# Motivation and emotion/Book/2015/Elective plastic surgery motivation

* Multimedia presentation (3 min)

## Overview

Elective plastic surgery has become a significant part of the 21st Century (American Board of Cosmetic Surgery, 2015). Most of the Hollywood stars have improved their body in one way or another over the last decade[factual?]. However, the small nose jobs and breast implants have overshadowed the true meaning of plastic surgery, to improve quality of life of people who where born with a deficiency or simply went through a trauma that scarred them for life (Bradley, ei[say what?] al, 2005). Sometimes undergoing an elective plastic surgery can mean having a “normal life” in society without body image issues or discrimination (Hoge, 2013). The motivation for the surgery can depend on the person's past experience as well as support that the person receives from the family and friends. The motivational reasons can differ from one person to another (Cole, ei[say what?] al, 2002).

## What is elective plastic surgery?

Plastic surgery is any non-emergency surgery that is aimed to reconstruct or improve parts of the body (American Board of Cosmetic Surgery, 2015). One of the most known characteristic aspects of plastic surgery is improvement of body image such as breast implants and nose reconstruction (American Board of Cosmetic Surgery, 2015). These surgeries are fully elective and participants are usually suffering from low self-esteem or body image issues[factual?]. There are different areas of plastic surgery:
* Cosmetic Plastic Surgery- focused on body changes such as nose reconstruction, breast implants and Botox shots (American Board of Cosmetic Surgery, 2015).
* Elective Plastic Surgery- focused on reconstruction such as breast reconstructions, skin reconstruction, birth deficiencies reconstruction (American Board of Cosmetic Surgery, 2015).
Example of Cosmetic Plastic Surgery
18-year-old Anna has experience some body image problems in the past. She has saved enough money to make an appointment with the plastic surgeon to talk about the changes she would like to do. She decided she would like to get breast implants and decrease the size of her nose. The surgeon informed her about all the options as well as about all possible complications of the surgery to ensure she has all the information needed. After a few weeks of thinking Anna decided to start with her nose and sometime in future come back to breast implants. She is very happy with her new look which has cured most of her body image issues.
Example of Elective Plastic Surgery
A 17-year-old Maddie carries a scar on her face reminding her of the day she was in traumatic car accident with her mum. A truck hit their car causing instant death of Maddie’s mum and injuring Maddie’s face and leg. She was 3 at that time and for the rest of her life she carries reminder of that day. She has found it hard to overcome the scarring on face and has been bullied at school and called names. She and her dad came to decision to remove the scars and have a reconstructive surgery on her leg. After the operation she will no longer have to carry that day with her and will have chance for real future.
Elective plastic surgery in contrast to cosmetic surgery is focused on reconstructive aspects of the plastic surgery. This chapter will focus mainly on birth deficiency reconstructions and burn victim skin reconstructions. Both of these types of surgeries have been practiced for few decades and are gaining popularity (American Board of Cosmetic Surgery, 2015). This type of plastic surgery is aimed at individuals who may have traumatic life experience that has left them with painful memory of the day in shape of a scare or deficiency that may end up defining they life (American Board of Cosmetic Surgery, 2015).

## What is motivation?

Motivation refers to Internal processes which provide individuals behavior mainly energy, direction and persistence. the energy aspect refers to the strength of the motive, direction refers to the purpose or reason behind the motive, and persistence refers to how often do we do experience this motive (Reeve, 2015).
Motivation is a reason for some behaviour. It is a fairly broad subject that can be explained in number of ways (Reeve, 2015). People tell us “we can achieve any if we put our mind to it”. Sometimes motivation can be classified as reasons behind decisions. To find the motivation we can ask different questions (Reeve, 2015):
* Why do I want to do this?
* What drives me to this activity?
* Why do I continue doing this?
* What does this help me achieve?
Motivation is closely related with emotions. Some can say that emotion is the drive for motivation (Reeve, 2015). Motivation can be a definition of our individual characteristics known as personality.

## Motivation leading to elective plastic surgery

There can be many explanations on what motivates plastic surgery. Two most common reasons are[factual?]:
* Body image struggles
* Determination to move on
Both of these motivations can be strongly influenced by internal and external sources and lead person to choices like plastic surgery.

### Body Image Struggles

* Definition of body Image
* Idealistic image of self in individual’s mind. This can be positive or negative feelings, depending on person’s mind set as well as influence of others in the environment. Can have dramatic effect on self-esteem and individuals sense of acceptance (O’Dea, Abraham, 2000).
Body image is a growing issue that is faced mainly by teen girls. It can lead not only to plastic surgery but also to eating disorders and even depression (Huang, ei al, 2007). These type of struggles are usually linked with sense of belonging to a group, but the main motivations may change when the individual grows up (O’Dea, Abraham, 2000). In the table before there are few motivations listed for each major group. As can be seen the belonging and acceptance aspect repeats itself over all three age groups while others differ to extend (Huang, ei al, 2007).
| Children | Teen | Adult |
| Peer pressure | low self esteem | insecurity |
| sense of belonging/ acceptance | sense of belonging/ acceptance | sense of belonging/ acceptance |
| problems with self acceptance in adult life | wanting to feel pretty/ match social standards | desperation for love |
Example of Body Image Struggles
16 Year old Maggie has been self conscious about her body. All of her friends have told her that she should lose some weight to get boys attention. She is a normal healthy size but because if her friends opinions Maggie to start a diet in desperation for friends approval. She drives herself to eating disorder and became anorexic.
Number of programs such as Shape Your Mind and Butterfly Foundation Program, have been put in place to provide support to victims of this struggle and ensure support system for recovery (O’Dea, Abraham, 2000). The disorders can include bulimia, anorexia, depression, as well as attempted suicide. Body image struggles leading individuals to more cosmetic plastic surgery rather then elective type of plastic surgery (Huang, ei al, 2007).

### Determination to move on

The determination to move on can be explained as leaving past behind and moving on from traumatic experience. Some victims may carry scar or other permanent reminders of what has happened to them in the past, which prevents them from moving with they life. Removing the mark can lead to closure or moving on from the traumatic event (Bradley, ei al, 2005).
This motivation is strictly linked to what person been through, mainly based in psychological and emotional trauma (Wilson, Keane, 2004). It is commonly associated with Post Traumatic Stress Disorder (PTSD) in different forms, however there are other disorders that may cause this motivation (Wilson, Keane, 2004). There are different types of therapies that individuals can undertake before choosing plastic surgery (Bradley, ei al, 2005). Some people are scared too deeply and have lost too much in the event to go back to normal life. A Few examples of emotions associated with this motivation to surgery can be (Wilson, Keane, 2004):
* Guilt
* Sadness
* Blame
* Anxiety
* Fear
There are also numbers of causes that can lead to this sort of condition are associated with childhood experiences, car accidents or other traumatic accident, domestic violence, lost of loved one in result of accident (Wilson, Keane, 2004). All of the causes have few things in common: leaving not only internal but external scars, may involve lost of loved one, hard for individual to overcome, seeking psychological treatment for the condition (Wilson, Keane, 2004). There is many options for treatment some as simple as cognitive behavioural therapy sessions (Bradley, ei al, 2005).. Mainly the treatment is based on acceptance of what happened and what person may have lost and moving on with understanding of the event (Wilson, Keane, 2004).
Example of determination to move on
25 year old Angie was in tragic car accident with her boyfriend. Her boyfriend died on the scene and Angie spend few weeks in hospital with bad face burns and cut all over her body. She has not been able to move on from that night and leave her boyfriend behind. Every time she looks in a mirror and sees the burns on her face, she has a flashback to the memory of the accident and how much she lost. After long therapy she decided she wants to do skin transplant to remove the burns and leave the past behind. After the surgery and some more therapy she was able to accept what happened and move on with her life.

## Statistics of plastic surgery

Plastic surgery is a fairly new surgery field that is still growing in popularity. Statistics can differ in each country, world wide it is estimated that in 2014, over 40,000 plastic surgeons are ready to provide help to these who need it (International Society Aesthetic Plastic Surgery, 2014). Taking as an example breast augmentation that will be talked about in detail later on, worldwide there were over 1,348,197 just for this type of breast surgery (International Society Aesthetic Plastic Surgery, 2014). United States of American as a country, have the biggest popularity base for cosmetic and elective plastic surgery and have largest number of specialist in plastic surgery field. America having 6,300 plastic surgery specialists who performed 297,297 breast augmentations, which ends up to conclusion that in 2014 21.2% of breast procedures where preformed on American soil (International Society Aesthetic Plastic Surgery, 2014).
Below is list of 30 countries ranked based on the estimated number of plastic surgeons working in 2014 (International Society Aesthetic Plastic Surgery, 2014):
* United States of America
* Brazil
* China
* Japan
* India
* South Korea
* Russia
* Mexico
* Turkey
* Germany
* Colombia
* France
* Spain
* United Kingdom
* Italy
* Chinese Taipei
* Canada
* Venezuela
* Egypt
* Peru
* Argentina
* Australia
* Thailand
* Greece
* Netherlands
* Belgium
* Iran
* Saudi Arabia
* Portugal
* Israel
Plastic surgery in America has stopped growing in popularity[factual?]. In 2014 the number of performed plastic surgeries was significantly smaller than in 2013. The difference 756, 003 patients deciding to under go either nonsurgical or surgical procedures for cosmetic surgery (American Society Aesthetic Plastic Surgery, 2014). Statistics for both types of surgeries are accumulated because number of elective plastic surgery procedures overlap with the cosmetic procedures which makes it difficult to establish the boundary in statistical differences (American Society Aesthetic Plastic Surgery, 2014). These types of surgeries are still more popular with females, but males are starting to build a large percentage when looking at gender based statistical differences.
10% of all patients where listed as male for procedures such as (American Society Aesthetic Plastic Surgery, 2014):
* liposuction
* nose surgery
* eyelid surgery
* male breast reduction (used for treatment of Gynecomastia)
* facelift
The most popular procedures with women are based on appearance improvement (American Society Aesthetic Plastic Surgery, 2014). The procedures include:
* Liposuction
* Breast Augmentation
* Tummy Tuck
* Eyelid Surgery
* Breast lift
There are some obvious similarities in the choice of surgeries with both male and females. Females are quicker to make the decision for plastic surgery, however it is a growing trend with males. It is possible that the number of males having plastic surgery will grow (American Society Aesthetic Plastic Surgery, 2014).

## Birth deficiencies

Birth deficiencies are any physical or mental abnormality present at birth. This can be caused by number of internal and external sources. Birth deficiencies can have internal (gene, chromosome) or external (mother alcohol or drug abuse) causes (Birth defects, 2014). Each of these can cause a different, unnecessary physical defect; in some lucky cases the deficiency can be so minor there would not be any impact on individual’s life (Birth defects, 2014).
Internal causes: changes or mutations in gene or DNA can lead to birth deficiencies such as down syndrome, cancer attraction (Birth defects, 2014). The internal causes can be related to family medical history and passed on from generations. The heritage defects can be heart problems, asthma, etc (Birth defects, 2014). These deficiencies can be either physical or mental, and can have different degrees of influence on individual’s life.
External causes: these defects can be caused by; the outside environment such as alcohol and drug abuse by mother in first trimester of the pregnancy (Birth defects, 2014). Infection or accident can also cause deficiencies. These are usually mental deficiencies like brain damage rather than physical one (Birth defects, 2014). Tumours can be an external cause deficiency or side effect of another defect. External defects can have major impact on person’s everyday life.

### Example - Robert Hoge Author of best seller "Ugly"

Robert Hoge was born with large tumour on his head that pushed his eyes to the sides. On top of the facial deficiencies his legs were twisted together and not valuable (Hoge, 2013). As a child Robert was forced to undergo number of plastic surgeries to achieve “normal” appearance, the surgeries continued through his adolescence to present with the face he has now (Hoge, 2013). His family was very supportive of the procedures he has chosen which allowed him to continue through with the painful procedures for so many years. He finished journalism degree and recently published his memoir “Ugly” (Hoge, 2013). He is known for his political journalist career and for his emotional blog entries about his own experience of bulling and self esteem issues (Hoge, 2013). Robert has grown up against all the physical obstacles into an inspirational person, and shared his story in a best seller (Hoge, 2013). His motivation to not give up on his dreams and believe in his own abilities carried him to great success.

## Skin graft: Burn victims

A skin graft is a medical procedure involving skin transplant, usually removal of skin from other areas and transplanting it to the burn area. With some large and deep burns cadaver skin graft is used.
Burn victims are more complex area to consider when looking at elective plastic surgery. This group is usually deeply traumatised by past event. The treatment can depend on degree of the burn suffered. Figure 5 below presents the difference between the burn degrees (Cole, et al, 2002).
* First-degree burn: burn that only affects the superficial skin layer
* Second degree burn: burn that affects some underlying skin layers
* Third degree burn: burn that penetrates deeper into skin layers and creates real injury.
Skin graft is one of the most popular options with people who suffered a second or third degree burns (Cole, et al, 2002). Second-degree burns are not usually severe enough for skin graft depending on cause of burn. Skin graft is not the only option available for burn victims, there is number of options that can be taken into account before making treatment decision (Cole, et al, 2002):
* Skin graft: transplant of skin from one area of body to another
* Microsurgery: mainly used for reattachment of body parts like lips, fingers, toes, etc.
* Tissue expansion: procedure that allows skin to regenerate. This happens with surgically placed under skin balloon to push skin to stretch.
Each of these treatments is a highly complicated procedure that has long recovery time. Patients who undergo these procedures are usually desperate and traumatised (Cole, et al, 2002). Another option for skin graft is to have a transplant for cadaver if a larger skin transplant is needed. This options popular with patients with large burn scars on face (Cole, et al, 2002). The procedure becomes a lot more complicated and the wait time becomes even longer, in result it is not as popular as standard skin graft procedure (Cole, et al, 2002).

## Breast reconstruction

Breast reconstruction is a form of treatment for woman facing breast cancer. It is involves replacing breast after removing tumour for higher survival chances (Breast Cancer Network, 2015). Breast cancer is becoming one of the most common cancer types with females and forcing number of woman to decide on breast reconstruction (Loaring, el., 2015). It is a common treatment for patients self esteem. The reconstruction of breast can contribute to faster recovery from other cancer treatments (Breast Cancer Network, 2015). Physical appearance can have major effect on person’s well being specially when examining such terrifying disease (Loaring, el., 2015). Individuals need strong motivation and support group to fight the disease and achieve remission (Breast Cancer Network, 2015). The procedure of breast reconstruction is similar to breast implant procedure however the motivation behind them varies.
There are different types of reconstructions available for woman, and they on average can get up to 18 months to decide between the different options. These options include (Breast Cancer Network, 2015):
* Breast implants: the end result may not feel as natural as other options, however it is an easier surgery with shorter recovery time (Breast Cancer Network, 2015). There is also the issue of no size change, especially important with cancer patients while undertaking other treatments that may result in major weight loss. If reconstructing only one breast, it is common to end with uneven breasts because of the difficulty of matching existing breast to the reconstructed one.
* Using own tissue: transplant of tissue from different areas of the body to fill the missing breast tissue (Breast Cancer Network, 2015).
The main advantage of this procedure is more natural looking breast and the size flexibility of weight loss and weight gain (Breast Cancer Network, 2015). The transplanted muscle works the same way as normal muscle therefore it is hard to tell the difference. The disadvantage is the longer recovery time and more complex procedure (Breast Cancer Network, 2015). Another disadvantage could be higher risk of infection and more visible scars in different spots on the body and the risk of muscle being rejected by the body.
The number of remissions is still increasing, however the number of woman under 40 diagnosed with breast cancer has also increased (Raque- Bogdan, el, 2015). The option of breast reconstructions has grown in popularity in past decade due to change in these statistics (Breast Cancer Network, 2015). The support from partners and family towards the treatments cannot be measured or placed into statistics, however the time taken to make decisions about the procedure have significantly shorten when looking at younger woman suffering from cancer (Loaring, el., 2015).
Breast amputation is not the first choice of treatment but considered one of the sure ones (Breast Cancer Network, 2015). Followed by chemotherapy and radiation. Removing the tumor can stop the cancer from spreading and increase chances of survival and remission (Loaring, el., 2015). Sometimes after removing the tumor, individuals can go into remission before starting chemotherapy or any other treatment (Breast Cancer Network, 2015).

## Theory

Motivational theories can be applied to almost everything[vague]. There are many sub theories that can explain person’s motivation towards different things (Reeve, 2015). There are three main theories that always should be considered before looking into sub theories.
The Will Theory: proposed by Descartes focusing on understanding the will to understand motivation (Reeve, 2015). It was one of the first theories introduced as motivation theory and creating a definition of motivation. This theory was accepted as explanation of processes and providing overview of what is motivation (Reeve, 2015).
The Instinct Theory: Darwin’s idea of motivation being linked to human physiological and biological base and it is encoded into human genes (Reeve, 2015). Darwin looked back at the animal-human connection that was assumed in other areas of medicine (Reeve, 2015). Understanding humans know they need to care for children, like animals do. This theory was very popular and supported by many until the third major theory was introduced (Reeve, 2015).
The Drive Theory: Freud’s idea was once again based on the drive to motivation being related to physiological needs like hunger (Reeve, 2015). These needs drive us to act the way we do. Hull after Freud took the theory and examined the strength of the drive and the strength of motivation (Reeve, 2015). Good example of this theory would be getting hungry and having motivation to eat.
From these three core theories sub theories or mini theories where created to examine particular area of motivation (Reeve, 2015). There are large numbers of mini theories for motivations to choose from which link in the end to the core concept of the area.

### Self determination theory

Self-determination theory is based on the concept of motivation coming from inside the individual rather than from the environment. It can be strengthen by the outside sources, however the main source of motivation in person themselves (Deci, Ryan, 2012). These can be motivations of belonging like was mentioned previously in the chapter or emotions translated into motivations. Understanding that concept of self-motivation with limited influence from outside sources can be beneficial when examining such complex and personal topic like plastic surgery (Deci, Ryan, 2012).
Self- determination theory proposed by Daci and Ryan created an understanding of support that person needs and the self-motivation that is needed (Self motivation theory, 2015). According to this theory self-determination can be lead by three main concepts:
* Autonomy- making informed decision and proceeding towards a specific goal, accepting the moral responsibility of the actions taken (Deci, Ryan, 2012).
* Competence- ability to do something well and efficiently. Being able to achieve a set goal.
* Relatedness- the chance that two individuals would share same motivation sources or reactions to stimulus.
The theory was first researched in the 80’s but did become popular till 2000s for case studies (Self motivation theory, 2015). Is has grown with popularity with cases of self-esteem and individuals psychological health.
Example how self-determination theory fit into plastic surgery
25 year old Mel have been bullied her whole life because of surgery scars on her face After many years of being called names she decided she is ready for the surgery. She removed the scares from her face and was able to live a normal happy life without being called ugly or stared at.
Autonomy: Mel has made informed decision and she accepted the moral and physical consequences like recovery time.
Competence: She removed her scars to achieve better chances for future opportunities.
Relatedness: The scars on Mel’s face may not bother some but have made an impact on her life. Being called ugly motivated her to make changes for future.

## Conclusion

[Provide more detail]