TABLE I.

Studies of Psychosocial Outcomes from Cosmetic Surgery Procedures

Author (year)	Study Objective	Procedure	No., Sex, Mean Age	Study Design	Control Group	Scales Used	Follow-Up Period	Outcome	Factors Associated with Poor Outcomes
Jacobson et al. (1960)⁹	Evaluate presurgical and postsurgical status of male cosmetic surgery patients	Mainly rhinoplasty (66%); other procedures included lip and chin	33, M, 30 yr	Preoperative and postoperative self-administered ratings	None	-Sentence completion -Guildford-Zimmerman Temperament Survey -Minnesota Multiphasic Personality Inventory -Morale-Loss Scale -Self-Concept Scale -Draw a Face–Draw a Person Test	2 wk; 2, 6, 12 mo	-All patients expressed subjective satisfaction -Not as preoccupied with appearance -Increased sense of well-being and self-confidence	n.s.
Meyer et al. (1960)³⁶	Determine motivation for cosmetic surgery	Rhinoplasty	30, F, 20 yr	Presurgical and postsurgical psychiatric interview and self-administered psychological tests	None	-Guildford-Zimmerman Temperament Survey -Self-Concept Scale -Draw a Face–Draw a Person Test -Sentence Completion Test -Edwards Personal Preference Schedule	2 wk; 2, 6, 12 mo	n.s.	-No obvious deformity -Expectation of “magical outcome” -Adolescence
Edgerton et al. (1960)¹⁶	Study patients with minimal deformity seeking plastic surgery	Rhinoplasty, face lift, and facial surgery	83, F; 14, M; age n.s.	Preoperative and postoperative interviews	None	n.s.	2 wk; 2, 6, 12 mo	55% had some postoperative psychological disturbance (some patients with psychiatric disorders did well)	-Males -Complaints of skin blemishes, wrinkles, acne scarring -Depression -Unrealistic expectations
Edgerton et al. (1961)³⁸	Evaluate experiences of patients undergoing augmentation mammaplasty	Augmentation mammaplasty	84, F, 17–52 yr	Presurgical and postsurgical interviews and psychological tests	None	-Guildford-Zimmerman Temperament Survey -Morale-Loss Scale -Tennessee Dept of Health Self-Concept Scale -Sentence Completion Test	6 mo to 3 yr	-Patients generally pleased with results -Improvement in self-esteem	-Marital problems -Depression -Seeking surgery at request of husband -Patients urgently seeking surgery -Unrealistic expectations
Edgerton et al. (1964)¹⁹	Survey patients requesting surgery to aging face	Face lift and blepharoplasty	64, F; 8, M; 48 yr	Preoperative and postoperative interviews and self-report tests	7 patients age matched to only those undergoing psychological testing	-Rorschach -Johns Sentence Completion -Thematic Apperception Test (only 8 patients)	2 mo to 10 yr	86% reported improved sense of well-being	Age under 40
Knorr (1972)¹⁷	Investigate syndrome of “loss of identity” encountered in rhinoplasty patients postoperatively	Rhinoplasty	9, F, 26–64 yr	Case study interviews	None	n.s.	n.s.	-Results of initial surgery poor and requested further surgery -Patients said surgeon had difficulty understanding their complaint	Longstanding dissatisfaction with physical appearance
Hay & Heather (1973)⁴⁵	Determine whether degree of deformity is of major importance in the decision to undergo rhinoplasty	Rhinoplasty	12, F; 5, M; 23.4 yr	Presurgical and postsurgical interviews and psychological testing	None	-Hysteroid-Obsessoid Questionnaire -Personal Illness Scale of the Symptom Sign Inventory	6 mo to 2 yr	-16 of 17 felt surgery helped them feel better about themselves	No evidence that improvement in psychological functioning relates to initial degree of disfigurement
Wright & Wright (1975)¹⁸	Study personality characteristics of those seeking cosmetic surgery, and degree of change in personality traits	Rhinoplasty	90, M and F, 30 yr	Presurgical and postsurgical interview and psychological testing (only 25 patients followed up)	25 noncosmetic surgical patients	-Minnesota Multiphasic Personality Inventory	18–24 mo	-No major personality change -Improved self-concept -Socially more-self assured	-Psychosis -Neurosis -Decisional discrepancies with partner -Personality disorder (narcissism)
Goin et al. (1977)⁴⁰	Determine psychological reactions to reduction mammaplasty	Reduction mammaplasty	8, F, 35 yr	Preoperative and postoperative interview	None	n.s.	Up to 13 mo	-Transient emotional disturbance in 5 patients -Longer-term outcome good, with improved self-esteem and reduced physical symptoms	Preoperative psychological disturbance in body image
Shipley et al. (1978)²⁸	Examine effect of breast augmentation on psychosocial functioning	Augmentation mammaplasty	19, F, 30.5 yr	Presurgical interview and postsurgical mail survey	20 small-busted women and 19 average-busted women	-California Psychological Inventory -Ziller Social Self-Esteem Test -Dress, Popularity and Activity Questionnaire	3 mo	-Improved body image -No effects on personality or self-concept	n.s.
Sihm et al. (1978)²⁹	Psychological and psychiatric evaluation of augmentation mammaplasty patients	Augmentation mammaplasty	20, F, 21–45 yr	Presurgical and postsurgical psychological and psychiatric examination	None	Unspecified measures of body image, identity, intellectual level, and personality integration	12 mo	-More self confident -No change in personality structure	n.s.
Goin et al. (1980)²⁰	Psychological study of face lift patients	Face lift	50, F, 56 yr	Longitudinal prospective	—	Minnesota Multiphasic Personality Inventory	Postoperative days 5, 14, 21, 60, 180	-54% displayed short-term psychological disturbance -30% transient depression -28% improved self-esteem	-Idealized the surgeon -Severe psychological disturbance following other operations -Paranoia
Marcus (1984)²¹	Examine psychiatric status of rhinoplasty patients	Rhinoplasty	15, F; 5, M; 23 yr	Presurgical and postsurgical interviews	25 dental patients (18 males)	-Secord-Jourard Body Cathexis Scale -Anxiety and Depression Scales -Self-Esteem Scale	3 mo	-90% pleased with surgical outcome -Increased ability to enjoy life -Increased social confidence	n.s.
Moses et al. (1984)⁴¹	Assess satisfaction with rhinoplasty	Rhinoplasty	34, F, age n.s.	Presurgical and postsurgical interviews	—	-Subjective nose image measure -Objective nose image measure -Subjective improvement score	1 wk; 1 and 3 mo after cast removal	High satisfaction with surgical outcome	n.s.
Burk et al. (1985)^*	Investigate patient attitudes to body parts versus overall appearance	Various cosmetic procedures	40, F, 21+ yr	Longitudinal	—	-Semantic Differential Test -Tennessee Self-Concept Scale -Personal Self Scale -Physical Self-Scale -Self-Criticism Scale	2, 4 mo	Increased physical self-esteem and satisfaction with operated body part	n.s.
Hueston et al. (1985)²²	Assess psychological profile of cosmetic surgery patients and effects of surgery on psychosocial functioning	Various procedures: augmentation and reduction mammaplasty, face lift, blepharoplasty, abdominoplasty	169, M and F, 35 yr	Presurgical and postsurgical testing	53 hand surgery patients	-Middlesex Hospital Questionnaire -Life Events Questionnaire -Social Adjustment Scale -Locus of Control Scale -Rosenberg Self-Esteem Scale	3 mo	Psychosocial functioning of both the aesthetic and hand surgery groups improved	n.s.
Beale et al. (1985)³⁹	Assess predictors of successful outcome from augmentation mammaplasty	Augmentation mammaplasty	61, F, age n.s.	Subsample (n = 39) followed longitudinally	28 females from general population	Cesarec-Mark Personality Schedule	12 mo	78% completely satisfied with outcome	-Psychiatric problems -Unrealistic expectations -Patients using surgery to improve relationship
Hollyman et al. (1986)⁴²	Examine body perception prereduction and postreduction mammaplasty	Reduction mammaplasty	11, F, 22.4 yr	Presurgical and postsurgical interviews and psychological testing	19 females not seeking breast surgery	-Crown-Crisp Experimental Index -Body perception apparatus -Visual analogue scales	2, 8, 16, 26 wk	-Postsurgery relief of psychological distress -Improved body image	n.s.
Kilman et al. (1987)²⁷	Evaluate impact of augmentation mammaplasty on personality and relationship functioning	Augmentation mammaplasty	75, F, 35 yr	Retrospective questionnaire study	None	Author’s questionnaire	3 mo to 3 yr	-Positive effects on perceived attractiveness, body and self-image -Greater sexual interest of partner	n.s.
Meyer & Ringberg (1987)²³	Evaluate personality, psychosocial and psychiatric characteristics	Augmentation mammaplasty	38, F, 38.4 yr	Presurgical and postsurgical interviews	33 female surgical outpatients	-Cesarec-Marke Personality Scheme -Marke-Nyman Test	1 yr	86% satisfied, and social and psychological expectations fulfilled	Unspecified personality characteristics
Robin et al. (1988)³⁷	Assess psychological status of rhinoplasty patients	Rhinoplasty	31, M and F, 25.8 yr	Presurgical and postsurgical psychological testing	31 matched controls (see text)	-Facial Appearance Sorting Test -General Health Questionnaire -Rochford Masculinity/Femininity Scale	6 mo	Marked reduction of psychiatric symptom scores (controls showed no change)	n.s.
Goin & Rees (1991)¹⁴	Assess psychological reactions to rhinoplasty	Rhinoplasty	103, F (18 yr); 18, M (20 yr)	Presurgical and postsurgical questionnaire	None	Brief Symptom Inventory	1, 6 mo	-98% said cosmetic outcome was what they had desired -53% said operation changed their lives -21% said others behaved differently to them	Pre-existing anxiety disorder
Edgerton et al. (1991)⁴³	Summary of author’s experience in treating 100 “significantly psychologically disturbed” patients	Various procedures	100, of whom 87 (59 F) received surgery	Retrospective case studies	None	n.s.	Mean 6.2 yr	83% considered to have a positive psychological outcome	n.s.
Slator & Harris (1992)³⁴	Validate earlier reports of psychiatric morbidity in rhinoplasty patients	Rhinoplasty	41, M and F, 31.2 yr	Retrospective mailed questionnaire	None	-Rust Inventory of Schizotypal Cognitions -Crown-Crisp Experimental Index -Personal Distress Scale	Mean 9.5 yr	No evidence that patients requesting cosmetic rhinoplasty at high risk of severe psychiatric disorder	Males
Napoleon (1993)³³	Identify personality types associated with poor outcome from cosmetic surgery	Various cosmetic and reconstructive procedures	133, M and F, 45.6 yr	Preoperative assessment of personality, longitudinal follow-up	None	-Author’s own; personality diagnoses according to DSM-III	1.5 yr	62% satisfied with outcome	-Unrealistic expectation of surgery outcome -Borderline and narcissistic personality disorder
Young et al. (1994)^†	Evaluate impact of surgery on psychological parameters and interpersonal functioning	Augmentation mammaplasty	112, F, 33 yr	Retrospective telephone interviews	None	Authors’ questionnaire	5 yr	-Decreased self-consciousness (86%) -Improved self-confidence (88%) -Felt better about themselves (95%) -Surgery met their expectations (95%)	n.s.
Klassen et al. (1996)²⁴	Assess health status before and after breast reduction surgery	Reduction mammaplasty	166, F, 30.5 yr	Presurgical and postsurgical questionnaire and psychological testing	General population sample	-Short Form 36 -Rosenberg Self-Esteem Scale -General Health Questionnaire 28	6 mo	86% expressed great satisfaction with postoperative result	n.s.
Klassen et al. (1996)⁴⁶	Assessment of health status after variety of cosmetic interventions	Various cosmetic procedures	198, M and F, 32.6 yr	Presurgical and postsurgical questionnaire and psychological testing, longitudinal	General population sample	-Short Form 36 -General Health Questionnaire 28 -Rosenberg Self-Esteem Scale	6 mo	-Most pleased with outcome -Gains in psychological, social, and physical function	n.s.
Guyuron & Bokhari (1996)³⁵	Evaluate patient satisfaction following cosmetic surgery	Rhinoplasty	381, F; 87, M; 38.1 yr	Retrospective	None	Authors’ questionnaire	n.s.	Most very satisfied with outcome	Younger males
Shakespeare & Cole (1997)²⁵	Assess outcomes of plastic surgery procedures	Reduction mammaplasty	110, F, 35 yr	Presurgical and postsurgical postal questionnaire	None	-Short Form 36 -Rosenberg Self-Esteem Scale	3, 6 mo	Substantial benefit to psychological and physical health and well being	n.s.
Schnur et al. (1997)²⁶	Examine psychological outcomes after reduction mammaplasty	Reduction mammaplasty	363, F, 40.6 yr	Retrospective review of medical charts and postsurgical postal questionnaire	None	Author’s questionnaire	Mean 5.7 yr	97% believed outcome very successful and improved their lives	n.s.
Rankin et al. (1998)^‡	Examine quality of life after cosmetic surgery	Various procedures, including liposuction, rhinoplasty, facial surgery, abdoplasty, and breast augmentation	91, F; 14, M; 31–50 yr	Presurgical and postsurgical self-report questionnaire	None	-Health Measurement Questionnaire -Personal Resources Questionnaire -Centre for Epidemiologic Studies Depression Scale -Ways of Coping Scale	1, 6 mo	Improved quality of life	n.s.
Ercolani et al. (1999)³⁰	Assess short-and long-term psychological changes in rhinoplasty patients	Rhinoplasty	25, M; 54, F; 22 yr	Presurgical and postsurgical questionnaire	None	-Maudsley Personality Inventory -Inventory for Personality and Anxiety Testing	6 mo, 5 yr	-Decrease in anxiety and neuroticism and increase in extraversion -No significant change in body dysmorphic disorder patients	“Dysmorphophobia”
Ercolani et al. (1999)³¹	Psychological effects of rhinoplasty	Rhinoplasty	36, M; 37, F; 21.6 yr	Presurgical and postsurgical questionnaire	None	-Maudsley Personality Inventory -Inventory for Personality and Anxiety Testing	8 mo	Majority of patients benefited psychologically from the operation	n.s.
Glatt et al. (1999)⁴⁹	Assess physical and psychological outcome following reduction mammaplasty	Reduction mammaplasty	61, F, 37.8 yr	Postal questionnaire	None	-Body Dysmorphic Disorder Examination Self-Report -Breast Chest Ratings Scale		Decrease in physical symptoms and high degree of patient satisfaction	n.s.
Sarwer et al. (2002)³	Investigate body image change following cosmetic surgery	Various cosmetic procedures	57, F; 45 followed up; 40.6 yr	Preoperative and postoperative assessments	None	-Body Dysmorphic Disorder Examination Self-Report -Multidimensional Body–Self-Relations Questionnaire	6 mo	87% “extreme satisfaction” with feature operated on, but no change in overall body image satisfaction	Body dysmorphic disorder
Cash et al. (2002)⁴	To examine the psychosocial outcomes of women receiving bilateral breast augmentation	Breast augmentation	360, F, 32 yr	Prospective	None	Questionnaire at initial consultation to assess reason for and expectations of surgery and concerns regarding perceived risks	6, 12, 24 mo	More than 90% were consistently satisfied with surgery and attained expectations of enhanced body image	Events within the first 6 months after surgery which compromise the aesthetically desired outcome

M, male; F, female; n.s., not stated.

Burk, J., Zelen, S. L., and Terino, E. O More than skin deep: A self-consistency approach to the psychology of cosmetic surgery. Plast. Reconstr. Surg. 76: 270, 1985.

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Young, V. L., Nemecek, J. R., and Nemecek, D. A. The efficacy of breast augmentation: Breast size increase, patient satisfaction and psychological effects. Plast. Reconstr. Surg. 94: 958, 1994.

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Rankin, M., Borah, G. L., Perry, A. W., and Wey, P. D. Quality of life outcomes after cosmetic surgery. Plast. Reconstr. Surg. 102: 2139, 1998.