MICHEL MARTIN, host: I'm Michel Martin and this is TELL ME MORE from NPR News. Coming up, my weekly Can I Just Tell You commentary. That is in just a few minutes.

But first, we go behind closed doors as we often do on Mondays. That's where we talk about issues people usually keep private. Today, we want to take a close look at body image.

A new study finds that one-third of those who have had plastic surgery to change the look of their noses have something called body dysmorphic disorder or BDD. That means they are excessively concerned about some part of their appearance.

We were particularly interested in how this plays out in communities of color, who, you might be interested to know, are actually more likely to have some cosmetic procedures than white people are.

We've called upon Dr. Anthony Youn. He's a board certified plastic surgeon. You might have seen him on the Rachel Ray show, where he is a regular guest, or you might have read his memoire, "In Stitches," which came out earlier this year. We talked to him about that earlier.

So Dr. Youn, welcome back to the program. Thanks so much for joining us.

Dr. ANTHONY YOUN: Thanks, Michel.

MARTIN: Would you tell us a little bit more about this new study? It appeared in this month's issue of Plastic and Reconstructive Surgery. That's the official medical journal of the American Society of Plastic Surgeons. It's called "High Prevalence of Body Dysmorphic Disorder Symptoms in Patients Seeking Rhinoplasty."

So break it down for us.

YOUN: Yeah. This is an interesting study out of Belgium where plastic surgeons interviewed 266 patients who came into their office for nose-related surgeries. And what they found is that only two percent of those who came in for functional issues with their nose. Let's say they couldn't breathe very well or they had a deviated septum. Only two percent of those had body dysmorphic disorder-related symptoms, whereas 33 percent of those who came in for cosmetic-related issues had moderate or severe symptoms of BDD.

And you mentioned, you know, what BDD basically is, is this psychiatric condition that people have where they look in the mirror and they see something completely different than what everybody else sees.

MARTIN: How do you diagnose something like that? Because aren't we all that way, to some extent?

YOUN: Well, it's very normal and it's commonplace for people to have some type of issue that they may not like about their body, but the difference with body dysmorphic disorder or BDD, is that their concern with these patients is way out of proportion to what most people have.

And so, for them, let's say they have a little bump on their nose - and we see this as a little bump on their nose. Well, for them, that bump is the size of a melon and these patients undergo, unfortunately, multiple plastic surgeries, oftentimes, to correct a perceived defect that was really never there in the first place.

And this can create a spiraling down of these people and their whole life, to the point where almost 30 to 50 percent of them have tried to commit suicide at some point in their lives.

MARTIN: So that would seem to be a severe condition, if somebody is that upset about his or her appearance that one has suicidal thoughts.

You've told us that you think that this might be actually more prevalent in communities of color than people might think, because I think I'll just be blunt about this. I think many people might have this impression that concern about appearance is something that's a bigger issue in the majority community, because maybe that's who we see on television and so forth, talking about these issues.

You're saying that you think this might be actually more prevalent among ethnic minorities. Is that true and why do you think that might be?

YOUN: I agree with that and there are a number of reasons why. Number one, this study really focuses on rhinoplasty, or nose jobs. And in the United States, there are a lot of Caucasians who have rhinoplasty or nose jobs.

However, if you look overseas and the country with the actual highest per capita of plastic surgery is South Korea. You know, I was born here in the states, but my parents are Korean. They're from South Korea and so I've actually seen this culture of plastic surgery from afar with my relatives.

So when you combine - once again, it's rhinoplasty. Now, if you look at other cultures, rhinoplasty is the most common facial plastic surgery among Latinos, among African Americans and it's a close number two among Asians.

And when you look at the reasons why people have BDD, there are some potential neurologic reasons with serotonin and serotonin uptake, but one thing that we really focus on is society. And if you look at society, we're really a society that is unfortunately based upon a Caucasian ideal of beauty.

And one thing that if you ever look at the People magazines, 50 sexiest people in the world, there are very few, number one, Asian American males in that demographic in those groups. And you see that, also, with other types of ethnicities.

MARTIN: Well, I guess that would be my next question, is I wonder if this is an example of the society pathologizing something that it itself created. Which is to say that, you know, the society creates the conditions that makes people crazy and then blames them for being crazy.

YOUN: Yes.

MARTIN: It sets up an ideal of beauty. It's kind of reinforced constantly in the media and in entertainment particularly, and then if you don't meet that ideal, people - and then you do something about it, people are going, oh, well, what's wrong with you, that you don't like yourself? And I have to wonder whether this isn't kind of a feedback loop and the study is kind of - it's a study, but it's implicitly criticizing people for trying to meet a beauty ideal that they didn't create.

YOUN: That's true. And I think it's more than just that, though. Because a lot of these feelings, they are rooted, you know, in childhood. And the average diagnosis, age of diagnosis of BDD is 17. And so what happens is, is children who are African-American, who are Asian-American, who are Latino, they grow up with these images of beauty that are traditionally Caucasian in appearance. Even African-American and Asian-American models that you see, a lot of them have more quote/unquote Caucasian-type features than they may features that are more stereotypical of, you know, their race.

And so, when these children are exposed to this over and over again - even if you go to Japan and Korea - a lot of those people who are the famous models and actors and actresses, they don't have those typical Asian-American features. You know, they've got the double fold of the eyelid. They have the nose that's a little bit thinner that may have been augmented by plastic surgery. And when these children have these images that are just, they're bombarded with when they're children, as they get older, in those who are susceptible, I do believe that they develop these issues of body dysmorphic disorder.

MARTIN: If you're just joining us, this is TELL ME MORE from NPR News. We're talking about body dysmorphic disorder. Our guest is board certified plastic surgeon Dr. Anthony Youn. You might have seen him on "The Rachael Ray Show." He also was a guest on this program recently to talk about his memoir "In Stitches." Well, Doctor, you know, to that point, let me press the question with you. You have had - you talked about this in your memoir - you yourself have had plastic surgery. You did this when you were a young man, you were just out of your teens, right? Or you were still a teenager...

YOUN: Yeah.

MARTIN: ...or reconstructive surgery on your jaw, and now you're part of this field where you are changing people's appearance. And I wonder if you ever feel that perhaps you're part of this cycle of pushing people toward a narrow aesthetic that rather than, you know, encouraging people to appreciate the diversity of appearances that we have in this very large world of ours.

YOUN: Yeah. And it's something that- just need to say, I'm very conflicted with it. Now, I did have plastic surgery when I was 17 where my jaw was literally broken and reset and I discussed that, you know, when we talked last time, and in my book "In Stitches."


YOUN: But I have been performing myself these types of procedures we talk about. Although, honestly, as I've gone forward in my career, I perform less and less of them and I'm also less and less comfortable with doing it. I think the difference is, is when patients are having this type of procedure - let's say an Asian eyelid surgery where we create a double fold of an eyelid, or rhinoplasty, where we thin the nose a bit, and they're adults, they're in their 20s, their 30s, their 40s, I feel more comfortable with that versus what you see in a lot of Asian cultures where literally some studies are showing 25 percent of Korean mothers of daughters in their teens, 12 to 16, have already encouraged their daughters to have plastic surgery. I am not a fan of any type of cosmetic surgery for anybody who is a minor. And even people who are in there, you know, late teens, early 20s, and they are quote/unquote adults, I'm very uncomfortable performing these types of procedures on them.

MARTIN: Well, what do you say to parents who come in and say to you, look, this is just common sense. You know, this whole black is beautiful thing, brown is beautiful, you know, love who you are thing, that's fine. But I'm just trying to help my child function in the world and this is, you know, fitting in, meeting that European aesthetic is the way to go, and I'm just trying to make my kid's life easier. You know, what do you say to that?

YOUN: Well, it's difficult. I've actually had to deal with this even in my own family. I had an aunt who had a daughter who was in her late teens and her daughter had already actually traveled to Korea to have plastic surgery done. And we were at a family reunion at one point. And she said - and she was actually looking at her daughter and said, oh, look how ugly you are. You need to get your nose re-done and your eyelids redone and this and that. And she said, Tony, don't you think she should do that?

And I said that's crazy. You know, she's beautiful. But the problem is, is these ideas are ingrained in their society and in their upbringing. For me, what I try to do is discuss it with the patients and with their family and try to give them as much insight into these issues as possible. Unfortunately, after I turn them down they usually go to somebody down the street and will get it done anyway.

MARTIN: Does it - do you find it curious in a way that, you know, we are having this conversation, that this issue is emerging at a time when there are more diverse images in the media actually than there ever were in the past? I don't know about you, you know, when I was growing up, when there was an African-American on TV, you would run to see who that - on the TV. You know, you'd do a call-out, hey, there's a - I don't remember what words we used, there's a black person on TV. And you know, and you'd run to see that person. And I don't know if it was the same with you but, you know, when you and I were growing up, there were, you know, there was what, Hop Sing on...

YOUN: Yeah.

MARTIN: ...on what was that - what's that show? I'm sorry, I'm showing my age here.


MARTIN: But, you know, one of those - "Bonanza."

YOUN: I think...

MARTIN: You know, there were just very few people of color on television period or in the major media period. And you just...

And so, but now we are, there are many more. And in fact, there are last season - there are many television shows where there are some Asian prominent, you know, characters, and different, you know, not as many as many people would like. But we're having this conversation now.

YOUN: I do believe...

MARTIN: What do you think this is about?

YOUN: I do believe it's getting better. You know, in the past when it was really bad you would see Caucasians playing Asians, playing African-Americans. Now we have, you know, our ideals of beauty, it has kind of gotten better where we have seen Halle Berry be a very, you know, distinct ideal of beauty, but she's also lighter skinned. What we're not seeing yet, however, are people who are let's say Asian-American who have very stereotypical Asian features. You know, with eyes that are not wide open. They don't have the double fold. You know, in general I think society is getting better. You know, we are seeing more and more diversity, but I think we still have a long ways to go, and that's what I'm hoping. And, you know, my field of plastic surgery is as guilty as the, as society with, you know, the beauty magazines and all that, of contributing to this. And I'm hoping that as time goes on things do get better.

You know, as I have gone on in my practice I have felt less and less comfortable doing these types of quote-unquote ethnic surgeries, and I do very little of it now. But once again, I'm just one surgeon.

MARTIN: Well, I think you're quite handsome and it's good to see you on "Rachel Ray."


YOUN: Well, thank you, Michel.

MARTIN: Dr. Anthony Youn is a board-certified plastic surgeon. He's a regular guest on "The Rachael Ray Show." He's also been on "Dr. 90210," on CNN and other outlets. His memoir is titled "In Stitches." If you'd like to hear my previous conversation with Dr. Youn about his memoir, just go to our website. Go to npr.org, click on the Programs tab and then on TELL ME MORE. Dr. Youn was kind enough to join us from Detroit, Michigan. Dr. Youn, thanks so much for joining us once again.

YOUN: Thank you, Michel.


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