last year when I shadowed a plastic surgeon did I realise that plastic surgery isn’t just nose jobs and lip filler. It’s reconstructive surgeries and breast augmentations for cancer patients and its skin grafts for burn victims and much more.
Alongside 2 other girls in my year (Jess and Dinara), I run a weekly club called Facial Reconstruction Club. We meet weekly to discuss ethical dilemmas surrounding plastic surgery and we work on a 6- week project modelling reconstructed faces on real life skulls. As my first article, I would like to give a brief explanation of what plastic surgery is from my perspective and some of the lesser none ethical issues that surround it. I also want to highlight why people get plastic surgery and the psychological issues that can arise as a result.
Plastic surgery is a branch of surgery that changes a person’s physical appearance and ability to function. There are two types: Reconstructive and Cosmetic. Reconstructive surgery involves procedures that correct defects on the face or body, and these include but are not limited to: birth defects such as cleft lips, ear deformities, traumatic injuries or the aftermath of disease treatment such as the reconstruction of a woman’s breast after surgery for breast cancer. Cosmetic surgery also known as aesthetic surgery alters a part of the body that an individual is dissatisfied with. These include but are not limited to: liposuction, breast augmentation and rhinoplasties. 
Currently, Cosmetic surgery has spread across the world and is very popular in Western culture. Several factors are involved in this rapidly evolving field, such as socio-economic development, changes in cultural norms, globalisation and the effects of Western culture, advertising, media, and mental disorders. The majority of cosmetic plastic surgery are concerned with restoration, maintenance and enhancement of one’s physical features. 
Cultural changes and developments in different societies have increased concerns over appearance and subsequently, increasing the demands for plastic surgeries. But, despite all these factors, the demand for cosmetic surgery is generally motivated by psychosocial factors. The desire for beauty in human nature has long existed since the creation of the features. They have an interest to modify and improve their appearance and surroundings.  According to Dr Lara Devgan, the Chief Medical Officer of RealSelf, ‘“Most patients seek [cosmetic] procedures to feel like the best version of themselves’. Thus, it is said that cosmetic surgery helps with an individual’s sense of self and helps to better their experience of life. 
However, while many people believe that cosmetic plastic surgery has more positives than negatives there are many ethical considerations and psychological problems that arise after a procedure.
Some of the ethical dilemmas surrounding plastic surgery are most common in invalidated surgery i.e. plastic surgery that is purely cosmetic. There is a large debate over the concept of ‘playing God’ in surgery as some individuals believe that deliberately interfering with an individual’s outwards appearance, that isn’t for medical reasons is interfering with ‘God’s plan’ or ‘Nature’s plan’. While the act of changing one’s breast size may not look like a significant issue at first, there are issues regarding when or if a line can be drawn with surgery. Is it ethical for someone to want to mimic someone else's facial features? Or have multiple surgeries with the aims of looking like a certain celebrity to the point where the original features of the face are completely lost? An individual’s obsession with looking perfect can lead to a psychological addiction, termed plastic surgery addiction, which can have extremely debilitating results. The effects of extreme plastic surgery are broadcasted all over social media and showcase the life-changing results of such procedures. The reality television show ‘Botched’ is an example of this and follows doctors Terry Dubrow and Paul Nassif as they "remedy extreme plastic surgeries gone wrong.” 
Another ethical issue is coined the ‘can vs should argument’, which looks at a surgeon’s responsibility in deciding whether to go ahead with a cosmetic procedure. If a patient wants to completely change their appearance, and you as the doctor know that there is a plethora of psychological issues such as detachment issues and depersonalisation, that can be attached to such a drastic change should you continue with the surgery? This is a very big issue, due to the fact that cosmetic surgery, that isn’t covered by insurance, is a profitable business. At times it can be difficult for surgeons to find the balance between patient autonomy while simultaneously acting in accordance with nonmaleficence. Another example of this is a patient with body dysmorphic disorder (BDD), a psychiatric illness where an individual obsesses over flaws that are seemingly insignificant and has a warped self-image. A surgeon who recognises that the procedure would likely be insufficient to meet the goals of a patient with BDD and the outcome could actually lead to further mental discomfort, shouldn’t go ahead to perform the operation. Simply because mutually understood and agreeable expectations cannot be established within the patient-surgeon relationship and the intended outcome will end up causing more harm than good. The principle is that even though a surgeon can perform an operation, it doesn’t mean they should.
The issues I have discussed above just scratch the surface of plastic surgery and cosmetic procedures and their implications on an individual’s life. However, I believe it is of the upmost importance that patients are fully informed of all issues that can arise as a result of plastic surgery, to maximise their satisfaction after surgery.
https://kidshealth.org/en/teens/plastic-surgery.html 2.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5109381/ 3.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3513261/ 4.https://www.healthline.com/health-news/more-people-getting-plasticsurgery#What-the-data-shows