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Try out PMC Labs and tell us what you think. Learn More. The authors reviewed the literature on psychological and psychosocial outcomes for individuals undergoing cosmetic surgery, to address whether elective cosmetic procedures improve psychological well-being and psychosocial functioning and whether there are identifiable predictors of an unsatisfactory psychological outcome. They identified 37 Insatiable and unsatisfied studies of varying cosmetic procedures that utilized disparate methodologies.
Overall, patients appeared generally satisfied with the outcome of their procedures, although some exhibited transient and some exhibited longer-lasting psychological disturbance. Factors associated with poor psychosocial outcome included being young, being male, having unrealistic expectations of the procedure, unsatisfactory cosmetic surgery, minimal deformity, motivation based on relationship issues, and a history of depression, anxiety, or personality disorder.
Body dysmorphic disorder was also recognized by some studies as a predictor of poor outcome, a finding reinforced by reference to the psychiatric literature. The authors conclude that although most people appear satisfied with the outcome of cosmetic surgical procedures, some are not, and attempts should be made to screen for such individuals in cosmetic surgery settings. Plastic and cosmetic surgeons regularly report high satisfaction rates among their patients, and they have provided clinical and empirical evidence supporting positive outcomes in terms of patient satisfaction with cosmetic Insatiable and unsatisfied procedures.
Patients can be satisfied with their appearance change following the operation but may experience no change in psychological characteristics. Scant literature on the topic of whether successful cosmetic intervention actually in measurable and meaningful improvement in psychosocial functioning and psychological well-being in the long term 2910 suggests this issue should be studied further. Most people seeking cosmetic surgery procedures appear psychologically healthy; however, some are not, and for these individuals cosmetic procedures may have a negative outcome, creating problems for both patient and surgeon.
This article reviews the literature on psychological and psychosocial outcomes for individuals undergoing cosmetic surgery procedures.
There have been reviews of this area, 1715 but these have not had a specific focus on studies that incorporated preoperative and postoperative assessments. The current review includes only those studies with preoperative and postoperative measures of psychological and psychosocial functioning with a view to addressing the following: a whether elective cosmetic procedures improve psychological well-being and psychosocial functioning; and b whether there are identifiable predictors of an unsatisfactory psychological outcome.
We then focus on those individuals who are dissatisfied with objectively successful cosmetic procedures. Finally, we present some screening questions that might aid cosmetic surgeons in identifying individuals who appear at high risk for a poor psychological outcome after elective cosmetic procedures.
We have ly presented a selective synopsis of this work. Further articles were sourced from the reference lists of articles ascertained through the search. We included studies that Insatiable and unsatisfied subjective ratings of satisfaction with the cosmetic procedures as well as variables such as distress, body image, self-esteem, mood, social confidence, social interaction, and quality of life. Our search strategy yielded 37 studies meeting the criteria indicated above; they are presented in chronological order in Table Iwhich is available on-line at www.
We included data on study type, types of procedure, main psychological and psychosocial measures used, and where available parameters associated with a poor outcome. As can be seen, these studies were undertaken in a variety of surgical populations using various methodologies and measures. The sample sizes varied from eight toand a preponderance of subjects were female. Most studies were of specific procedures e. The earliest reported studies meeting criteria for inclusion in this review are from rhinoplasty, face lift.
The earliest relevant augmentation mammaplasty study was published inand that for reduction mammaplasty was published in Most of the studies from the last decade have been of rhinoplasty patients or women undergoing mammaplasties. The outcomes for specific procedures varied to some degree. Overall, mammaplasties were fairly uniformly associated with a good outcome, with a somewhat more mixed picture for facial procedures. Thus, psychological and psychosocial outcomes appear to be most consistently positive for mammaplasties. Rhinoplasty procedures showed a somewhat more mixed picture, perhaps reflecting the individual study de.
While most of the rhinoplasty studies reported high rates of satisfaction and enhanced social confidence, the study of Edgerton et al. Personality attributes were also identified as having an impact on outcomes in this study, with 50 percent of patients being diagnosed with a personality disorder. In a study of personality characteristics of rhinoplasty patients, Wright and Wright 18 identified psychosis, neurosis, and narcissism as factors adversely affecting the outcomes for some patients.
For face lift, the early study of Edgerton et al. Several studies reported enhancement of social functioning, relationships, and general quality of life 41821 — 26 after cosmetic surgery procedures. A of studies investigated the personality profiles of patients undergoing cosmetic procedures and found no change in personality as a result of the procedure.
Of the studies reviewed here, 14 specifically addressed factors that tended to be associated with poor psychological or psychosocial outcome. In some studies, these were simply clinical impressions, and in no study was there a rigorous statistical evaluation of predictors of poor outcome or of the amount of variance potential predictors could explain. However, there was some degree of congruence in the factors that appeared to be associated with poor outcome, including the following:.
Demographic factors: being male three studies 163435younger age Insatiable and unsatisfied ages not recorded; three studies 193536. Relationship issues: being motivated by the belief that the cosmetic surgery procedure would save a relationship, or a disagreement between partners on the necessity for the procedure three studies 183839. Unrealistic expectations regarding the outcome of the procedure three studies 333839. surgical procedure with which the patient was dissatisfied three studies 172040 ; and. Minimal deformity one study It should be noted that these conclusions are based on the of individual studies and that no attempt has been made to pool.
The heterogeneity of the different studies included in this review precluded any attempt at meta-analysis. Although most studies reviewed here suggest that the majority of people undergoing cosmetic surgery procedures have a positive outcome in psychosocial terms, methodological limitations of the studies preclude drawing firm conclusions and limit the confidence that can be placed in the findings. Some of the studies have important methodological strengths, such as large s of subjects 414222633 and clear delineation of cosmetic procedures.
However, all of the studies suffer from at least some methodological shortcomings, including inter alia small sample size, 174142 ascertainment bias e. In earlier studies especially, patients were often interviewed by psychoanalytically trained psychiatrists whose theoretical biases may have contributed to the high levels of psychopathology. are sometimes confusing and contradictory; for example, some studies using clinical interviews reported favorable psychological outcomes, 192137 while others observed negative consequences 3643 and others Insatiable and unsatisfied no change or mixed.
Goin and Rees 14 showed favorable psychological change, while two other studies observed no change. Only 11 studies included controls, with the choice of controls varying among studies e. An example of a study that used a more suitable control group is that of Hollyman et al. Shipley and colleagues, 28 in their retrospective study of women undergoing breast augmentation, Insatiable and unsatisfied two comparison groups, one of women with small breasts and one of women with average-sized breasts, who were not seeking surgical augmentation. Some studies merely resorted to general population responses on the measures used.
We are aware of no studies that used a randomized controlled de to explore change in psychological functioning and psychological status after cosmetic surgery procedures, leaving open the question of whether the recorded outcomes of change and improvement were due to the procedure itself, to nonspecific elements of the intervention, or to other factors that were not controlled for by the study de e.
There is also the problem of how representative study samples are and therefore whether study can be generalized to the larger population of individuals who seek and receive cosmetic enhancement. For example, some studies assessed exclusively women undergoing breast reduction, 24 — 264042 and it is Insatiable and unsatisfied necessarily the case indeed it is arguably highly unlikely that from this group would pertain to men or to women undergoing other procedures.
Furthermore, studies tend to report aggregated rather than individual outcomes. While this is a methodological advance over small series or case reports, it does not make clear whether outcomes for certain individuals differ from those of the group as a whole. There is also the inevitable problem of investigators choosing to study and report only selected outcomes. Finally, the extent of bias in sample selection was not adequately reported in any of the reviewed studies.
For example, it is probable that many individuals who are dissatisfied with the surgical outcome will decline to participate in a follow-up assessment, thus biasing the toward good outcomes and improvement in psychological status. Despite these methodological concerns, the studies reviewed here suggest that most people are satisfied with cosmetic surgery and experience a positive psychological and psychosocial outcome. However, it is clear that some individuals are not satisfied, even when the outcome is objectively acceptable.
Of the studies reviewed, Edgerton et al. A of studies used the Body Dysmorphic Disorder Examination—Self-Report but did not determine the outcome of body dysmorphic disorder in cosmetic surgery patients as such. Glatt et al. Sarwer et al.
A of studies have investigated rates of body dysmorphic disorder in patients attending cosmetic surgeons, with rates between 7 percent and 15 percent being reported. Studies from the psychiatric literature suggest the body dysmorphic disorder patients usually have a poor psychosocial outcome following cosmetic procedures and that occasional patients with the disorder are even violent toward the treating surgeon.
In a series of 25 body dysmorphic disorder patients who had undergone cosmetic procedures, Veale 54 reported 76 percent to be dissatisfied with the outcome. Twenty-three percent had received cosmetic surgery for the perceived deformity; the most common outcome from surgery Insatiable and unsatisfied particular was no change in concern with the treated body part 48 percent or in overall disorder symptoms 58 percent.
Seventeen percent reported improvement in the disorder following the surgical procedure, and 24 percent reported worsening of the disorder. Fifty-four percent of all surgeries that patients requested were not received, primarily because the surgeon refused to provide it. A later U. Treatment was sought by Dermatologic treatment was most often received by These treatments rarely improved the symptoms of the disorder, indicating that a majority of patients with the disorder who receive nonpsychiatric treatment tend to respond poorly.
A recent survey of U. Presumably these poor outcomes reflect no change or even a worsening in psychological well-being in these patients, although no study to our knowledge has assessed change in characteristics such as self-esteem in patients with body dysmorphic disorder who undergo cosmetic surgery procedures. Another notable limitation of existing Insatiable and unsatisfied on this disorder is that most studies have been retrospective and have assessed patients seeking psychiatric treatment for the disorder. This may bias the findings toward a poor surgical outcome, given that patients who do not respond well to cosmetic interventions are probably more likely than those with a good response to be referred for subsequent psychiatric care.
Further prospective studies are needed that assess body dysmorphic disorder patients in a surgical setting both before and after their operation as opposed to a psychiatric setting only after the operation to evaluate their response to surgical intervention. The foregoing review reveals that there are only limited rigorous scientific data that help clinicians predict who will fare poorly in psychological and psychosocial terms following a cosmetic procedure.
However, the studies do provide some guidance for cosmetic specialists, as detailed in reviews of this area 856 and as reinforced by the current review. First, there are issues related to the cosmetic complaint itself. Patients should be given the opportunity to articulate their specific appearance concerns in detail.
Past cosmetic interventions should be explored in some detail, as the literature suggests that surgery with which the patient was dissatisfied is a risk factor for yet another poor outcome.Insatiable and unsatisfied
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A Review of Psychosocial Outcomes for Patients Seeking Cosmetic Surgery