Most of us have a hard enough time trying to understand how cosmetic surgery works so the question of why people do it can be even more baffling. Aesthetic tweakments are more popular than ever, but many question the necessity of them.

What isnt widely understood is that turning to the needle or knife is often less about vanity and more about identity.

In fact, the man credited with inventing cosmetic surgery did so with psychology in mind. The surgeon Sir Harold Gillies developed his methods of facial reconstruction during the First World War when dealing with soldiers life-changing injuries. He focused not only on repairing the functionality of the face but on the aesthetic details too, believing that the psychological impact of how they would look could be as affecting as the physical injuries. Ida Banek, a trained psychologist and the founder of Ouronyx, an aesthetic clinic in London that focuses on facial procedures, believes that understanding this link is a key component of treating clients.

As part of her consultation process, patients have to have a strong and deep conversation about their personality type, to clarify their objectives, how they see themselves and how they wish to see themselves. The vast majority, she says, have goals that are based on confidence and emotions, rather than looking different or younger.

Turning to aesthetic treatments or surgery can be a way to restore confidence, although the link between the procedure and the emotional result isnt always linear, says the psychotherapist Emma Reed Turrell. Confidence is less about appearance and more about self-consciousness, she says. We know that there is strong correlation between self-consciousness and unhappiness: its not so much about how we look, its how we feel about the way we look. Rather cruelly, though, negative feelings about our looks cant always be attributed only to low self-esteem they can be psychologically hard-wired.

Our brain leads us to see ourselves differently from how we see others, and analyses our own image in high-definition detail, says Rajiv Grover, a consultant plastic surgeon and former president of the British Association of Aesthetic Plastic Surgeons. But our perception of others is similar to that of an impressionist artist [appreciating the form as a whole]. This means we look at ourselves with a more critical eye.

However, out of about 1,000 clients questioned at Ouronyx, 95 per cent in all but one age group said they wanted to look fresher and well rested. It was only among the under-30s that clients wanted to look more striking, feminine or masculine. They want to change their appearance rather than optimise it, Banek says, which is one of the reasons were very cautious with that particular group. Three quarters of those in their twenties have been turned away, she adds; what the clinic doesnt want to promote is a fast-beauty culture, which has the potential to encourage young people [to have] premature and possibly unnecessary cosmetic interventions.

Sadly not all clinics adhere to these principles, and regulation within the industry is weak. Im clearly biased, but I would love everyone to have access to a therapist or psychologist whenever they are making major decisions in life, such as cosmetic surgery, Reed Turrell says. Although, of course, its difficult to draw a line: would a millilitre or two of filler be considered a major life decision? It cant hurt to understand your motivations more clearly, she says, so you can feel grounded and confident, however you choose to move forwards.

Though its now widely accepted that the aesthetics route is one people should be able to take freely and safely, there is often the risk of someone altering their appearance beyond what would be considered natural-looking, or becoming addicted to procedures. Sometimes this is because of body dysmorphia, a diagnosable medical condition that requires treatment outside an aesthetic clinic. In other cases, Banek says, its simply human nature. We tend to forget the past relatively fast and focus on what we see in the mirror in the moment. You forget what the starting point was.

Before-and-after photos can help to remind patients of their journey, as well as to manage their expectations so they dont face disappointment or try something else. Ive worked with people who find themselves disillusioned and sometimes physically and financially damaged by procedures that could never fix the problem, Reed Turrell says, because it wasnt simply one of appearance, it was one of self-worth.

This is why industry leaders including Banek and Grover are passionate about making sure that patients seriously contemplate the risks and consider psychological guidance. In the meantime, Banek says, the best we can do is to ensure regulation becomes stronger. Education around the psychological reasons for and impact of aesthetic decisions, especially for younger people, is paramount.

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Why psychology is as important as physiology for plastic surgery - The Times