While Joan Rivers was only joking when she recently told The Daily Telegraph that she’s had 739 surgical procedures, that doesn’t mean that plastic surgery addiction, which can be a byproduct of Body Dysmorphic Disorder (BDD), isn't real. New York board certified plastic surgeon Dr. Sydney Coleman has been quoted saying that “BDD affects both men and women and “manifests as a preoccupation with an imagined physical defect or an exaggerated concern about a minimal defect…[which] can lead the patient to a plastic surgeon or dermatologist in an attempt to try to change the perceived defect.” And one study suggests that as many as one third of those who have nose jobs have symptoms of BDD.

Heidi Montag, who two years ago had 10 plastic surgery procedures in one day, told Good Morning America that she couldn’t be addicted to plastic surgery because, "If you're addicted to something, you have to do it all the time, not once every couple years, if even.” Experts agree that while the behavior isn’t an addiction in the classic sense, it bears remarkable similarities to other addictions. "The pleasure you get from having people think you're beautiful isn't quite the same as an intoxication from a substance, but it's similar enough that I'm willing to consider this a potentially addictive behavior," says Tom Hovarth, a psychologist who operates an addiction treatment center in La Jolla.

"Two of the defining features of an addiction are tolerance and withdraw," says Dr. Paul Hokemeyer, a marriage and family therapist who specializes in addiction and is a consultant to the Caron Treatment Centers. "As it applies to behavioral addictions, tolerance means the person needs to engage in more and more of the behavior to get the same baseline level of satisfaction. Withdraw means that they experience emotional angst when they even consider the thought of not being able to access their surgeons or dermatologists. The line starts to appear on their forehead and they become filled with anxiety and can't get to the dermatologist fast enough to 'fix' the situation." Ultimately, Hokemeyer says, people in this situation are fighting a losing battle. "There's not enough Botox in the world," he says, "to fix the cracks in people's hearts and souls."