However, such parameters have not been studied in a rigorous manner.
Factors identified with unsatisfactory outcomes included being male, being young, suffering from depression or anxiety, and having a personality disorder. Few of the studies we reviewed formally dealt with this issue.
What has been even less rigorously examined is the question of what factors are associated with an unsatisfactory psychosocial outcome after cosmetic procedures. Finally, most studies evaluated very specific procedures, and it is unclear how generalisable their results are to other types of cosmetic intervention. Of particular concern is that not all studies used valid assessment instruments, which hampered the interpretation of results. Furthermore, clinical interviews are potentially subject to bias on the part of both the respondent and the interviewer, and very few studies employed “blind” raters. Arguably, patients who agree to participate in such research, and oblige with pre-and post-intervention interviews, represent a biased group, but none of the studies estimated the extent of such potential bias. However, many of these studies have methodological limitations, including small sample sizes and potentially biased ascertainment. Domains of functioning showing improvement included “self worth”, “self esteem”, “distress and shyness” and “quality of life”. This was particularly the case for women undergoing reduction mammoplasty. Overall, the studies suggest that most patients were pleased with the outcome and felt better about themselves. Other studies have used normative data from general population samples, which may not be appropriate as reference data. Only 11 studies formally included a control group 5 – 15 - these are shown in the Box. Follow-up intervals for testing of psychosocial outcomes ranged from immediately postoperative to 10 years after the procedure (in one study). Most were investigations of patients undergoing a specific procedure, including rhinoplasty (12 studies), breast augmentation (7 studies), breast reduction (5 studies) and face-lift (3 studies), while other studies encompassed a variety of interventions. Using the search terms “cosmetic surgery”, “plastic surgery”, “patient assessment”, “body awareness”, “body image” and “body dysmorphic disorder”, we identified 36 studies of varying design and quality. We reviewed the literature on psychosocial outcomes following cosmetic surgery, using MEDLINE, PsychLit, PubMed, PsychINFO, Sociological Abstracts, Social Work Abstracts, Proquest 5000, Web of Science and CINAHL. Clinicians and researchers have attempted over the years to evaluate whether improvement in psychosocial wellbeing following cosmetic enhancement can be objectively verified, but few methodologically robust studies have been done. While studies spanning four decades have reported that most people undergoing cosmetic interventions are satisfied with the result, 3, 4 what has been less studied is the outcome in psychosocial terms. Furthermore, such procedures are performed by a variety of different practitioners, including cosmetic physicians, dermatologists, and plastic surgeons.Īs people generally seek cosmetic interventions to feel better about themselves, one would anticipate that cosmetically successful procedures would lead to enhanced self-esteem, mood, and social confidence. 2 Systematic Australian data are not readily available, as there is no central registry or reporting requirements. Rhinoplasties were performed on 102 943 people (2.2% of the total number of procedures), and there were 100 203 facelifts (2.2%), 191 583 breast augmentation procedures (4.2%) and 89 769 breast reductions (1.9%). 2 In 1999, more than 4.6 million such procedures were performed, with the top five being chemical peels (18.3% of the total), botulinum toxin A injection (10.8%), laser hair removal (10.5%), collagen injection (10.3%), and sclerotherapy (9.0%).
Figures provided by the American Society for Aesthetic Plastic Surgery reveal that cosmetic procedures (surgical and non-surgical) performed by plastic surgeons, dermatologists and otolaryngologists increased 119% between 19. 1 Paralleling this trend, an increasing number of both men and women are resorting to cosmetic procedures. In a 1997 US survey, 56% of women and 43% of men reported dissatisfaction with their overall appearance. More and more people report being unhappy with their appearance.
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