Dr. Mark Constantian, a brilliant, accomplished surgeon, becomes a modern day Sherlock Holmes to uncover the causes of a grand theft of self-esteem in some patients and the never-ending quest for an illusory body perfection through plastic surgery. Meticulously researched and illustrated with evocative vignettes, readers will enjoy this as much as a suspense thriller. Highly recommended for physicians and patients.
Donald J. Palmisano, MD, JD, FACS, Former President of the American Medical Association, Clinical Professor of Surgery and Clinical Professor of Medical Jurisprudence at Tulane University School of Medicine
I am extremely excited about the opportunities that Dr. Constantian’s innovative, courageous pursuit offers. I have told my colleagues about how we found each other, and how his open-minded response to my books led to his own; I experienced a similar epiphany with Peter Levine’s writings. This is a golden chance to enlighten the lay and medical communities and pave the way for a dramatic break-through in the role of trauma in body dysmorphic disorder.
Robert Scaer, MD., author of The Body Bears the Burden, The Trauma Spectrum, and 8 Keys to Brain-Body Balance.
Dr. Constantian writes extremely well and gives the patient a voice that will be chillingly familiar to those who have dealt with these unfortunate individuals. His extensive literature and clinical research establishes the influence of childhood trauma on someone with BDD. We all know these people, and most physicians will ultimately face a BDD patient. His book should be required reading for all lay and professional people who care for the BDD patient.
Jack H. Sheen, MD, author of Aesthetic Rhinoplasty
Dr. Constantian is, in my opinion, spot on in his observations on re-visioning body dysmorphia, which are excellent and long overdue. They are particularly exceptional from the point of view of a reconstructive surgeon.
Dr. Peter Levine, author of Waking the Tiger: Healing Trauma; In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness and Trauma and Memory: Brain and Body in a Search for the Living Past: A Practical Guide for Understanding and Working with Traumatic Memory
Dr. Constantian introduces a new perspective into the challenging existence of those struggling with body dysmorphia. As a plastic surgeon, he brings a fresh set of insights to the therapeutic world that can free up those chains of shame, trauma and hopelessness that too often define the world of anorexia, bulimia or binge eating disorder, and provides an antidote to such pain and suffering. This is a must book for anyone interested in body distortion.
Ralph E. Carson, LD, RD, PhD, Senior Clinical and Research Advisor, Eating Recovery Center and BETR program and author of The Brain Fix: What’s the Matter with Your Grey Matter
Understanding what drives our patients is quintessential. In cosmetic medicine the stakes are higher and motivational algorithms much more complex. In this volume influential plastic surgeon Mark Constantian explores these issues with and - for those of us who fear the abyss - for us. It is a true historical masterpiece. Encompassing, almost bottomless and exceptionally original. The magic glue however is Dr. Constantian’s story telling, which makes this volume irresistibly personal and meaningful.
Capi C. Wever, MD, Facial Plastic Surgeon, The Hague
In this good read, Dr. Constantian's powerful contribution extensively researches the surgical and mental health literatures to expose the underworld of adverse childhood events. We visualize the toxic trajectory of childhood trauma and its devastating impact on self-worth, distorting reality and body image and driving the desire for excessive plastic surgery. Dr. Constantian shows that resilience is the antidote to childhood trauma. After all, when there is recognition and treatment, optimism follows.
Eugene B. Kern, MD, Endicott Professor of Medicine at the Mayo Foundation, Professor of Rhinology and Facial Plastic Surgery Emeritus at the Mayo Clinic School of Medicine, and Clinical Professor of Rhinology and Facial Plastic Surgery at the State University of New York (SUNY) at Buffalo
A plastic surgeon presents insights into patients' motivations based on his practice and empirical research.
In this medical book, Constantian (Rhinoplasty, 2009) analyzes patients who have undergone multiple cosmetic surgeries and are unsatisfied with the results, finding that their reactions can often be connected to disturbing childhood experiences. The author combines anonymous anecdotes from his patients with peer-reviewed research into the lasting impacts of traumatic events in childhood to show that many cases are the result of patients' reactions to family dysfunction or abuse. He argues that the pursuit of elective cosmetic surgery—rhinoplasties, or nose jobs, in Constantian's practice—should be understood in that context. The deeply researched book (each chapter includes several pages of endnotes, and full credit is given to existing rubrics like the Mellody model) takes readers through existing literature on human psychology, including body dysmorphic disorder, an exploration of how behaviors related to body image can be a response to trauma, and the physiological effects of painful experiences. He concludes that patients can be best served by developing a sense of resilience and dealing with the underlying issues as opposed to going to surgeons who simply accede to requests to lengthen or shorten their nose tips by a few millimeters. The author urges physicians to understand the "intensity of emotion" that may be involved in a case and to acknowledge the connections between emotional state and physical health.
The writing here is strong, though certainly technical, and it is clear from the opening pages that the book is intended as a professional reference rather than casual reading material. The target audience is surgeons, and understanding that keeps the authoritative narrative tone from becoming overbearing ("Physicians see the effects of this neglect in patients who become childlike following surgery, or in Internet conversations where patients give medical advice to each other or pose questions that should be directed to their surgeons—or not even asked"). Although the patients who appear in the work's many anecdotes may appear extreme (one's "six-page letter read like the Unabomber Manifesto"), Constantian provides a level of detail and empathy that renders them entirely plausible, allowing readers to see how domineering parents, the lasting effects of physical abuse, or other childhood traumas can shape patients' enduring unhealthy relationships with their bodies. The volume's conclusions are based on solid science, and the author acknowledges socio-economic factors that may further shape patients' responses. The occasional bits of humor ("If I were marooned with her for three days, she could probably turn me into Prufrock") add a distinctive touch without detracting from the treatment of a serious subject. The concrete and actionable information provided gives readers useful takeaways, like comparisons of satisfaction rates between patients correcting real deformities and those having features that appear normal to a casual observer. There is some discussion of how patients can develop the resilience that seems to be the most effective way of managing these disorders, but the book remains focused on its readers, providing surgeons with guidance on improving their interactions with troublesome patients.
A solid, well-researched, and well-argued analysis of the behavior of plastic surgery patients.