Prof. Nevzat Tarhan: "Plastic surgery should also be related to the psychological health of patients"

President of Üsküdar University, Psychiatrist Prof. Nevzat Tarhan addressed many dermatologists and plastic surgeons who are experts in their fields at the Holistic Aesthetics Congress. Tarhan made a presentation titled "Body Dysmorphic and Aesthetic Perception Disorder" and expressed that these people, who are overly focused on their bodies and physical appearance, are people who are overly anxious due to imaginary or slight defects. Reminding that plastic surgery should be related not only to the physical health of patients but also to their psychological health, Tarhan stated that in such cases, surgeons should cooperate with a psychiatrist with the suspicion that their patients may have body dysmorphic disorder. Stating that surgical operations should be avoided in these cases, Tarhan added that these patients can usually request many aesthetic interventions, and they can put pressure on the physician because they do not want to.

The congress, which was held on September 26-29 at İstanbul Ataşehir Selectum City Hotel, attracted great attention.

"Face reading is our biggest problem in measuring micro-facial expressions"

Stating that he wanted to start his speech by addressing the common issues of aesthetic specialists and psychiatrists, psychiatrist Prof. Nevzat Tarhan made the following remarks: "What are the difficulties of a plastic surgeon or aesthetician? What are our challenges as a psychiatrist? There is a difficulty that psychiatrists have in filling. He had a Duchenne smile. This is a smile that has also become a reference in positive psychology. It has been introduced in the literature. People have crow's feet around their eyes. In these people, 50% of these lines are upwards. These people live eight and a half years longer and face fewer health problems. This was detected and this duchenne smile was introduced the literature in the form of a reference to us. However, with aesthetics, these lines are removed or reduced with various touches. These people do not have a duchenne smile. We cannot measure it. In other words, our biggest problem in measuring micro gestures is face reading in this area. Because there are two types of emotion expression in the patient's emotional expression. It starts from the brain, but we need to distinguish whether the expression of emotion is central or peripheral. Some people are very obsessive. They suppress it, it becomes a face like a mask, it has no expression. Or it is that there is a difficulty that we are experiencing, as if it is due to the blockage of the person peripherally in the person. If you have had botox or something, I say that you should never look at the mirror thinking if you I have a duchenne smile."

"If one puts their physical appearance at the center, aesthetic perception disorder occurs"

Underlining that people with body dysmorphic disorder have excessive mental effort, Tarhan stated that “The group of patients with body dysmorphic disorder, especially in these patients, have body image disorders. In other words, there are people who are overly focused on their bodies and physical appearance. We see that there are people who are overly anxious because of an imaginary or slight defect that they perceive as such. These people often check the mirror. The most common situations we encounter in them are that they often stand in front of the mirror. As another feature, these people constantly ask for approval from the environment in physical appearance, they seek approval. When it comes to us, the most important thing is the excessive mental preoccupation with physical appearance. There are extreme mental efforts such as feeling good for 50 minutes out of 60 minutes, sitting in front of the mirror or constantly following fashion magazines about it, comparing yourself with others. They constantly try not to accept the body parts they do not like. They are constantly in an extreme interest in attracting and arranging themselves. When we meet these people, there are various tests that indicate which part of the body they are interested in regarding body dysmorphic disorder. They are being done. There are those who are within the acceptable limit here. This is true for everyone, but if a person has put it at the center of their life, that is what matters. If a person puts their physical appearance at the center of their life, after a while, an aesthetic perception disorder related to the body dysmorphic disorder emerges. This aesthetic perception disorder does not get better by saying ‘ Do not overthink it, you are beautiful, you do not have anything bad, but it...' Definitely, because the program in these people's brain areas related to somatic perception is impaired."

"The field of perception in the brain is impaired"

Drawing attention to the phantom phenomenon in aesthetic perception, Tarhan stated that "Sometimes we come across such cases that somatic perception of body dysmorphic disorder is at the level of delirium, in the form of eating disorders. For example, even though one weighs 29 kilograms, they perceive themselves as 150 kilos. The field of perception in the brain is impaired. We can explain this with the following examples. For example, how aesthetic perception is related to a person's mental perception, in aesthetic perception the person has a phantom phenomenon. For example, one has an amputated limb. A person's arm has been amputated, and then they feel the pain of their arm, which was not there since their arm was amputated. They say, 'My arm hurts,' but they do not have an arm. Here, they actually know that their arm was amputated, but their brain does not. They say that their brain does not know. They say my limb hurts. The person is not lying. That is how they perceive themselves, that is how they feel and see themselves in the mirror. They replace their absent limb with a mirror, when they raise their right arm, nothing lifts, and when they raise their left arm, its counterpart in the mirror also lifts. Moreover, when we do these exercises and teach that person's brain that they do not have an arm, the pain goes away. Painkillers are not effective in these people. This phantom phenomenon is something that is seen in the literature. What is this, the same thing exists here. In other words, the brain perceives something that does not exist as if it exists and takes a position accordingly. The brain struggles mentally about it, makes connections about it, and starts to interpret everything about it."

Approaches such as be your own doctor do not work...

Mentioning that paranoid disorders are a subgroup of delusional disorders, Tarhan said that "I know a patient with somatic delirium who says 'My back hurts, I am going to be paralyzed' without getting out of bed for 1.5 years. We also see this in this panic disorder, with the fear to be paralyzed by bodily perception. The person even goes to the toilet waiting, goes in slow motion, holds the door open. The perception of these people is more with the fear of death and disease... They are dealing with extreme degree of delirium, feeling that they will be paralyzed at home. The person's life is restricted. At that time, this disease was not recognized, they did received therapy. It is a panic disorder. And even though one weighs 130 kilos with the disease, they do not leave the house and not event move at all, due to the fear that they will get sick. If I move, I will have a heart attack, and a small movement invites fear. For this reason, I wanted to emphasize that approaches such as ‘it is not a big deal’ and ‘be your own doctor’ do not work."

"Each of us is a chemist"

Mentioning that people who are in pursuit of ideas, ideals and meaning can teach their brains to secrete serotonin, Tarhan stated that "Each of us is a chemist. When we manage ourselves in our lives, we work like a chemist in our brain. In our brain, for example, dopamine is related to pleasure, and this aesthetic perception increases dopamine more. For example, ecstasy but it increases all kinds of dopamine, and in the same way as these endorphins that are released with orgasm, but serotonin secretes dopamine in the brain in those who live pleasure-oriented lives. A pleasure ends, and when that pleasure ends, it seeks another pleasure. When that pleasure ends, it seeks another pleasure. However, for the person who pursues ideas, ideals and meanings, the brain continues to secrete serotonin because it thinks long-term because it pursues ideas, goals, ideals when a step ends on that path. Serotonin is related to long-term, and the chemical in the brain is dopamine, which is related to short-term instant gratification. In other words, cocaine and similar substances release dopamine. Such a substance releases dopamine. For this reason, people who are in pursuit of an idea, an ideal and a meaning can do this to teach our brain to secrete serotonin. It is peaceful. For example, reducing sadness is a condition seen in people who are at peace with themselves, and it manages the chemicals in their brains."

Body dysmorphic disorder is 12-13% in adolescents.

Drawing attention to the fact that the measure of beauty and valence is a kind of consumption strategy offered by modernism, Tarhan stated that "In fact, there are genetic factors, there are environmental factors. There is a lack of self-confidence. There are psychological problems. For example, let us say genetic factors, this body dysmorphic disorder is 2-3% in adults, but 12-13% in adolescents. In other words, adolescence is a period when physical appearance is at the forefront. Therefore, there are also many psychological conditions for adolescents. An adolescent who behaves like the four seasons is not suffering from a disorder at all. This is what adolescence requires. You need to know this. They also have a lot of extreme beauty in terms of physical appearance, especially in female adolescents. Sometimes there is too much going on in the family in the upbringing. Beauty is becoming a measure of valence. In other words, there are pyramids of goals in one's life. At the top of this goal pyramid, we are taught, ‘If you are beautiful, you are valuable, if you are not beautiful, you are worthless,’ so what does the person do when we teach that person? This time, one makes it their ego ideal to be beautiful. And when it is not the case, it feels bad. The fact that beauty is a measure of valence is a kind of consumption strategy offered to us by modernism. In other words, the consumption strategy given by the capital system, unfortunately, continues to affect all of us with the entertainment industry. There are environmental factors, upbringing, and people with a lack of self-confidence want to use physical appearance as a label. Many people with depression also try to express themselves in this way."

"It should be clarified that the problem is not a surgical problem, but a psychological one"

Talking about what experts should do when they encounter a patient with body dysmorphic disorder, Tarhan stated that "What should we do as a plastic surgeon in such cases? I will say to make a psychological evaluation of the patient. Here, especially if you are dealing as a plastic surgeon or a dermatologist, to evaluate the psychological state of the patients to determine whether surgery is appropriate. If the patient suspects that he may have body dysmorphic disorder, surgeons should pay attention to this situation and cooperate with a psychiatrist. So, even if the good master performs surgery, you cannot prevent it. One comes again, and when they do not get what they want, they repeatedly put pressure on you. In other words, you must determine the reason for the measure, as they say. It is easy to avoid a hasty surgical intervention. Patients with body dysmorphic disorder usually demand many aesthetic interventions, but surgical intervention based on expectations that will not really happen does not solve the problem. In such cases, surgical operations should be avoided. It should be clarified that the problem is not a surgical problem, but a psychological one."

Not only physical health, but also psychological health should be taken care of...

Underlining that patients should be interested not only in their physical health but also in their psychological health, Tarhan concluded his remarks as follows: "Patients with body dysmorphic disorder have psychological treatment and referrals. When you get the diagnosis, if someone needs behavioral therapy, psychotherapy, and pharmacological treatments, these people have an overdose of surgery on themselves because their perception of the disease is distorted and their aesthetic perception is impaired. Aesthetically, their first state may be more acceptable than their final state, and while doing this, it is necessary to establish open communication with the patient first. That is, we usually understand the expectations of the patients, carefully discuss whether his expectations are realistic or not. Open and empathetic communication is very important in order to notice whether the patient's appearance reduces or increases their defects. Another important feature is that if surgical intervention is performed with the support provided, it is important for patients to follow their psychological state in the longer term. In other words, it is important that plastic surgery patients are not only concerned with their physical health, but also with their psychological health."

 

Üsküdar News Agency (ÜNA)