They aren't who you think they are.

Who gets cosmetic plastic surgery? Forget the stereotype of the over-50 socialite who needs psychiatry more than a zillionth face lift.

An Internet survey shows that most people seriously seeking plastic surgery — 71 percent — make $60,000 or less. Sixty-four percent are under 50, and 81 percent haven't had plastic surgery before.

The findings come from a study commissioned by the American Society of Plastic Surgeons. Study leaders Sarah Thorne and Tanya Darisi are with Decision Partners LLC, a Pittsburgh-based research and communications firm.

Darisi, Thorne, and colleagues conducted in-depth interviews with 60 people who had contacted the ASPS referral service to find a plastic surgeon. They distilled the information into a questionnaire. A national polling firm used the questionnaire in an Internet-based survey of 644 adults seriously considering plastic surgery in the next year. The findings appear in the Sept. 1 issue of Plastic and Reconstructive Surgery.

"We spoke to people from all racial and ethnic backgrounds, jobs, income levels — there isn't really a typical person getting plastic surgery," Darisi tells WebMD.

"The only thing we found that was typical was how thoughtful people were about undergoing plastic surgery," Thorne tells WebMD. "We talked to moms who just had kids and wanted to have a few things nipped and tucked so they could feel better about themselves. We talked to young guys who had something that had bothered them all their lives and who saved money for an operation since their teens or early 20s. We talked to older women who, now that they had the time and perhaps the ability to have surgery done, wanted something fixed because it had always been important to them."

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Why People Have Plastic Surgery

People who seek plastic surgery obviously want to change their appearance. But that isn't at the heart of what they want.

"It all starts with people wanting to improve imperfections so they can feel better about themselves," Thorne says. "Some spoke about improving physical features that had bothered them for some time. They felt they would be happier, that others would respond to them better, that they would have improved social lives. Men in particular thought they would have improved career opportunities."

Jafar S. Hasan, MD, resident surgeon in the University of Michigan plastic surgery training program, has studied why people seek cosmetic surgery.

"Some older studies suggested that the average plastic-surgery patient is likely to have some psychological disturbance — especially male patients," Hasan tells WebMD. "But this is old research. I found that on average, the plastic surgery patient does not suffer from any psychiatric disorder. Those older views are outdated."

One reason this may be true is that the ASPS and the American Society for Aesthetic Plastic Surgery stress that board-certified plastic surgeons should conduct extensive consultations before agreeing to operate on a patient. Mark Jewell, MD, is president of the American Society for Aesthetic Plastic Surgery.

"When people go to a plastic surgeon, we want them to feel listened to rather than sold something," Jewell tells WebMD. "A consultation can go wrong when you tell someone what they need rather than listen to what they want. What they want may change during the consultation, but most patients are more reasonable than you would believe. We take time, listen, develop rapport. And if a patient doesn't fit our criteria for safe surgery, we say so."

Another reason why patients have realistic expectations: They do their homework.

"Not every problem people perceive with their bodies can be fixed with plastic surgery," Darisi says. "But our interviews with patients showed they did not see surgery as a panacea for everything in their lives. They could foresee changes in relationships, but these were very targeted changes. They did not see plastic surgery as a magic bullet. They had a very realistic idea of what they could expect."

But can plastic surgery really make a person happier? Yes — within limits, says Harvard psychologist Ted A. Grossbart, PhD. Grossbart has studied the psychosocial issues surrounding plastic surgery.

"If someone is unhappy with their nose and comes out with a nose he or she is happier with, it works," Grossbart tells WebMD. "If they are not looking to change the fundamental quality of their lives and all their doubts — if they come in with realistic expectations — people can probably get the results they are hoping for."

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By Daniel J. DeNoon, reviewed by Michael W. Smith, MD

SOURCES: Darisi, T. Plastic and Reconstructive Surgery, Sept. 1, 2005; vol 116: pp 907-916. Tanya Darisi, research leader, Decision Partners LLC, Pittsburgh. Sarah Thorne, partner, Decision Partners LLC, Pittsburgh. Mark Jewell, MD, president, American Society for Aesthetic Plastic Surgery. Jafar S. Hasan, MD, resident surgeon, plastic surgery training program, University of Michigan, Ann Arbor. Ted A. Grossbart, PhD, senior associate and clinical supervisor, department of psychiatry, Beth Israel Hospital; assistant clinical professor of psychology, Harvard Medical School.