Ten days ago I returned from a week long workshop in Carefree, Arizona. Competition to be included in the workshop was keen, and of course I was the only plastic surgeon among 25 therapists, most of them very experienced. During that week we got the details of the effects of childhood abuse and neglect on a child’s sense of self-esteem, reality, the ability to protect and contain him or herself, and the abilities to self – care and live in moderation. Traumatized children are wounded, and without help they do not develop into mature, functional adults. This explains a great deal of adult behavior, and also explains something about unhappy surgical patients.

Some patients whose trauma and sense of shame has focused on body image seek plastic surgery in order to feel better, to feel valued and precious. When surgery does not work, as it cannot, the patient will regress to an earlier level of maturity because the traumatized wounds and the sense of worthlessness are reopened. The patient may blame the surgeon for his or her unhappiness, but the real injury happened long before.

This is not to say that every unhappy patient is being unreasonable; some patients have had suboptimal results and require corrective surgery. Every surgeon experiences imperfect results, despite his or her best efforts. However, the perspective of childhood events adds depth to the patient’s history. I hope that by piecing this information together with the body image, trauma, and plastic surgery literature in my upcoming textbook, The Face of Trauma, I can help guide surgeons and patients into more successful outcomes for both.