The media has recently bombarded the American public with images of "successful" makeovers that transform lives. Many of these makeover shows gloss over the importance of having a realistic and appropriate expectation of the procedure(s). They use the best plastic surgeons in the country and never mention any cases where problems occurred or the patient was unhappy with the outcome. The patients also never have to worry about the cost, either, since the television networks take care of that.

The message these shows send is that if you have any insecurities about your appearance, they can be fixed, no problem. In a culture where body image dissatisfaction is rampant, this can be a very dangerous message. Furthermore, these surgeries are presented in a manner that suggests they are quick, simple and relatively pain-free. It is no wonder so many people are feeling inadequate about themselves unless they look 'perfect' everyday.

There has been a significant increase in the number of cosmetic surgeries in the past decade. According to the American Society of Plastic Surgeons, 9.2 million cosmetic surgeries were performed in 2004, a five percent increase from 2003. Approximately 8.4 billion dollars are spent every year on elective cosmetic surgeries. The most common procedures, in order, are liposuction, nose reshaping, breast augmentation, eyelid surgery, and facelift.

About 40% of all cosmetic surgery patients seek additional surgeries, likely because they weren't satisfied with the outcome and because once they fix one 'problem' they find another that needs fixing, too.

The risks of cosmetic surgery are often underplayed or completely overlooked on the makeover shows. These risks include infection, bleeding during and after surgery, blood clots, hematomas (blood pooling around the surgical site), scar tissue, permanent nerve damage, anesthesia risks and death. Clearly, the potential risks, complications and chance that the outcome won't be what was expected are issues that warrant important consideration prior to making a decision about surgery.

Why the temptation?

It is not difficult to understand why we as a society are attracted to the glamour of cosmetic surgery. We are constantly exposed to images of perfect bodies: Ultra-fit, ultra-thin, young, happy people. The assumption we make is that if we, too, could look like that, our lives would somehow be better, they would have to be. What is further implied is that if we do not abide by the 'rules of attractiveness' in our culture, we are ultimately flawed.

Our general intolerance for accepting differences in body shapes and sizes is pervasive. Our culture strongly values competition, goal-directedness and a constant pursuit for self-improvement. In keeping with these values, it is expected that we will do everything in our power to look 'fantastic,' as narrowly defined as that is. Even people with relatively healthy self-esteem are left asking themselves if they "need some work done" to keep up the unrealistic appearance standards supported by the culture.

Other possible explanations for the allure of cosmetic surgery include the increased income in many families. The majority of today's households have two working adults and the availability of disposable income allows elective surgery to be an option. This access can lead people to feel they have worked hard and deserve this luxury of cosmetic surgery.

Furthermore, many adults in the workforce believe they need these surgeries to remain competitive. The increased availability and marketing of cosmetic surgery can also reinforce the belief that we can and should indulge. Advertising has placed a strong emphasis on the "before and after" shots that depict a much happier, thinner, more beautiful person following surgery.

What should we do?

With all the focus and pressure on attaining the ideal body, how does one cope? There are several issues to consider and questions to really explore:

• Why am I considering this surgery?

• Is your life so negatively impacted by your appearance that you cannot function?

• Does your appearance make it difficult to get through day-to-day activities?

• Are any of your other real life problems going to be solved as a result of surgery?

When people are really challenged to examine why they want the surgery, it is more often related to internal beliefs and insecurities about not only appearance, but performance in their various life roles and general competency in life. An external fix -- larger breasts, fewer wrinkles, a flatter stomach - may provide satisfaction for a while, but when the novelty wears off, the other problems and insecurities still be there.

• What are my expectations for the surgery?

It is not uncommon for patients to have unrealistic expectations and the belief surgery will dramatically change their life, but it is rare for patients of cosmetic surgery to live happily ever after simply because of the surgery. It is not unusual for plastic surgeons to refer patients seeking surgery to psycho-therapists to evaluate body image issues, motivation for surgery, expectations of the procedure(s) and other underlying issues that may complicate their recovery.

• What about my self-esteem?

Often times people who feel poorly about themselves feel justified in considering making cosmetic changes since they want to believe it will dramatically improve their self-esteem. While the environment and how a person is both perceived and received by others contributes to self-esteem, it does not determine self-esteem.

Self-esteem is an internal experience that is shaped by our many life experiences and our ability to care for ourselves physically, mentally and emotionally. Depending on our appearance to carry our self-esteem puts us in the precarious position of allowing everyone else to decide whether we are acceptable enough. This, then becomes a no-win situation.

Whatever your motivation may be for considering cosmetic surgery, it is essential that you honestly explore why you are feeling the need for this and if it is truly likely to cure what really ails you.