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The Psychological Benefits of Cosmetic Surgery
Olivia Kam, BA,* Sean Na, BA,* Michael La Sala, DO,†
Christina I. Tejeda, MD,‡and Maju Mathew Koola, MD§
Abstract: The objective of this review is to shed light on the literature regarding
the psychological impact of invasive cosmetic surgery and to discuss future im-
plications for research and clinical practice. Articles published through October
2021 were reviewed to answer the question, “Does cosmetic surgery improve a
patient's overall psychological health?”Psychological well-being was examined
through the lens of body image, self-esteem, anxiety, and depression scores.
The studiesrevealed that although cosmetic surgery seems to boostpatients' body
image, other crucial aspects of psychologicalwell-being may or may not similarly
benefit. Notably, factors such as a patient's preoperative mental status, level of ed-
ucation,type of cosmetic procedure, postoperative healing time,sex, and age play
a role in determining the direction and magnitude of psychological change after
surgery. Limitations includethe lack of diversity in study populations and the po-
tential role of body dysmorphic disorder. Overall, researchers have concluded
that cosmetic surgeryimproves body image but remain in disagreement on its ef-
fects on self-esteem, anxiety, and depression.
Key Words: Body image, cosmetic surgery, psychological distress, anxiety,
depression, self-esteem
(JNervMentDis2022;210: 479–485)
Cosmetic surgery, or “body image surgery,”primarily aims to ame-
liorate patients' body dissatisfaction, with the hope that physical
modifications will ultimately translate to psychological improvement
(Pruzinsky and Edgerton, 1990). Despite this widely held motivation
for performing these elective surgeries, medicalprofessionals have lim-
ited knowledge on the psychological effects of cosmetic surgery on pa-
tients. Since the 1960s, researchers and clinicians in the field of cosmetic
surgery psychology have indicated that those seeking cosmetic surgery
tend to experience lower levels of self-esteem and higher levels of anx-
iety and depression than noncosmetic/functional surgical candidates
and controls representing the general population (Meningaud et al.,
2001; Petrie and Greenleaf, 2011). Consequently, psychologists and
cosmetic surgeons have united to elucidate the potentially beneficial
postoperative psychological effects of cosmetic surgery in this particu-
larly vulnerable population.
The objective of this review is to investigate the benefits of cos-
metic surgery on psychological domains, including body image, self-
esteem, anxiety, and depression. Research included solely invasive
cosmetic surgery rather than noninvasive (e.g.,Botox)orreconstructive
surgeries for functional purposes. Currently, there is no ubiquitous def-
inition of an invasive cosmetic surgery; however, this critical review
will define it as a medical procedure that alters normal bodily features
by cutting into skin to attain a more desirable physical appearance
(Cousins et al., 2019; Dean etal., 2018). Noninvasive cosmetic surgery,
in contrast, will be defined as a medical procedure that encompasses
the use of a plethora of energy-based devices and injectable agents
without the traumatic breaching of skin (Cousins et al., 2019).
METHODS
A literature search was conducted in PubMed and Google
Scholar with key phrases, including, but not limited to, postoperative
cosmetic surgery, rhinoplasty, and mammoplasty as it relates to body
image, self-esteem, anxiety, depression, psychological distress, and/or
body dysmorphia. The literature search was restricted to articles pub-
lished in English from the search engine's inception to October 2021.
Relevant clinical evidences from studies that measured both preopera-
tive and postoperative scores on body image, self-esteem, anxiety,
and/or depression were included in this article.
Defining Psychological Outcomes of Cosmetic Surgery
Before defining the psychological components of focus, it is im-
portant to note that body image, self-esteem, anxiety, and depression
are intricately related. For example, body image is a large determinant
of self-esteem in the adolescent population but may be less so in youn-
ger and older age groups, as self-esteem is also largely influenced by
importance attached to social roles and daily functioning (Cash and
Smolak, 2011). Furthermore, negative body image is highly correlated
with lower self-esteem, depression, and anxiety (Mayo Clinic, 2018).
Depression and anxiety, although distinct diagnoses, are often comor-
bid and may be difficult to clinically distinguish (Aina and Susman,
2006). Hence, although this review will discuss body image separately
from the other psychological factors, they should not necessarily be
conceptualized as separate entities. The variables influencing the deci-
sion to undergo cosmetic surgery are summarized in Figure 1 and are
described below.
Body Image
Commonly evaluated by the Multidimensional Self-Relations
Questionnaire (MBSRQ), body image encompasses the beliefs,
thoughts, and feelings toward the physical self, which include physical
appearance, fitness, and health/illness (Cingi et al., 2011).
Self-Esteem
Although various definitions of self-esteem exist in the litera-
ture, studies have used the 10-item Rosenberg Self-Esteem Scale
(RSES) for assessment. According to Rosenberg (1965), self-esteem
occurs when “a special object (oneself) has a positive or negative atti-
tude that has basically the same qualities and attitude toward other ob-
jects (other than oneself)”(Hosogi et al., 2012). That is, an individual’s
self-evaluation of his/her value can be quantitatively measured.
Depression
This medical illness constitutes depressed mood and/or loss of in-
terest or pleasure in typically enjoyed activities (American Psychiatric
Association, 2017). Other symptoms include feelings of worthlessness
*Stony Brook University Renaissance School of Medicine; †Department of Psychiatry
and Behavioral Health, and ‡Department of Dermatology, Stony Brook University
Renaissance School of Medicine, Stony Brook, New York; and §Department of
Psychiatry and Behavioral Health, Cooper University Health Care, Cooper Medical
School of Rowan University, Camden, New Jersey.
Send reprint requests to Olivia Kam, BA, Stony Brook University Renaissance School
of Medicine, 101 Nicolls Rd, Stony Brook, NY 11794. E‐mail: olivia.kam@
stonybrookmedicine.edu.
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
ISSN: 002 2-3018/22/21 007–0479
DOI: 10.1097/NMD.0000000000001477
REVIEW ARTIC LE
The Journal of Nervous and Mental Disease •Volume 210, Number 7, July 2022 www.jonmd.com 479
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
or guilt, suicidal ideations, inability to think or concentrate, fatigue, and
weight loss or gain.
Anxiety
Symptoms include excessive fear, worry, or nervousness; inabil-
ity to concentrate; weakness or tiredness; avoidance of triggers; in-
creased heart rate; hyperventilation; and a sense of impending doom
(Mayo Clinic, 2018).
Body Dysmorphic Disorder
According to the Diagnostic and Statistical Manual of Mental
Disorders, 5th Edition, body dysmorphic disorder (BDD) includes
symptoms concerned with one or more physical features that are negli-
gible or not easily detectable by others; severe mental stress, anxiety, or
depressed mood concerned with the bodily area; and adoption of repet-
itive rituals (e.g., mirror checking, seeking reassurance) or mental atti-
tudes (e.g., comparison with others, obsessive thoughts) toward the
body area (Perrotta, 2020).
DISCUSSION
Effect of Cosmetic Surgery on Body Image
Researchers have generally agreed that cosmetic surgery im-
proves a patient's body image. A study using the MBSRQand BDD ex-
amination self-report to assess both overall body image and body image
specific to the site of surgery, respectively, reported significant im-
provements in patients' postoperative self-ratings of overall appearance
and attractiveness of the specific feature altered (Sarwer et al., 2008).
Evident at just 3 months after cosmetic surgery, patients experienced
a more positive body image that lasted throughout the 2 years of study.
The researchers studied a variety of procedures, including blepharo-
plasty, lipoplasty, rhytidectomy, and rhinoplasty; however, the most
common procedure among the subjects was breast augmentation
(Sarwer et al., 2008).
One possible limitation is that lumping different cosmetic sur-
gery patients into a single group distorts results and overlooks unique
features that may exist in one surgical category alone. Murphy et al.
(2009) conducted a prospective study examining body image solely
in Natrelle-filled silicone breast augmentation patients and drew the
same conclusion (Murphy et al., 2009). Their data showed significant
improvements in body image, specifically in feelings of sexual attrac-
tiveness, which remained consistent throughout the 6-year postopera-
tive period. However, they note that these data are not generalizable,
as the benefits may only pertain to specific thoughts and feelings
about breasts and not body image as a whole (Murphy et al., 2009).
Notably, one study using the breast-specific questionnaire BREAST-Q
found a significant improvement in mammoplasty patients’body image
(Alderman et al., 2016). Of the 17,899 patients enrolled, 81.1%
(n= 14,514) responded preoperatively and postoperatively. Sixteen
subjects were excluded due to unsuitability for long-term follow-up
with a final sample size of 14,448. Both implant groups experienced
better body image postoperatively. After controlling for age, body mass
index, marital status, smoking status, race, incision site, and thoughts
about suicide before baseline, silicone-filled implant patients
(n= 12,726) were found to be significantly correlated with greater
improvement in satisfaction with breast appearance compared with
FIGURE 1. Psychological aspects of cosmetic surgery. Factors that may contribute to the preoperative and postoperative psychological health of cosmetic
surgery patients.
Kam et al. The Journal of Nervous and Mental Disease •Volume 210, Number 7, July 2022
480 www.jonmd.com © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
their saline-filled counterparts (n= 1,788) at 1 and 4 years postopera-
tively (Alderman et al., 2016). A comparative study sought to address
the limitation of external validity by observing MBSRQ values among
three groups: breast reduction, liposuction and abdominoplasty, and
breast augmentation (von Soest et al., 2009). The authors similarly dis-
covered that body image improved postsurgery, with no significant dif-
ferences in effect by the procedures performed. Although they could
not extend these findings to rhinoplasty patients, a separate study con-
ducted on 225 rhinoplasty patients indicated consistently positive
changes in rhinoplasty patients (Cingi et al., 2011). In this study, sub-
jects scored higher on the MBSRQ’s appearance orientation subscale
1-year postoperation compared with preoperation, indicating an overall
enhancement in body image. Klassen et al. (2016) developed the
FAC E -Q scales. The FACE-Q scales comprise five items measuring
satisfaction with the appearance of the nose, the appearance of the
nostrils (e.g., width at the bottom, bridge,tip, shape), and the overall ap-
pearance of the face, as well as psychological and social functioning
specifically for rhinoplasty patients (Klassen et al., 2016). All 23 pa-
tients who completed the survey presurgery and 1 to 6.5 months post-
surgery experienced significant improvement in all five domains. Sim-
ilarly, upper blepharoplasty patients' postsurgical body image increased
when measured with a self-report body image questionnaire specific to
the lateral eye region of the face (Bashizadeh et al., 2018). Across the
diverse populations studied, researchers have consistently shown that
body image improvement is a common outcome of cosmetic surgery.
In contrast, experts have largely remained in disagreement on the po-
tentially ameliorative effects of cosmetic surgery on patients' self-
esteem, anxiety, and depression symptoms. A summary of the studies
reviewed in this section is provided in Table 1.
Effect of Cosmetic Surgery on Self-Esteem
Although disagreement exists, experts contend that there are
beneficial effects of cosmetic surgery on self-esteem. One of the earliest
studies to investigate self-esteem in rhinoplasty patients concluded that
nasal modification increased patients' self-esteem (Sheard et al., 1996).
Participants displayed heightened feelings of worthiness, personal com-
petence, and attractiveness within the first week after surgery. Similarly,
a recent study that compared 24 aesthetic rhinoplasty patients to 24
functional rhinoplasty patients at a tertiary care center found significant
improvement in RSES scores at 6 months postoperation in the aesthetic
rhinoplasty group (Chowdhury et al., 2021). Notably, baseline self-esteem
was significantly lower in the aesthetic rhinoplasty patients compared with
their functional surgery counterparts, which may explain the lack of
significant RSES score improvement within the functional rhinoplasty
group (Chowdhury et al., 2021). Studies have also indicated an im-
provement in self-esteem postsurgery in blepharoplasty (Viana et al.,
2010), maxillofacial (Akhlaghi et al.,2015), and mammoplasty patients
(Alderman et al., 2016). Patients benefited most if they were female
with identity diffusion (Akhlaghi et al., 2015) or had achieved higher
levels of education (Viana et al., 2010). Furthermore, patients with
BDD typically do not benefit from cosmetic surgery; that is, many ex-
perts have agreed that the degree of preoperative psychological distress
and/or psychopathology can influence the extent of the psychological
benefits of cosmetic surgery (Ercolani et al., 1999; Sarwer et al., 2008;
Viana et al., 2010; von Soest et al., 2009). This confounder could be
one reason some researchers have not witnessed postoperative psycho-
logical improvements in cosmetic patients. Most recently, a large system-
atic review and meta-analysis of 16 studies (n= 6,296) demonstrated
that cosmetic surgery could boost self-esteem (Yoon and Kim, 2020).
Although some experts have provided strong evidence for prom-
ising outcomes, others argue that there are no postoperative improve-
ments in self-esteem. Sarwer et al. (2008) and Murphy et al. (2009)
found no significant changes in RSES scores among cosmetic surgery
patients over a 2- and 6-year postoperative period (Murphy et al., 2009;
Sarwer et al., 2008). Even with a newly devised, facially specific self-
esteem questionnaire, researchers drew the same conclusion ina sample
of blepharoplasty patients (Bashizadeh et al., 2018). With conflicting
TABLE 1. Summary of Studies Examining the Impact of Cosmetic Surgery on Body Image
Study Participants Design Duration Primary Measure Outcome
Cingi et al. (2011) 100 patients Prospective,
multisite study
2 y MBSRQ-AS, BDD
Examination
Significant improvement in
appearance and body area
satisfaction at 3, 6, 12,
and 24 mo postoperatively;
significantly reduced body
dysmorphia at 3, 6, 12, and
24 mo postoperatively
Sarwer et al. (2008) 455 female breast augmentation
patients
Prospective,
multisite study
6 y Rowland's 1993 16-item
scale, Franzoi Sheild's
1984 Body Esteem Scale
Significant improvement in body
image 4 and 6 y postoperatively
Murphy et al.
(2009)
155 female cosmetic patients
(breast reduction and
augmentation, liposuction,
abdominoplasty)
Prospective study 6 mo MBSRQ Significant improvement in body
image 6 mo postoperatively
Alderman et al.
(2016)
225 rhinoplasty patients Prospective study 1 y MBSRQ, Rhinoplasty
Outcomes Evaluation
Questionnaire
Significant improvement in body
image 1 y postoperatively
von Soest et al.
(2009)
60 upper blepharoplasty
patients
Quasi-experimental
study
3 mo Body image questionnaire Significant improvement in body
image 3 mo postoperatively
Klassen et al.
(2016)
23 rhinoplasty patients Prospective study 5 y Face-Q scales Significant improvement in body
image of the nose, nostrils, and
face 1–6.5 mo postoperatively
Bashizadeh et al.
(2018)
17,899 mammoplasty patients Prospective
observational study
10 y BREAST-Q, breast
augmentation module
Significant improvement in body
image of the breasts at 1 and 4 y
postoperatively
MBSRQ-AS, Multidimensional Body-Self Relations Questionnaire–Appearance Scales.
The Journal of Nervous and Mental Disease •Volume 210, Number 7, July 2022 Benefits of Cosmetic Surgery
© 2022 Wolters Kluwer Health, Inc. All rights reserved. www.jonmd.com 481
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
opinions, more studies are warranted to define the effects of different
types of cosmetic surgery on self-esteem. A summary of studies re-
viewed is provided in Table 2.
Effect of Cosmetic Surgery on Anxiety and Depression
Studies have been unable to reach a consensus on the beneficial ef-
fects of cosmetic surgery on anxiety and depression. It is worth noting that
investigators examining both components of mental health concluded that
anxiety and depression changed in the same direction (Murphy et al., 2009;
von Soest et al., 2009; von Soest et al., 2012). This phenomenon can be
explained by their comorbidity and/or interconnectedness.
Early evidence found a significant reduction in the anxiety sub-
component of the Derogatis Stress Profile (DSP) after surgery (Sheard
et al., 1996). Similarly, patients who underwent rhinoplasty experienced
a notable decrease in the anxiety/depression domains of the European
Quality of Life Questionnaire (EQ) (Cingi et al., 2011). Although these
results are highly suggestive, the DSP and EQ primarily quantify general
stress and quality of life, respectively, and therefore do not hold high con-
struct validity when inspected under the scope of anxiety alone. Using an
anxiety-specific questionnaire, researchers further supported the above
findings, reporting that rhinoplasty patients experience both short-term
(6 months) and long-term (5 years) postoperative psychological improve-
ments exhibited by significantly decreased levels of anxiety (Ercolani
et al., 1999). Another study supplemented psychometrics with a semi-
structured clinical interview to likewise demonstrate that mammoplasty
patients experienced substantial reductions in both state- and trait-anxiety
(state anxiety measures changes induced by experimental situations,
whereas trait-anxiety assesses personality-related anxiety characteris-
tics) after breast reduction (Chahraoui et al., 2006). Interestingly, au-
thors have highlighted the importance of healing time, hypothesizing
that improvements in psychological well-being may be related to spe-
cific body parts (Moss and Harris, 2009). Although rhinoplasty
(Cingi et al., 2011; Moss and Harris, 2009; Sheard et al., 1996) and
mammoplasty (Chahraoui et al., 2006) appearance improvements are
visible by 3 months, other operations, such as upper limb surgery, take
longer. Nonetheless, they concluded that regardless of procedure type,
patients were less depressed and anxious postoperation. These findings
were also extended to include blepharoplasty and rhytidectomy patients,
suggesting that anxiety and depression are independent of the type of
operation—contrary to initial speculations of Moss and Harris (2009)
—and are a function of patient body image dissatisfaction.
On the contrary, there has been significant evidence that claims a
lack of postoperative improvements on anxiety and depression. In a
TABLE 2. Summary of Studies Examining the Impact of Cosmetic Surgery on Self-Esteem
Study Participants Design Duration Primary Measure Outcome
Sarwer et al. (2008) 155 female cosmetic patients
(breast reduction and
augmentation, liposuction,
abdominoplasty)
Prospective study 6 mo MBSRQ Significant improvement in
self-esteem 6 mo
postoperatively
Murphy et al. (2009) 53 rhinoplasty patients Prospective study 4 mo Self-Esteem Inventory,
DSP
Significant improvement in
self-regard and value of
existence 1 wk and 4 mo
postoperatively
Alderman et al. (2016) 50 lower blepharoplasty
patients
Prospective study 2 y Rosenberg Self-Esteem
Scale
Significant improvement in
self-esteem 6 mo
postoperatively
von Soest et al. (2009) 46 patients (maxillofacial) Prospective study 4 mo Coopersmith's Self-Esteem
Inventory
Significant improvement in
self-esteem 4 mo
postoperatively
Bashizadeh et al.
(2018)
100 patients Prospective, multisite
study
2 y MBSRQ-AS, BDD
Examination
No significant change in
self-esteem at 3, 6, 12,
and 24 mo postoperatively
Sheard et al. (1996) 455 female breast
augmentation patients
Prospective, multisite
study
6 y Rowland's 1993 16-item
scale, Franzoi Sheild's
1984 Body Esteem Scale
No significant change in
self-esteemat1,2,4,and6y
postoperatively
Chowdhury et al.
(2021)
24 cosmetic rhinoplasty
patients and 24 functional
rhinoplasty patients
Comparative study 1 y Rosenberg Self-Esteem
Scale
Significant improvement in
self-esteem at 6 mo
postoperation in the cosmetic
rhinoplasty patients only
Viana et al. (2010) 60 upper blepharoplasty
patients
Quasi-experimental
study
3 mo Rosenberg Self-Esteem
Scale
No significant change in
self-esteem at 3 mo
postoperatively.
Akhlaghi et al. (2015) 6296 cosmetic surgery
patients
Systematic reviewand
meta-analysis
Not applicable Rosenberg Self-Esteem
Scale, correlation
analyses
Appearance management
intention, cosmetic surgery
intention, and body
satisfaction categories
demonstrated intermediate
effect sizes
Yoon and Kim (2020) 17,899 mammoplasty
patients
Prospective
observational study
10 y BREAST-Q, breast
augmentation module
Significant improvement in
self-confidence and
self-assurance at 1 and 4 y
postoperatively
MBSRQ-AS, Multidimensional Body-Self Relations Questionnaire–Appearance Scales.
Kam et al. The Journal of Nervous and Mental Disease •Volume 210, Number 7, July 2022
482 www.jonmd.com © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
large cohort of adolescent females who underwent a variety of cosmetic
procedures, anxiety and depressive symptoms remained fairly stable
preoperatively and postoperatively (von Soest et al., 2012). These re-
searchers proposed that negative psychological states not only pre-
dicted cosmetic surgery, but also appeared to worsen postoperatively.
In other words, although cosmetic surgery may improve specific body
part satisfaction, patients run the risk of exacerbating any existing
mental health problems. It is noteworthy that although this particular
study population tended toward higher psychopathology (von Soest
et al., 2012), other studies have demonstrated that even in subjects
with initially little to no depressive symptoms, psychological well-
being did not significantly improve (Sarwer et al., 2008). This obser-
vation seems to contradict the finding that fewer preoperative psycho-
logical problems predicted greater psychological benefit (von Soest
et al., 2009). However, given the nature of the quasi-experimental
and/or cross-sectional studies in this field, many other potential mod-
erating factors—such as family factors, relationships, and postsurgical
complications—that could explain this phenomenon remain unde-
tected (Sarwer et al., 2008; von Soest et al., 2009; von Soest et al.,
2012). Nevertheless, experts have provided strong evidence for the
notion that although body image may improve after surgery, other
psychological variables do not. A summary of these studies is shown
in Table 3.
Despite the inconclusive findings so far, the evidence suggests
that patients do not benefit in measures of “psychological well-being”
postoperatively. Therefore, it is critical to not only increase awareness
and training among cosmetic surgeons on screening for psychological
symptoms during clinical interviews, but also to partner with clinical
psychologists and psychiatrists in practice. Given that patients seeking
these surgeries tend to be more psychologically vulnerable and have the
potential to greatly benefit, there may be more medical grounds to sub-
stantiate increased accessibility. Researchers have already begun to de-
bunk the idea that cosmetic surgery is merely skin deep.
Limitations
Cosmetic surgeons and psychologists are confronted with a di-
lemma of the heterogeneity of methodologies used and populations
studied, which provide extensive evidence for both sides of the debate
yet render comparability and absolute conclusions nearly impossible.
Recently, a meta-analysis on the association between cosmetic surgery
and self-esteem was performed (Yoon and Kim, 2020).
Although advances in and the diversity of psychometrics used
have greatly expanded the field of cosmetic surgery psychology, re-
searchers are still working toward devising the best means to measure
psychological changes after appearance modification. For example,
experts measured anxiety symptomatology with the DSP (Sheard
et al., 1996), Inventory for Personality and Anxiety Testing (IPAT) scale
(Ercolani et al., 1999), State-Trait Anxiety Inventory (Chahraoui et al.,
2006), Crown-Crisp Experiential Inventory Anxiety Scale (Moss and
TABLE 3. Summary of Studies Examining the Impact of Cosmetic Surgery on Anxiety and Depression
Study Participants Design Duration Primary Measure Outcome
Cingi et al. (2011) 225 rhinoplasty patients Prospective 1 y European Quality of Life
Questionnaire
Significant decrease in
discomfort and anxiety 12 to
48 mo postoperatively
Sarwer et al. (2008) 100 patients Prospective, multisite
investigation
2y MBSRQ-AS,BDD
Examination
No significant change in
depression at 3, 6, 12, and
24 mo postoperatively
Murphy et al. (2009) 455 female breast augmentation
patients
Prospective, multisite 6 y Rowland's 1993 16-item
scale, Franzoi Sheild's
1984 Body Esteem Scale
No significant change in mental
health at 1, 2, 4, and 6 y
postoperatively
von Soest et al. (2009) 155 female cosmetic patients
(breast reduction and
augmentation, liposuction,
abdominoplasty)
Preoperative and
postoperative
questionnaire
6 mo MBSRQ No significant change in
psychological problems of
anxiety or depression 6 mo
postoperatively
Sheard et al. (1996) 53 rhinoplasty patients Prospective 4 mo Self-Esteem Inventory,
DSP
Significant improvement in
self-regard and value of
existence 1 wk and 4 mo
postoperatively
Ercolani et al. (1999) 79 rhinoplasty patients Prospective 5 y IPAT scale for anxiety Significant reduction in anxiety
6 mo and 5 y postoperatively
von Soest et al. (2012) 71 female cosmetic surgery
patients (mammoplasty,
liposuction, ear operations,
rhinoplasties, birth mark
operations, ear operations, scar
corrections, blepharoplasty)
Prospective
investigation
13 mo Rosenberg Self-Esteem
Scale
Significant deterioration of
anxiety and depression
postoperatively (between T2
andT4;2to13yafterT1
initial response rate)
Chahraoui et al. (2006) 20 female breast reduction
patients
Prospective 4 mo State-Trait Anxiety
Inventory
Significant improvement in state
and trait anxiety 4 mo
postoperatively
Di Mattei et al. (2015) 85 cosmetic surgery patients
(rhinoplasty, mastoplasty,
mammoplasty,
abdominoplasty,
liposuction of thighs/hips/
legs/buttocks)
Prospective 1 y Psychological General
Well-Being Index
Significant improvement in
psychological well-being
1 y postoperatively
MBSRQ-AS, Multidimensional Body-Self Relations Questionnaire–Appearance Scales.
The Journal of Nervous and Mental Disease •Volume 210, Number 7, July 2022 Benefits of Cosmetic Surgery
© 2022 Wolters Kluwer Health, Inc. All rights reserved. www.jonmd.com 483
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Harris, 2009), EQ (Khanjani et al., 2012), Psychological General
Well-Being Test (Moss and Harris, 2009), and the Hopkins Symptom
Checklist (von Soest et al., 2009; von Soest et al., 2012). Cosmetic
surgeons and psychologists are currently formulating new question-
naires, such as the eye-specific body image and self-esteem self-report
(Bashizadeh et al., 2018) and the FACE-Q scales for rhinoplasty patients
(Klassen et al., 2016). Moreover, the association between cosmetic sur-
gery and self-esteem can be complicated by variables such as sociocul-
tural attitudes and body satisfaction (Yoon and Kim, 2020).
As this field of study has only rapidly grown in the past two de-
cades, there is not enough literature on any one cosmetic procedure to
adequately draw conclusions from cross-study comparisons. Further-
more, the majority of studies focus on breast reductions and augmenta-
tions, which are the most common procedures among women (von
Soest et al., 2009). Researchers have also not accounted for or excluded
patients based on health-related breast reductions, as health-related
mammoplasty may more closely resemble functional surgery. Similarly,
few investigators have been able to achieve within-study surgical compar-
isons, as it is often the case that group numbers reduce analytical power
(Moss and Harris, 2009; von Soest et al., 2012). Of those presented, only
the studies by von Soest et al. and Di Mattei et al. provided surgical
comparisons, albeit exclusively in a female population (Di Mattei
et al., 2015; von Soest et al., 2012). Many studies were unable to recruit
enough male participants to conduct comparisons.
Despite the increasing number of males opting for cosmetic sur-
gery across the globe, females still comprise the majority of consumers
and, consequently, are the primary target of marketing efforts in the aes-
thetic medical industry (Kain and Amar, 2020; Matera et al., 2018).
Nevertheless, the most popular cosmetic surgical procedures marketed
to men include gynecomastia reduction (58%), liposuction (17%),
blepharoplasty (13%), and facelift (10%) (Sinno et al., 2016).
It is known that body dissatisfaction, internalization of media,
and peer influence all contribute in some respect to a patient's decision
to undergo cosmetic surgery; however, there is not enough literature to
discern whether there are significant differences between sexes. The
first empirical study to investigate body dissatisfaction in male cos-
metic surgery patients found that this group did not experience any
significant difference in overall body image dissatisfaction compared
with their nonsurgical male and female cosmetic surgery counterparts,
yet both female and male subjects did have greater dissatisfaction to-
ward the specific part for which they sought surgery (Pertschuk et al.,
1998). Another study thereafter also found that males experienced
greater body image dissatisfaction toward their respective surgical
body part than did community males who never had cosmetic surgery
(Abbas and Karadavut, 2017).
According to a recent meta-analysis on sex differences in body
appreciation, males tended to have higher levels of body appreciation
than females (He et al., 2020). This marker is characterized by favorable
opinions, acceptance, and respect for one's body, including protective
cognition that rejects unrealistic body ideals. Hence, body appreciation
is a separate entity from the commonly measured body dissatisfaction,
which focuses on the negative pathologies of body image. Body appre-
ciation and dissatisfaction can be experienced concurrently; both vari-
ables are closely related to other psychological health outcomes and,
importantly, may be modified by age.
Researchers have observed that there tends to be an inverse rela-
tionship between body appreciation and age in women: As women age,
they are less likely to attach physical appearance to their self-esteem
(Cash and Smolak, 2011; He et al., 2020). Although the same could
not be said for men, it is clear that there is an association between
age, body dissatisfaction and appreciation, and incentive to seek cos-
metic surgery. Experts have noted that although adolescent females
tend to experience an increase in body dissatisfaction over time, adolescent
males experience the greatest dissatisfaction in early adolescence (Bearman
et al., 2006). Meanwhile, others have posited that body dissatisfaction in
males remains stable over time (Quittkat et al., 2019). Furthermore,
four studies have shown age to be a direct predictor of the acceptance
or pursuit of cosmetic surgery. Therefore, it may be useful to gather
more data on the interrelationship between age, sex, and body image
(positive and negative) to comprehensively convey the postoperative
psychological benefits of cosmetic surgery (Quittkat et al., 2019).
CONCLUSIONS AND FUTURE DIRECTIONS
Paralleling the increased popularity of cosmetic surgery world-
wide, the field of cosmetic surgery psychology has gained momentum
in the past couple of years. Henceforth, understanding the psychologi-
cal effects of cosmetic procedures is paramount. If clinicians possess a
greater means to predict the psychological outcomes of a surgery, they
can help patients make more informed decisions. Studies so far have
strongly supported the notion that mentally healthy patients benefit
the most from surgery (von Soest et al., 2009), whereas patients with
preexisting body image disorder or high psychological distress do not
experience similar psychological improvements postoperatively. As this
field of study has only rapidly grown in the past two decades, there is
not enoughliterature on any one cosmetic procedure toadequately draw
conclusions from cross-study comparisons. Future research that ac-
counts for the potential biases resulting from patients with eating dis-
orders and body image pathologies (e.g., BDD) will provide valuable
insight on the cosmetic patient population, as these individuals are
more likely to seek out cosmetic surgery than others (von Soest et al.,
2012; Yoon and Kim, 2020).
ACKNOWLEDGMENTS
Ms. Kam would like to extend special thanks to her colleagues, Dr. La
Sala, Dr. Tejeda, and Mr. Na, and her supervisor, Dr. Koola. Ms. Kam's
inspiration for this manuscript originated from a psychology course in
college titled, “Body Image: Etiology, Psychopathology and Treat-
ment,”taught by Dr. Leela Jackson at the University of Pennsylvania,
Philadelphia, PA.
DISCLOSURES
Ms. Kam wrote the manuscript. All authors edited with intellectual
contributions. All authors reviewed and approved the final version of
the manuscript.
The authors declare no conflict of interest.
The manuscript preparation was not funded.
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The Journal of Nervous and Mental Disease •Volume 210, Number 7, July 2022 Benefits of Cosmetic Surgery
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