The public watched the sad descent of Michael Jackson into an endless cycle of face-distorting surgical procedures as we wondered why a beautiful young man would subject himself to what amounted to disfiguring mutilation. This case, and those of other celebrities like it, was all too familiar to today's special guest Dr. Mark Constantian. The plastic and reconstructive surgeon recognized a truth that he has witnessed repeatedly in his more than 40 years of practice—people who have had a troubled childhood may manifest their distress in body dysmorphia, an unrealistic preoccupation with the body or its parts.
Constantian recognized early on in his practice that his patients’ particular type of dysmorphia didn’t conform to the description of body dysmorphic disorder (BDD) described in the Diagnostic and Statistical Manual of Mental Disorders. He observed that his patients tended to be high-functioning and guarded about past traumas that may have impacted their mental and emotional health. This forced him to play detective in order to figure out whose BDD prevented any sort of positive outcome—even if the surgery was 100 percent successful.
By combining anonymous anecdotes of actual case histories with his carefully researched studies, Constantian reveals that the mystery surrounding plastic surgery and BDD—and many other addictions and self-harming behaviors—is no mystery at all when a patient’s trauma history is taken into account.
Mark Constantian M.D., FACS, has practiced plastic surgery in Nashua, NH since 1978 and has faculty appointments at the University of Wisconsin and the University of Virginia. He is the author of more than 100 professional journal articles and book chapters and two previous textbooks, including Rhinoplasty: Craft and Magic.