Should I or Shouldn't I? Deciding Whether to Have a Cosmetic Procedure

"Should I, or shouldn't I?" I hear this question a lot from people who are not really sure they should have a cosmetic procedure. Is plastic surgery "OK"? Is cosmetic dermatology the right thing to do? Obviously it's a personal decision. But with all these women — and men! — asking the question, it's clear people need help thinking through this whole "changing my appearance" thing.

One woman told me she hasn't gone out in shorts since she was a teen. Even around the house she wears "long shorts" only. Why? Leg veins. Now, I see a lot of women with significant leg veins wear shorts. Maybe they care, but they just wear shorts anyway. This woman's veins are the tiny starbursts only visible up close. What's the difference?

Well, they bother her. They make her self-conscious. Just enough to make her change her behavior, and avoid shorts. The truth is, everybody has different tolerance levels about leg veins, facial or bikini hair, fat bulges, or too-early signs of aging.

Now, right up front, we do have to address a problem that exists outside the individual. No question: We live in an appearance-conscious, image-consuming culture, and maybe the culture itself isn't quite… right. Often, the prime value isn't inner beauty, or even health (take sun-tanning — it's BAD for you!).

But even if you "get" the undue pressure from media images, you'll still have to deal with their impact on how you feel about yourself — it's where we live. We each make our peace with the pressures on our lives. So it's essential to be clear about our motivations.

I've often said cosmetic procedures, medicine and products are really not about the wrinkle, hair, spots, fat — whatever — but about self-confidence and self-esteem. So, if you find yourself feeling dissatisfied with some part of your physical presentation, the first step is a little self-quiz. If you're repeatedly focusing on, say, the loosening skin on your neck, ask yourself: How do I feel about myself aside from that? If I did something about my neck, would I be expecting that change to improve other issues?

Obviously, it won't. It will simply make you feel better about how your neck looks — which can improve your self-confidence around your appearance. The trick is in knowing who you are, and having reasonable expectations. Your essential worth, of course, doesn't lie in your appearance. Are you someone who is always there for colleagues and friends? Who makes people laugh? Gets the job done? Knows how to ease a tricky situation? These are the things people will remember about you, not how you look.

Still, this doesn't make it wrong to want to improve your appearance. And that brings up the common question: Is it right to spend money on a cosmetic procedure? Well, "afford" is a relative, personal term. One client kept stuffing her closet with new clothes and shoes. She sold most of it off to a consignment store when she realized that Fraxel laser treatments would make the cosmetic change she really desired, rejuvenating and toning the skin on her face and neck — which would actually free her from the nagging concern with how she looked.

Bottom line, you'll have to make the call, but it's no more "wrong" to spend money on a cosmetic procedure than on anything else relating to your appearance.

In muddling through the "should I" question, the most important thing is to find professionals you can really trust. But how do you know you can? Well, start by choosing a practice with caring people, who emphasize listening to your concerns, telling you all your options, helping you think things through, and building a long-term relationship.

Nowadays there are great alternatives to more expensive, invasive surgical procedures. A cosmetic dermatologist who specializes in these alternatives can help you choose what's right for you, from surgery through laser, laser liposuction or microdermabrasion, to collagen, Restylane or Botox. Maybe all you need is a botanical facial peel, or just skin-care products.

Once you understand what cosmetic procedures can — and can't — do for you, your choice will be easier. You know you will not be perfect. Ever. And that's a good thing, because — let's be honest — perfect isn't all that interesting.