Childhood Abuse, Body Shame, and Addictive Plastic Surgery: The Face of Trauma

Dr. Constantian's book is a definitive work on the present day obsession of a select population addicted to cosmetic surgery and the underlying causes that brings such a person into a surgical spiral, resulting in a never-ending quest to "look Better."If you are a doctor, friend or relative or even someone with Body Dysmorphic Disorder (BDD), this book is for you. Dr. Constantian pulls all the elements together from a neurological and professional point of view. I was intrigued by the immutable relationship between BDD and PTSD and childhood trauma. Most of us have suffered from some form of bullying or abuse as a child or grown up. The unquenchable quest to improve one's appearance is different from the average cosmetic surgery patient , merely wanting to improve his or her appearance to feel better about themselves. He aptly points out that plastic surgery can change the way you look, it cannot change your past or the world in which you live.Dr. Constantian's anecdotal history of his BDD patients is written like a master novelist. I felt like I was in the exam room, seeing what he sees and feeling what he feels. It is obvious he has a love of all his patients and is dedicated to improving the patient's life, surgically and psychologically. Kudos to Dr. Constantian, you have taken on a timely and sensitive subject in an artful and professional manner.

I'm an ENT surgeon who performed rhinoplasties in NH. I've known Dr Constantian's work since the mid 1980's. He is at the pinnacle of the plastic surgery world and widely esteemed. I have personally seen his surgical results and can attest that he is the finest plastic surgeon I have observed. This statement includes noted plastic surgeons whose work I observed in Beverly Hills, NYC, London, Palm Beach and elsewhere during my fellowship training. I mention this to emphasize that this book is from a professional who is the top person in his field. This books target audience includes plastic surgeons, mental health workers, and anyone interested in understanding the range of consequences of childhood abuse and neglect. He delves into the fruits of neglect and abuse including not just body dysmorphic disorder but also drug addiction, sex addiction, eating disorders, obesity, plastic-surgery addiction, depression, and obesity. An important insight is that these disorders are the "solution" that the individual has been compelled to adopt. He approaches a range of questions such as "what creates self-worth" and emotional resilience. The writing style is polished and engaging. The substance is fascinating and delivered by multiple attention absorbing means. This includes vignettes of patient encounters coupled with in depth research and insights.

Dr. Constantian's book offers superb insight into the relationship between BDD and psychological trauma. His book is well-written and thorough. It will be useful to the neophyte surgeon as well as one with years of experience.

Mark Constantian is a plastic surgeon in Nashua, New Hampshire, known for rhinoplasty revisions. When I was covering plastic surgery for Allure, I became interested in his work after attending one of his lectures. Unlike other nose specialists, he wasn’t showing a series of before-and-after pictures to demonstrate his results. He was showing a good result that the patient absolutely hated.And it is with this patient’s hurtful words that he begins his ground-breaking new book, “Childhood Abuse, Body Shame, and Addictive Plastic Surgery: The Face of Trauma.”“You've ruined my face….You…made…me…ugly.”Winding over six pages, he describes his consultation with this patient. The words they spoke and the attitudes and body language. It reads like a novel. We learn that this was her fifth nose surgery. That there was nothing wrong with her original nose, but she had all these operations because, as she told him, “I had to be prettier for my family." And she felt, “I was always a disappointment to my mother.” And ending with “In my whole life…every man has betrayed me.”This woman fit the standard definition of BBD, Body Dysmorphic Disorder--- preoccupation with one or more body defects that are not observable or appear slight to others. But the definition never included a cause. Constantian thought he could find a cause in patients’ childhoods.After spending the last decade doing his own studies and collecting date from others, and he blames all manner of childhood trauma-- neglect and verbal, mental, physical, and sexual abuse that manifest in various body issues from BBD to cutting, sexual addictions and eating disorders.(I should mention that Constantian is a talking head in my film, “Take My Nose…Please! In it, he gives a capsule of this theory—explaining the difference between the patient with “body dissatisfaction,” who has realistic expectations, and the patient with “body shame,” for whom repeated surgery is never enough to cure the real dissatisfaction—some childhood trauma. )“Childhood Abuse…” is published by a so-called academic house, but the author hopes that individuals plagued with these conditions will read it, too, in search of self-awareness. While the book has enough scientific studies and statistics to be worthy of quoting in peer-reviewed medical journals, it also has a human side. Throughout the book he underscores each point with replays of his conversations with challenging patients that are more riveting and insightful than any reality show. The yin and the yang of the scientific and the deeply personal make this book unique. It even has a hint of a happy ending. No matter how deeply wounded some people are by their childhoods, the author has met many who, because of their resilience, have overcome their addictive behaviors. Some even like their noses.

A well-crafted book written by a true master in his field. This book will be appreciated by people of all medical specialties who wish to better understand and identify patients with BDD. Dr Constantian is a brilliant author who along with endless research and understanding of this topic has written a highly engaging and insightful book utilizing his knowledge, expertise, and occasional inserts of much appreciated dry humor. The actual patient/doctor dialogue is utilized by the author in this book allowing a glimpse into the pain these patients hold on to from their past, therefore revealing how surgery will never be able to make them whole.I've had the privilege of attending lectures by Dr Constantian and greatly respect his international recognition in the field of Rhinoplasty. He cares deeply for his patients both physically and emotionally, and I very much enjoyed reading this highly educational book!