Quotes of the Day

Joan Rivers is certainly right to assert, in the title of her new book, that Men Are Stupid ... And They Like Big Boobs. But the book's 288 pages are better described by the subtitle, which is uncharacteristically dry for Rivers: A Woman's Guide to Beauty Through Plastic Surgery.

Rivers, 75, who wrote the book with the help of magazine writer and novelist Valerie Frankel, devotes most of the text to describing the medical details, costs and complications of various cosmetic procedures, nearly all of which she has undergone. Rivers says she has had her lips, breasts, nose, stomach, eyes and arms worked on and that she regularly gets Botox. (If you want to see what all this does to a person's appearance, check this out.)

Partly because Rivers is Rivers — willing to say anything for a laugh — her book has won a great deal of media attention. She's done the predictable Regis–Rachael Ray–Jimmy Kimmel appearances, but she's also been in the New York Times and on NPR to promote her view that women should undergo as many cosmetic procedures as they can afford. "Looking good," she and Frankel write, "equals feeling good ... I'd rather look younger and feel happy than look older and be depressed." But are they right? Does cosmetic surgery actually make you feel better? (See the top 10 most common hospital mishaps.)

Not always. In the most comprehensive study to date, published in 2004 in the journal Plastic and Reconstructive Surgery (it's available for free here), a team of three authors reviewed 37 previous papers on the psychological effects of cosmetic surgery; the papers dated back to 1960 and, overall, included more than 3,300 test subjects. The authors concluded that most people do feel better psychologically after undergoing cosmetic surgery, especially breast reductions. (Rivers had her breasts taken down some after giving birth to her daughter Melissa, which she says led to her developing "major bazonkas.") Only 3% to 14% of women who undergo reduction mammaplasty are unsatisfied afterwards.

But the results are mixed for many other procedures. At least four studies conducted in different countries have found that women who get breast implants commit suicide at significantly higher rates than women in the general population, although one explanation for that may be that women already predisposed to suicide are more likely than other women to want bigger breasts.

As for face lifts, older people — those in their late 40s and above — tend to be happy after undergoing them. But the Plastic and Reconstructive Surgery paper found that people under 40 who sought face lifts were less likely to have an improved sense of well-being after the procedure. In general, men — especially young men — who seek cosmetic surgery are far less likely than women — especially older women — to be happy once they can see the results in the mirror. (Read "The Young and Plastic Surgery Hungry.")

In her book, Rivers seems pleased with the results of her own surgeries, but many who seek multiple cosmetic procedures aren't. Some patients who want repeated surgeries suffer from body dysmorphic disorder (BDD), an illness defined in the Diagnostic and Statistical Manual used by mental-health professionals as a "preoccupation with an imagined deficit in appearance" that causes distress in life. BDD sufferers may also be those who spend countless hours at the gym or abuse steroids. About three-quarters of BDD patients who have cosmetic procedures are dissatisfied with the outcome, according to a British study published in 2000 in Psychiatric Bulletin.

Sometimes people with BDD also have bulimia, according to Brown psychiatrist Katharine Phillips, a leading authority on the illness. In Rivers' 1997 autobiography Bouncing Back: I've Survived Everything ... And I Mean Everything ... And You Can Too!, she says she became bulimic after her husband, TV producer Edgar Rosenberg, committed suicide in 1987. Rivers is heartbreakingly funny about the subject. Of her admission that she never told her therapist that she was gagging herself after meals, she writes, "Exactly how would I have put it? 'By the way, doctor, my finger isn't just for reading the wind and calling cabs. Two or three times a day, I stick it down my throat.'" (Read "Plastic Surgery Below the Belt.")

Which is not to say that wanting cosmetic surgery is necessarily a sign of illness. The Plastic and Reconstructive Surgery paper makes the point that most of those who have realistic expectations about what cosmetic procedures can accomplish are happy with the results. They know they won't look like a supermodel even if the best surgeon is wielding the scalpel. Rivers says that everyone can "be beautiful," which just isn't true, at least not on the surface. The beautiful wouldn't look beautiful unless they looked better than the rest of us. But I do agree with Rivers about one point: when big-nosed women go up to her and say "God created this nose," she responds, "And he also created plastic surgeons to fix it."

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• John Cloud
• It certainly worked for her. But studies show that for many others, cosmetic surgery doesn't make you feel better about yourself