(Excerpted from Dr. Peter Adamson’s book Fabulous Faces (available on and edited for our blog.)

Fear can be a powerful obstacle preventing us from reaching our goals. Sometimes that fear is of the unknown. Sometimes we fear the way our desire might be perceived. In our five-part series we will expose the myths of cosmetic surgery to assuage those fears. In our last post, we debunked the myth that only the rich have cosmetic surgery. Today, Toronto cosmetic surgery patients share some their insights and dispel the notion that only the vain pursue cosmetic surgery.

Cosmetic Surgery Myth:Only the Vain

Myth: Only vain people have cosmetic surgery
We all want to look our best—and most of us are deeply conflicted about it. List the pros and cons of having cosmetic surgery, and the word “vanity” invariably appears on the “con” side.

The truly vain person’s entire sense of self-worth revolves around his or her appearance. You may know such people. They’re often consumed by a desire for more of everything. They’re beautiful, but not beautiful enough. They have an unrealistic sense of entitlement and are invariably frustrated when things don’t go their way. Does that sound like you? Probably not.

You’re concerned about your aging face but not consumed by it. Unlike the truly vain person, you stew and fret about what others may think. It isn’t so much about vanity as it’s about being seen as vain. Harvard psychologist Nancy Etcoff says in her book Survival of the Prettiest that our beauty, as others judge it, isn’t linked strongly to self-esteem. While self-image is determined by how others see us, self-esteem is determined by how we see ourselves. Etcoff quotes Eleanor Roosevelt, who was sensitive about her distinctive but not classically beautiful looks, as saying, “No one can make you feel inferior without your consent.”

There’s something more primal about it. We’re hardwired to both survive and reproduce. A sagging jowly face, hooded eyelids, or a drooping nasal tip are unwelcome signs of age and mortality. We look for ways to turn back the hands of time. Beyond that, we’re all players in the reproductive sweepstakes. Wanting to appear sexually attractive is a signal of health and vitality— and an innate desire.

In my opinion, it isn’t as much about vanity as it’s about having the courage to take a big, life-altering step to do something for yourself. This is the main source of conflict. It’s rare to meet a cosmetic surgery patient who hasn’t thought long and hard about the process.
Sarah is a successful, independent, forty-year-old single woman with a career as a medical research coordinator. Until she had it fixed, she had a nose that she had hated since puberty. It was big and crooked. For years, she thought about rhinoplasty, even made plans for it, but always backed away. She kept telling herself that wanting to change her nose was simply a reflection of her lack of self-worth.

Marguerite had doubts about what her family and friends would think. Her daughter was aghast. Before the surgery, when the subject came up among friends, one said that Marguerite would never do such a thing. She was too au naturel for that. Facing that kind of skepticism, incredulity, and outright opposition from those closest to you can be very difficult.

When Christina was in her twenties, she raised the subject of rhinoplasty with her family. “Get your head on straight,” her dad told her. Her family laid a huge guilt trip on her, telling her that wanting to change the contour of her nose was a sign of weakness on her part. They played the ethnicity card, accusing her of turning her back on her strong-featured Italian heritage. Years later, there are still some issues about it within the family, but they’re being resolved.

Doreen, a widow in her sixties, encountered opposition from her grown children and some work colleagues. Her children told her she was being vain, while her co-workers said that she looked fine as she was and didn’t need it. Doreen says there was also an underlying suspicion that she was out to get a man. “People don’t always understand you,” she says. “They presume that I’m either looking for a male friend or have some other reason beyond just wanting to do it for myself, so I had to start saying, ‘Look, I want this just for me, just for myself. When I look in the mirror, I want these wrinkles to be gone.’”

Once the perception of vanity takes hold, it’s often accompanied by guilt. Some guilt comes from within, but much of it is imposed by others’ judgments. You’re doing something just for yourself—not for your spouse or your children—and you feel bad about it or others make you feel bad about it. This can be a nerve-racking experience and very difficult to overcome. The people nearest and dearest to you can cause you to doubt yourself. But in the end, your family and true friends will come around. As financier and statesman Bernard Baruch once said, “Those who matter don’t mind, and those who mind don’t matter.”

Some believe that the media encourages people to have cosmetic surgery. It’s the “in thing” to do. Television and entertainment magazines are full of stories, some true and some pure nonsense, about aging celebrities who have had work done. I don’t buy it. I think people are primarily driven by their own desire to look their best.

I also see evidence in my Toronto patients that any lingering sense of guilt goes away after surgery. When people feel better about themselves, they contribute more to society. They do more for others. If you’re better able to realize your own expectations in life, you’re likely to do more for others.

Generally, people who undergo cosmetic surgery feel like outsiders and just want to be part of the “normal” group. They aren’t looking to be better than everyone else or trying to live forever. They just want to be part of the crowd. It’s not about vanity; it’s about courage.


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