Article

Depression, anxiety and quality of life: Outcome 9 months after facial cosmetic surgery

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Abstract

The request for cosmetic surgery is of a psychological nature. Very few studies have quantitatively assessed whether or not this psychological need was actually satisfied, and more precisely, which psychic components were satisfied. This is a multicentric, prospective cohort study. One hundred and three patients scheduled for facial cosmetic surgery from three different hospitals were examined before and after surgery using four assessment scales validated using European populations. The Montgomery and Asberg depression rating scale (MADRS) measured the existence and intensity of depression, the self-assessment test of thoughts in social interaction (SISST) measured the positive or inhibitory thoughts in the context of social relationships, and the European quality of life 5 dimensions (EQ-5D) (generic test) measured the quality of life. In addition, a semi-directive interview was specially created by our team. For statistical analysis, ANOVA and Student's t test were applied. Twenty-four patients were lost to follow-up. Although the initial MADRS index was high (p<0.05), it did not change after surgery (p>0.1). SISST+ (positive thoughts): the social anxiety of the individual examined was significantly greater than that of the control group (p<0.005) and improved after surgery (p<0.01). The SISST- (inhibitory thoughts) did not change (p>0.1). The EQ-5D visual analogue scale (VAS) did not reveal any difference (p>0.1) while the descriptive EQ-5D demonstrated over-representation of anxiety/depression (p<0.01), and an improvement of this (p<0.05) postoperatively. The mean subjective satisfaction index was 8.1 (scale of 1-10) without sharing any influence of the complications suffered (65% of the patients made self-assessments). The best indications for facial cosmetic surgery seem to be a lack of self-confidence associated with a desire for social interaction, and a request focused on a specific physical feature. The results presented add documentary confirmation to the impression shared by the majority of cosmetic surgeons. However, it was also confirmed that cosmetic surgery is not limited to its technical components, but remains a medical act which must consider the overall effect on the whole patient.

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... As BDD patients have underlying psychiatric or psychological problems, they tend to exaggerate slight physical deformities, and are delusional about their physical features (1). Therefore, today, plastic and maxillofacial surgeons tend to evaluate the psychological status of individuals before cosmetic rhinoplasty, however technical results seem to be more important according to their views (1,3). In Iran, rhinoplasty has seemingly become the most favorite cos-metic surgery in the recent years (3,4). ...
... Therefore, today, plastic and maxillofacial surgeons tend to evaluate the psychological status of individuals before cosmetic rhinoplasty, however technical results seem to be more important according to their views (1,3). In Iran, rhinoplasty has seemingly become the most favorite cos-metic surgery in the recent years (3,4). Yet, it seems necessary to understand the psychosocial motivations of patients; self-confidence, body image and social pressure, before the surgery is done. ...
... This study clarified that patients seeking for cosmetic rhinoplasty, suffer from low self-confidence, decreased body image, and are in social pressure to undergo the surgery. Some other studies (1,3,4) have manifested these results. Austin J (2015), in the study of "body dysmorphic disorder: prevalence and outcomes in an oculofacial Plastic Surgery Practice", claimed that the prevalence of body dysmorphic disorder in an oculofacial surgical setting matches reports from other surgical specialties, and is significantly higher than the general population. ...
Article
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Background: In Iran, rhinoplasty has seemingly become the most favorite cosmetic surgery in the recent years, yet, there are limited reports about its psychosocial aspects Objectives: The main goal of this study was to assess self-confidence, body image and social pressure in cosmetic rhinoplasty surgery candidates. Patients and Methods: Using convenience sampling, 210 participants over the age of 20 years were enrolled in this study. The only inclusion criterion was agreement to participate in the study. A standard Likert-type questionnaire was used for gathering related data. This study was ap:proved by the Qazvin University of Medical Sciences. All gathered data were analyzed using the SPSS software with 95% Confidence Interval (CI). Results: Mean and standard deviation of self confidence, body image and social pressure were lower than the normal community. Statistical analyses showed a significant difference between genders only for mean self-confidence (p≤0.05). Conclusions: Cosmetic rhinoplasty candidates are in lower psychosocial status than the normal population. Researchers proposed a randomized clinical trial with at least a 12-month follow-up, to assess the effects of surgery on psychosocial dimensions of clients. Keywords: Self-Confidence, Body Image, Social Pressure, Rhinoplasty
... These findings are in accordance with those obtained in the majority of other investigations that have dealt with this issue. 21,22 Specifically, the aesthetic surgery population was found to be more anxious, depressed, and less self-confident than the general population, which partially could explain their reason for aesthetic intervention and the possibility of a rapid improvements of their mood and self-esteem. There are several possible explanations regarding the mechanism of these improvements: physical elimination of the blemish, better social life, feeling that they have done something for themselves, or a mix of these. ...
... This finding was also supported by results in other investigations. 22 Many of the studies found that patients were more self-confident and had more social skills after aesthetic intervention. [22][23][24] It is clear that improvement in appearance after facial plastic surgery could deeply influenced improvement in psychosocial adjustment and interpersonal relations. ...
... 22 Many of the studies found that patients were more self-confident and had more social skills after aesthetic intervention. [22][23][24] It is clear that improvement in appearance after facial plastic surgery could deeply influenced improvement in psychosocial adjustment and interpersonal relations. Some limitations of the present study need to be kept in mind during the interpretation of the results. ...
Article
An investigation of the effect of facial lipofilling on patient's satisfaction is a challenging and ongoing research area. Therefore, the aim of this study was to investigate the impact of aesthetic intervention on self-perceived improvement in facial appearance and quality of life (QoL) after 1- and 6-month follow-ups. In the period from October 1, 2014, to March 1, 2015, a total of 63 consecutive subjects who underwent a facial lipofilling were included in the study. The satisfaction with facial appearance was estimated by using the Satisfaction with Facial Appearance Overall scale. QoL was assessed by using the 36-Item Short Form Health Survey (SF-36). Severity of depressive and anxiety symptoms was quantified by using the Hamilton depression and anxiety rating scales. The self-esteem was assessed by Rosenberg self-esteem scale. The average Satisfaction with Facial Appearance Overall scale score at baseline was 45.5 ± 13.0, while this score reached values of 84.5 ± 16.2 after 1 month (Z = -6.744, p < 0.001) and 82.7 ± 12.6 after 6 months (Z = -6.545, p < 0.001) of follow-up. The mean change of Satisfaction with Facial Appearance Overall scale score from baseline to 1-month follow-up was 38.9 ± 21.2 and from baseline to 6-month follow-up was 37.1 ± 18.9. Statistically significant improvement in QoL at each subsequent time point, compared with those at baseline, was detected for all domains of the SF-36 except for subscales of physical functioning and pain. It has been highlighted that advanced social life was strongly associated with improvement in satisfaction with facial appearance, better self-esteem, and lower level of anxiety and depression during the period of follow-up after facial lipofilling. The results of this study supported the hypothesis that the level of self-confidence and mental health-related QoL could be significantly improved following facial lipofilling treatment. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
... Although the anxiety/ depression dimension of the EQ-5D indicated worse QOL at baseline, the mean EQ-5D VAS (overall QOL) scores did not significantly differ from community norm values. 29 This illustrates the challenge in the assessment of QOL due to difference between study groups and the different measurement techniques used for assessing patient QOL. 13 Potentially eligible studies N = 721 ...
... The findings indicate that 1-year postoperative QOL improved significantly compared to baseline across a variety of cosmetic procedures. Patients who underwent blepharoplasty, lipoplasty and rhinoplasty, 16 augmentation 16,17 and reduction 25,26 mammoplasty, liposuction and abdominoplasty, 13,38 and facial cosmetic procedures 29 have been shown to experience significant QOL improvements compared to baseline after nearly 1 year. Notably, in one age-matched controlled study of reduction mammoplasty, the 12-month scores for the mammoplasty patients were close to the age-matched SF-36 scores, indicating normalization. ...
... However, depending on the scale being used, some studies showed similar QOL ratings in both the treatment and community norm values. 29 Again, this may be due to the possibility that study groups did not actually differ in terms of QOL or due to a consequence of the different measurement strategies employed for assessing patient QOL, which emphasizes the need for cosmetic procedure-specific QOL scales across procedure types in future studies. Our review also explored QOL following cosmetic surgery. ...
Article
Full-text available
This article reviews the literature regarding the impact of cosmetic surgery on health-related quality of life (QOL). Studies were identified through PubMed/Medline and PsycINFO searches from January 1960 to December 2011. Twenty-eight studies were included in this review, according to specific selection criteria. The procedures and tools employed in cosmetic surgery research studies were remarkably diverse, thus yielding difficulties with data analysis. However, data indicate that individuals undergoing cosmetic surgery began with lower values on aspects of QOL than control subjects, and experienced significant QOL improvement post-procedurally, an effect that appeared to plateau with time. Despite the complexity of measuring QOL in cosmetic surgery patients, most studies showed an improvement in QOL after cosmetic surgery procedures. However, this finding was clouded by measurement precision as well as heterogeneity of procedures and study populations. Future research needs to focus on refining measurement techniques, including developing cosmetic surgery–specific QOL measures.
... Available studies have failed to reach a consensus with regard to the perceived efficacy of cosmetic surgery. There is evidence demonstrating that cosmetic surgery improves the patient's body image (Kamburoglu & Figen, 2007;Nye & Cash, 2006;Soest, Kvalem, Roald, & Skolleborg, 2009), social image, attitude, social interactions (Meningaud, 2003), mental health and self-esteem as well as quality of life (Neto, 2007) and overall satisfaction (Kamburoglu & Figen, 2007). However, some studies have shown that cosmetic surgery does not have a significant effect on self-esteem, quality of life or overall satisfaction (Crerand, Franklin, & Sarwer, 2008;Soest, Kvalem, Roald, & Skolleborg, 2009;Meningaud et al., 2003;Bolton, Pruzinsky, Cash, & Persing, 2003;Cash, 2000). ...
... There is evidence demonstrating that cosmetic surgery improves the patient's body image (Kamburoglu & Figen, 2007;Nye & Cash, 2006;Soest, Kvalem, Roald, & Skolleborg, 2009), social image, attitude, social interactions (Meningaud, 2003), mental health and self-esteem as well as quality of life (Neto, 2007) and overall satisfaction (Kamburoglu & Figen, 2007). However, some studies have shown that cosmetic surgery does not have a significant effect on self-esteem, quality of life or overall satisfaction (Crerand, Franklin, & Sarwer, 2008;Soest, Kvalem, Roald, & Skolleborg, 2009;Meningaud et al., 2003;Bolton, Pruzinsky, Cash, & Persing, 2003;Cash, 2000). ...
... For instance, some evidence show that cosmetic surgery helps in improving body image (Crerand, Franklin, & Sarwer, 2008;Soest, Kvalem, Roald, & Skolleborg, 2009;Kamburoglu & Figen, 2007) and health-related quality of life and self esteem (Neto et al., 2007). However, there are some other studies demonstrating that cosmetic surgery did not have a significant effect on self-esteem, quality of life or life satisfaction (Crerand, Franklin, & Sarwer, 2008;Soest, Kvalem, Roald, & Skolleborg, 2009;Meningaud et al., 2003;Bolton, Pruzinsky, Cash, & Persing, 2003). ...
Article
Aim: The present study sought to assess the relationship of cosmetic surgery with self-concept and self-esteem. Materials and Method: A total of 46 candidates for cosmetic surgery filled an Ego Identity Status - Self Esteem Questionnaire before and 4-months after cosmetic surgery. Results: Repeated ANOVA test showed no significant differences in self-conceptualization of patients after surgery; whereas, self-esteem improved significantly. Self- conceptualization of subjects with identity diffusion decreased post-operatively. Subjects with identity moratorium reported a significant decrease in their self-esteem after the surgery. Subjects who had a susceptible identity psychologically and receptive feelings for facial cosmetic surgery showed improved self-esteem and self- conceptualization post-surgery. Conclusion: Our study results demonstrated that self-esteem of respondents increased significantly after the operation but self- conceptualization did not improve significantly.
... Available studies have failed to reach a consensus with regard to the perceived efficacy of cosmetic surgery. There is evidence demonstrating that cosmetic surgery improves the patient's body image (Kamburoglu & Figen, 2007;Nye & Cash, 2006;Soest, Kvalem, Roald, & Skolleborg, 2009), social image, attitude, social interactions (Meningaud, 2003), mental health and self-esteem as well as quality of life (Neto, 2007) and overall satisfaction (Kamburoglu & Figen, 2007). However, some studies have shown that cosmetic surgery does not have a significant effect on self-esteem, quality of life or overall satisfaction (Crerand, Franklin, & Sarwer, 2008;Soest, Kvalem, Roald, & Skolleborg, 2009;Meningaud et al., 2003;Bolton, Pruzinsky, Cash, & Persing, 2003;Cash, 2000). ...
... There is evidence demonstrating that cosmetic surgery improves the patient's body image (Kamburoglu & Figen, 2007;Nye & Cash, 2006;Soest, Kvalem, Roald, & Skolleborg, 2009), social image, attitude, social interactions (Meningaud, 2003), mental health and self-esteem as well as quality of life (Neto, 2007) and overall satisfaction (Kamburoglu & Figen, 2007). However, some studies have shown that cosmetic surgery does not have a significant effect on self-esteem, quality of life or overall satisfaction (Crerand, Franklin, & Sarwer, 2008;Soest, Kvalem, Roald, & Skolleborg, 2009;Meningaud et al., 2003;Bolton, Pruzinsky, Cash, & Persing, 2003;Cash, 2000). ...
... For instance, some evidence show that cosmetic surgery helps in improving body image (Crerand, Franklin, & Sarwer, 2008;Soest, Kvalem, Roald, & Skolleborg, 2009;Kamburoglu & Figen, 2007) and health-related quality of life and self esteem (Neto et al., 2007). However, there are some other studies demonstrating that cosmetic surgery did not have a significant effect on self-esteem, quality of life or life satisfaction (Crerand, Franklin, & Sarwer, 2008;Soest, Kvalem, Roald, & Skolleborg, 2009;Meningaud et al., 2003;Bolton, Pruzinsky, Cash, & Persing, 2003). ...
Article
Full-text available
Aim: The present study sought to assess the relationship of cosmetic surgery with self-concept and self-esteem. Materials and Method: A total of 46 candidates for cosmetic surgery filled an Ego Identity Status - Self Esteem Questionnaire before and 4-months after cosmetic surgery. Results: Repeated ANOVA test showed no significant differences in self-conceptualization of patients after surgery; whereas, self-esteem improved significantly. Self- conceptualization of subjects with identity diffusion decreased post-operatively. Subjects with identity moratorium reported a significant decrease in their self-esteem after the surgery. Subjects who had a susceptible identity psychologically and receptive feelings for facial cosmetic surgery showed improved self-esteem and self- conceptualization post-surgery. Conclusion: Our study results demonstrated that self-esteem of respondents increased significantly after the operation but self- conceptualization did not improve significantly.
... Ces patients sont souvent perçus par leur entourage comme anxieux et/ou déprimés par leur « difformité » physique alléguée (Kisely et al., 2002 ; Greenbaum et al., 2003). Meningaud et al. (2002) indiquent que les niveaux de dépression évalués par la MADRS (Montgomery and Asberg Depression Rating Scale) chez les consultants en chirurgie esthétique sont plus élevés que dans la population générale, (moyenne = 8,29, σ = 6,97 p < 0,05) à partir d'un échantillon de 103 patients (11 hommes et 92 femmes, âge moyen = 39,7 ans). Mais les chiffres révèlent l'existence de traits dépressifs, et non de troubles dépressifs majeurs avérés. ...
... Cette absence de différence hommes, femmes, interroge le statut de chacun dans notre société et ses conséquences sur le souhait de modifier son aspect corporel. Meningaud et al. (2002) ont réalisé une étude auprès de 103 patients ayant subi une intervention du visage (92 femmes et 11 hommes, âge moyen = 39,7 ans). Avant l'intervention, ils n'observent pas de bas niveaux de qualité de vie, au moyen de l'Euro Quality of life (EQ-5D), sauf pour la dimension anxiété dépression chez les hommes et les femmes. ...
... Such psychological changes have not been investigated in individuals undergoing liposuction of large volumes of fat. In studies following other forms of cosmetic surgery, depression levels did not change post surgery [23,24] . About 3-15% of those seeking cosmetic surgery present with mild to severe Body Dysmorphic Disorder (BDD) [25][26][27][28] , a negative obsession with a part of the body. ...
... The lack of change in depression scores is consistent with a postsurgical study for breast reduction [24] , in which scores of depression and anxiety did not change [24] . Similarly, following a variety of cosmetic surgeries, negative thoughts, quality of life, and depression did not change at nine months [23] . ...
Article
Full-text available
Background Liposuction can remove a substantial amount of body fat. We investigated the effects of liposuction of large volumes of fat on anthropometrics, body composition (BIA), metabolic hormones, and psychological measures in overweight/obese women. To our knowledge, this is the first study to examine both physiological and psychological changes following liposuction of large volumes of fat in humans. Method Nine premenopausal healthy overweight/obese women (age = 35.9 ± 7.1 SD, weight = 84.4 kg ± 13.6, BMI = 29.9 kg/m² ± 2.9) underwent liposuction, removing 3.92 kg ± 1.04 SD of fat. Following an overnight fast, height, weight, waist, and hip circumferences were measured at baseline (one week pre-surgery) and post-surgery (wk 1,4,12). Blood samples were drawn for fasting concentrations of glucose, insulin, leptin, and ghrelin. The Body Shape Questionnaire (BSQ), Body Dysmorphic Disorder (BDD) Examination Self-Report (BDDE-SR), and Zung Self-Rating Depression Scale (ZDS) were administered. Results Body weight, BMI, waist circumference, and body fat consistently decreased over time (p < .05). Glucose did not change significantly, but insulin decreased from wk 1 to wk 12 (p < .05). Leptin decreased from baseline to wk 1 (p = .01); ghrelin increased but not significantly. Changes in body fat and waist circumference (baseline to wk 1) correlated positively with changes in insulin during that period, and correlated inversely with changes in ghrelin (p < .05). BSQ scores decreased significantly over time (p = .004), but scores for BDDE-SR (p = .10) and ZDS (p = .24) did not change significantly. Conclusion Liposuction led to significant decreases in body weight and fat, waist circumference, and leptin levels. Changes in body fat and waist circumference correlated with concurrent changes in the adipose-related hormones, insulin and ghrelin (baseline to wk 1), and body shape perception improved. Thus, besides the obvious cosmetic effects, liposuction led to several positive body composition, hormonal, and psychological changes.
... Ces patients sont souvent perçus par leur entourage comme anxieux et/ou déprimés par leur « difformité » physique alléguée (Kisely et al., 2002 ;Greenbaum et al., 2003). Meningaud et al. (2002) indiquent que les niveaux de dépression évalués par la MADRS (Montgomery and Asberg Depression Rating Scale) chez les consultants en chirurgie esthétique sont plus élevés que dans la population générale, (moyenne = 8,29, σ = 6,97 p < 0,05) à partir d'un échantillon de 103 patients (11 hommes et 92 femmes, âge moyen = 39,7 ans). Mais les chiffres révèlent l'existence de traits dépressifs, et non de troubles dépressifs majeurs avérés. ...
... Cette absence de différence hommes, femmes, interroge le statut de chacun dans notre société et ses conséquences sur le souhait de modifier son aspect corporel. Meningaud et al. (2002) ont réalisé une étude auprès de 103 patients ayant subi une intervention du visage (92 femmes et 11 hommes, âge moyen = 39,7 ans). Avant l'intervention, ils n'observent pas de bas niveaux de qualité de vie, au moyen de l'Euro Quality of life (EQ-5D), sauf pour la dimension anxiété dépression chez les hommes et les femmes. ...
Article
Full-text available
La chirurgie esthétique est une pratique de plus en plus répandue en France et dans le monde. L’augmentation incessante du nombre de consultants nous amène à nous interroger sur le choix de ces patients et sur les conséquences psychologiques de leurs démarches et des actes chirurgicaux. Des recherches internationales mentionnent l’existence de facteurs psychologiques divers : qualité de vie, éléments dysmorphophobiques, traits de personnalité... L’examen de la revue de la littérature nous conduit à nous interroger sur leur pertinence et sur leurs capacités explicatives de la démarche de consulter un chirurgien plasticien. On constate que la prise de décision de consultation s’inscrit dans un processus psychique où intervient la qualité de fonctionnement psychosocial et les traits de personnalité.
... Disfigurement due to HNC is stigmatized in society because beauty is a social goal, desire and standard. Disfigurement is significantly associated with deterioration of structures related to personal identity, communication skills, social relationships, impaired sexuality and clinical levels of depression and anxiety [13][14][15]. Despite the high risk of body image disturbances in HNC patients, there are no effective treatment options for these particular patients. ...
... In daily life, the negative changes in these patients (e.g., difficulties with appearance, disturbances in swallowing, dental hygiene, digestion, speech, pain, role function, movement and psychological well-being) reported in Patient Concerns Inventory often go beyond the realm of physical health, as the disease can also cause psychological problems and increase social demands [16]. The literature reports that 75% of surgically treated HNC patients experience psychosocial problems [15]. ...
Article
Full-text available
Background and Objectives: It is well known that among all cancers, cancers of the head and neck (HNC) have a major impact on patients’ quality of life. Disfigurement, anxiety and disabling physical and psychological symptoms affect people with HNC to such an extent that the suicide rate in this category of patients is exceeded only by that of patients with pancreatic cancer. The aim of this review was to summarize the published literature describing the severity of body image and quality of life impairment in patients with HNC over time, and to examine the psychosocial and functional associations and interventions implemented to improve body image and quality of life. Materials and Methods: We conducted a literature search from 1 January 2018 to June 2021 that included electronic searches of six major databases (PubMed, ScienceDirect, ProQuest, PsycINFO, PsychArticles and Scopus) and review of references of articles screened. Of 620 records, only 9 articles met the eligibility criteria. Results: Numerous studies have been conducted to analyze various psychological variables, but there is still a lack of standardization in the assessment of body image perception (BI) and quality of life, resulting in small-scale testing of interventions with poor results. Conclusions: Expected longitudinal studies describing the flow of body image problems and the mediation and balance factors associated with body image will allow researchers to design methods aimed at limiting body image disorders and thus improving quality of life of patients with head and neck cancer.
... This in turn will affect the quality of life and recovery from the facial trauma. [8,9] Depression and anxiety associated with facial trauma is often coupled with worries regarding recovery and length of the treatment process. [10] Facial trauma leads to disfigurement which also affects the social image of the patient. ...
Article
Full-text available
The face is a vital component of one's personality and body image. There are a vast number of variables that influence recovery and rehabilitation from acquired facial trauma many of which are psychological in nature. The present paper presents the various psychological issues one comes across in facial trauma patients. These may range from body image issues to post-traumatic stress disorder symptoms accompanied by anxiety and depression. Issues related to facial and body image affecting social life and general quality of life are vital and the plastic surgeon should be aware of such issues and competent to deal with them in patients and families.
... [7][8][9][10] Patients undergoing cosmetic surgery have emotional and social concerns that pertain to facial appearance more so than the general population. [11][12][13] It is this elevated concern that likely leads to the decision to undergo cosmetic surgery. Usually, this elevated concern does not manifest itself as a pathological state. ...
Article
This paper presents an extensive literature review of the psychology of facelift patients as it has evolved over the past 50 years. Earlier studies revealed significant levels of pre and perioperative depression. Facelift patients generally exhibit emotional and social concerns about facial appearance that are higher than the general population. Many are undergoing midlife situational stresses and may lack the positive characteristics to deal with them. The most common diagnoses seen include depression, impulsivity, unstable personality, and passive dependence, albeit not necessarily serious. Improvement in body image is the major driver for surgery. Characteristics of female patients as defined by their age are described. These include the younger emotionally dependent group, the worker group of middle age, and the older grief group. Male patients are seen to have a higher level of psychological dysfunction, but a higher improvement in postoperative quality of life. Motivations for surgery include increasing self-esteem, making new friends, improving relationships, and getting better jobs. Overall patient satisfaction is more than 95%, with improvement seen in positive changes in their life, increased self-confidence and self-esteem, decreased self-consciousness about their appearance, and overall improvement in quality of life. Postoperative psychological reactions are seen in about half the patients, these primarily being anxiety and depression of varying degrees. Predictors of patient satisfaction include the desire for self-image improvement in contradistinction to a change in life situation. Negative predictors include male sex, young age, unrealistic expectations, relationship disturbances, and preexisting psychological pathology. The importance of good patient selection in achieving a satisfied patient is outlined and emphasized.
... In this regard, a variety of studies have been conducted to assess mental health changes following rhinoplasty operation in different populations [2,[6][7][8][9][10][11][12][13][14][15][16][17][18]. Fatemi et al. in 2012 [11], Zojaji et al. in 2014 [13], and Hosseinzadeh et al. in 2017 [14] assessed changes of quality of life in Iranian population clients who underwent rhinoplasty. ...
Article
Full-text available
Background Psychological functioning of rhinoplasty must be evaluated in the community of Iran as the most prevalent center of rhinoplasty worldwide. Making a realistic public view about rhinoplasty psychological outcomes is necessary. In the present study, quality of life, anxiety, depression, and self-esteem alteration in rhinoplasty patients among the Iranian population were assessed. Methods This is an observational trial study conducted on 41 patients who underwent rhinoplasty in 2017–2018. The Persian version of standard questionnaires “World Health Organization Quality of Life (WHOQOL-26),” “Hospital Anxiety and Depressive Scale (HADS),” and “Eysenck Self-Esteem Questionnaire” were used for this aim. Therefore, questionnaires were filled pre and within 6 months postoperatively and then compared. Demographics including age, gender, marital status, and educational level association with the mentioned factors were assessed as well. Results The results revealed that rhinoplasty brought significant improvements in all aspects of QOL, including physical (P value = 0.011), psychological (P value = 0.002), relationships (P value = 0.019), environment (P value = 0.032), and general health (P value = 0.005). Depression (P value = 0.010) and self-esteem (P value = 0.004) scores change significantly in a positive manner as well. Anxiety improvement was the least (6.8%) with no significant change (P value = 0.334). None of the demographics including age, gender, marital status, and educational level showed association with psychological indices (P value > 0.05) except for age association with relationships domain of WHOQOL that was significantly higher among those younger than 30 years old (P value = 0.040). Conclusions Rhinoplasty can improve most of the psychological indices in the Iranian population, regardless of the candidate’s gender, marriage status, educational level, or age group. Level of evidence: Level II, therapeutic study.
... Moreover, there are the intervening issues of who actually seeks such surgery and the potential long term effects. Von Soest, found that body image evaluation and self-esteem scores improved after cosmetic surgery and Meningaud et al. (2003) found improvement in anxiety in patients following cosmetic surgery, but notes that those seeking cosmetic surgery were "more anxious" and "more depressed than the general population" (p. 48). ...
Article
The promise of cosmetic surgery is that one can reshape his or her body to remove perceived defects and thus have a perfect body. Although in practice this is not always the result, many continue to pursue this potential. One extreme example of this impulse is actress Heidi Montag, who underwent ten different plastic surgery procedures in one day. But the decision to undergo cosmetic surgery is not made in a vacuum. Individuals are influenced by others, including the media, the surgeons, and themselves. This essay uses Montag’s experience to explore four ethical considerations surrounding cosmetic surgery—the surgeon, the patient, the media, and society—and concludes with a discussion of potential correctives for ethical failures in each of these areas.
... This is in keeping with the consensus that esthetic surgery is important in the global assessment of health and psychological well-being. 11,12 It is interesting to note that there was a tendency toward the reporting of positive outcomes with regard to social wellbeing. It is hard to say exactly why this might be, but one may speculate that people may feel more comfortable in the company of others postoperatively because of factors related to self-consciousness. ...
Article
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Introduction: Up to 5% of all children have prominent ears. Psychological distress and bullying adversely affect these children and can cause significant social exclusion. In times of austerity, cosmetic procedures such as surgical correction of prominent ears are felt to be an unnecessary cost to the health service. Materials and methods: A retrospective case note review of all patients undergoing pinnaplasty was undertaken. Postoperative outcomes were compared against the Royal College of Surgeons of England standards. The Glasgow Benefit Inventory, a validated post-intervention questionnaire, was then posted out to all patients. Results: A total of 72 patients were identified. Average age at procedure was 13 years. Eleven patients were above the age of 19 years. Twenty-eight patients were male and forty-four female. Sixty-two cases underwent bilateral pinnaplasty. No patients developed hematoma, and there were no readmissions within 30 days of surgery. Twenty-nine patients responded to the questionnaire (40%), of whom 27 reported a positive impact on their psychosocial well-being with a mean score of 36. Conclusion: Pinnaplasty offers patients an opportunity to alleviate the psychological distress of bullying and harassment secondary to the appearance of prominent ears.
... 13 In contrast, individuals reporting external motivators are considered less likely to have their expectations met, 6,14-17 with limited evidence indicating any change in social, romantic, or employment factors postprocedure. [18][19][20] As such, many have proposed that unrealistic (and particularly extrinsic) expectations should be identified and managed to promote client satisfaction. 3,6,7 Unrealistic expectations often co-occur with other potential contraindications for cosmetic treatment, such as younger age, low educational attainment, single individuals, and those experiencing psychological distress, indicating several groups who may be at risk of poor cosmetic treatment outcome. ...
Article
Full-text available
Objective: To develop and validate a novel patient-reported measure to assess internally and externally driven expectations for change after a cosmetic procedure, termed the aesthetic procedure expectations (ASPECT) scale. Method: In total, 186 adults recruited from nonsurgical cosmetic clinics in Melbourne, Australia, accessed an online survey (150 completed; 81% response rate) including the novel ASPECT questionnaire, demographics, and measures of psychological distress. Results: The final sample included 141 women and 5 men with a mean age of 44.78 years (standard deviation = 11.68) with <10% missing data. Results supported a two-factor ASPECT scale measuring intrinsic and extrinsic expectations, with high internal consistency and convergent validity. Heightened extrinsic and intrinsic expectations were both associated with individuals who were emotionally distressed, younger, and had previously undertaken more cosmetic procedures. Cutoff scores for the ASPECT subscales are proposed to aid cosmetic practitioners in identifying clients requiring further assessment. Conclusions: The ASPECT scale may provide a reliable and useful clinical tool for cosmetic practitioners to assess unrealistic expectations and determine which clients may require more in-depth consultation before undergoing surgical or nonsurgical cosmetic treatment.
... Von Soest, found that body image evaluation and self-esteem scores improved after cosmetic surgery. Meningaud et al. (2003) found improvement in anxiety in patients following cosmetic surgery, but notes that those seeking cosmetic surgery were "more anxious" and "more depressed than the general population" (p. 48). ...
Chapter
In an increasingly visual society, beauty may seem only skin deep. This chapter considers the ethics of cosmetic surgery through the lens of posthumanism, a stance that suggests that defects of the body can be overcome through technology. Cosmetic surgery, with its reliance on prostheses and promise of reshaping the body, is, at its heart, a posthuman enterprise. Although many have engaged in cosmetic surgery, actress Heidi Montag became an exemplar of reshaping the body by undergoing ten different plastic surgery procedures in one day. Using Montag as foil, this chapter examines four ethical dimensions of cosmetic surgery: the ethics of the medical professionals who perform and advertise these procedures, the ethics of the individual making the decision, the ethics of the media structures that promote a homogenous ideal of beauty, and the ethics of those who tacitly approve of such procedures.
... (8) According to Meningaud et al. (2002), cosmetic surgery is statistically ineffective as a treatment for depressive disorders. (9) Therefore, the question is posed: "How should providers respond to requests for surgery in reaction to a job loss, an emotional disturbance, or bereavement?" Meningaud et al. (2002) suggest that the practitioner should, generally, advise the patient to wait for the event to settle first, even if it means reconsidering the request later to improve the patient's self-confidence. ...
... x (p. 209). It is clear that aesthetic surgery can have positive outcomes in self-perception and behavior, and thus serve as enhancement technologies. Still, there are the intervening issues of who actually seeks such surgery and the potential long term effects.found that body image evaluation and self-esteem scores improved after cosmetic surgery.Meningaud et al. (2003)found improvement in anxiety in patients following cosmetic surgery, but notes that those seeking cosmetic surgery were " more anxious " and " more depressed than the general population " (p. 48). However, von Soest, Kvalem, Skolleborg, and Roald (2009) question whether the increase in extraversion induced by cosmetic surgery " may be du ...
Chapter
In an increasingly visual society, beauty may seem only skin deep. This chapter considers the ethics of cosmetic surgery through the lens of posthumanism, a stance that suggests that defects of the body can be overcome through technology. Cosmetic surgery, with its reliance on prostheses and promise of reshaping the body, is, at its heart, a posthuman enterprise. Although many have engaged in cosmetic surgery, actress Heidi Montag became an exemplar of reshaping the body by undergoing ten different plastic surgery procedures in one day. Using Montag as foil, this chapter examines four ethical dimensions of cosmetic surgery: the ethics of the medical professionals who perform and advertise these procedures, the ethics of the individual making the decision, the ethics of the media structures that promote a homogenous ideal of beauty, and the ethics of those who tacitly approve of such procedures.
... the patients feel healthier and more satisfied with their appearance. meningaud et al. [11], examining outcomes after cosmetic surgery, confirmed the impression shared by the majority of studies: aesthetic surgery improves psychological well-being. rankin et al. [12] described an improvement in composite quality of life scores in the early 1-month postoperative evaluation and state that this significant difference not only persisted at 6 months but also showed further improvement. ...
Article
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To investigate health-related quality of life changes that occurred in children with prominent ears applied pre- and postoperatively. A prospective study was performed in 67 consecutive children who underwent otoplasty procedures between April 2008 and July 2010 and followed up for more than 2 years. Evaluations and interviews performed in the pre-and postoperative periods included the patients' history, clinical and routine laboratory examinations. Glasgow children's benefit inventory was the basis of the used inquiry for detecting the changes in health-related quality of life after otoplasty. For the children's cohort, the mean total Glasgow children's benefit inventory score was 23.9 (p < 0.001), indicating a benefit from the operation. All Glasgow children's benefit inventory subscores (emotion, physical health, learning, and vitality) were raised (mean 30.84, 14.98, 18.89, and 23.96, respectively). The health-related quality of life was raised in 63 of 67 children (94.03 %). Negative Glasgow children's benefit inventory scores or subscores were not found in a single case. Otoplasty can significantly increase patients' health-related quality of life and leads to a high rate of patient satisfaction in children with prominent ears.
... The fact that the cases had realistic expectations enhanced their satisfaction with surgical intervention [10]. Many studies have revealed that aesthetic surgery leads to favourable outcomes in terms of psychosocial aspect [19][20][21]. ...
Article
The aim of the present prospective and descriptive study was to assess the impact of facial aesthetic and reconstructive surgeries on quality of life. Ninety-one patients, of whom 43 had aesthetic surgery and 48 had reconstructive surgery, were analysed. The data were collected using the patient information form, body cathexis scale, and short form (SF)-36 quality of life scale. There were significant differences between before and after the surgery in both groups in terms of body cathexis scale and quality of life (p < 0.05 for both). It was observed that problems regarding the body image perception were encountered more, and the quality of life was poorer in both aesthetic and reconstructive surgery patients before the surgery. However, the problems were decreased, and the quality of life was enhanced after the surgery. Among the parameters of SF-36 quality of life scale, particularly the mean scores of social functioning, physical role functioning, emotional role functioning, mental health, and vitality/fatigue were found low before the surgery, whereas the mean scores were significantly improved after the surgery. The results revealed that facial aesthetic and reconstructive surgical interventions favourably affected the body image perception and self-esteem and that positive reflections in emotional, social, and mental aspects were effective in enhancing self-confidence and quality of life of the individual.
... Kasvoihin liittyvät operaatiot eivät rajoitu ihmisen pintaolemukseen ruokkien inhimillistä turhamaisuutta, vaan kyseessä on lääketieteellinen toimenpide, joka ankkuroituu ihmisen vuorovaikutuspsykolo giaan ja suhdeolemisen perusteisiin. Esimerkiksi laskeutuneen otsan korjaus, kasvojen kohotus (KUVA 5), hiustensiirto (KUVA 6) tai nenäleikkaus voivat parantaa merkittävästi potilaiden elämänlaatua (26)(27)(28)(29). ...
... Depression places the patient at increased risk for committing suicide, poor compliance with treatment, and poor rehabilitation outcome. This in turn will affect the quality of life and recovery from the facial trauma (Cuijpers & Smit, 2004;Meningaud, Benadiba, Servant, Bertrand, & Pelicier, 2003). ...
Article
Full-text available
This study hopes to compare levels of anxiety and depression in the maxillofacial and orthopedic injured patients over a period of 12 weeks. This was a prospective, repeated measure design. A total of 160 participants (80 with maxillofacial and 80 with long bone fractures) had repeated review follow-ups within 1 week of arrival in the hospital (Time 1), 4–8 weeks after initial contact (Time 2) and 10–12 weeks thereafter (Time 3), using hospital anxiety and depression scale questionnaire. Road traffic accident remained the main cause of injury in both groups of subjects. The Hospital anxiety and Depression scale detected 42 (52.5%) cases of depression at baseline, 36 (47.4%) cases at Time 2, and 14 (18.4%) cases at Time 3 in the maxillofacial injured group. In the long bone fracture subjects, 47 (58.8%) cases were depressed at baseline, 23(33.3%) cases at Time 2, and only 5 (7.2%) cases at Time 3. Both groups showed reduction in depression levels with time. Fifty-six (70.0%) had anxiety at baseline, 32 (42.1%) at Time 2, and only 9 (11.8%) had anxiety at Time 3 in the maxillofacial fracture group, whereas in the long bone fracture group, 69 (86.3%) subjects were anxious at baseline, 32 (46.4%) at Time 2, and 22 (31.9%) at Time 3. There were significant differences in depression and anxiety level in both the maxillofacial and the long bone fracture subjects at baseline (Time 1), Time 2(4–8 weeks) and Time 3(10–12 weeks).
... These traits were often reflected in behavior rather than in psychoticism (37). Essentially, they resorted to cosmetic treatments due to a lack of confidence, which was associated with specific physical defects and the desire to socialize (41). In addition, the contour of the mandibular angle was significant to the facial shape of Asian women, who believe that women with wide and square faces were more likely to be unhappy (42). ...
Article
Full-text available
Background: Cosmetic treatment was closely associated with beauty seekers’ psychological well-being. Patients who seek cosmetic surgery often show anxiety. Nevertheless, not much is known regarding how personality traits relate to the selection of body parts that receive cosmetic treatment. Aims: This study aims to investigate the correlation between personality traits and various selection sites for cosmetic treatment via Eysenck Personality Questionnaire (EPQ). Methods: A cross-sectional approach was adopted to randomly recruited patients from a general hospital planning to undergo cosmetic treatments. All respondents completed the EPQ and provided their demographic information. The EPQ involves four scales: the extraversion (E), neuroticism (N), psychoticism (P), and lying scales (L). Psychological scales were evaluated to verify that people who selected different body sites for cosmetic intervention possessed different personality portraits. Results: A total of 426 patients with an average age of 32.14 ± 8.06 were enrolled. Among them, 384 were females, accounting for more than 90% of patients. Five treatment sites were analyzed, including the body, eye, face contour, nose, and skin. Comparatively, patients with neuroticism were more likely to undergo and demand rhinoplasty (OR 1.15, 95% CI 1.07-1.24, P< 0.001). Face contour treatment was commonly associated with extraversion (OR 1.05, 95% CI 1.00-1.11, P= 0.044), psychoticism (OR 1.13, CI 1.03-1.25, P= 0.013), and neuroticism (OR 1.05, CI 1.01-1.10, P= 0.019). Conclusions: This novel study attempted to determine the personality profiles of beauty seekers. The corresponding assessments may provide references for clinical treatment options and enhance postoperative satisfaction for both practitioners and patients.
... Hosseini, Shahgholian, and Abdollahi (2015) found that those who sought cosmetic surgery were less psychologically hardy and more likely to have a negative self-perception. However, Von Soest, found that body image evaluation and self-esteem scores improved after cosmetic surgery and Meningaud et al. (2003) found improvement in anxiety in patients following cosmetic surgery, but notes that those seeking cosmetic surgery were "more anxious" and "more depressed than the general population" (p. 48). ...
Chapter
For many, cosmetic surgery holds the promise that one can reshape his or her body to remove perceived defects and thus have a more perfect body. However, the decision to undergo elective cosmetic surgery is not made in a vacuum, and it is easy to overlook the full range of ethical considerations surrounding cosmetic surgery. Many medical ethicists subscribe to an ethical code that centers mainly on the relationship between the doctor and patient, with a focus on respect for autonomy, nonmaleficence, beneficence, and justice. This chapter builds on this framework by extending the scope of actors to include not only the surgeon and the patient but also the media and the overall society. To illustrate this framework, the author uses the example of actress Heidi Montag, who underwent 10 different plastic surgery procedures in one day. The chapter concludes with a discussion of potential correctives for ethical failures in each of these areas.
... Depression puts the individual at more danger of suicidal tendencies, reduced treatment compliance, and poor convalescence aftermath. In such cases, quality of life and recovery from the maxillofacial trauma are often compromised [3,4]. ...
Chapter
Full-text available
Psychosocial and health-related quality of life following oral and maxillofacial injuries is an often neglected aspect of patients’ management. It has been noted that patients with maxillofacial trauma were more likely to be depressed, anxious with low self-esteem and poor health-related quality of life and possibility of post-traumatic stress disorder (PTSD). Depression and anxiety associated with facial trauma are often coupled with worries regarding recovery. Following trauma, there may be physical dysfunction especially facial disfigurement which may adversely affect the patients’ ability to undertake daily activities and lower their mood and self-esteem leading to overall poor health-related quality of life. Focusing on these psychosocial factors, this chapter also elaborated on the immediate and long term effects of these factors if not incorporated into patient’s care. In a study of 80 maxillofacial injured patients’ in Sub-Saharan Africa using hospital anxiety and depression scale (HADS) questionnaire, the HADS detected 42 (52.5%) cases of depression and 56 (70.0%) cases of anxiety at baseline. Rosenberg’s self-esteem questionnaire detected 33 (41.3%) patients with low self-esteem at baseline. WHO HRQoL-Bref questionnaire showed poor Quality of life in all the domains of the instrument with lowest in the physical and psychological domains. Similarly, the trauma screening questionnaire (TSQ) for PTSD detected 19 patients had symptoms of PTSD at Time 1 with a prevalence rate of 25%.
... Although pain, edema, and ecchymosis are transient postoperative complications of septorhinoplasty procedures, patients are afraid of these complications more than is popularly believed because the nose is the most exposed area of the face [10]. One study reported that patients requesting cosmetic surgery were more depressed and anxious than the general population [11]. Therefore, the most important outcome of the septorhinoplasty procedure is the patient's satisfaction. ...
Article
Background Pain, ecchymosis, and edema are major postoperative transient complications of septorhinoplasty procedures. They increase the patient’s anxiety and decrease satisfaction levels as well as extend recovery time in the early postoperative period. The aim of this study was to compare the effects of total nasal block (TNB) and central facial block (CFB) on postoperative pain, edema, and ecchymosis. Methods A total of 60 consecutive patients enrolled in this study and were divided into three groups as Controls (n = 20), TNB (n = 20), and CFB (n = 20). The two block methods mentioned above were performed at both the beginning and end of the surgery in the TNB and CFB groups. The Control group was not subjected to any block methods. Pain, edema, and ecchymosis score results according to the three scales were recorded postoperatively after 24 h, and on days 2, 5, 7, and 10. Results were analyzed statistically. Results Of all patients, 28 were male and 32 were female. Ages were between 18 and 52 years (mean = 26.3 years). Pain, edema, and ecchymosis scores were significantly lower in the TNB and CFB groups than in the Control group. Additionally, there was a significant difference between the TNB and CFB groups in terms of pain and edema at postoperative 24 h and on day 2. Ecchymosis scores were lower in the CFB group than in the TNB group at 24 h and on days 2 and 5 after the operation. Conclusion Both TNB and CFB decreased postoperative pain, edema, and ecchymosis in septorhinoplasty. However, CFB was more effective than TNB in terms of pain, edema, and ecchymosis relief after septorhinoplasty procedures. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www. springer. com/ 00266.
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Background A global approach to facial rejuvenation involves multiple treatment modalities. Objectives This study evaluated the impact of multimodal facial aesthetic treatment on self-reported psychological and social outcomes. Methods HARMONY, a prospective, multicenter, 4-month study, enrolled patients aged 35 to 65 years to receive on-label treatment with a combination of hyaluronic fillers (VYC-20L, HYC-24L, and/or HYC-24L+), onabotulinumtoxinA, and bimatoprost. Fillers were injected on day 1, with touch-ups performed on day 14. OnabotulinumtoxinA was injected at month 3 into glabellar lines and/or crow’s feet lines. Patients applied bimatoprost to eyelashes once daily for 17 weeks. Mean change from baseline on FACE-Q Psychological Well-being and Social Confidence Scales, FACE-Q Aging Appearance Appraisal Scale, and FACE-Q Age Appraisal Visual Analog Scale were assessed. Results Of 100 patients treated, 93 were evaluated at 4 months posttreatment. Significant improvement vs baseline was observed on the FACE-Q Scales for Psychological Well-being (mean change, −19.9; p < 0.00001), Social Confidence (mean change, −18.2; p < 0.00001), and Aging Appearance (mean change, −28.5; p < 0.0001). On average, patients’ self-assessed age was 0.1 year older than actual age at baseline and 4.5 years younger at month 4 (p < 0.001 vs baseline). Forty-two patients experienced adverse events, all mild to moderate. Conclusions Multimodal, full facial aesthetic treatment improves patients’ self-reported psychological well-being, social confidence, aging appearance, and perceptions of chronologic age.
Article
Importance Millions of surgical and minimally invasive cosmetic procedures of the face are performed each year, but objective clinical measures that evaluate surgical procedures, such as complication rates, have limited utility when applied to cosmetic procedures. While there may be subjective improvements in appearance, it is important to determine if these interventions have an impact on patients in other realms such as psychosocial functioning. This is particularly important in light of the Patient Protection and Affordable Care Act and its emphasis on patient-centered outcomes and effectiveness.Objectives To review the literature investigating the impact of facial cosmetic surgery and minimally invasive procedures on relevant psychological variables to guide clinical practice and set norms for clinical performance.Evidence Review English-language randomized clinical trials and prospective cohort studies that preoperatively and postoperatively assessed psychological variables in at least 10 patients seeking surgical or minimally invasive cosmetic procedures of the face.Findings Only 1 study investigating minimally invasive procedures was identified. Most studies reported modest improvement in psychosocial functioning, which included quality of life, self-esteem, and body image. Unfortunately, the overall quality of evidence is limited owing to an absence of control groups, short follow-up periods, or loss to follow-up.Conclusions and Relevance The current literature suggests that a number of psychosocial domains may improve following facial cosmetic surgery, although the quality of this evidence is limited (grade of recommendation 2A). Despite the dramatic rise in nonsurgical cosmetic procedures, there is a paucity of information regarding the impact of chemodenervation and soft-tissue augmentation on psychosocial functioning.
Article
Background: A previous report indicated that secondary rhinoplasty patients with normal preoperative noses displayed significantly higher prevalences of depression, demanding behavior, previous aesthetic operations, and confirmed trauma (abuse/neglect) histories than patients who originally had dorsal deformities or straight noses with functional symptoms. The authors hypothesized that abuse or neglect might also influence patient satisfaction and suggest screening criteria. Methods: One hundred secondary rhinoplasty patients stratified by their original nasal shapes were examined by bivariate analysis to determine the characteristics associated with surgical satisfaction. Mediation analysis established intervening factors between total surgery number and patients' perceived success. Random forests identified important patient attributes that predicted surgical success; logistic regression confirmed these effects. Results: Satisfied patients originally had dorsal humps, three or fewer previous operations, were not demanding or depressed, were not looking for perfect noses, and had no trauma histories. Dissatisfied patients originally had subjectively normal noses, more than three operations, were depressed, had demanding personalities, and had trauma histories. Patients who had undergone the most operations were most likely to request more surgery and least likely to be satisfied. A trauma (abuse/neglect) history was the most significant mediator between patient satisfaction and number of operations and the most prominent factor driving surgery in patients with milder deformities. Conclusions: Potentially causative links exist between trauma (abuse/neglect), body image disorders, and obsessive plastic surgery. Body dysmorphic disorder may be a model of the disordered adaptation to abuse or neglect, a variant of posttraumatic stress disorder. Our satisfied and dissatisfied patients shared common characteristics and therefore may be identifiable preoperatively.
Article
Both clinical research and evaluation research focus on the therapeutic outcomes. But unlike clinical research, evaluation research examines such results from the patient's perspective, the criteria being what the patient feels rather than physical or laboratory data. Such research is of utmost importance in aesthetic surgery since the real benefit is subjective rather than functional. Evaluation research provides some solution to the ethic problem of the risk: benefit ratio of aesthetic surgery. Parallel with its improvements, its indications are being better identified. In this type of research, the evaluation tools may be a satisfaction index, a quality of life rating scale, or a psychological rating scale. Satisfaction indexes are easy to use but there have a related limitation since responses may be easily inferred. They are obtained using visual analogue scales comparable to those used for pain assessment. Quality of life tests combine in a single composite score many dimensions such as physical, social, psychological and emotional criteria. Quality of life tests may be generic or specific. Specific tests take into account the disease or the patient's care-seeking, i.e. his (her) need for aesthetic surgery. Generic tests provide an overall quantification of the patient's quality of life regardless of the care-seeking dimension, and with a lesser risk of bias. Finally, psychological rating scales are naturally the most frequently used due to the psychological aspect related to the need for aesthetic surgery. They investigate depression, anxiety, bodily image, etc. A literature review shows that maxillofacial aesthetic surgery does not improve depression indexes but it clearly improves self-confidence, self-esteem and bodily image. Aesthetic surgery improves the results of generic or specific quality of life tests when they include some of the above-mentioned psychological parameters.
Article
Purpose: The aim of this study was to evaluate motivations, self-esteem, and oral health for undergoing orthognathic patients by gender in China before orthognathic surgery. Patients and methods: Using a prospective and control study design, 429 subjects in China were collected from December 2010 to May 2011. The patient group consisted of 210 consecutive healthy patients, and 219 young individuals comprised the control group. All the subjects filled out a questionnaire and were assessed by Self-esteem Scale and Oral Health Impact Profile validated for Chinese patients before surgery. To measure the discrepancy, the Student t test was computed. P <0.05 was considered significant. Results: In China, major motivations for orthognathic surgery are to improve facial appearance (83.33%), occlusion (50%), and self-confidence (48.1%). Females expect to improve facial appearance (83.87%), self-confidence (43.55%), and occlusion (41.94%). Males are for the improvement of facial appearance (82.56%), occlusion (63.95%), and self-confidence (54.65%). Self-esteem in the patient group is obviously lower (P < 0.01). There is a significant difference of self-esteem in female groups (P < 0.01), but none in male groups. Statistically significant differences were observed on oral health between both sexes. Conclusions: (1) Special attention should be paid on patients' ethnic, economic, cultural, and social aspects. In Chinese orthognathic patients, improving facial appearance is the primary motivation. Self-confidence has been more frequently mentioned, while headache far less than other countries. (2) Female patients have less self-esteem than females in the control group. (3) Patients' oral health are worse than those in the control group.
Chapter
The skin, especially the facial skin, is a powerful organ of communication and one of the most easily visible indicators of age, health, and disease, and of various socially important attributes such as social status, wealth, and sexual attractiveness [1]. The face is the part of the body invested with the greatest interpersonal meaning and is the focus of attention during communication. The aging of the facial skin secondary to both intrinsic and extrinsic factors (e.g., photodamage and smoking) and the development of hyperfunctional facial lines due to repeated expression of emotion over time can lead to aging of the appearance. Over the last several decades, the cultural and social meanings of growing old have changed and old age has started to acquire increasingly negative connotations. Often normal intrinsic aging is viewed as a medical and social problem that needs to be addressed by health-care professionals. The idea that chronological age itself does not signal the beginning of old age, and that one can get older without the signs of aging, has become increasingly prevalent, with a high value placed by the society on the maintenance of a youthful appearance [1].
The facial plastic surgeon potentially has a conflict of interest when confronted with the patients requesting surgery, due to the personal gain attainable by agreeing to perform surgery. The aim of this review is to discuss the potential harm the surgeon can inflict by carrying out facial plastic surgery, beyond the standard surgical complications of infection or bleeding. It will discuss the desire for self-improvement and perfection and increase in the prevalence facial plastic surgery. We address the principles of informed consent, beneficence and non-maleficence, as well as justice and equality and how the clinician who undertakes facial plastic surgery is at risk of breaching these principles without due care and diligence.
Article
Revision rhinoplasty is a unique challenge. In addition to the technical considerations that are inherently more difficult than primary cases, the surgeon must also be mindful of the psychological considerations that revision rhinoplasty presents. These patients are by definition unhappy with their prior rhinoplasty experience, and this perception of a suboptimal result is both legitimate and real, even if the surgeon is not in agreement. Tantamount to any intraoperative technique, the preoperative ability of the surgeon to sift through the myriad psychological and psychosocial issues is critical to achieving satisfactory outcomes for both patient and surgeon. Reasons for dissatisfaction with a primary surgery, reasons for seeking revision surgery, and the psychological profiles of revision rhinoplasty patients can be quite different from other facial cosmetic procedures. This chapter attempts to provide the reader with a better understanding of the complex interplay of these issues and, with this understanding, help the reader determine who is a favorable surgical candidate from one who is best left unrevised. © 2013 Springer-Verlag Berlin Heidelberg. All rights are reserved.
Article
Introduction: This work reviews the current state of patient-reported outcomes research in periocular cosmetic plastic surgery. Materials and Methods: A systematic review of the English-language medical literature from January 1946 through March 2013 was conducted for patient-reported outcomes measures used in periocular cosmetic plastic surgery patient populations. These measures were assessed for adherence to minimum standards recommended by the International Society for Quality of Life Research. Results: Thirteen outcome measures were identified. Upper-lid blepharoplasty was the only procedure for which an instrument, the Blepharoplasty Outcomes Evaluation, had been formally developed in the target patient group (periocular cosmetic surgery), and that met or exceeded minimum standards of reporting. Nine formally developed instruments were identified in the following applications: general facial cosmetic surgery (instruments that may be applied to periocular surgery, which are not restricted to any single facial intervention or anatomic region), chemodenervation, filler, and skin treatment. Of these, 5 instruments met minimum standards. Conclusions: Few well-developed, patient-reported outcomes measures targeted at periocular cosmetic patients exist at this time.
Chapter
For many, cosmetic surgery holds the promise that one can reshape his or her body to remove perceived defects and thus have a more perfect body. However, the decision to undergo elective cosmetic surgery is not made in a vacuum, and it is easy to overlook the full range of ethical considerations surrounding cosmetic surgery. Many medical ethicists subscribe to an ethical code that centers mainly on the relationship between the doctor and patient, with a focus on respect for autonomy, nonmaleficence, beneficence, and justice. This chapter builds on this framework by extending the scope of actors to include not only the surgeon and the patient but also the media and the overall society. To illustrate this framework, the author uses the example of actress Heidi Montag, who underwent 10 different plastic surgery procedures in one day. The chapter concludes with a discussion of potential correctives for ethical failures in each of these areas.
Article
Background and Aim: Nowadays, the tendency towards cosmetic surgery especially rhinoplasty is increasing in our society. Prediction of patients' satisfaction after surgery depends on psychological characteristics of the patients. The purpose of this study was to compare emotional intelligence, body image and quality of life between the patients seeking rhinoplasty (before surgery) and control group. Matherial and Method: The method of this study was based on ex post facto. The study sample was selected from two non-governmental plastic surgery clinics in Arak City during a six-month period (from October 2010 to April 2011). 80 patients seeking rhinoplasty were selected by simple sampling method and compared to 80 people who were accompanying these patients. These groups were matched in relation to age, sex and marital status. Each group consisted of 40 men and 40 women. Also variables of this study were measured by use of Shiring emotional intelligence Questionnaire, quality of life (sf-36) questionnaire and Multidimensional Body-Image Relations Questionnaire (MBSRQ). Data analysis was performed by t-test for the two independent groups. Results: The results showed that the scores of social skills and appearance evaluation were significantly lower and score of appearance investment was significantly higher in the patients seeking rhinoplasty in comparison to the control group. Conclusions: This study showed that patients seeking rhinoplasty had inadequate social skills, low score for appearance evaluation and high appearance investment.
Article
The outcome research, like the clinical research, examines the end results of medical interventions. However, unlike clinical research, the outcome research systematically considers outcomes from the patient's perspective. Therefore, assessments do not focus on physical data or laboratory test, but on the patient's feelings. This approach is essential in cosmetic surgery where the main outcome is psychological and subjective rather than functional. Outcome research is useful in solving the ethical problem of the risk-benefit ratio in cosmetic surgery. Parallel to its evolution and advances, it should allow a better definition of the indications for cosmetic surgery. In outcome research, the assessment may be an index of satisfaction, a scale for quality of life, or a scale for psychological evaluation. Satisfaction indexes present a great advantage related to their simplicity, but such easiness of response constitutes also a limitation. They are essentially based on visual analogue scales such as those commonly used to assess pain. Evaluation tests for quality of life assessment include in a single score several dimensions such as physical condition, and social, psychological, and emotional criteria. Specific tests take into account the pathology or the need for care as asked by the patient, such as cosmetic surgery. Generic health status tests focus on the quantification of overall quality of life independently from the patient's demand; this makes them less biased. Finally, psychological scales are the most commonly used due to the psychological aspect of a need for cosmetic surgery. They screen depression, anxiety, etc. A literature review revealed that maxillofacial surgery doesn't improve depression indexes. It improves significantly self-confidence, self-esteem, and physical self-image. Cosmetic surgery improves the results of generic or specific tests for quality of life assessment, provided these tests include some of such psychological parameters.
Chapter
One of the most difficult challenges in aesthetic surgery is dealing with the unhappy postoperative patient. Unhappy patients are unpleasant in any field of medicine. Surgeons by and large are perfectionists, deeply engaged and heavily invested in their work, and immersed in the responsibility of getting the best possible result for their patient. Therefore, we are disappointed and personally affected by any patient who is unhappy with their result. But I believe that in aesthetic surgery, the stakes are particularly high. The patient doesn’t start out with a life-threatening problem: they typically come in healthy. Their expectations are high. They have paid a lot of money out of pocket and therefore feel entitled to a good result. Therefore, when things go awry in the postoperative course, the stage is set for a very bumpy ride. The surgeon must be most masterful in order to guide the patient through this part of their journey and achieve as good a result as possible both physically and psychologically.
Chapter
A request for cosmetic procedures for aging skin is typically emotionally or psychosocially motivated as such procedures are usually life enhancing versus life saving. The primary responsibility of the clinician is to ensure that (i) he or she can accomplish what the patient desires and that (ii) the patient is satisfied with treatment outcome. Both of these points can be significantly influenced by psychosomatic factors. Overall trends indicate an increasing number of younger individuals in the 13–29 years age group, and mainly women are seeking cosmetic treatments for facial rejuvenation, especially the minimally invasive procedures. This has important implications as two-thirds of patients with body dysmorphic disorder (BDD), which is considered a contraindication for cosmetic procedures, experience symptoms prior age 18 years. In addition to BDD, younger age, male gender, minimal deformities, unrealistic expectations, and narcissistic and obsessional personality traits are some of the major negative predictors for patient satisfaction with outcome of cosmetic procedures. A slim and well-toned body is typically a feature of a youthful appearance, and in some individuals fear of aging can culminate in excessive drive for thinness and an eating disorder. Several studies suggest that patients seeking cosmetic procedures should be screened for depressive symptoms with a special focus on recent significant losses such as bereavement and divorce. A direct enquiry about abuse history can be psychiatrically destabilizing and heighten suicide risk in patients who may seek cosmetic procedures as an unconscious attempt to “fix” a body that is perceived as tainted by childhood sexual abuse.
Chapter
A request for cosmetic procedures for aging skin is typically emotionally or psychosocially motivated as such procedures are usually life enhancing versus life saving. The primary responsibility of the clinician is to ensure that (i) he or she can accomplish what the patient desires and that (ii) the patient is satisfied with treatment outcome. Both of these points can be significantly influenced by psychosomatic factors. Overall trends indicate an increasing number of younger individuals in the 13–29 years age group, and mainly women are seeking cosmetic treatments for facial rejuvenation, especially the minimally invasive procedures. This has important implications as two-thirds of patients with body dysmorphic disorder (BDD), which is considered a contraindication for cosmetic procedures, experience symptoms prior age 18 years. In addition to BDD, younger age, male gender, minimal deformities, unrealistic expectations, and narcissistic and obsessional personality traits are some of the major negative predictors for patient satisfaction with outcome of cosmetic procedures. A slim and well-toned body is typically a feature of a youthful appearance, and in some individuals fear of aging can culminate in excessive drive for thinness and an eating disorder. Several studies suggest that patients seeking cosmetic procedures should be screened for depressive symptoms with a special focus on recent significant losses such as bereavement and divorce. A direct enquiry about abuse history can be psychiatrically destabilizing and heighten suicide risk in patients who may seek cosmetic procedures as an unconscious attempt to “fix” a body that is perceived as tainted by childhood sexual abuse.
Article
Examination of the mental state of patients suffering from facial trauma is rarely ever recorded, let alone screening them for posttraumatic stress disorders (PTSDs) or generalized anxiety disorder. Providing early support to the patient in light of such psychological conditions can improve the overall quality of life. The aim of this study was to perform a literature review to assess the relation of mental state disorders to facial trauma in terms of their prevalence, assess screening methodology, and also to evaluate the prognosis of individuals subjected to psychological intervention/screening at an early stage of clinical examination. Research databases such as ScienceDirect, Google Scholar, PubMed, and Medline were searched using the keywords “psychological trauma,” “facial trauma,” and “PTSD.” Only meta-analyses, systematic reviews, and original research articles in the English language were included in the study. Correspondence to journal editors and clinician opinions were excluded from the study. Out of a total of 459 results, only 8 articles satisfied the inclusion criteria of the study. The literature review showed that patients suffering from orofacial trauma had significantly increased levels of mental state disorders such as PTSD and generalized anxiety disorder, more so in victims of assault. The results of this literature review clearly point toward an increased prevalence of mental state disorders in patients suffering from facial trauma, which warrants for early intervention in this regard to improve the quality of life of these patients.
Article
Background: Aging leads to a panoply of changes of facial morphology. The present study was conducted to analyze modifications of the facial skeleton with aging, using high-resolution imaging and comparing the same individuals at two time points. Methods: The electronic medical record system was reviewed since its inception in 2001 for patients for whom two computed tomographic scans of the midface were obtained at least 9 years apart. The computed tomographic scans were converted into three-dimensional craniofacial models for each patient, using the initial and the follow-up computed tomographic scan data. The models were used to highlight areas of bone growth and bone resorption using a color scale and to perform a cephalometric analysis. Results: Seven patients with a mean age of 61 years and computed tomographic scans on average 10.3 years apart were included. Bone resorption was consistently present (100 percent) at the pyriform aperture and the anterior wall of the maxilla. Resorption was noted at the superocentral (71 percent), inferolateral (57 percent), and superomedial (57 percent) aspects of the orbital rim. Resorption occurred earlier at the inferolateral orbital rim followed by the superomedial orbital rim in later decades of life. Paired-analysis of change in the orbital rim height and width demonstrated a mean decrease over time but was not significant. Conclusion: Bone remodeling in the same individual, over a period of 10 years, was characterized by resorption at the pyriform aperture; anterior wall of the maxilla; and superocentral, superomedial, and inferolateral aspects of the orbital rims.
Article
Introduction: Protruding ears are a very common esthetical problem, with 5% prevalence. Otoplasty is a universally accepted surgical procedure, taking into account the psychological issues related to this deformity. Materials and methods: A retrospective study of 111 children, who underwent otoplasty to correct protruding ears in a Portuguese Hospital Center, for the last 4 years, was performed. A telephonic questionnaire to assess patients satisfaction related to the procedure and its impact in quality of life was applied to the parents. Results: A population of 75 (68%) male and 36 (32%) female children was analyzed. The procedure was performed, in average, between seven and eight years of age, and 36% were operated in pre-school age. The type of otoplasty was a combined technique, with 98 bilateral cases and 13 unilateral, making a total of 209 corrective otoplasties. Complication rate was low (3.8%). The questionnaire was performed in 98 patients, with a median of 4-5 (scale 1-5) in all items evaluated, reporting an overall satisfaction and positive influence of the procedure in quality of life. Discussion and conclusion: Corrective otoplasty of protruding ears had a direct positive impact in quality of life and self-esteem in patients; this underlies the relevance of referring these children to a specialized surgical center.
Article
Objectives Facial surgery for cosmetic purposes aims to improve the physical appearance and self-image of normal individuals. The aim of the guidelines is to answer questions related to legislation, patient evaluation and motivations, relevance and risk assessment, patient information and patient follow-up. Methodology Analysis and synthesis of the medical literature through research of bibliographic databases in French and English from 2000 to 2017. Research and use of guidelines from evaluation agencies and academic societies. Drafting of guidelines with indications on levels of evidence. Results 24 guidelines with levels of evidence B (scientific presumption), C (low level of evidence) or EO (expert opinion) were selected to answer the questions. Cosmetic facial surgery must be performed by certified, qualified professionals in authorized structures. It must follow certain specific rules as well as a charter and code of ethics so as to enforce the rules of practice.
Article
Over the past 60 years, a growing body of research has investigated the psychological aspects of cosmetic surgery and related minimally-invasive treatments. While the earliest studies were influenced by psychoanalytic thinking, much of the work over the past several decades has been influenced by Thomas Cash's cognitive-behavioral theory of body image and has focused on the appearance concerns of patients who seek these procedures. The majority of individuals interested in the procedures report heightened dissatisfaction typically focused on the feature being considered for treatment. Studies from around the world also have suggested that between 5–15% of patients who present for cosmetic procedures meet diagnostic criteria for body dysmorphic disorder (BDD). While individuals with BDD typically do not report a reduction in their BDD symptoms following a cosmetic procedure, the great majority of patients without the disorder do report improvement in body image. The paper reviews this literature and also discusses the role of body image in three newer areas of plastic surgery—body contouring after massive weight loss, genital procedures (either for cosmetic purposes or as part of gender reassignment), and vascularized composite allotransplantation, including face and hand transplantation.
Chapter
This entry provides an overview of psychosocial issues related to cosmetic medical treatments, including surgical and minimally invasive procedures. It includes a discussion of psychological factors that motivate individual patients to seek treatment. Psychiatric conditions commonly seen in these patients are described. Studies that have investigated changes in psychosocial status following successful treatment are reviewed. The article highlights two newer areas of research—body contouring after massive weight loss and genital procedures. It concludes with a discussion of how mental health professionals and physicians can collaborate to identify psychologically appropriate patients and maximize the psychosocial benefits of these procedures.
Article
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The construction of a depression rating scale designed to be particularly sensitive to treatment effects is described. Ratings of 54 English and 52 Swedish patients on a 65 item comprehensive psychopathology scale were used to identify the 17 most commonly occurring symptoms in primary depressive illness in the combined sample. Ratings on these 17 items for 64 patients participating in studies of four different antidepressant drugs were used to create a depression scale consisting of the 10 items which showed the largest changes with treatment and the highest correlation to overall change. The inner-rater reliability of the new depression scale was high. Scores on the scale correlated significantly with scores on a standard rating scale for depression, the Hamilton Rating Scale (HRS), indicating its validity as a general severity estimate. Its capacity to differentiate between responders and non-responders to antidepressant treatment was better than the HRS, indicating greater sensitivity to change. The practical and ethical implications in terms of smaller sample sizes in clinical trials are discussed.
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Full-text available
Although outcome measurement in medical care has traditionally included various aspects of clinical and functional status, patient satisfaction is another important metric in the assessment of health care quality. Determining which factors contribute most to patient satisfaction can assist health care providers in improving care. In an era of diminishing resources, satisfaction ratings can further aid third-party payers in determining who provides those services. The authors used the ordinal logistic regression method to develop a predictive model for patient satisfaction in an outpatient plastic surgery clinic. Consecutive patients who attended a university outpatient plastic surgery clinic were asked to complete the Visit Specific Patient Satisfaction Questionnaire (VSQ) after their clinic visit. Type of clinic (e.g., hand clinic, aesthetic clinic, breast clinic) and demographic variables like age, gender, race, and education were added to the questionnaire to control for possible confounding effects. The authors constructed an ordinal logistic regression model using the overall visit response as the dependent variable and the eight other response categories as independent variables. A total of 345 patients completed the VSQ, which takes each patient less than 2 minutes to complete. The patient response rate was more than 95%. Statistically significant predictors included (1) personal manner of physician (odds ratio [OR], 18.0; p = 0.0002), (2) time spent with physician (OR, 4.7; p = 0.0099), (3) length of time to get an appointment (OR, 4.6; p = 0.0055), and (4) explanation of what was done (OR, 3.9; p = 0.0263). There was no statistically significant association between overall satisfaction scores and the following factors: (1) length of wait in the clinic (OR, 2.7; p = 0.0747), (2) getting through to the clinic by phone (OR, 0.71; p = 0.5439), (3) convenience of the clinic's location (OR, 2.3; p = 0.1368), and (4) technical skills of the physician (OR, 1.0; p = 0.9974). The predictive model was adjusted for possible confounding due to the type of clinic and demographic variables. In this study the most important predictors of patient satisfaction were those related to efficient clinic operation (scheduling of appointments and clinic waiting time) and the quality of the patient-physician interaction. Clinic facilities (like clinic location and ease of phone contact) were not significant predictors. Because patients often have difficulty assessing the technical skills of physicians, this variable was not a significant predictor. To improve patient satisfaction in plastic surgery outpatient clinics, efforts and resources should be directed toward expedient and empathic delivery of care.
Article
The recent emphasis on cognitive factors in the treatment of emotional problems has stimulated the development of cognitive assessment techniques. This paper presents the development and initial validation of an instrument to assess self-statements about social interactions. The 30-item questionnaire contains 15 positive (facilitative) and 15 negative (inhibitory) self-statements that were derived from subjects who listed thoughts while imagining difficult social situations. Item selection was accomplished by using judges' ratings of those thoughts. Validity studies with two samples compared scores on the self-statement measure with self-report, judges' and confederates' ratings of skill and anxiety following taped role-play and face-to-face interactions, and with questionnaire measures of social anxiety and skill. The measure appears to be a reliable, valid measure of cognitions associated with social anxiety. Research directions in cognitive assessment are suggested.
Article
The convergent and discriminant validity of the Social Interaction Self-Statement Test (SISST) were evaluated in a sample of men and women awaiting treatment for fear and avoidance of social interactions. Partial correlations revealed that negative, but not positive, self-statement scores were generally related to self-report measures of anxiety and depression. Heart rate and subjective anxiety ratings derived from a behavioral simulation of a personally relevant anxiety-provoking situation were unrelated to SISST scores. However, subjects' reports of negative thoughts obtained via the thought-listing procedure were related to the SISST negative self-statement scores, suggesting that the negative subscale of the SISST and the thought-listing procedure tap similar dimensions. Finally, the negative subscale of the SISST discriminated between social phobics whose primary fear involved social interactions and social phobics whose anxiety was confined to public-speaking situations. The findings support the use of the SISST with clinically socially anxious patients.
Article
The construction of a depression rating scale designed to be particularly sensitive to treatment effects is described. Ratings of 54 English and 52 Swedish patients on a 65 item comprehensive psychopathology scale were used to identify the 17 most commonly occurring symptoms in primary depressive illness in the combined sample. Ratings on these 17 items for 64 patients participating in studies of four different antidepressant drugs were used to create a depression scale consisting of the 10 items which showed the largest changes with treatment and the highest correlation to overall change. The inter-rater reliability of the new depression scale was high. Scores on the scale correlated significantly with scores on a standard rating scale for depression, the Hamilton Rating Scale (HRS), indicating its validity as a general severity estimate. Its capacity to differentiate between responders and non-responders to antidepressant treatment was better than the HRS, indicating greater sensitivity to change. The practical and ethical implications in terms of smaller sample sizes in clinical trials are discussed.
Article
292 patients with a variety of "low-priority" conditions completed the Health Measurement Questionnaire self-report instrument (HMQ) on admission for surgery, and again 6 months post-operation. Comparison of the two questionnaires permitted the change in Quality of Life (QoL) to be measured. Overall, of the respondents, 73% gained benefit from surgery in terms of improvement in QoL. The largest gains were in the breast surgery group, but there were individual patients in all groups who gained substantial improvement in QoL. The results suggest that the HMQ is a useful method of measuring benefit in patients admitted for low priority plastic surgery procedures.
Article
To assess the health related quality of life of patients before and after aesthetic surgery. A survey by questionnaire of patients before receiving surgery and 6 months after surgery. 656 patients anticipating surgery were sent a preoperative questionnaire, to which 443 replied. Subsequently 259 of these received a postoperative questionnaire, of which 198 were returned. Health status was assessed using three standardised health status instruments (The Short Form 36 Health Survey Questionnaire (SF-36), the General Health Questionnaire (GHQ-28) and the Rosenberg Self Esteem Scale. Comparisons were made between the health status of the plastic surgery patients and that of a random sample of the general population. Patients receiving breast reduction surgery experienced significant improvements on all three health status measures. Patients in all surgical groups experienced significant improvements in self-esteem. Patients receiving aesthetic surgery experience a wide range of physical, psychological and social problems. Surgery was shown be effective at addressing these problems. Health status assessment provides a valid and independent method for measuring the effects of such health care interventions.
Article
An 8-year survey of patient satisfaction in an academic aesthetic surgery clinic at the University of Toronto was carried out by means of a mailed questionnaire. A total of 265 questionnaires were mailed; 131 completed questionnaires (49.4 percent) were returned. Of these, 93.1 percent would recommend this clinic (88.1 percent in the first year of operation and 95.4 percent in the subsequent 7 years), and 92.9 percent would undergo the same procedure again, if required (88.3 percent in the first year and 95.0 percent in the next 7 years). The highest patient satisfaction (10 of 10) was seen in augmentation mammoplasty (average, 9.1); blepharoplasty (average, 9.0); rhytidectomy (average, 7.8), and rhinoplasty (average, 6.9). The results obtained compared favorably with recently published data of more experienced surgeons.
Article
The EuroQol Group first met in 1987 to test the feasibility of jointly developing a standardised non-disease-specific instrument for describing and valuing health-related quality of life. From the outset the Group has been multi-country, multi-centre, and multi-disciplinary. The EuroQol instrument is intended to complement other forms of quality of life measures, and it has been purposefully developed to generate a cardinal index of health, thus giving it considerable potential for use in economic evaluation. Considerable effort has been invested by the Group in the development and valuation aspects of health status measurement. Earlier work was reported upon in 1990; this paper is a second 'corporate' effort detailing subsequent developments. The concepts underlying the EuroQol framework are explored with particular reference to the generic nature of the instrument. The valuation task is reviewed and some evidence on the methodological requirements for measurement is presented. A number of special issues of considerable interest and concern to the Group are discussed: the modelling of data, the duration of health states and the problems surrounding the state 'dead'. An outline of some of the applications of the EuroQol instrument is presented and a brief commentary on the Group's ongoing programme of work concludes the paper.
Article
Surgery is a high-stakes stressor with possible consequences that include death, pain, disfigurement, economic losses, and alterations in social roles. Often, the most disturbing complications to surgeons and patients are psychological rather than physical. Ineffective management of psychological complications of surgery can have profound consequences, resulting in delayed recuperative times, delayed return to work, poor patient compliance, dissatisfaction with the surgical outcome, hostility toward surgeons, and anxiety. The purpose of this study was to investigate in a large randomized group of plastic surgery practices the relative incidence of negative psychological outcomes and to compare these with the incidence of adverse physical outcomes to gain a greater appreciation of the relative magnitude of each type of perioperative complication. The study design was a descriptive, correlational survey that assessed psychological complications reported by plastic surgeons. The Plastic Surgery Questionnaire was sent to 702 randomly selected board-certified plastic surgeons. The sample consisted of 281 board-certified plastic surgeons (40 percent response rate). The study instrument was found to be highly reliable, with inter-item Cronbach's alpha r = 0.85. The demographics were representative of the specialty as a whole. It was found in general that psychological complications were much more prevalent than physical problems such as hematoma or infection. Anxiety reactions were commonly encountered by 95.4 percent of surgeons; disappointment (96.8 percent), depression (95.0 percent), nonspecific physical complaints (92.2 percent), and sleep disorders (88.5 percent) were the next most commonly reported complications. Most surgeons (75.8 percent) reported that screening for depression was important, but only 18.8 percent identified screening for post-traumatic stress disorder as important, even though 86 percent had diagnosed post-traumatic stress disorder in their postoperative patients. Psychological complications occur at rates equal to or greater than those of physical complications in the plastic surgery practice. Patients who experience physical complications are much more likely to simultaneously experience psychological complications. Patients with preexisting psychological conditions are more at risk for postoperative psychological complications. Disappointment, anxiety, and depression were the most frequently seen psychological complications. Nursing personnel are perceived by plastic surgeons to have the primary role in screening patients for pertinent psychological history. Directed research should be undertaken to determine which treatment regimens are most effective in reducing preoperative psychological complications. Controlled clinical trials of pharmaceuticals and alternative therapies must be designed and carried out in a prospective manner to establish the optimum treatment for alleviation of adverse emotional consequences of surgery. The next frontier for the specialty is to actively and consciously investigate and improve our patients' emotional and psychological results from surgery.
Article
Previous studies have addressed the difficulties in training residents in aesthetic surgery. The purpose of this study is to analyze patient satisfaction with cosmetic surgery at an inner city teaching hospital as well as to evaluate referral patterns. The patients included in this study underwent aesthetic surgical procedures through the Kings County Hospital Plastic Surgery Clinic (KCHC) from January 1, 1997, to June 30, 1998. Patients were informed that the procedure would be performed by a plastic surgery resident with attending supervision. Data were obtained in a retrospective fashion using telephone surveys. Fifty-five patients participated in the study, which accounted for 68 aesthetic procedures. Sixty percent of patients considered the results of surgery as excellent or good. On a patient satisfaction scale from 0 (unhappy) to 10 (exceedingly happy), patients' self-reporting average was 6.59. This mean value may not be completely indicative of patient satisfaction. Eighty-nine percent of patients would refer a friend and 78% of patients would have the same procedure performed again. Sixty-nine percent of the patients had been referred by past KCHC patients. All of these numbers tend to convey a higher degree of patient satisfaction. The results of the study appear to convey the importance of developing residents' ability to accurately explain to patients the anticipated results of aesthetic surgery.
Article
Our purpose was to compare 3 approaches to the measurement of quality of life in patients referred for specialist care of acne. A questionnaire was sent to 130 patients referred for management of their acne. Follow-up questionnaires were sent 4 and 12 months after treatment began. The questionnaire contained a generic index measure (EuroQol EQ-5D), a generic profile measure (Short Form 36), and a disease-specific measure (Dermatology Life Quality Index). Pretreatment results for the EQ-5D were compared with normative data. The responsiveness of the EQ-5D was compared with that of the other measures. Before treatment, the sample reported substantially more pain/discomfort and anxiety/depression on the EQ-5D compared with a population sample. The disease-specific measure was more responsive to change compared with both generic measures. Our study highlights the importance of combining information from generic measures with information from instruments designed specifically for use in people with skin disease.
Article
MAIN OBJECTIVES: Cosmetic surgery raises the ethical problem of the balance of risks and benefits of an operation the benefit of which is psychological and difficult to evaluate. The aim of this study is to improve the understanding of the factors that influence an unsatisfactory outcome. In this context, we have analyzed complaints from patients the alleged damage to whom proved to be ultimately non-existent or minimal. Review of the case notes of 20 patients who had sought damages through the French judicial system for minimal or non-existent alleged damage. Data were collected in 1999. We found fifteen complaints of insufficient results, two for cause and effect relations with pathologies without any connection, and three for lack of information. 5 patients received compensation, the rest having been ruled out of court. The gender ratio (17 F/3 M), the average age (38 years old), the distribution of the operations and the socio-professional categories reflect the characteristics of a standard cosmetic surgery population. The average period of time between an operation and a complaint was 4.3 years (SD = 4.2). Among the medical histories we found two cases of depression, one treatment "for the nerves", one suicide attempt, and two cases of alcoholism without possible interpretation in the framework of this study. In six cases, the surgeon's qualification was not appropriate to the type of operation. The unprofessional conduct of colleagues had an influence on the effect of the procedure as an independent factor. These results call for more responsibility from professionals and encourage the undertaking of prospective complementary studies in order to evaluate more precisely the balance of risks and benefits.
Article
Objective: To measure cosmetic surgery patients' state of psychological vulnerability. Method: A multicentre prospective study was carried out in three hospital departments. One hundred and three patients scheduled for cosmetic surgery were examined using a structured interview and using three assessment scales: the MADRS (Montgomery and Asberg Depression Rating Scale), the SISST (Social Interaction Self Statement Test) and the EQ-5D (EuroQol) which measures quality of life. Results: The MADRS index was higher than that of the control group (p<0.01) with 20% depressive patients. SISST: the social anxiety was greater than that of the control group (p<0.001). The EQ-5D visual analogue scale average was 77.39% indicating that there was no significant difference when compared with the control group, but the descriptive EQ-5D revealed an over-representation of the anxiety/depression category (p<0.01); 50% had already taken psychotropic treatment of which 27% were an antidepressant. Conclusion: The cosmetic surgery population presents a significant state of psychological vulnerability. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.
Article
The measurement of health outcome is central to the evaluation of medical treatment and intervention. In the past, such measurement has been based on data relating to survival and life expectancy. There is now general acknowledgment that a through assessment of the benefits of health care must examine the quality of life, as well as its quantity. The Health Measurement Questionnaire (HMQ) has been developed as a way of collecting self-report information from which a disability/distress rating could be derived on the Rosser Classification of Illness States. This discussion paper provides a fuller review of the data collected as part of a general population survey in which the HMQ was used as a self-report measure of health status alongside the GHQ and the NHP. The HMQ appears to have both construct and convergent validity. It has also discriminated between groups of the population which differ in terms of health status or in the degree of psychiatric morbidity. Several factors have been shown to contribute to overall distress, particularly pain, sadness/depression and dependence on others. It is evident that there is considerable morbidity in the community. These data reinforce the need for continued measurement of health status within the general population, with the dual aim of identifying areas of need, and then monitoring improvement as services are adjusted to meet that need.
Revalidation de l’échelle de Montgomery et Asberg (MADRS) sur un groupe de 147 patients déprimés hospitalisés
  • F Peyre
  • R Martinez
  • M Calache
  • H Verdoux
  • M Bourgeois
Description d’un échantillon de 300 échelles MADRS portant sur des sujets déprimés
  • J Pellet
  • M Decrat
  • F Lang
  • L Chazot
  • P Tatu
  • Y C Blanchon
  • J M Berlier