Plastic surgery addiction: Fact or fiction?

Apparently we are supposed to care that reality TV star Heidi Montag has had a lot of plastic surgery, to the point that she has had to deny accusations of “plastic surgery addiction.” Liposuction, breast implants (maybe she thought that’s what the title of her TV show “The Hills” refers to), chin reduction, fat injections to her cheeks, revision rhinoplasty (updating her previous one), and more, all told some 10 hours worth. Even Nightline is weighing in on the subject, along with a People magazine cover story. And let’s not forget the news about Tiger Woods in treatment for sex addiction. Where does obsession end and true addiction begin?


I don’t know (and don’t particularly care) about Tiger Woods’ sex life, but the question of plastic surgery addiction is worth exploring. In a medical sense, there are strictly defined criteria for addiction; it involves compulsive, persistent dependence on a drug (substance abuse) or behavior (process addiction.) There are known to be genetic factors with drug dependency, and true addictions are associated with actual structural changes in the brain. Another consistent feature is withdrawal symptoms, which can be severe and even life-threatening with some drugs. These physical manifestations are one reason why addictions can be so hard to treat.

But the behavioral addictions – gambling, shopping, sex, maybe even plastic surgery – have more obscure origins. It appears likely that there is a large area of overlap between obsessive but controllable activities and what are commonly considered to be addictions. There is a known diagnosis in the plastic surgery world called Body Dysmorphic Disorder, or BDD, characterized by anxiety stemming from perceived defects in appearance. Plastic surgeons are well-tuned to recognize BDD because many of those with it become serial plastic surgery patients and are never satisfied. What else could explain the bizarre extents to which people like Jocelyn Wildenstein have gone? Counseling rather than surgery is the best treatment for these cases.
So does a marathon makeover surgery on an already attractive 23 year old represent a step on the road to addiction? Despite her announced plans to do more, Heidi Montag’s motives may be a simple case of an attempt to remain in the spotlight as the allotted 15 minutes of fame elapse. I can hardly wait for the next round of updates on the new and even larger implants.