A Review Of Psychological Changes After Cosmetic Surgery Procedures
The study assesses the health related quality of life of 443 cosmetic surgery patients (81% female) from UK undergoing different cosmetic procedures. GHQ, SF 36 and RSE were used for assessment of psychological well being, mental health and self esteem. They were administered preoperatively and six months postoperatively. A random sample from the general population was studied using same measures. Results show moderate improvements of mental health postoperatively for all surgery types. Significant improvements were observed in self-esteem of patients undergoing breast operations, and pinnaplastys while moderate improvements were observed in rhinoplasty and abdominoplasty patients. No significant increase in psychological well being occurred except for breast reduction patients.
The study investigates changes in body image after cosmetic surgery in 45 women from USA. No control group was observed. MBSRQ and BDDE-SR were administered preoperatively and postoperatively. There were significant improvements in body image dissatisfaction with a feature altered by surgery but no significant changes in overall body image occurred despite the fact that the occurrence of negative emotional and behavioural body image experience was reduced. BDDE-SR scores were lower postoperatively than preoperatively.
Norwegian study deals with 201 patients (97% women) and investigates effects of cosmetic surgery on body image, self esteem and other psychological issues. A comparison group of 907 random women was examined. MBSRQ, RSE and SCL-25 were administered preoperatively and postoperatively. Body image improved and self esteem scores increased after surgery, however the improvements were rather small in size. Body image orientation did not change. No differences in psychological effects between different surgery types were found. Fewer psychological problems before surgery predicted greater satisfaction with the result of surgery and enhanced effects of cosmetic surgery on improvement in body image evaluation and self esteem. No influences of patient age or time of measurement on self esteem and body image were observed in the study.
In this study of 51 patients (67% female) from UK undergoing appearance enhancement procedures (PSG - plastic surgery group) the psychological impact of cosmetic surgery is evaluated with DAS24, CCEI and BDI. All were administered three times: first preoperatively (T1) and then three (T2) and twelve (T3) months postoperatively. A comparison group of 105 patients undergoing appearance non altering surgery is used (CSG - comparison surgery group). CCEI anxiety scores were higher in PSG than in CSG preoperatively and lower postoperatively. There was a reduction in depression in PSG from a mean of 7. 6 preoperatively to 5. 9 postoperatively. There were no significant differences in anxiety and depression between measurements at T2 and T3. DAS24 scores from T1 in PSG improved at T2 for breast operations and rhinoplasty patients and not for upper limb surgery patients. No significant improvement in DAS24 was noticed in the CSG. At T3 DAS24 scores of patients undergoing breast operations and rhinoplasty were maintained but improved for patients undergoing upper limb surgery. Improved DAS24 scores were postoperatively comparable to normal scores of the general population.
The study effectively explores and compares different psychological outcomes and post operative satisfaction of 142 Australian elective surgery patients undergoing different cosmetic procedures, through the use of MBSRQ, RSE, HADS, DCQ and other different satisfaction scales, all administered preoperatively and six months postoperatively. Results indicate a significant improvement in appearance evaluation and body areas satisfaction measured by the MBSRQ, and also a significant decrease in postoperative anxiety, depression and dysmorphic concern. No changes in self esteem were observed. No control group was used for the comparison of the results.
Study of 544 cosmetic surgery patients and 264 patients interested in having plastic surgery from Germany focuses on examining the characteristics and goals of plastic surgery patients and compares them to population comparisons. Many different psychological screenings such as RSE and some others were made preoperatively and three, six and twelve months postoperatively. Improvements in self esteem, well being, quality of life and measures of psychopathology such as anxiety and dysmorphia were observed. Improvements in depression and social phobias were nonsignificant. The surgery group did not experience any negative psychological effects. Body image investment was decreased for the same group.
The study of 85 Italian patients (91% women) undergoing cosmetic surgery explores the effects of cosmetic surgery procedures on psychosocial well being and body image by using BUT and PGWB-S, both administered preoperatively and postoperatively and the GBI administered postoperatively. Results show: that the existence of a body image disorder affects the outcome of the cosmetic intervention, that body image disorders tend to show also postoperatively, that cosmetic surgery does not substantially modify alterations of body representations and that the post operative satisfaction depends on severity of the GSI (higer GSI -lower satisfaction). There was no control group.
Study follows changes in self esteem, self concept and identity status of 46 patients from Iran undergoing different cosmetic procedures, with the use of different scales, such as the EOM-EIS-2, CSEI and RSCS. The results show that self-esteem of respondents increased significantly postoperatively but there were no significant differences in self-conceptualisation except with facial cosmetic surgery patients where it significantly increased. In addition the patients suffering from identity moratorium reported a significant decrease in self-esteem postoperatively and the self-conceptualisation of patients with identity diffusion postoperatively decreased as well.
Study of 90 German rhinoplasty patients uses many different screening measures such as the GBI, RSE, FLZM and others for examination of the influences of rhinoplasty on quality of life, self esteem and some other factors. Increased GBI results postoperatively indicate improved quality of life. Significant improvements were also observed in relationship/sexuality part of the FLZM. RSE scores indicated high self esteem postoperatively in comparison with normal data of german population and have significantly improved after surgery.
Discussion
The studies collected provide ample evidence that cosmetic surgery procedures have at least some psychological effects. However the same studies show that these effects are more significant on some psychological aspects than others. A great advantage of all the studies collected is that they use standardised measurement scales with good psychometric properties, internal and construct validity and test retest reliability. In addition the studies originate from many different countries around the world. However some setbacks are still present, namely there are issues with how representative the samples are as they mostly or in some studies completely consist of females. The age of participants is not observed in most studies, except in Von Soest et al. Therefore it cannot be with certainty determined whether age or gender have an influence on psychological changes after cosmetic procedures.
Effects on body image
Despite the fact that there are indications that cosmetic surgery effects body image this relationship remains to some extent unclear. Sarwer et al. , Von Soest et al. and Di Mattei. et al have shown that body image increases after cosmetic procedures, however insignificantly. Contrary results of Dowling et al. a significant improvement in appearance evaluation. Furthermore two studies (Dowling et al. and Sarwer et al. ) show that there are significant improvements in satisfaction with specific body areas altered by surgery. Margraf et al. have suggested that body image investment decreases after surgery, meaning that the patients are less involved in their appearance. Body image and its pathologies were more thoroughly investigated by Di Mattei et al. who have found out that the presence of a body image disorder affects the outcome of the intervention itself and that the disorders also tend to show postoperatively.
Effects on self-esteem
Results on the effects of cosmetic surgery on self esteem are more uniform and conclusive than those for body image. An increase in self esteem has been observed the studies conducted by Klassen et al. , Von Soest et al. , Margraf et al. , Akhlaghi et al. and Niehaus et al. . In addition Niehaus et al. has shown by comparing the results to German norm data that after cosmetic surgery the patients have a higher self esteem than the normal German population. Klassen et al. observed differences between different procedures as the self-esteem of patients undergoing breast operations, and pinnaplastys increased more than self esteem of rhinoplasty and abdominoplasty patients. However the study by Von Soest et al. suggested that these increases in self esteem are very small in size. We also have contrasting results by Dowling et al. where no improvements in self esteem have been noticed after cosmetic procedures and by Akhilagi et al. where patients with identity moratorium showed decreases in self esteem after surgery.
Effects on mental health: anxiety, depression and BDD
Studies by Moss & Harris, Dowling, et al. and Margraf et al. suggest a significant reduction in anxiety postoperatively. Moss & Harris and Dowling, et al. also observed a decrease in depression whereas Margraf et al. observed no significant changes in depression or any social phobias. As indicated by Župan & Ahčan retrospective studies often show a common bad outcome of plastic surgery procedures for patients with diagnosed BDD, but not for those with slight indications of it. Supportingly Sarwer et al. have observed that BDDE-SR scores were lower postoperatively than preoperatively. Nevertheless as indicated by Margraf et al. BDD is when diagnosed usually a contraindication for aesthetic surgery.
Effects on psychological wellbeing and overall quality of life.
Moss & Harris found that negative emotional and behavioural consequences of appearance self-consciousness are less frequent and less important. Dowling et al. discovered a decrease in dysmorphic concerns.
Stating with certainty whether aesthetic procedures have an impact on quality of life is largely reliant on how we define the term it self. If we say that a subject has a higher quality of life when he doesn't suffer from mental issues, low self esteem, body image etc. than we can with previously mentioned evidence with some confidence conclude that cosmetic surgery procedures increase the overall life quality of individuals which undergo them.
Conclusion
The goal of my research was to investigate whether cosmetic surgical procedures affect an individuals body image, self esteem, state of body dysmorphic disorder, depression, anxiety and overall quality of life. By closely examining the collected studies I have established firstly that cosmetic surgery does not significantly increase overall body image. However it tends to increase satisfaction with a specific body area and decrease body image investment. Secondly, that cosmetic surgery patients which, do not have any serious psychological issues (identity moratorium) undergoing cosmetic procedures tend to experience an improvement in self esteem, however one study has not observed this improvement. Postoperatively patients even tend to have higher self esteem than the average population as shown by Niehaus et al. Thirdly, I found that there are some indications that cosmetic surgery has a positive effect on anxiety and depression, however evidence that it has no effect on depression and social phobias can be found. And lastly that cosmetic surgery can have positive effects on indications on BDD when there are slight indications of it but does not improve the state of BDD when it diagonsed but can make it worse as the presence of this condition can negatively affect the outcome of the surgery, namely patients tend to be less satisfied with the result thus feeling less satisfied with their appearance.
Interestingly more psychological problems preoperatively positively correlate with less positive or negative surgery outcomes. Studies originate from different cultures all around the world therefore it might be possible, if larger samples were observed or if more studies were reviewed, to find out whether culture plays a role in determining these effects. So far with the data I have gathered it is difficult to come to a conclusion about this. The results gathered are to some extent limited as the samples studied were not very large and mostly consist of females It would be very feasible to investigate what role gender and age play in this. Some differences between different cosmetic procedures were observed however only in one study. Other studies did not focus on this topic. It would surely be interesting to see whether different procedures produce different effects.
As I continued investigating after I have explored the effects in the way that I have I read about a more objective way of combining results of different scientific studies called the meta analysis. Using this technique I would surely improve the reliability of my conclusions. Also it would be interesting to compare the conclusions I have made to those which I would have made when using the meta analysis technique.
To summarise, I have with my investigation shown that cosmetic surgical procedures have an effect on different psychological aspects mentioned. However these effects may substantially vary in size and can also be in some cases negative. Nevertheless cosmetic surgery and psychology stay tightly interrelated on many different levels which still offer much room for investigation.
