Why do some people repeatedly go under the knife (or opt for other enhancements such as Botox, repeated microdermabrasion and countless other non-surgical procedures)? Is it to feel better about themselves (they rarely do, if they keep going back)? Is it to overcome or compensate for perceived deficiencies? Is it to be more loved? Does this compulsion stem from childhood abuse, partner violence, a family history of substance abuse and\/or mental health issues (including disordered eating)? To arrive at some answers, we spoke with Dr. Michael Baron, MD, MPH, FASAM, who serves as medical director at The Ranch in Nunnelly, Tenn. \u201cWhat drives most people is rampant insecurity - they don\u2019t feel good about themselves. There\u2019s a huge cultural pressure to remain young, to be thin and to be beautiful. People who think that they aren\u2019t beautiful, aren\u2019t anorexic-like thin, but strive to be, don\u2019t have it in their genetic predisposition to have high cheekbones or large breasts or whatever the anatomical desire is, can find a plastic surgeon who will accommodate them.\u201d Dr. Baron is quick to point out that reconstructive surgeons do a great job of caring for patients with burns and disfigurements suffered as a result of accidents and injuries. It\u2019s in the area of cosmetic work that some practitioners really \u201cprey on people\u2019s insecurities and desires to remain young, healthy and thin, with good skin and a good complexion.\u201d Fighting to Turn Back the Clock Looking in the mirror and spotting more and more wrinkles causes many women (and, increasingly, men) to consider getting \u201csome work done.\u201d This may wind up being a series of Botox injections or other nonsurgical techniques, but it also includes facelifts, eyelid lifts, tummy tucks and a few other procedures. Do some people age faster than others? Why do some people go from looking their age (or, conceivably younger) to looking much older than their years? One study found that aging is determined by an accumulation of changes during our lifetime - but also from the genes we inherited from our mothers. So, for many people worried about the rapid appearance and advance of crow\u2019s feet, smile lines, forehead wrinkles and other aging facial conditions, we were more or less born with them. No wonder so many people - especially baby boomers, those born between 1946 and 1964, a group of about 79 million - are ready and willing to do whatever it takes to remain younger-looking longer, including consideration of one or multiple cosmetic plastic surgeries. As a consequence of the 2009 recession, fewer than 15 percent of Americans age 50 and older believe they\u2019ll be able to retire when they turn 70. The need to continue working compels many to seek to put on as good a \u201cface\u201d as possible. Among those 55 and older in 2011, an estimated 3.5 million searched out some form of cosmetic surgery. Under Pressure It\u2019s no secret that women feel more pressure than men to keep up appearances as they age \u2013 the data bears it out. According to the American Society for Aesthetic Plastic Surgery, in 2013 women had more than 10.3 million cosmetic surgery procedures, compared to 1 million such procedures for men. In women, this represents a 471 percent increase in cosmetic procedures since 1997. For men, the increase was 273 percent. As Dr. Baron points out, some cosmetic surgeons take advantage of people\u2019s insecurities about aging. \u201cThey\u2019ll take a very attractive woman and do another facelift or breast augmentation or a tummy tuck or a butt lift and really they\u2019re tweaking something that doesn\u2019t need to be tweaked,\u201d Dr. Baron said. \u00a0\u201cIt may make a woman feel better about herself for a little while, but then it\u2019s lost and she wants another operation or another collagen or Botox injection to feel beautiful again. Most people can\u2019t tell any difference in the person, but the person can tell and it really goes to that they\u2019re not happy in their own skin and need to change it to feel good about themselves. But in fact, it never works well.\u201d The top five plastic surgery procedures performed in 2013 were: \tLiposuction \u2013 363,912 procedures \tBreast augmentation \u2013 313,327 procedures \tBlepharoplasty (cosmetic eyelid surgery) \u2013 161,389 procedures \tAbdominoplasty (tummy tuck) \u2013 160,077 procedures \tRhinoplasty (nose surgery) \u2013 147,996 procedures Let\u2019s not forget that plastic surgery is expensive, exceedingly expensive. The national average in 2013 for breast augmentation was $3,266 (with saline implants) and $3,618 (with silicone gel implants). Buttock lift\/augmentation cost an average $4,329\/$4,885 while a tummy tuck averaged $5,391. Eyelid and facelift surgery cost $2,726 and $6,675, respectively, while nose surgery averaged $4,352. Psychiatric Origins Who goes in for repeat cosmetic plastic surgeries? Studies in this area are limited, but some evidence points to those who are diagnosed with body dysmorphic disorder (BDD) having a greater tendency to repeatedly seek out plastic surgery solutions for something that is psychiatric in origin. In other words, such individuals perceive a flaw where none exists. According to a 2000 press release from the American Society for Aesthetic Plastic Surgery, \u201cmultiple procedures with multiple doctors may be sought in a search for a solution to a physical complaint, which is psychiatric in origin.\u201d A 2013 study said that BDD, which \u201caffects about 1 percent to 2 percent of the general population, has been found to be up to 15 times more prevalent in patients seeking plastic surgery.\u201d The report also said that the course of BDD is both gradual and chronic in nature, and can be \u201cexacerbated by social stressors or even surgical intervention.\u201d One rather disturbing trend is that the rise of \u201cselfies\u201d is apparently promoting an increase in requests for procedures due to people being more aware of their appearance in social media. Thirteen percent of members of the American Academy of Facial Plastic and Reconstructive Surgery surveyed said increased photo sharing and patients\u2019 dissatisfaction with their images on social media sites is part of a rising trend. They also noted a 10 percent increase in rhinoplasty, 7 percent in hair transplants and 6 percent in eyelid surgery in 2013 compared to 2012. According to The Ranch\u2019s Dr. Baron, a key point to remember is that behavior takes a long time to change.That\u2019s why surgery alone often doesn\u2019t work. \u201cYou change cellulite, but it\u2019s not enough. It\u2019s never enough. Like cocaine is never enough. They get hooked on plastic surgery and it\u2019s never enough,\u201d he said. Bottom line: If you feel compelled to go for one nip-and-tuck after another, or find yourself repeatedly making appointments for Botox or microdermabrasion procedures in an effort to eradicate or change a perceived imperfection, seek professional help to get at the root of the problem. Often it\u2019s not how you look that\u2019s driving you to take such drastic measures, but rather your inaccurate self-perceptions. Treatment can help.