TABLE I.
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.
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.
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.