Yesterday morning a young, attractive, very accomplished woman came to see me in consultation about revision rhinoplasty.  She had undergone what was a conservative surgery with a satisfactory result.  Though she had some changes that she didn’t expect and though some airway and contour improvements were possible, the surgeon had done a very competent job.

But the critical part was what the patient told me.  Listen to her language: “After surgery, I looked like an animal”… “I felt like a fool for having to try to change who I was”… “I just thought surgery would make me feel better about myself.”

I don’t know much about this woman and I did not try to elicit a childhood history.  But what could a surgeon do that would make any patient look “like an animal”?  Would she ever say that her children look like animals?  Never.  Would she ever want her children to change who they were through surgery?

These statements indicate toxic shame, probably from childhood trauma, and certainly self – dislike and absence of feelings of self-worth.  For this smart, accomplished young woman, appearance could determine her value and her femininity.  When that didn’t happen, her self-criticism got even harsher.

You don’t have to probe to get a trauma history.  You just have to listen.  What this means, where it comes from, and how to interpret it is all in my new book, Childhood Abuse, Body Shame, and Addictive Plastic Surgery: The Face of Trauma, available everywhere.