117. Do Something

36 year old Ashley recently ran a marathon.  She is 5-5 and weighs 130.  Her first words to me are, "people say I look pregnant. I need you to do something about it" 


Internal scarring from her two cesarean deliveries cause a retraction of subcutaneous tissue at the site of the incision, with a subsequent small bulge above the incision.  I acknowledge that scar tissue has resulted in unwanted anatomic changes.


But I don't tell her that she looks pregnant.  And I can't how imagine friends or co-workers could come to that conclusion.  Are they feeding into a serious self-image problem?  Or is she making it all up to stir me to action, thinking, I guess, that I can perform or approve some type of corrective surgery?


My options:
1.  Reassure her: "No, you look fine; your friends are just jealous."
2.  Pass the buck: "We don't have cosmetic surgery here, you need a cosmetic surgeon."
3.  Tell it like it is: "You have a body-image distortion."
4.  Or, a Rogerian:  "I see what you mean; sounds like you are really frustrated to have worked so hard but still short of your goal."