Ask Beatty: So What About an Inside Makeover?

Young woman receiving lip injection makeover
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Dear Beatty,

I hate to admit it but I am hooked on plastic surgery. I am a 29-year-old, single, Harvard MBA graduate with a great job in New York City. I have already had multiple cosmetic surgeries including a face lift, rhinoplasty and breast surgery. I am embarrassed to admit it but I’m already considering other procedures. I have been to the best cosmetic surgeons in the country and yet I am never satisfied with the results. I also should mention that I am a “sugar baby” and have been having financial and sexual arrangements with sugar daddies since I was 20 years old. This helped pay for college since I’ve been on my own and have been estranged from my family for many years. I realize I have a lot of problems — I drink to the point of blacking out and am obsessed with pornography. After reading a few of your articles in Dan’s Papers, I decided to write and see if you can help me.

Rhianna, Southampton and New York City*

*(“Rhianna” has become a patient of mine. I have changed all of the identifying information to protect her anonymity and confidentiality.)

Dear Rhianna,

It took a great deal of courage to reach out, and clearly you have a lot of issues, both past and present, that need to be acknowledged, addressed and resolved. The good news is that you realize you need help and that cosmetic surgery is not the answer to the problems that you have already identified. I congratulate you in realizing that it is better to be dealing with your issues at 29 than to spend an entire life on a roller coaster ride — a ride which will undoubtedly not end well.

It has become virtually impossible to browse through popular magazines and newspapers without coming across all kinds of beauty enhancers promising to keep us eternally young. Look at all of the “extreme makeover” shows that are popping up on television. Cosmetic surgery has become mainstream. In 2020 there were 17.5 million surgical and minimally invasive cosmetic procedures performed in the United States. The United States is the number one country in the world that performs the most cosmetic surgeries and procedures. Brazil is a distant second.

Women and more and more men are flocking to doctors in record numbers for Botox, laser surgery, weight loss pills, breast enhancements, breast reductions, rhinoplasty, tummy tucks, face lifts, blepharoplasty (eyelid surgery), body lifts, permanent makeup and even male “enhancements.”

Designer clothes, handbags, shoes and jewelry — many of these items costing thousands of dollars — adorn the covers of magazines. People yearn to have larger homes, expensive cars and “material toys” of every description — believing that external beauty and an extravagant lifestyle is the recipe for true happiness. Ads and television commercials continually reinforce the idea that if you are a beautiful woman who marries a handsome and wealthy man, you’ll live happily ever after in a mansion on the water. Not true!

What is true is that being physically attractive and not having to worry about paying your mortgage or putting food on your table is indisputably a plus in life. The reality of having treated hundreds of some of the wealthiest, best educated and “successful” men and women in my private practice has taught me something else about fame and fortune.

The real lives and relationships of the rich and famous (not the lives superficially interviewed on the red carpet or at benefits) are no happier than the majority of people at large. Clearly, having a lot of money and being beautiful does indeed open doors. However, once inside, we all still need to confront our inner selves, our demons and our relationships — the good, the bad and the ugly. If we do not deal with our depression, anxiety and other psychiatric problems — including drug and alcohol issues, gambling and pornography addictions, as well as our dysfunctional and frequently abusive relationships and sexual challenges — our money and extravagant lifestyle will only help ease the pain temporarily.

What are the consequences of not stepping up to the plate to deal with one’s demons? In my experience, the majority of people, both men and women entering therapy, have had a variety of physical problems which have included insomnia, high blood pressure, migraines, gastrointestinal problems, high cholesterol, back problems, ulcers and a variety of other physical aches and pains. When these brave men and women gave themselves permission to finally step up to the plate and deal with their psychic pain, the majority began to feel much better — not only emotionally, but physically as well. Keeping a stiff upper lip of repression is a sure recipe for disaster. If we continually “stuff” our emotions, these unexpressed feelings of pain, anger, disappointment, depression, rejection, humiliation, disrespect and abandonment will surely find a place to lodge somewhere in our body.

So what is emotional and mental health? Emotional and mental health occurs when we successfully face our pain head on so that it can finally be put to rest. It is only then that we are truly able to embrace living a joyful life. Good therapy with a knowledgeable, caring therapist can be a valuable contributor to that better life.

Beatty Cohan, MSW, LCSW, AASECT is a nationally recognized psychotherapist, sex therapist, author of For Better for Worse Forever: Discover the Path to Lasting Love, columnist, national speaker, national radio and television expert guest and host of The Ask Beatty Show on the Progressive Radio Network. She has a private practice in New York City and East Hampton.

Beatty would love to hear from you and welcomes your questions and comments. Email her at [email protected] or visit for more information.

Beatty Cohan, MSW, LCSW, AASECT
Beatty Cohan, MSW, LCSW, AASECT

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