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Plastic surgeon, Dr. James C. Marotta has repeatedly heard patients, particularly women, express shame and guilt about wanting to change their appearance. They second-guess themselves and worry about seeming superficial or vain. Listen in as he explains why you should never feel bad about wanting to look how you choose.

Dr. James C. Marotta

Dr. James C. Marotta is a dual board certified facial plastic surgeon. He attended Columbia University and later graduated as president of the medical honor society at SUNY Stony Brook School of Medicine. He trained at Yale University in head and neck surgery and was recognized as the top surgeon in the program.

Through his fellowship with the American Academy of Facial Plastic and Reconstructive Surgery, Marotta volunteers his time and surgical expertise to FACE TO FACE, helping victims of domestic violence with facial injuries and to F2F FACES OF HONOR, helping veterans who had face or neck injuries while deployed overseas. He’s the author of “You’re Not a Vanity Purchase: Why You Shouldn’t Feel Bad About Looking Good.” Learn more at www.MarottaMD.com.

Gabe Howard

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

To learn more about Gabe, please visit his website, gabehoward.com.

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.

Gabe Howard: Welcome to this week’s episode of Inside Mental Health: A Psych Central Podcast, I’m your host, Gabe Howard, and I want to thank our sponsor, Better Help. You can get one week of free, Better Help counseling just by visiting BetterHelp.com/PsychCentral. Calling into the show today, we have Dr. James Marotta. Dr. Marotta is a dual board certified facial plastic surgeon. He trained at Yale University in head and neck surgery and was recognized as the top surgeon in the program. He is the author of “You’re Not a Vanity Purchase: Why You Shouldn’t Feel Bad About Looking Good.” Dr. Marotta, welcome to the show.

Dr. James C. Marotta: Thank you so much for having me. I appreciate it, Gabe.

Gabe Howard: I don’t want our listeners to think that they tuned into the wrong podcast. This is still Inside Mental Health, where we explore all things mental health, mental illness and psychology. Now, while some folks might not think that there is a connection between mental health, psychology and plastic surgery, today’s guest assures us that there is. Dr. Marotta, can you elaborate?

Dr. James C. Marotta: My book addresses really the psychological issues around plastic surgery that people struggle with. The guilt, negativity, the naysayers, discussions with friends and family about choosing to have plastic surgery. The public perception of plastic surgery is being overly negative and guilt ridden and it addresses a lot of the psychological issues that patients struggle with in and around their procedures.

Gabe Howard: You talk a lot about the importance of reckoning with the guilt of plastic surgery. How do you guide your patients through those guilty feelings?

Dr. James C. Marotta: You know, I’m a facial plastic surgeon, I’ve been in practice for 15 years and on a daily basis would encounter a patient saying, you know, I don’t know why am I doing this, doctor? Am I vain? Am I just, you know, why do I care about the way I look so much? My friends are telling me I’m crazy. My family is telling me I’m crazy. Am I going to? You know, all this kind of guilt around the procedure and I needed a better explanation. I needed something to help those patients kind of navigate those issues that they were dealing with. I needed to find out really what was their motivation behind seeking these procedures. Why they shouldn’t really feel that kind of negative vibe.

Gabe Howard: During my research for this show, I saw the phrase that plastic surgery is addictive over and over again, sometimes positively, sometimes negatively. But the word addiction came up a lot. Is that a fair statement or is that some sort of mumbo jumbo that people just say on the Internet?

Dr. James C. Marotta: I think it really is overblown, people’s general perception is that plastic surgery patients are addictive personalities that are hyper focused or hyper obsessed with one physical flaw, which leads them to correct another physical flaw, which reads them correct another physical flaw. And then they end up suddenly looking like some of the people that they associate with bad outcomes or celebrities who have gone wild and done procedures like Joan Rivers, or they are going to end up looking like Jocelyn Wildenstein, who is the lioness of Park Avenue, and that somehow that’s going to happen to everybody who pursues plastic surgery. And it’s really kind of the, in my experience, the exact opposite. The most common plastic surgery patient is the everyday person who has a physical flaw which impedes them from living their best life, something that bothers them and something that gets in their way. I mean, somebody who with eye bags who looks really tired and forlorn and is hearing it every day in the office, gee, did you get enough sleep? How do you feel? You sure you’re feeling OK? You know, because they’re walking around with that physical baggage, which leads to emotional baggage. Maybe their nose is way out of proportion to their face, and so they hate their profile and they don’t even want to be seen in pictures. They don’t want to get their camera out. They don’t want to take selfies. And they’re hiding from social interactions with friends and family because of the physical flaw. And so many times you see that hold people back in life. And that’s really how sometimes a physical transformation can lead to a psychological, emotional transformation for people. To not undersell or underwrite the roadblock that physical appearance can put in people’s way of becoming their best self. And I think sometimes seeing it as a vanity purchase is really just really doing such a disservice to what I do on a daily basis. I literally have patients cry with joy. I would say, at least on a weekly basis, cry with joy, because they’ve been lifted of that emotional weight and they look now how they wanted to look. That is obviously why I do what I do to give people that confidence to go forward in life and feel great about how they look and how they interact with the world.

Gabe Howard: In the interest of full disclosure, I have had plastic surgery, I used to weigh 550 pounds and I lost pretty much all of the weight. I got down to about 220 pounds. And when the weight came off, I had two prominent physical flaws. One was just a ton of loose skin around my stomach area. And two, I had what I lovingly referred to as man boobs, which I know male breasts is probably a better way to explain it on the podcast. But I was so disappointed, I did all of this work to lose more than half of my body weight. It took a couple of years. I went through a lot to do it. And here I had these problems and I had plastic surgery and it was wonderful. It was wonderful. I’ve never regretted it. Absolutely amazing. And even though I was able to show my friends and family this excess skin and how it was hurting me, I had to lift up this skin apron in order to urinate.

Dr. James C. Marotta: Oh my boy.

Gabe Howard: That’s pretty excessive.

Dr. James C. Marotta: Yeah.

Gabe Howard: Even then I got well, but you look fine in clothes. You’re already married. Is that worth the risk? And then, of course, I got hit with the big isn’t this vanity?

Dr. James C. Marotta: Yeah.

Gabe Howard: That’s the one, of course, that got me because

Dr. James C. Marotta: Right.

Gabe Howard: Isn’t vanity always bad? Isn’t plastic surgery inherently vain? So therefore, isn’t it always bad?

Dr. James C. Marotta: You obviously have firsthand. Here you’re struggling with not only a visual impairment, but something that’s a physical impairment to your function, you know, on a daily basis, walking with that amount of skin, getting in your way, and then just the having to carry that still carrying, quote unquote, the weight around, even after you’ve done all that work and lost the weight. And then people seeing that as vanity. It’s just that’s heartbreaking and a great story. And I think you elucidated it exactly. Vanity is such a negative word. It imports so many kind of psychologically dismissive terms. OK, you obviously are vain, you’re self-absorbed. You’re a superficial person. All you care about is the way you look. And newsflash, not only do you care about the way you look, the entire world cares about the way you look. From birth we are born as basically visual judgment machines. Our brains constantly scan the environment for physical cues from other people about who they are, what they mean to us. And our brain automatically interprets those things in the blink of an eye.

Dr. James C. Marotta: So somebody who lost a lot of weight and they have a lot of excess skin everywhere and they’re in their mid-40s. They might look like they’re 70 years old. And that person applying for a job interview will be seen as a different person than a vital, healthy person who’s able to perhaps perform the job. They’ll be seen as maybe past their prime. That visual interpretation by that interviewer is done automatically by the brain. It’s not something that vanity comes into play. It’s the reality is we are visual interpreting machines. Our brains have entire centers dedicated towards ascribing meaning to physical appearance. We are visual machines. We interpret data. A lot of the data points are how we physically appear and everybody knows this. It’s common sense and your common experience, I’m sure as a human being. You get a great haircut, you look good, you dress well, you walk into a meeting and you feel just that burst of confidence. You feel that extra feeling of and people seem to receive you in a different way when you do appear your best. And there’s a feedback loop. You look better.

Dr. James C. Marotta: People perceive you as being better. They give you more positive feedback, you feel better about yourself. And that obviously influences your interactions with people, which influences your entire life, success, failure, winning, losing all those things. While they’re not 100 percent physical appearance, there’s a huge component of it that’s physical appearance that we cannot deny. And I cite a lot of statistics about appearance called the attractiveness advantage, conveying advantages to people in life on almost every stage. Obviously in Hollywood, the bar of entry is you have to be physically appearing to even have that job. News networks, obviously, that physical appearance is obviously important. But even in politics, typically the candidate who is the likable candidate, i.e. more physically attractive candidate, has an edge in a political race. And it’s statistically been proven CEOs who are above a certain height earn on average five to seven percent more than those counterparts who are shorter. Go down and on and on through the list of physical advantages conveying an advantage in life. That’s the reality. To deny that is really to say it’s vanity is really missing the point.

Gabe Howard: I could not agree more, even in my own situation, I felt so much better, I behaved so much better, my confidence went up and on and on and on and on and on. Now, you sort of hinted at a controversial view that you hold and why people should view plastic surgery in a certain way, that pretty people have more advantages.

Dr. James C. Marotta: Yeah.

Gabe Howard: Isn’t that weird? Like, that’s not controversial. That’s just common sense. I

Dr. James C. Marotta: Yeah, yeah.

Gabe Howard: It’s weird that there is a controversy there.

Dr. James C. Marotta: We were just discussing a little bit about the attractiveness advantage, people who look better typically will have an advantage in the workplace, in social interactions in life. That basically when all is equal or else is unequal, pretty people get the nod when it comes to garnering social support, garnering financial support, garnering better jobs, even interactions with infants. There was a study where gaze preference was studied in infants. They took babies and they flashed a bunch of photographs and people who were deemed above a certain level of attractiveness and people who are deemed below a certain level of attractive and put those two on a screen and babies were preferentially gaze towards the prettier people. OK? So it’s controversial, I guess it’s upsetting to think of us as human beings being, quote unquote, so vain that we’re so superficial, that we’re only concerned about the way people look and instead should be really what’s inside that counts. OK, there’s lots of expressions or common expressions that we have that try to steer us towards seeing the deeper person, the soul that the person has or the behind the, behind the mask, so to speak. There’s an overall perception that it’s wrong to evaluate people based on their appearance and to judge a book by its cover. You can kind of deny that fact. But biologically, sociologically, from numerous studies, it’s shown that we do it, we do it. To deny that fact is really to deny a very well-established portion of human interaction, human evolution, human existence.

Gabe Howard: One of the things that you say is that the decision to have plastic surgery can be empowering and it’s healthier than we thought. Can you explain that a little more? Because as we’ve talked about this whole podcast, most people think that it’s not empowering at all.

Dr. James C. Marotta: Again, people struggle with the guilt, the shame, the vanity label, all the negativity around plastic surgery because of that perception that it’s not empowering. You’re giving in, you know what you’re giving in to what everybody else thinks about you. And you’re doing it because you’re you don’t value yourself as you are enough to not have to go to that extreme. That is the general judgment out there, especially in America, perception of who plastic surgery patients are. And my point is, just as we just discussed, denying that it’s a part of reality, that you’re going to be visually judged, that visual perception of human appearance is part of who we are. To flip that say, you know what, honestly, taking an active role in how I look and doing the best at what I can with what I was given, that’s actually empowering way to look at this whole situation, because you’re taking charge of what you can do and optimizing your appearance. Just as you would do anything else. OK, you’re given a certain base level of intelligence. You can just kind of sit on that intelligence or you can cultivate it. You can read more books; you can study more. You can become a more interesting person. You can stretch your mind. My point is, you can avail yourself of all medical science has to optimize your appearance as well. It’s a healthy, empowering way to look at plastic surgery, instead of from being always a vanity purchase.

Gabe Howard: We’ll be right back after these messages.

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Gabe Howard: And we’re back with board certified plastic surgeon and author Dr. James Marotta discussing his book “You’re Not a Vanity Purchase.”Now, I noticed that you target the book more toward women. Do you find that women feel more guilty than men in regards to cosmetic enhancements and plastic surgery?

Dr. James C. Marotta: I don’t find that women necessarily feel more guilty about the procedures. I mean, I think predominantly plastic surgery is definitely more of a female market than there is a male. I mean, every year the media says, oh, this is the year of the man where plastic surgery patients are going to be. Men are going to be coming in in droves. Usually it’s about 80/20, 90/10 female male ratio. My experience with struggling with these questions of vanity and guilt, etc., are more with female patients because just statistically, they make up a larger percentage of my practice than the male patients do. Men tend to be a little bit more transactional. They’re a little bit more less emotionally vulnerable when it comes to plastic surgery. They don’t want to talk about how they feel about what they’re doing. They come in, Doc, I don’t like this. How much is it? When can I get on the schedule? Let’s do it kind of thing. You know, that much more abrupt. You may say, yes, women struggle a little bit more with the with the guilt side of it. I think it’s just more they’re used to dealing with the emotional portion of a decision, whereas I think men kind of subvert it or have already dealt with it themselves or just don’t want to address it.

Gabe Howard: It’s probably fair to point out that women sort of get the short end of the stick when it comes to appearance and looks. The standard is higher for them. So the decision is more important. And even if they get the same amount of criticism for getting plastic surgery, the expectations are high. So they get criticism for having a physical flaw and they get criticism for correcting it. Do you find that that’s the case?

Dr. James C. Marotta: I think there’s definitely a double standard when it comes to looks, you know, men who are aged, George Clooney, for example, in his 40s, mid 40s, was the sexiest man alive. And you’d never see a woman in her mid-40s grace the cover of Sports Illustrated. There’s a double standard where aging men are seen as distinguished. Aging females are seen as past their prime. And certainly you see that in Hollywood as well. But women are also more astute socially. I mean, appearance is a much bigger factor for them with regard to their social perception. And so there’s a lot more layers with regard to physical appearance, at least in my perception for women than there are for men. So it’s much more layered in women, the whole plastic surgery vanity issue and motivations behind plastic surgery.

Gabe Howard: In the book, you talk about people who spend a lot of time obsessing over what they see as a major physical feature, that may just be like a minor physical feature. What happens when they have that feature altered? After it’s all over are they happier? And do they then move on to something else? Do they get another obsession? Do they want additional surgery or does that solve the problem for them? And they just go on with their lives happily ever after?

Dr. James C. Marotta: That piece is in the discussion of body dysmorphic disorder and how it kind of cycles into that, how you can tell that line, the difference between people who are genuinely concerned with a real physical flaw as a way of moving on with their lives through plastic surgery and then those who end down the other end, which is the unhealthy rabbit hole of a perceived physical flaw, which is not necessarily there, or it’s magnified by the individual. And then they have a surgical procedure to alter or change that. And that, of course, doesn’t satisfy the need. And then they seek another surgeon, another procedure. And that’s how some of these plastic surgery nightmares happen. It’s a continual rabbit hole that people go down. I talk about how to tell yourself or in a loved one if you’re crossing the line with plastic surgery. What is the definition of body dysmorphic disorder? How do people tell the signs and symptoms of it? You know, why plastic surgery is never the right answer for patients suffering with that illness and obviously to seek psychological, psychiatric help in situations like that. And we have screening tools in plastic surgery that we use when we might suspect that the patient is of that. We know that it’s never, plastic surgery is never the right answer in that case.

Gabe Howard: But it sounds like for the average person, they get that feature altered. I’m not saying corrected here either. I want to be very clear. They get that feature altered and then they’re happy. They live happily ever after. It’s not this. I understand that you’re covering this extenuating circumstances, extreme case, but for the average person, feature altered, move on with their life.

Dr. James C. Marotta: Oh, yeah, yeah, I mean, that is the 99%, 99.9% of my practice is everyday normal people have a procedure. Love the results. Move on with their life.

Gabe Howard: And you never see him again.

Dr. James C. Marotta: Yeah. And I never see him again. You know, I mean, you do have patients come back for a different procedure at a different time in their lives. I’ve had patients who I did a rhinoplasty on 15 years ago and now they’re coming back because they’re older and their eyelids have aged and they want to do their eyelids. But it’s not what people perceive as this. Oh, I did one thing and I’m suddenly addicted to plastic surgery. Now I need to do twenty thousand things in the span of six months and end up down the rabbit hole of deformity or abnormality or looking like a different person. And that’s all just on the very far extremes and fringes of plastic surgery. That is the exception. That is not the rule. Generally, people’s perception, even when I mention what I do sometimes to people, those are some of the first things I hear. Oh, my God. Did you see so-and-so celebrity? Did you see what they look like? Oh, my gosh, I can’t. You know, and that’s the first thought that comes to people’s minds is plastic surgery, nightmares, deformity, depravity, the extremes, the circus of plastic surgery. You know, that’s really what people’s general perception or at least the most salacious parts of it that they want to talk about when the cocktail conversation comes up. For me, it’s kind of embarrassing. And to be frank, it’s just not the part of my profession that I’d like to discuss, but that’s what people are interested in. Kind of like watching the car wreck. You can’t help but turn your head. People love plastic surgery nightmares. That’s what plays in the media. That’s what plays on the tabloids. It’s what sells books. It’s what sells just as any media tries to play towards our greatest fears. In the world of plastic surgeons, it’s no different.

Gabe Howard: Why do some people care so much about certain aspects of their physical appearance? I mean, realistically, most people aren’t looking at you and judging that appearance, at least that’s sort of how I feel about it. I mean, it might bother me, but it probably doesn’t bother others.

Dr. James C. Marotta: When you have a physical flaw that bothers you, you know people are perceiving you in a certain way. And again, it’s not vanity. It’s something that you if you’re bothered by it, you want to do something about it because you don’t want to live that way.

Gabe Howard: Why are people so invested in what other people are choosing to do with their bodies, their money, their time? A lot of this is coming from society. Who is not involved with the person with your practice or at all.

Dr. James C. Marotta: Yeah, I thought a lot about that, why is the general perception one of negativity? Well, usually it comes from fear. Persons coming in, they have a consultation for changing their appearance in some way. And a loved one is concerned that they’re going to come out being a different person or looking like a different person. They weren’t in the consultation process. They’re worried about the person having a complication. They’re worried about the person dying during the anesthesia. They’re worrying about. It’s all fear based. It’s all fear. And the patient who’s gone through the consultation process learns all the information to allay those fears. The judgment part, the issues with generally from other people can be also a part of just envy. This person has the confidence to take a step forward. The other person’s like is a naysayer because they’re envious because maybe they’re afraid, afraid to take the step forward or address the physical flaw that they have. Negativity and guilt around from other is a common theme, a common issue that patients have to deal with.

Gabe Howard: The book is called “You Are Not a Vanity Purchase: Why You Shouldn’t Feel Bad About Looking Good.” It is available on Amazon.com and wherever books are sold. Dr. Marotta, how can folks find you?

Dr. James C. Marotta: The easiest way is just go to the website, it’s www.MarottaMD.com.

Gabe Howard: Dr. Marotta, thank you so much for being here and to all of the listeners, thank you for being here as well. My name is Gabe Howard and I’m the author of “Mental Illness Is an Asshole and Other Observations,” as well as a nationally recognized public speaker. You can grab a signed copy of the book or learn more about me over at gabehoward.com. Wherever you downloaded this podcast, please take a moment to subscribe. Also rank and review. Use your words and tell other people why they should check out Inside Mental Health: A Psych Central Podcast. I’ll see everybody next Thursday.

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