The Psychology of Cosmetic Surgery

The Psychology of Cosmetic Surgery

The Psychology of Cosmetic Surgery Transcript

Dr. Kate: Good evening Los Angeles. Welcome to Behind Closed Doors, heard every Saturday at 6 p.m right here on Talk Radio 790 KABC. I’m Dr. Kate Balestrieri.

Lauren: I’m Lauren Dummit, Marriage and Family Therapist.

Dr. Kate: And together we are the co-founders of Triune Therapy Group, a psychotherapy practice based in Los Angeles. Behind Closed Doors is a show about Sex, Relationships, Mental Health, Addiction staying healthy and related current events and today we are going to be focusing our time on the psychology of cosmetic surgery. If you have any questions about this topic you can give us a call at Triune Therapy Group at 3109334088 or you can message us on Instagram or Facebook at Triune Therapy Group. So Lauren, this topic came about because a couple of weeks ago I was out with some friends and finally someone showed me the snap chat filter phenomenon. Have you used it?

Lauren: Technology. I have not.

Dr. Kate: Oh my gosh!!

Lauren: I’m a little behind in that department.

Dr. Kate: Snapchat filters are amazing. They give you the ability to alter your face and make like goofy contorted faces or wear sunglasses when you wouldn’t be or have little hearts floating around your face when you are talking but the main thing that they do which is really phenomenal is erase all flaws on your face. They immediately change some of the filters, change the shape of your face and give you like an automatic contouring effect so even if you are having the worse hair day and skin day of your life, if you throw on Snapchat filters you look like a million dollar super model. It’s pretty amazing.

Lauren: So glad we can just carry that around.

Dr. Kate: It’s really fun. It got me thinking about how many things people will do to alter their appearance some of that being makeup and attire and just how we can port ourselves every day in the world but really thinking about some of the more extremes that people take to alter their appearance and we both read that article a few weeks ago about how people are engaging in a lot more cosmetic surgery so that their real life appearances can match the avatars and filtered version of themselves on social media and I thought what a fantastic and phenomenal thing to talk about since it seems to be a predominant influence over our world right now.

Lauren: Yeah and it’s so interesting you bring up the point of like people changing their appearance to like these avatars because it also brings into question like where we get our standards of beauty. Think about cosmetic procedures and they have been going on for so long like if you think about in ancient China when they would bind their feet or the extent and lengths people would go to synch their waist with the guarders and things. So it’s not.

Dr. Kate: Some unattainable aspect of beauty that…

Lauren: Even certain tribes in Africa they would do things to their ears and neck so yeah that’s so interesting.

Dr. Kate: Right body modification is not a new concept and yet here we are in 2018 and there seems to be a lot of stigma around body modification and the question I guess is why? Why are some people for it? Why are some people against it and what does it really mean? So here we are talking about the psychology of cosmetic procedures.

Lauren: I think there is a lot of a misconception because a lot of people assume that if someone is having a thing altered on their appearance that they have low self-esteem and that we certainly know that’s not true in terms of looking at history and I think it varies the reasons people get cosmetic procedures today.

Dr. Kate: It really does. I mean we work with a lot of people at Triune Therapy Group who talks about getting some minimally invasive procedures like Botox or filler and for them it’s about maintenance much in the same way that some people color their hair or get a new bag every fall or update their wardrobe every spring. I guess what I wonder about is what are we doing, why are we doing all of this pea cocking? Is it for ourselves? Is it for other people? How did it come to be?

Lauren: Well I think that there are many different reasons and I can’t say that any two people are exactly the same. I think there are a lot of reasons that just have to do with doing it for yourself and just wanting to feel more confident or there is something that they easily change and they have the money to do it then why not. I think that when people are doing it for other people that are when you get into a little more questionable reasons I should say.

Dr. Kate: I think when we look at our motives for doing it is why I am asking the question why we change our appearance or try to amplify our appearance. I think of the very corks of it there are couple of reasons.

1. We are creatures hardwired for social connection. So we think about what are the things that attract us to other people and in turn attract other people to us. One of the first things is appearance and we as a culture if you take a snap shot of any period in time we will make lots of assumptions about people based on their appearances. We make assumptions about them based on their appearance to define their social status, to define if they are safe for us. Are they going to be someone who is friendly or not friendly? It’s really amazing how quickly we make snap judgments about someone’s aesthetic. There are all sorts of memes that are online about resting b-face. I think this really speaks to the phenomenon of appearance. Some people’s faces are just not as glowing and aesthetically positive.

Lauren: I am laughing because my resting thinking face is like throwing my brow and making the dollar sign. Every time I am around my mom she is consulting her finger and pushing it there. They look mad and really I am just thinking.

Dr. Kate: My brothers used to call me and still do, Queen of Sheba because on Christmas morning when everyone else is enthusiastic to be opening presents my resting face would rather be in bed and it shows so now every time I am not smiling. Going back to this idea the assumptions that we make right, do we kind of have expectations that if someone is not smiling or not laughing or they have laugh lines or something that it might mean something about their personality and to some degree we all ascribe different characteristics based on what our expectations are for appearance. When it comes to having work done whether it’s minimally or more mutually invasive I think everyone’s motive are a little bit different.

Lauren: I’m thinking about the fact that on a normal day to day basis I am not really thinking about like my wrinkles and how other people perceive them. When I become self-conscious is when I have to go get my hair done and I am sitting in front of a mirror for 2 hours. I don’t personally want to look at my wrinkles. I don’t care if other people see them. I think there is a law somewhere that says every hair salon has to have the worse lighting possible. Hair salon needs snapchat filter.

Dr. Kate: Yes, they do. I am thinking about some of the different reasons people have talked to me about wanting to have cosmetic procedures done and the spectrum is really diverse. For some people it’s about I am just not ready to look like I am so old. For some people it’s about wow I have migraines and getting a little bit of Botox not only smoothes out my forehead but also helps with my migraine. So they get a 2 for 1 deal there. For other people it’s a little bit more psychological in its core. I have worked with several women who have had traumatic situations or they have been someone who grew up in a family that they don’t feel very close to and when they look in the mirror what they see is actually very painful because they might look like a family member who was abusive to them or they might feel a connection or resemblance to a family of origin that they feel very strained in their relationships with. So I think sometimes the motivations can be based on empowerment and taking a position of assertion back over ones appearance and really saying this is who I am and really redefining our identity as opposed to going for the aesthetic.

Lauren: That brings to mind also I am just thinking of a situation in which I knew someone who went through a traumatic experience and after that she went through a pretty significant depression and lost a lot of weight. There was so many different ways that it affected her body and she just wanted to feel normal in her body again and wanted to look how it had before. It wasn’t necessarily like trying to get away from thinking that this was going to solve her problems but just trying to have a more positive relationship with her body again.

Dr. Kate: Absolutely, yeah. I think as people who work in the mental health field there are lots of different ways to go about rekindling that relationship with our bodies and usually it’s two fold. It’s an inside out process. We talk about it as being an inside job when we are working with patients and really looking at identifying the defaces and confidence or the defaces and self-esteem or the triggers for trauma wherever that might be. Like you said if someone is looking in the mirror and it feels a synchronies to what they are experiencing the second part that is addressing it from the outside in and really saying okay how can I match what I see with how I feel and sometimes when there is an incongruence there it’s really jarring.

Lauren: Right so there is the incongruence and then sometimes it’s just looking in the mirror and for example for that person just seeing something that reminds them of the trauma that they might not be thinking of when they are not looking at themselves.

Dr. Kate: Absolutely. This isn’t really to be confused with somebody who has more body dimorphic tendencies because that condition is about seeing oneself in the mirror and seeing something that’s completely distorted or exaggerated from what is in reality a perceived or real flaw.

Lauren: I think when people are making changes based on that again the condition is about a distorted view. I think that’s when you see people that to everyone else they might look like they have gotten carried away and this person might not even see it.

Dr. Kate: I think the thing to really consider there is that if the cosmetic procedures somebody is having done aren’t solving the dissatisfaction someone has with their appearance there might be a bigger psychological issue going on underneath all of that, that needs to be addressed?

Lauren: Just like anything, it can also become compulsive.

Dr. Kate: Yes, well we are going to talk more about the psychology of cosmetic surgery when we come back from this break with Dr. Ben Stong. He is an internationally renowned plastic surgeon and the owner of Kalos Plastic Surgery in Atlanta so stick with us; follow us on Instagram and Facebook at Triune Therapy Group. Message us with your questions, we’ll be right back.


Dr. Kate: Welcome back, you are listening to Behind Closed Doors. I’m Dr. Kate Balestrieri.

Lauren: I’m Lauren Dummit, Marriage and Family Therapist.

Dr. Kate: And together we are the co-founders of Triune Therapy Group a Practice here in Los Angeles specializing in Trauma, Addiction, Sex and Relationship issues. Today we are talking about the psychology of cosmetic surgery with internationally renowned plastic surgeon and the owner of Kalos Plastic surgery in Atlanta Dr. Ben Stong. Dr Stong, thank you so much for joining us today.

Dr. Ben: Thank you for having me. I appreciate it.

Dr. Kate: Yeah we are so excited to have you on this is a really interesting topic. But before we dive in, can you tell us a little about yourself and your background and your practice?

Dr. Ben: Yeah. I grew up in a military family, moved all over the world and ultimately did training at Emory University in Atlanta. Went up to New York City for a year of facial plastics and then ultimately decided to do my practice in Atlanta about 8 years ago. We are currently building a surgery center in a clinic space guess you heard.

Dr. Kate: I have. It’s a great area. Congratulations! How did you choose this specialty?

Lauren: I was just thinking the same thing having grown up in a military family.

Dr. Ben: Yeah that’s a good question. I initially was drawn to head and neck surgery and so that’s when I ultimately did my residency had a neck surgery and once I got into that specialty I was of the sub discipline in that I was drawn to plastic procedures and surgeries and just really enjoyed them and ultimately that’s how I made my decision to do a fellowship.

Lauren: And you also do philanthropic work. Can you tell us a little bit about your work with the National Collision against Domestic Violence?

Dr. Ben: Absolutely. I’m on the advisory board actually with Dr. Kate and we help advise them on how to particularly from a physician standpoint gets needed services like reconstructive surgery from abuse situations and I also perform surgeries for those people.

Dr. Kate: It’s such an amazing program Dr. Stong and we are just thrilled to have you being a part of it and what I love about being on that board is just how motivated the board is to help get survivors of domestic violence aligned with the services that they need to try and move through any physical damage that remains as a result of their trauma.

Dr. Ben: Absolutely. It’s not easy to pair people up. Some of these clients and patients have to travel really long distances to get services that they need.

Dr. Kate: They do but if anyone has any questions about how to find out more about that program you can always call us at Triune Therapy Group and we can set you up with the National Collision against Domestic Violence and you can reach us at 3109334088. Dr. Stong tells us about the most frequent procedures that are inquired about or performed at your practice.

Dr. Ben: Well it’s changed over the 8 years I have been in practice. I used to do a ton of reconstructive surgery and now I am almost 100% cosmetic.

Dr. Kate: What’s the difference?

Dr. Ben: Well cosmetic is pretty much purely elective and the reconstructive stuff is from either cancer or some sort of other trauma to the head and neck region and then you are fixing it for functional as well as cosmetic purposes.

Dr. Kate: Okay.

Lauren: What are some of the motivations that you see your patients coming in to have these procedures?

Dr. Ben: Listening to your segment a lot of what you guys already said is part of my consultation talk with the patients. One thing you mention was in particular is motivation for doing these procedures. I’ve helped people all the time that you should only be doing these types of things for yourself and nobody else, not your boyfriend, not your family member, not your spouse. If you are doing it for those reasons, those are the wrong reasons. You shouldn’t be having these procedures and then in particular aging phase surgery like eyelids etc, especially 3 reasons people do them.
1. We are living longer than we ever have, we are typically healthier than we ever have been in history and when we look in the mirror how we feel on the inside doesn’t match how we look on the outside. We just want to look as good as we feel on the inside.
2. Its typically the more sacred when the kids go out to college and parents gets off and split up at that time. They are going back out on a dating singles market and they want to get some procedures to feel more confident in that arena.
3. A lot of people or some people get these procedures to remain relevant in their occupations longer. You have puffiness under your eyes or bags under your eyes and you look tired your boss is taking responsibility away from you and you have got some young hot shot who is ready to take your salary and your job as soon as possible. A lot of people will get them. Get procedures to look less tired and look more rested.

Lauren: That’s certainly true and the entertainment industry as well. I can’t even imagine that pressure and certain roles.

Dr. Ben: Interestingly enough we are seeing a ton of Hollywood out in Atlanta now. It’s not major motion pictures but overall filming it I think it’s the number 1 spot in the entire world.

Dr. Kate: For filming?
Dr. Ben: Yeah and they are building motion pictures studios out here so I see in my practice people from the Hollywood industry.

Dr. Kate: Well that’s pretty fantastic.

Lauren: I also know that it’s been an issue for people not necessarily in the entertainment industry but are in the public eye, so news casters, politicians, things like that. I think like I was saying I don’t like seeing my own wrinkles when I go to the hairdresser. Having to see yourself on TV I could imagine how that would motivate you to want to have to look your best.

Dr. Ben: Absolutely and to take it a little bit of a step further. Instead of your opening statement you have an increase in the number of cosmetic surgery and procedures and reasons why used to be except for your family photographs. Most people didn’t see themselves as frequently as like celebrities do on TV or in magazines or in stories and so they are constantly seeing themselves over and over again and they had to fight aging or they are obligated to fight aging. Since the year 2000 the number of cosmetic procedures in the country has gone up by 150%. I would solely almost attribute that to the rising of the selfie. Everybody is walking around with their camera in their pocket taking selfies. We see 100 of snaps, 1000 of pictures of ourselves a year almost and it’s from different angles that we have never seen before and so psychologically we are still figuring how to deal with that. People are coming into procedures pick themselves up and feel better and hopefully take a better selfie for themselves.

Dr. Kate: What’s interesting about that also is that when you use your camera for a selfie and you flip the screen around so that it’s front and center the camera actually reverses the way that we see ourselves so we are seeing ourselves from a different perspective than we do when we see ourselves in the mirror. And often that’s why people are having such a negative reaction to their selfie pictures because they have never seen that perspective before and it’s alarming. They feel distorted. I can’t tell you how many people have said things to me like oh my gosh Kate I took a picture of myself and I look like Shrek. I see the picture and I am like no you look great because that’s how I see them every day. But when we look in a mirror it’s a different angle and so we are not used to seeing ourselves so often and with these perspectives so it can be very jarring.

Lauren: And you say I think you look great; we always are our self-critics. So when we are seeing pictures of ourselves constantly it’s hard not to notice every single flaw.

Dr. Ben: Before there were Snapchat filters there was Photoshop. We talk about the fashion model celebrity industry. Photoshop has always been around for touching up little flaws like pimples or wrinkles or whatever.

Dr. Kate: It’s true and it does create an idea of what we should be like as oppose to really celebrating a reality of who we are not to say that it’s wrong to want to improve ourselves but I think we have to make sure to make space for challenging the fantasy that comes with all these different filter programs and applications.

Lauren: I’m talking about that with my clients that have disorders because often the people they are looking up to first of all these super models who are like a phenom biologically and then they are being Photoshoped so the images that they are seeing and holding themselves up to are completely unrealistic.

Dr. Kate: So Dr. Stong I am curious when you are working with people is this in line with your experience that people would use cosmetic procedures to improve their psychological well-being, not just their aesthetic well-being?

Dr. Ben: I don’t 100% dig deep into a patient’s psychology. I don’t have as much time. I am not professionally trained in it but there is a ton of psychology. I don’t ask them about their anxiety or their depression. But you can sort of get a sense of it from them and certainly people’s self-esteem and overall moods and how well adjusted they are can be improved greatly with even the simplest little procedure like single lip injection gives somebody a ton of confidence and they just love it. That’s the best part of my job or when I told my staff I love talking the cast off because it’s one of the most transformative operations you can make on the face so I love seeing the reaction when they see the new nose. There is a level of anxiety they have had a cast on for a week. They knew what they look like before surgery and when they take that cast off it’s a big reveal for them. It’s gratifying to watch their reactions.

Dr. Kate: It really can be I imagine and just understanding the pivot point from this is who I was, what I looked like before to this is what the next chapter of my life looks like. It can be a huge demarcation between where I was and where I want to be.

Dr. Ben: For sure and I think one thing that I am still learning about and I think underestimated in the past is a level of anxiety. Not just that these people may have their day to day lives or depression and their day to day life but the level of anxiety that surrounds actually having these procedures.

Dr. Kate: That’s a really good point and we have to take a quick break but when we come back let’s talk more about that and the psychology and cosmetic surgery. We’ll be right back with Dr. Ben Stong, owner of Kalos Plastic Surgery in Atlanta. Follow us on Instagram and Facebook at Triune Therapy Group and stick with us.


Dr. Kate: Welcome back, you are listening to Talk Radio 790 KABC, this is behind closed doors. I’m Dr. Kate Balestrieri.

Lauren: I’m Lauren Dummit, Marriage and Family Therapist.

Dr. Kate: And together we are co-founders of Triune Therapy Group, a psychotherapy practice in Los Angeles that specializes in treating Trauma, Addiction, Sex and Relationships issues. If you are just tuning in today we are focusing on the psychology of cosmetics surgery with internationally renowned plastic surgeon and the owner of Kalos plastic surgery in Atlanta Dr. Ben Stong. Dr. Stong are you still with us?

Dr. Ben: Yes, hey.

Dr. Kate: Wonderful. Just before we took a break we were talking about how a lot of people have anxiety or depression in general that may or may not be a participating factor for their decision to have a cosmetic procedure. One of the things you said that was so interesting is how much anxiety there is around the actual decision to have a procedure done and then during the procedure can you talk a little bit more about that?

Dr. Ben: Yeah I was saying that in my career I think I underestimated the level of anxiety and even depression that concerns some of these procedures. Particularly the healing phase afterwards we live in an instant gratification society and these aren’t instantaneous results they take time. Also there seems to be process that occurs after they change their face, getting used to the new them and who they are. Everybody is a little different. Some people sail through the post-procedure period very easily and some people just require a little bit more reassurance. The level of anxiety before and during the phases afterwards can be significant as well as depression.

Dr. Kate: So how do you work with patients around that?

Dr. Ben: As best as I can. I don’t really have a mental health professional that I work with but if I have them I wouldn’t mine that arrangement either. I always see them as frequently as they needed to be seen or want to be seen and just try to be as positive as I can about the results and how great they are going to look and encourage them to be as positive as they can be.

Lauren: I imagine even just kind of walking them through the process and providing some like psycho education around that. I even know people that have had procedures and they get the bandages off or whatever it may be they go through this depression and who knows perhaps it could be from the anesthesia wearing off and how that affects our nervous system. Sometimes they are just swollen and so they go into the state of a mild depression and if they were to wait a couple more weeks they would be a lot happier.

Dr. Ben: Absolutely and there is very little we can actually do to speed the healing process up. You could go get treatments and that’s going to do a little bit but it’s really time is the main factor. I am preparing my clients for face lifts I say don’t have any major life event plan for at least a month. Don’t have your kid’s college graduation or a wedding that you need to be camera ready for or give me a month. It doesn’t mean you are going to be looking like a freak or anything for a month but it means that there is swelling that takes time to go away and I do a mini face lift so technically I do deep through which is sort of the best of both worlds but no matter the surgeon and the procedure there is real healing time. Unfortunately, some of the TV shows that we have and had on make it seem like these results should be overnight and the audience doesn’t realize that there is 3 months, 6 months, a year between the before and the after photos.

Lauren: I imagine every single person body heals in a different way and at a different pace. Some people might be looking well look my friend look better in a month than I don’t look the same and I think that goes for everything.

Dr. Kate: It also comes to expectations. I think that’s a big part of what I work on with patient’s male or female who are anticipating a cosmetic procedure and really want to weigh the pros and cons. We talk about what are your expectations? What will be different in your life and how will you feel if the healing takes 1 month, 3 month, 6 months or doesn’t quite align with what your hopes are. That’s a big I think conversation to have when somebody is hinging a lot of hopes on a procedure.

Dr. Ben: Absolutely, setting expectations is priority number 1 for me and that’s why I have to go and talk. You are going to have this beautiful cute new nose after I take this caste off but then it swell up a lot because I don’t have the dressing on anymore. The end result is what does it look like in the final analysis. That’s ultimately in my head and the way I think that’s the most important thing. On that side the patient priority particularly in the short term so there can be short term pains and growing pains that hopefully in the long run they generally forget about. Once they see the final product and they are in love with it and they are enjoying it or their friends are telling them hey did you lose weight or you just look good, have you gone on vacation, you look rested. I can’t figure it out what’s going on. That’s really where you want the end point to be but it takes time to get there and that’s part of what my job is. It’s reassurance and being their biggest cheerleader that I can be.

Lauren: You mentioned that people should be doing these things for themselves and that if someone is really doing it to please somebody else that’s not a good reason. I’m just curious, are there any other instances in which you would dissuade someone from going through with a procedure?

Dr. Ben: Body dysmorphia. You have already mentioned it. If you have a known body dysmorphic person in the industry try not to operate on them. I had actually interestingly not that I had a patient come and tell me 3 or 4 months ago and he started out with me. He was 19 years old only and he started out with me said I am body dysmorphic and I said okay. Are you in therapy for that? Do you have a therapist? He is like yes I do and I said okay that’s good. I legitimately listened to his concerns and the one thing that he brought up that I agreed with him on was doing a rhinoplasty for him. He had a large tip and we made an improvement for him. I told him I said look before I will operate on you I want to talk to your therapist and I want to talk to your mother. She’s been with him his whole life and I just wanted to get their insight and see how you would handle this. I don’t think that it’s. You got to see okay you have body dysmorphia but does that exclude them from ever having a procedure. I don’t think that’s necessarily a fair thing either if they have an issue. I recognize and they recognize now. If there were other things in that consultation that I had to say this is probably more along your lines if your body dysmorphia I don’t think we should be focusing on that but you do see a legitimate issue on. I have had one patient who was psychotic come into my office and scare me actually one time. He flew in from Minnesota for the day and asked me to take these implants out of his face. The government was monitoring his thoughts. I mean most people in my practice are fairly well adjusted and doing it for the right reasons. We sat down and I spend a lot of time with them. I spend an hour in the consultation with them. I don’t hurry people through the consultation. I can see more clients and more people to sign up I think understanding who you are going to operate on because that’s how you look at it. You are doing these procedures, I don’t know them that well, and they don’t know me that well. We still have a whole process afterwards getting to know each other.

Dr. Kate: A lot of people carry assumptions and judgments about cosmetic procedures, what are some of the biggest assumptions and judgments that you have heard and how did you address that when patients come in with those kinds of concerns?

Dr. Ben: The two biggest concerns that every patient has and is uniformly is the healing process afterwards. When can I get back the life? When can I get back to work? The second is oh my gosh I don’t want to look unnatural. That’s the biggest hurl to overcome with almost even something as simple as a lift injection or Botox. They will come in and I don’t want to look like so and so and they will bring out their celebrity, so many celebrity, classic celebrity Goldie Han or whatever. People will bring up in relation to I don’t want to look like this person. What I tell them is that’s purely the doctors that person chose. The Doctor has to have taste and understand what come with tasteful and good as opposed to unnatural and artificial. Just because you have a face lift doesn’t mean you are going to look like John Rivers. I was just going to say to finish that thought it’s about the surgeon you choose and it’s about them knowing how to accomplish a natural result. I talk about subtle yet dramatic results. What I mean by that is your best friend could be sitting with you year after surgery after you are healed and gone and just sitting there and they can’t put your finger on why you look better, how you look better but if you look to the side by side comparison of the before and they after 12 months down the road. There would be a dramatic change. You would say wow that’s a dramatic change but very nonobservant in that regard. And so they are not, my whole job is to analyze people’s faces. It’s what I do. I could be at the restaurant. I could be at the public event I am looking at faces constantly. I am looking for a variation that’s a whole different talk about the psychology of attractiveness.

Dr. Kate: Yes let’s address that when we come back but right now we have to take a quick break so stay tune to hear more about the psychology of cosmetic surgery with internationally well-known plastic surgeon and the owner of Kalos Plastic Surgeon in Atlanta, Dr. Ben Stong. Message us on Instagram and Facebook at Triune Therapy Group with your questions. Stay with us we’ll be right back.


Dr. Kate: Welcome back you are listening to Talk Radio 790 KABC. If you just tuned in you are listening to behind closed doors. I am Dr. Kate Balestrieri.

Lauren: I’m Lauren Dummit, Marriage and Family Therapist.

Dr. Kate: Together we are the cofounders of Triune Therapy Group, a psychotherapy practice in Los Angeles that focuses on treating Trauma, Addiction, Sex and Relationship issue. If you are just joining in we are speaking with internationally renowned plastic surgeon and the owner of Kalos Plastic Surgery in Atlanta Dr. Ben Stong and we are talking about the psychology of cosmetic surgery. Dr. Stong just before we went on break you mentioned the psychology of attraction and how that’s different from the psychology of cosmetic surgery. What’s your take on that?

Dr. Ben: I think they are both very complex but the psychology of attraction or attractiveness or what another person finds attractive is very multifactoral. One person finds one individual attractive and the next person doesn’t. There is this whole bio evolutionary talk that I heard one time about genetic diversity and diversification of genetics. Does somebody have the hip to waist ratio that classically demonstrates fertility? There are all sorts of things that go into our subconscious about attractiveness. The one thing that I have sort of come to think is that you are born into this world and you grow up in an environment. What you are exposed to in that environment is profoundly shape and form what you find attractive in the world. If you grow up in an ethnic household you are going to have much more tendency to find ethnic characteristics attractive. If you grow up in a very diverse environment with many different ethnicity and exposure to many different types of people you are going to probably have a more diverse view on what you find attractive.

Dr. Kate: It’s interesting to hear you say that because I agree with what you are saying I want to add that a lot of people who grow up within a traumatic family or a chaotic family, dysfunctional family often will either over identify in terms of what they find attractive and the similarities between their families of origin as a means of staying close but also as a proxy and a safety buffer to resolve relationships that may be feel more strained whereas other people will have a very adverse reaction to characteristics that are maybe similar to those within their family or ethnic group because for them it represents so much that is unsafe in their relational context. It’s interesting the polarities in people’s reactions and how that can influence their arousal template or what they find attractive in other people.

Lauren: That also reminds me as you are talking about that when you mention people that grew up in a traumatic family of origin. I was also thinking about there is some people who are very damaged and wounded on the inside and no matter what they do they don’t feel attractive on the outside and it really is an inside job. I think that’s where you see a lot of the body dysmorphia or kind of various psychological factors coming into play.

Dr. Kate: Absolutely. So Dr. Stong in our intro we were talking a little bit about some of the different studies that have been out right now and the increase of surgeries or cosmetic procedures to align people’s reality with their social media personas or whatever their social media filters are avatars can create. In terms of their appearance what are you seeing in that trend?

Dr. Ben: I haven’t had anybody come in with a Snapchat filter. What I typically get is people showing me a celebrity on Instagram or noses that they like in magazines. While we can improve their appearance we also have to be realistic about what can work and fit. So for instance just a simple example, Angelina Jolie has lips and she is a very attractive woman in general. Before she ever got any filler put into her lips. She had good anatomy to work with. She had good red lips show how we would put it in the industry so filling that only made it look more sensual and just look good. Same with Kylie Jenner’s lips. That’s some very common thing people come in and talk to me about. So that’s really what I get is they show me celebrities and what their lips look like or what their eyes look like, what their knows looks like, ask about recreating that and what we can often do things to get very similar and close we still have to be realistic about what we are starting with. You got to work from what you have. That’s I guess how I would put it when people come talk to me about that type of thing.

Dr. Kate: I think that’s a really great point and one of the things I want to highlight in this episode is that we are coming up in an era where body positivity is part of the vernacular every day. We are also seeing as you said 150% increase in cosmetic procedures over the past several years. It’s so curious to me that in culture that talks about body positivity and inclusiveness and creating a safe space for everyone to be attractive and to celebrate their physical characteristics, why are we seeing such an upsurge in cosmetic procedures and how do you reconcile those two phenomena?

Dr. Ben: I mean the upsurge I think like we talked about is due to social media and just seeing ourselves in dated with photographs. One thing that I talk with almost every patient and I hear almost uniformly every single patient who comes in my practice says okay doc what do I need or do I need that or do you think I need this? I say to them let’s start from the premise that you don’t need any of this. This is all what you want. This is all a want. This has nothing to do with your medical health. You are not going to die from not having Botox and or a facelift. I think that really sets the tone with the patients in my practice because from hey this is something that I am entitled to or everybody should be getting to this is sort of a luxury thing even something as simple as Botox. If you do it regularly it gets expensive you are spending 4, 5, $6000 a year just on Botox. So not everybody can afford this and I think that’s another thing. I am not anybody’s financial manager. I don’t make judgments on that. I see people who come in and can’t really afford it. What am I supposed to do at that point. I am really just a technician but so I think there is this whole thing of I tell people you are not entitled to life liberty, the pursuit of happiness and the facelift in your life.

Lauren: I think also sometimes I would imagine people.

Dr. Ben: I think that maybe in the California.

Dr. Kate: It might be in the California.

Lauren: I think a lot of people like you are just saying come in asking what they need. I think it’s important people identify what is it they don’t like. Sometimes people are just wanting to have things done but they aren’t able to identify what they are unhappy with or what is bothering them. It’s just that they think they need to have something done or they need something more.

Dr. Ben: For preventative in this point in time. I mean when people come in and they start talking to me about Botox I just say I have gone every which way in this thought process. I had a medical student; I watched a 23 year old get Botox and a dermatology practice that I was rotating on. I was like wow how shameful this 23 year old feels the need to get Botox. Over a decade I help people look the age of consent in United States is 18 you can legally sign a consent form at 18 on one half of your face you are doing Botox and on the other half you are doing Botox creams, lasers and all the sort of stuff that’s non-surgical. On the other half you do nothing. You are going to see significant differences 5 years, 10 years, 15 years, 20 years. You are going to delay the need for more aggressive procedures by taking care of yourselves. It’s not much different than eating a healthy diet or whatever I guess.

Dr. Kate: That’s a really good point. I think as a clinician what I always talk about with people is where you are dissatisfied with your appearance and what will it mean to you to change it and that’s an important question for people to ask especially hearing that the number 1 question they ask you Dr. Stong is what do I need. When we go into a situation not really discerning what would be good for us then we’re really disempowered in our decision making process and I think that’s an important demarcation to make. Who are you doing this for? Why are you doing it? What’s the goal? What will be different if you have less laugh lines on your face than before? A lot of people can’t answer that question.

Lauren: I think there is some magical thinking sometimes too. For example; addicts often don’t necessarily want to feel better they just want to feel different. I think people go into with that like I just want to feel different and thinking that’s a solution.

Dr. Kate: Well we are thinking about the body positivity movement really what stands out to me is that there is no right or wrong way to be in your own skin. The only thing that is important to really think about is how I am comfortable in my own skin and if I want to make changes what will that do for me. Do I have the means to make that happen? Really I think it’s important to remember that some people love their laugh lines. For them it’s a roadmap of every joyous experience they have had in life and that’s really beautiful. For other people they don’t want those laugh lines on their face, they prefer their map to an undiscovered territory. That’s fine. Either is okay. It’s about personal choice and that to me is what the body positivity movement really is about. Dr. Stong thank you so much for joining us today. If our listeners want to get a hold of you or learn more about your procedures how can they contact you or learn more?

Dr. Ben: Our website is Our office number is 4049636665 or if you prefer email to get in touch with our staff that will be able to answer your questions.

Dr. Kate: Wonderful and if you missed any of that you can always check out our website or call us at 3109334088 at Triune Therapy Group. Thank you so much for joining us today. Tune in every Saturday at 6p.m for Behind Closed Doors. Next week we’ll be talking about codependence, love addiction and love avoidance. A big thank you to our guest Dr. Ben Stong owner of Kalos Plastic Surgery in Atlanta and of course thank you our listeners we do it for you. Have a great weekend everyone.


Ask the experts

Often, when anger is the first response, it’s considered impolite, crazy, bitchy or dismissed as overly emotional. Yet, there are many instances in which one’s anger is stirred, and the key is putting it to good use. For instance, when a loved one is unfaithful, or when insensitive remarks are made concerning one’s ambitions or dreams, when feelings are questioned or when a woman is told to be more vulnerable and subservient. Though family and social expectations place unnecessary burdens on women (and men too), they can channel their anger-filled responses into action by going against the grain, pursuing their own interests or business, going to graduate school and much more. In turn, they’re encouraged to surround themselves with like-minded individuals, committed to supporting and cheering on one another, and ultimately helping the other discover their true potential. This system of support will continue to help individuals convert their anger into action, and perhaps enjoy a few laughs, too.

Yes. One hundred percent. Women are socialized to put relationships before themselves, and this often leads to stifling anger or any feeling that might compromise the bond between two people. This is especially the case in their relationships with men, or in competition for men, and over time, women’s anger and aggression has become more user wraps, or covert. Passive aggression seems to be both the only “acceptable” means of communicating anger, but women are also labeled “manipulative” when they attempt to express themselves indirectly. It becomes a vicious circle of anger, denial or minimization of anger, and then make ourselves smaller just to avoid being a “problem.”

While it is becoming more acceptable for women to show anger, progress is slow. Most of the time, female anger is couched in comedy or parody, and only accepted in small soundbites. Those invested in a patriarchal perspective, men and women, hold firm in their beliefs that women ought to act a certain way, or not make waves. The vary act of saying “we’re angry!” is a bold and pioneering move. Further, some women hold more internalized oppressive views, and refuse to participate in a movement that is labeled feminist or angry. For some women, to do so would compromise their social standing, romantic relationships, financial security, etc. It is scary, because the backlash is real. To take a stand is mark of bravery, and not everyone is ready to avail themselves to the fiery response of those in opposition. My opinion is that over time, the backlash will subside and change will take place. Cultural growth is a slow moving process, and with every voice heard, the collective voice of a paradigm shift grows louder and more effective. I don’t think women (or men) should care about acceptability. The more those who are angry attempt to hustle for the approval of their oppressors, the more power is given away. From my perspective, those who are angry a well suited to unite and establish new norms, refusing to tolerate mistreatment any further.

There are so many way to channel one’s anger constructively. I do not condone any violence (unless in self-defense) and instead think about using anger as a collaborating force within and with others. Being of service to others is one way to channel anger. This is especially relevant because so many women today do not have strong female role models, who they can turn to for advice. Get engaged. Mentor younger women, get a mentor, get creative. How can you pass along the resources (i.e., emotional, financial, logistic, etc) that were not available to you and resulted in your marginalization? What do you wish existed that could have helped you through a particularly challenging experience? Create it. I did, and it changed my relationship with anger and helped me take it for what it is a healthy emotion that lets us know when we feel disrespected or mistreated. This is key information that keeps us psychologically and rationally healthy. Anger is invaluable and an essential part of the human experience. When we embrace that, we can make it work for us in myriad ways.

As a psychologist, patients, friends and family are always asking me advice on their relationships and, let’s be real, everyone else’s relationships. One of the biggest questions they have, is why are there no good men or no good women out there? There are good people out there, I reassure them, but they inevitably come back with some retort about having to settle or face being single forever; for some, a fate worse than death. So herein lies the conundrum stay single forever or settle. Well, let’s back out of the black and white thinking that keeps us stuck for a moment and think about what it means to settle. Most of us have arbitrary ideas or checklists we drag around to assess our swiping situation. Does he make a certain amount of money? Is she pretty enough to take around my friends? Is she/he tall enough/too tall? Is she/he fit enough? What kind of car does he/she drive? Do they like dogs? All-important questions, but what do they really mean about a person’s character or how well you’ll get along? When considering the question of settling, it is important to ask what we:

  1. need in relationships
  2. want in relationships and
  3. won’t tolerate in relationships?

No two relational blue prints will look the same, and there are no right or wrong answers. Let’s look at needs first. We all have intimacy needs, like support, trust, security, communication, touch, respect, etc. They may change over time. That’s okay. Its hardwired in us. We also have relationship wants, the qualities that might ignite our fire a little more intensely. Physical appearance, fitness level, similar hobbies, values, job, financial standing, etc. are examples of wants. There is nothing wrong with wanting whatever you want in a partner. But many times, we mistake our wants for needs and then we feel like we’re settling if the want boxes are not checked, because we’re ignoring the meaning we assign to these traits. For example, consider meeting someone who is two inches shorter than your preferred height in a partner. He or she is funny, witty, charming, consistent, honest, and generous with their time, all of the other wants and needs you’ve identified. They just happen to be a little short-changed in the height department. What does height mean to you? Does it represent strength? Safety? Protection? Status? What does it mean about you if you date this person anyway? Whose judgment do you hear in your head? Why is their judgment so important? Asking these tough questions can help you decide if this is a want or a need, and if the underlying meaning is a need, can that need be met in other ways by this partner or other people in your circle? We often expect our partner to meet all of our needs, and overlook the inevitable disappointment in that expectation. Many people do not know what they need or want in relationships, because they are so eager to be in a relationship that they haven’t stopped to consider what they are looking for in their other half. They accept what is available, to avoid being alone. One day, they wake up and think, “Hey, I think I want more than this. I wish my partner would….” and realize that they might be settling but are afraid to leave. This brings me back to the last point, knowing what you won’t tolerate in relationships. It is just as important to know what doesn’t work for you when considering whether to start, stay in or leave a relationship. For some, deal breakers might include violence or infidelity. For others, perhaps smoking or liking heavy metal is the end of the line. Knowing yourself is key in defining your needs, wants, and deal breakers for relationships. If you don’t know some answers to these three factors, perhaps you’ve been neglectful (and settling!) in the most relationship of all, the relationship you have with yourself. Only when you set intentions and cultivate a relationship with yourself can you invite in the kind of love you are seeking and deserve to have. Until then, you’ll be running in circles, chasing ideas and looking to define yourself in the reflection of another.

Obsession, a thought that continually preoccupies or intrudes on a person’s mind, is often what drives addiction. Obsession is about hypervigilance. When we feel the object of our affection (whether real or in fantasy) may not feel the same way, we perseverate about them, ourselves and the relationship. This rumination and over-focus is an emotional survival strategy that keeps our brain playing out all of the what-ifs and looking for answers to the sometimes unconscious ques- tion, “How can I make sure my partner doesn’t leave me?” A milder version of obsession can look like ruminating thoughts. “What if he likes her more than me?” “Did she talk to her ex-boy- friend last night?” “If only I lost those last 10 pounds…” Perhaps you find yourself checking their social media accounts for proof they are with you, or have moved on. Maybe you enlist your friends or family to investigate or check on your desired. At the extremes, obsession can morph into stalking and domestic violence. If we feel threatened at the loss of someone, and re- taliate with this level of possession, it can be dangerous for everyone involved. Contrary to what may be glamorized in movies, extreme jealously and stalking are not healthy courtship behaviors, and can lead to emotional and physical trouble.

Obsession with another person may be a symptom of love addiction, which is essentially an ad- diction to the experience or “high” of being in love, and generally appears on the form of putting another person on a pedestal, creating the fantasy that they are perfect or the one, ignoring their faults or certain red flags that point to the contrary. Love addicts often expect their partners to care for all of their needs. Love addicts often neglect to care for or value themselves while they in the relationship. There often exists a toxic bond or an obsessive attachment in love addicted relationships. Love addicts often continue to engage in the relationship, trying desperately to connect as they search for their self-worth in the relationship, even if the object of their desire is pejorative, hurtful, or abusive. Inappropriate boundaries, abuse, neglect, intimacy issues, chaos, drama are some of the deleterious characteristics of these relationships. Love addicts suffer from profound feelings of shame, anguish, and fear of abandonment.

Since love addicts typically suffer from an anxious or preoccupied attachment (hypervigilance about their partner or the relationship), some signs to watch out for would be someone who is wanting speedy closeness, says “I love you before the first argument, has poor boundaries, is constantly expressing insecurities and worrying about rejection, is often very unhappy when not in a relationship, plays games to keep your attention, has difficulty with direct communication, struggles to effectively express their wants, needs, thoughts, and feelings, expecting you to guess or read his or her mind, acts out, tries to make you jealous, always makes things about him/her- self in the relationship, lets you set the tone of the relationship, seems preoccupied with the relationship, calls or texts excessively, stops by your home or work unexpectedly, fears that the small acts will ruin the relationship, seems to be trying too hard to keep your interest, and is extremely jealous.

If you suspect that the person you are getting to know has obsessive or love addicted tendencies, this does not mean you have to cut them out of your life completely. However, it is important to take things slowly, establish very clear boundaries, assess what works for you and get consulta- tion from friends and loved ones about your experience, pay attention to any attempts to get you to change or disregard your boundaries or needs, use direct, clear communication, and effectively verbalize your wants, needs, thoughts, and feelings. – Dr. Kate Balestrieri, Psy.D., CSAT-S, Licensed Clinical and Forensic Psychologist, and Lauren Dummit-Schock, LMFT, CSAT, CoFounder

The first step to getting help from this type of toxic relationship is to recognize narcissism in your partner or spouse. This involves identifying the traits and warning signs of this disorder, which you may have been living with for quite some time. At Triune Therapy Group, we have skilled clinicians who are highly trained to treat those that are in a relationship with a narcissist.

To help you understand the condition and how you may or may not have been affected, please explore the following Frequently Asked Questions and Answers provided by Licensed Psychologist Dr. Kate Balestrieri: Read More FAQs About Narcissistic Personality Disorder

Perhaps the greatest hope surrounding the #MeToo movement and other similar movements is that it will generate an awareness of the magnitude of sexual assault and harassment, particularly in the workplace. In doing so, maybe it will initiate and rebirth conversations regarding equality that have since gone underground. This is important, because many people fail to see the ways in which others misuse power and privilege, and how this leads them to engage in predatory behaviors. In another sense, the #MeToo movement could educate people on how to avoid being exploitative, while enlightening them on affirmative consent, power imbalances and how to classify and pursue intimacy and happiness in a authentic, healthy manner.

I work with new mothers and I have on multiple occasions worked with mothers who have experienced a the loss of a pregnancy close to becoming a mother. It is indeed a double whammy. There is so much that gets stirred up, and it intensifies the transition into motherhood and the processing of these loss, exacerbating common life-cycle events, and resulting in undue pressure on new moms, emotionally, physically, spiritually. When we’re trying to understand how motherhood and losses affect us, it is imperative to remember that the transition into motherhood and assimilation of loss are multi-dimensional and encompass physical, social, emotional, spiritual aspects of humanity. Although we mostly associate motherhood with new beginnings and joy, the questions of loss and death and endings actually also come up. Becoming mothers is a definite end to our earlier self, our pre-motherhood bodies and relationships, and mothers must mourn how the idealized fantasy of motherhood is never matched with the reality of the day to day. This is all considered “normal” to go through unless it gets complicated with trauma or major stressors. But if the transition to motherhood coincides with a loss, mothers get all of this thrown at them at the speed of light. It’s like existential pressure overload. – Helena Vissing, M.S., Psy.D. Clinical Associate, Psychological Assistant

The mental health of mothers is a major public health concern. Research demonstrates that depression and anxiety in mothers impact their children. The exact ways children are impacted by their mothers’ mental health involves a complex interplay of factors. We always have to look at the unique combination of risk factors and protective factors for each mother-child couple. If you grew up with a mother who suffered from postpartum depression, you are not necessarily determined to suffer. But we know that on a large public health scale, there is a clear connection between mothers’ mental health and lifelong mental health of their children. The immediate effects of mothers’ depression is that babies become withdrawn and irritable. This is happening at a sensitive time when babies are beginning their lifelong development of emotion regulation. Development is layered and scaffolding throughout life, so a baby who is experiencing these challenges already during their first years will be What we often experience in the consulting room is adults who struggle with feelings of shame and inadequacy or “never being enough”, even when they are normally functioning. They might describe a vague sense of unworthiness that has always “haunted” them. Although it’s widely acknowledged now that our sense of ourselves is rooted in our earliest relationships, it is still overlooked how issues in this area can stem from the emotional pain the child of a depressed mother experienced. This pain does not just disappear as the child grows or if the mother’s mental health improves, as it has influences the very core of the child’s sense of self. Infants and children are developmentally unable to make sense of the intensity of their mother’s depression, but they still feel it. This is because our earliest sense of self is built from our early nonverbal and physical experiences of being cared for. The only way and infant can interpret the signals from a depressed mother is to internalize it, which manifest as a sense of never being enough. Even when the child grows up to be an adult who can rationally separate their mother’s emotions from their own self-worth, the early experiences can still linger and manifest as issues with unworthiness. For each person, it’s a unique story of with all the risk factors and the negative impact on one hand, and then all the mitigating factors and strengths on the other hand. The adult who describes feeling shame and unworthiness might struggle to pinpoint the root of their issues, especially if their mother’s emotional issues were hidden, denied in the family, or minimized. The mother’s emotional state during the crucial early years is often that missing piece to help an adult fully understand their development and life story. Often they are not in a position to communicate about sensitive material with their mothers. This is why it’s crucial that maternal mental health is addressed clearly at all levels of society. The taboo still surrounding motherhood and postpartum emotional issue has devasting consequences for the entire family. I know this is a lot. Feel free to use what makes sense, and let me know if I should clarify things? I tried to use language for laypeople. – Helena Vissing, M.S., Psy.D.