Ethical storm clouds hover over cosmetic surgery at the best of times. Is it consistent with a doctor’s ethic of healing to turn his skills into a consumer product? Is it right to use surgery to treat psychological problems? But the latest news on this front is even more disturbing. It suggests that one outcome of cosmetic surgery is not just changing your appearance, but ending your life. According to a special report in New Scientist, women with breast implants are two to three times as likely to kill themselves as those who have not. And this could be an underestimate, as these women also have a higher risk of road accidents, and some of these could be suicides.

What’s going on? The first explanation is that nothing is. Dr James Wells, of Long Beach, California, told the magazine that most of the women who committed suicide all had their implants decades ago. "It’s a very different world now," he says. "The implants are better, how we assess the patients is better, and implant failure rate is lower." However, epidemiologists are not convinced. A remote possibility is that leaks from the implants trigger changes in brain chemistry. Another is that women with breast implants are more likely to be substance abusers.

But the most plausible explanation is that the women who seek cosmetic surgery come with personality traits or psychiatric disorders which their doctors fail to detect. Indeed, a Danish study found that 8% of women with breast implants had earlier been in a psychiatric hospital. As well, an estimated 6% to 15% of patients who seek cosmetic surgery are believed to have a condition called body dysmorphic disorder, more commonly known as "imagined ugly syndrome". These people are obsessive about non-existent flaws in their personal appearance. They are 45 times as likely to commit suicide as normal people — more than twice as much as people with major depression.

Dr Sabine Wilhelm, of Harvard Medical School, urges cosmetic surgeons to screen their patients for "psychological appropriateness". "Focus on their suffering and seek help from a psychologist," she says. And if they insist? "Cosmetic surgery is an elective procedure. Some surgeons say, ‘If a patient elects to do it, shouldn’t I go ahead?’ My answer is: ‘You as the surgeon can elect not to do it.’"

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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