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Stuck On the Surface

Jonathan Alpert -- Take the time to understand if a friend's choice for plastic surgery is merely about looks or more than skin deep.

A friend of mine had Botox last year and now is thinking about having more extensive work done. She's attractive and, in my opinion, looks fine just the way she is. She nitpicks every little thing about herself and thinks plastic surgery is the answer. We're very close and share everything, so I feel I have a right to speak to her about my concerns. I just don't know how to do it. What points should I make? I'm really worried that she has been sucked into the superficial culture of ours. -- Heather

I've seen many clients who were depressed despite their multiple Botox injections. Although surgical procedures may buy beauty, that doesn't necessarily lead to happiness. Michael Jackson quite possibly is proof positive that neither is gained through plastic surgery. Given the closeness to your friend, you have every right to express your concerns, as there are risks involved.

Although enhancing looks may make her feel better about herself, one wonders if she seeks approval from others and thinks she has to live up to a certain societal standard, fueled largely by Hollywood. Try to understand why she wants the surgery by asking: What are your expectations? How do you think surgery will change your life? Reasons like "I'll finally be able to meet the man of my dreams" are inadequate.

Give her the benefit of the doubt. Maybe a genuine medical condition exists that warrants surgery, such as Pamela Anderson-esque breasts causing back pain or a crooked nose interfering with breathing. Or if the reasons are purely vain, is she trying to fix a psychological problem through surgery? Find out how she views herself. Commonly, those who seek plastic surgery strictly for enhancement focus on physical traits they perceive negatively, ignoring positive mental and physical characteristics. This leads to a poor self-image, lack of confidence, and a disregard for the core of who she is -- a good friend, loving daughter, funny, intelligent, etc.

This article was originally published in MetroUS, November 5, 2007.

Jonathan Alpert is a Manhattan-based licensed psychotherapist and authors an advice column for the LA Times and Metro newspaper. His "No More Drama" column runs in the New York, Boston, and Philadelphia editions of Metro newspaper ( For more information, Jonathan can be reached at 212-947-7111, Ext. 528, by cell at 202-841-3458, or by email at

© 2007 Jonathan Alpert

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