My patient inquires about one final issue during her appointment. After wavering for years, she’s decided to travel to Florida for liposuction. She has saved portions of her paycheck over the past year to pay her airfare, hotel, and surgical fee. The surgeon requires X-rays, an EKG, bloodwork, and preoperative clearance. And I am asked to provide them.

Often patients unhappy with their weight—and physical appearance—dream of a quick fix. With an internet recommendation of a surgeon and a few Zoom calls, the surgery is booked.

As she hands me the preop paperwork, my patient asks, desperately, “You think this will be okay, right?”

I face a no-win dilemma. I want to support my patient. To help her feel good about herself. To assist her in getting safe care. Yet can I recommend that she have this procedure? No. I cannot.

I hedge in my response, asserting that she is strong and beautiful, that it is more important to have healthy habits, that nasty businesses profit handsomely by perpetuating beauty myths. I describe other patients’ bad outcomes after liposuction: horribly disfiguring scars, life-threatening infections, and chronic pain that interferes with basic activities, such as lying on one’s stomach or back.

Do I wish I had a flatter stomach? Sadly, I do. Many of us have a body part that draws our attention away from seeing our internal and external beauty. We have absorbed societal messages about superficial “flaws” and, being good students of commercialism, continually amass evidence to support our dysfunctional thinking. The illusion that one’s life would radically improve after body-part revision is an omnipresent tease.

My colleagues and I have ordered preop labs for countless liposuction procedures during the pandemic. Patients need documentation of a negative COVID test before traveling to Florida or Latin America for surgery. Women who test positive must postpone. Consequently, they lose deposits, then need to have the labs and tests redone, since results need to be from within a certain timeframe before the surgery.

Postoperatively, many patients stay at “recovery houses” before returning home. Care quality there is variable, so complications are frequent. At their postop visits with me, women spend several minutes unbuckling the constrictive garments they must wear to support their healing. None of these women look particularly delighted or comfortable as they confide in hushed tones, “I don’t know if it was worth it.”

Pamela Adelstein
Newton, Massachusetts


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