We came across a very interesting article recently that got us thinking about mental health after major surgery. The article – about a now famous case in the U.S where a doctor performed the most successful “full facial transplant” surgery to date – examines the patient’s life after this miraculous transformation. The journalist asks the questions many of us would ask: How would it feel to look in the mirror and see someone else’s face looking back at you? What would it feel like (mentally) to use someone else’s mouth? Teeth and tongue? Obviously, the patient – who became a recluse after an injury that destroyed his face at the age of 22, now in his 40’s – has been granted the opportunity to live a more public life. But the question remains: Is he OKAY now? How did this major surgery and life changing event affect his mental health?

We were inspired to talk about how these questions relate to the TMB practice, in our work performing elective cosmetic surgery. Although the circumstances are very different, cosmetic surgery is essentially doing something similar – changing a person’s exterior, the person they are used to seeing in the mirror everyday. The implications of these changes go beyond just the physical – they affect a person mentally as well. HOW these changes affect a person’s mental state is of course relative. Some patient’s wake up after surgery and are back to normal life within hours! Other patients (definitely a very small percentage) have trouble dealing with the recovery process – the fatigue, the pain, the wounds as they heal – and this can lead to a deeper depression post surgery.

It is our job, and Dr. Born’s job, to be prepared for the possibility that a patient may experience some kind of depression or difficulty after surgery, and to inform every patient beforehand that this may happen to them as well. There are many factors that can contribute to post surgical depression, and it is important to start by identifying what make a person more susceptible to depression during the initial consultation(s) with Dr. Born:

1. People with a history of depression or anxiety are obviously at greater risk to relapse after surgery. Many of our patients have been on some kind of anti-depressants or other medication in the past, and it is important to divulge this information to the doctor before moving forward with ANY procedures. If you are currently on medication to treat depression, or seeing a therapist to deal with depression, you may want to inform the prescribing doctor and/or your therapist as well. They can provide you with the tools  you need to deal with any issues that may come up. We know many patients are secretive about their cosmetic procedures – but your physician, therapist, and even pharmacist are resources that you should exploit – they are there to HELP, not judge.

2. People who have unrealistic expectations about the outcome of their cosmetic procedure(s) are likely to become depressed afterward when those expectations are not met. Your plastic surgeon should help you to understand what you can realistically expect from any procedures. In your 50’s? Its probably not realistic that you are going to come out of surgery looking like a 20 year old. A warning sign for us (and something we discourage patients from doing) is when people bring in photos of celebrities and say “Make me look like this.” Cosmetic procedures should enhance  your beauty and/or correct imperfections – they should not attempt to CHANGE who you are intrinsically. Expecting that you will look like Angelina Jolie after surgery will just lead to disappointment, and that disappointment can lead to deeper feelings of depression.

3. People who do not have an adequate support network of friends and/or family to help them through the difficult stages of recovery may be at a greater risk for depression after surgery. It helps to have someone around who can help you understand that the temporary things you are feeling or experiencing are just that – temporary. No matter how many times the doctor assures you of that, it just doesn’t have the same meaning as when it comes from someone you know well and trust. Make you you have at least one person you can confide in – a friend, or a professional to talk to. If you are alone – its okay! Just let your cosmetic surgeon know about your circumstances before your procedure(s). They can either help to find a caregiver for you, or will arrange for a few more post op visits with the doctor or nurse just to make sure you are okay.

Once we have identified any potential depression triggers before surgery, we can address the things that can cause depression after surgery. There are many factors that can cause the blues after surgery – even in people who have never suffered from depression. They include:

  • General Anesthesia and pain medications.
  • Side effects such as swelling, visible bruising – seeing your bruised and swollen face in the mirror can be shocking. Take a deep breath and remember these side effects are temporary.
  • An inability to get back to normal life and activities, especially if you are a busy and active person.
  • Needing to depend on others for help, especially if you are a very independent and/or stoic person who hates being perceived as “weak.”
  • A lack of support from family or friends after surgery – family and friends can be supportive, and they can also be the opposite – judgemental and cruel. Try and stay away from the ones you know will only be negative. Remember its YOUR choice and only you know what will make you happy.
  • Disappointment over the outcome, seeing visible scars – remember that these will fade and the immediate results you are seeing in the first days after surgery are NOT the final outcome.Try and be patient.

While we wouldn’t go so far as to say that depression after surgery is “normal,” it is possible, and it isn’t something that anyone should feel ashamed of. Like any illness – depression can be dealt with, and treated – IF it is identified. Be honest and candid with your surgeon about your feelings and he/she will help you find a way through it.

Read the article that inspired this post, about the patient who underwent full facial transplant surgery: http://www.gq.com/news-politics/newsmakers/201408/richard-norris