Psychosocial Outcomes of Cosmetic Surgery

I had a difficult time getting information on the psychosocial outcomes of cosmetic surgery when I googled the topic. I guess I need to review Psychiatry sources in the U.S. I did find some information from the Australian Psychological Society. Cosmetic surgery can enhance your life as well as your looks, according to industry advertisements and televison shows, such as Extreme Makeover and Nip/Tuck. The idea is that a face "lift" will also boost one's spirits and self-confidence. The problem is that evidence supporting this assumption is tentative. Research shows that, following cosmetic surgery, patients variously report their mental health has either improved, not changed or diminished. Psychiatrist David Castle, a leading Australian researcher on the psychological outcomes of cosmetic surgery, is concerned by the "gloss" applied to cosmetic surgery that suggests that you will have a new life. He believes that it doesn't change the person you are on the inside. David, who is a professor at the University of Melbourne and the Mental Health Research Institute of Victoria, says that some research shows that cosmetic surgery can enhance self-esteem, which can feed into social confidence, but the eveidence for long-term effects on psychological wellbeing is scant and requires further investigation.

David and colleagues recently reviewed the literature on psychological outcomes for patients seeking cosmetic surgery (Honigman, Phillips and Castle, 2004). The authors analyzed 37 studies that evaluated psychological and psychosocial functioning before and after a range of elective cosmetic surgery procedures. Breast surgery (reduction and augmentation) was the procedure that was most consistently associated with good psychological outcomes. Nose and facial procedures produced mixed outcomes. Several studies that examined personality in cosmetic surgery patients also found mixed results, suggesting the way personality affects the surgical experience is unclear.

Overall, the review showed that most patients were satisfied with their results, but some demonstrated poor psychological outcomes. One of the strongest predictors of a poor outcome was having an extreme and unrealistic expectation of the surgery results, such as being able to find a new job or relationship. Younger women seemed to do worse than older people. Younger people are more likely to be seeking procedures for abnormalities which you and I would not see, or would think trivial concludes David. He reported that other predictors of poor outcomes include a history of numerous past procedures, depression and anxiety, and narcissistic or borderline personality traits although David cautions that very few studies examined personality systematically.

The evidence that some cosmetic surgery patients are dissatisfied with the results of surgery, despite it being an objective success, intrigued psychologist Julie Malone, who recently completed her doctoral thesis on the topic at the University of New England in north-east New South Wales. Her study followed the outcomes of 91 females aged 18 to 64 years (average age 42 years) who had elective facial cosmetic procedures, including nose procedures, face lifts, eye surgery and other minor procedures such as chins and teeth (Malone, 2003). Sydney-based plastic surgeons handed out anonymous questionnaires to patients to complete pre and post (three months after) surgery.

Julie's aim was to investigate the kind of person would be a poor candidate for cosmetic surgery. The factors she considered were age, type of procedure, number of previous remedies attempted, history of previous cosmetic surgery, mental health, and level of dysmorphic concern, which is the degree to which one is preoccupied with an imagined or perceived flaw.

Age was the only good predictor of satisfaction; older women reported higher levels of satisfaction with outcomes. Further investigations of this finding revealed that young women having nose procedures were the most dissatisfied group, Julei says. " I researched noses further and concluded that young people are seeking a quick fix for their image dissatisfactions", she says. "What I implied in my study was that they are shopping around for a new nose instead of accepting themselves for who they are and seeking other forms of therapy." Drawing on the literature, Julie says the implications are that young people are jumping into cosmetic procedures without thinking and are more susceptible to media presentations of beauty. Further, there is evidence that younger patients are looking for more external rewards, like romance or a better job, while older people are looking for internal rewards, like self-worth. As Hongiman et als (2004) review showed, seeking unrealistic rewards predicts a poor outcome.

Julie goes on to talk about how satisfied patients report lower levels of dysmorphic concern compared to dissatisfied patients. I will talk about the different findings on how patients with higher levels of dysmorphic concern are less likely to benefit from cosmetic surgery, psychological screening for cosmetic surgery and treatment of Body Dysmorphic Syndrome in my next blog.