When reality TV show star Heidi Montag announced last week that she had undergone 10 plastic surgeries, all in one day, the news was met with some (naturally) raised eyebrows. But she's not alone in her obsession to look perfect by enduring multiple cosmetic enhancements, a phenomenon that has the makings of an addiction, or at least a binge behavior, experts say.
Though Montag, 23, has argued she's not addicted to cosmetic procedures, some psychologists would disagree.
And as for what's driving her and others, some researchers say the media is part of the problem, bombarding us with images of this ideal Barbie-doll person that's unattainable without nips and tucks, and more. The result, especially for someone who starts at such a young age, could be disastrous at least on a psychological level.
"I think, fundamentally, when somebody goes on for many, many, many procedures, and starts at a young age, they're trying to change something about themselves, they want to become a new person, and you can't just do that through a scalpel," said Debbie Then, a California-based psychologist who specializes in women and appearance. "The bottom line is they want to in some way change who they are because they're not happy with it at the core," and that problem can be more of a psychological one, she said.
Why go under the knife?
Montag's surgeries may have shocked fans, but plastic surgery and other cosmetic procedures are common and on the rise.
An estimated 12.1 million cosmetic procedures were performed in 2008, according to the American Society of Plastic Surgeons (ASPS), up 3 percent from the year before. And by 2015, the ASPS estimates that number will jump to 55 million. However, most of these procedures are minimally invasive, a category which includes less dramatic body tweaks, such as Botox and laser hair removal.
But why do woman like Montag, who was clearly attractive naturally, go under the knife? The reasons are as plentiful as the surgeries. Besides the desire to look younger, some can be fueled by a longing to be more socially accepted, or appear less ethnic, Then said. And others may have been teased when they were younger, as Montag says she was, which makes them feel pressure to be more attractive.
In some cases, those who seek surgery do so because they have an unrealistic perception of their features, a psychological condition known as body dysmorphic disorder.
"The thing they want to change, they fixate on, and it's not even visible to other people," Then said.
One question that arises with plastic surgery is why so many seemingly attractive people end up going under the knife. The answer may be that the beautiful value their looks highly, and believe it is the only thing they have going for them, Then said.
"They've gotten by on their looks, and they haven't built up any other kinds of substance for themselves, and they're so afraid of losing their looks, that they feel like they have to go and do all these things to change them or to better themselves, because they think that's all they have," she said.
Women lead the way in terms of plastic surgery patients, making up a whopping 91 percent of the total 2008 cosmetic procedures. This staggering percentage is likely tied to the way women are viewed in our society. "The fact that in our culture women are judged on their looks, is an absolute truism," Then said.
And the most common group to receive cosmetic surgery are those aged 40 to 54, with 5.7 million procedures performed in this age bracket in 2008, according to the ASPS.
But some, such as Montag, start surgeries much younger. An estimated 750,000 cosmetic procedures, 271,000 of which were surgical, were performed in people aged 20 to 29 in 2008, according to the ASPS. And 219,000 (81,900 surgical) procedures were done on children and young adults aged 13 to 19.
Then believes that more people are starting plastic surgery at a younger age, and that they are motivated by images they see in the media, leading to a skewed view of what is important in life.
"I worry about the pressures, especially on young women in their 20's these days, because they look at women in the media, and they look at women on these reality shows, and they think that if they just look a little better, that they're going to get more of the goodies in life," she said, "And that's not necessarily true."
Indeed, while some studies have found that many who have plastic surgery are happier, there is slim evidence that the procedures actually boost self esteem or lead to advancements in career, according to Diana Zuckerman, president of the National Research Center for Women & Families, who spoke with LiveScience last year.
And most people who have plastic surgery won't see a drastic change in their beauty — they won't be going from a 3 to a 10 on the looks scale, she added.
And since even the celebs like Montag are striving for unnatural perfection in the looks arena, this sense of the "ideal" is even more unrealistic, such as a Barbie-doll body, psychologists have said. In this sense, one couldn't get close without cosmetic nips and tucks.
Can you be addicted to surgery?
Montag has countered some of her critics by saying she is not addicted to plastic surgery. "If you're addicted to something, you have to do it all the time, not once every couple years, if even," she said on Good Morning America on Tuesday.
So is Montag right, or is she an addict in denial?
The answer is not so black-and-white, experts say. While Montag does have a point, that multiple plastic surgeries may not be considered an addiction in the classic sense, the behavior does have some components of addiction.
Some experts believe addiction is marked by three fundamental symptoms: repeated involvement in an activity; an act brought on by cravings; and one done despite negative consequences, said Tom Horvath, a psychologist who operates an addiction treatment center in La Jolla, Calif.
A classic example would be smoking, Horvath said: a habit users continue to engage in, deriving pleasure from their cigarettes, even in the face of multiple health problems strongly tied to the action. While having plastic surgery isn't exactly like smoking, there are some parallels, and in certain situations, the behavior could be thought of as a kind of addiction, Horvath said.
"The pleasure you get from having people think you're beautiful isn't quite the same as an intoxication from a substance, but it's similar enough that I'm willing to consider this a potentially addictive behavior," Horvath said.
Indeed, cosmetic surgery can have negative outcomes, including infections, going into debt after paying the surgery's high price-tag, and being socially ostracized, Horvath added. In rare cases, people die during or after procedures.
However, the problem with thinking of plastic surgery as a true addiction is that you can't get a procedure done very frequently, as is the case with lighting up a cigarette. "You might have several surgeries in a year, but probably not more than that," Horvath said.
However, Then believes that people can absolutely become addicted to plastic surgery. While some people may tweak one body part and be satisfied, others never seem satiated. How can you tell? "The minute they have something done, they'll talk about wanting the next thing done," she said.
But what about having multiple surgeries at once, as Montag did? According to Horvath, her behavior may be more along the lines of a binge drinker than a full-blown addict. If you consider addictive behavior as a continuum, from non-addict all the way to junkie, her behavior doesn't register very high on this scale, he said.
"Even though you had ten surgeries in one day, that doesn't seem very far down the continuum [of addiction]," Horvath said.
But to Then, a case like Montag's could lead to trouble down the road, especially if the person is motivated by an underlying desire to change who he or she is, rather than simply adjust an unsightly feature.
In order to avoid plastic-surgery addiction, Then said plastic surgeons should screen their patients to make sure they are not suffering from underlying psychological problems.
"I think that plastic surgeons have to develop, in conjunction with psychologists, more and better screening mechanisms for people, specifically young women who want to go under the knife very early and for lots of different things," she said.
Such screening might help avoid scenarios in which a young adult ends up trying to fix flaws that don't exist, such as women boosting up with Botox before they even have wrinkles, Then said. "And a brow lift, in your 20s, I mean, your skin isn't even loose enough to drop then," she added, referring to one of Montag's body tweaks.
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Rachael is a Live Science contributor, and was a former channel editor and senior writer for Live Science between 2010 and 2022. She has a master's degree in journalism from New York University's Science, Health and Environmental Reporting Program. She also holds a B.S. in molecular biology and an M.S. in biology from the University of California, San Diego. Her work has appeared in Scienceline, The Washington Post and Scientific American.