For a long time I wondered why some plastic surgery patients with excellent results were still unhappy postoperatively. Further, their distress did not correlate with the degree of the deformity: many patients were distraught from almost invisible imperfections. Thirdly, my colleagues and I have all recognized that these distraught patients cannot be comforted by logical discussion. These observations have also appeared in the mental health and body image literature, without any satisfactory explanation. Severely unhappy patients are a significant problem for patients and physicians that needs better attention by plastic surgeons.

My recent published clinical research shows that a very high percentage of my plastic surgery patients have had traumatic childhoods of abuse or neglect. Despite that, many are very resilient and still function in high performing professions. I find this resilience very inspiring. In the worst cases, however, significant childhood trauma can cause body dysmorphic disorder.

I have also presented research that indicates that many unhappy revision rhinoplasty patients actually suffer from post traumatic stress disorder. In some cases, the symptoms– nightmares, flashbacks, intrusive thoughts– have lasted for decades; one can only imagine how unhappy surgical experiences have colored these patients’ lives. Fortunately, successful reconstructive surgery can decrease these PTSD symptoms. Those patients who are most likely to have had PTSD also had traumatic childhoods, a connection that cannot be ignored.

I am now researching the prevalence of childhood abuse or neglect in many of my plastic surgery patients. The results will be the focus of papers that I hope to percent in national plastic surgery meetings next spring. All of this research will be the subject of my 3rd book, The Face of Trauma, now in preparation.