A new study indicates that patients experience improved body image after undergoing common cosmetic surgery procedures, but the research did not suggest that participants experience decreased depressive symptoms or improvements in their body image-related quality of life.
Up to 12 months post-surgery, the 72 women in the study reported satisfaction with their outcomes, improvements in their overall appearance and improvements from specific changes from plastic surgery--as well as improvements in overall body image. They also reported a reduction in their degree of dissatisfaction with the features altered by surgery and in their frequency of negative body image emotions in specific social situations.
According to lead author David B. Sarwer, Ph.D., associate professor of psychology in psychiatry and surgery at the Center for Human Appearance at the University of Pennsylvania School of Medicine, the findings indicate that people's motivations for surgery may be different than they used to be.
"My colleagues and I have speculated that the primary motivation for cosmetic procedures is body image dissatisfaction--unlike 20 and 30 years ago, when many believed that people sought plastic surgery because they were addressing some deep-seated psychologic issues," Dr. Sarwer says.
Motivation for surgery
Dr. Sarwer adds that the motivation of many patients who undergo cosmetic surgery may simply be that they do not like a specific part of their physical appearance.
"We now have a growing body of evidence that suggests that not only do patients report heightened body image dissatisfaction prior to surgery, but they also report improvements in body image after surgery," he says.
But the fact that respondents did not report an enhanced body image-related quality of life after surgery was a surprise.
"We are interested to see if we are going to replicate that finding, or if patients will report improvements in body-image quality of life two years after surgery," Dr. Sarwer says.
This study, funded by the Aesthetic Society Education and Research Foundation of the American Society for Aesthetic Plastic Surgery (ASAPS), addresses issues that previous research did not fully cover.
"A number of studies have shown high rates of patient satisfaction following cosmetic surgery. Fewer studies, however, have documented changes in psychosocial functioning in the years following surgery and (have) used reliable and valid measures of those domains," Dr. Sarwer says.
"Most of those studies also focused on a single cosmetic surgery practice. One of our goals was to conduct a study using plastic surgery practices throughout the country."
Dr. Sarwer and colleagues collaborated with eight plastic surgery practices located around the United States--including Florida, Illinois, Pennsylvania, New York, Oregon, Georgia and Missouri. They surveyed participants before surgery, at three months postop and then again at six and 12 months. Before surgery, participants answered questions about body image, depressive symptoms and self-esteem. They answered additional questions about postoperative satisfaction and self-rated attractiveness post-surgery.
The researchers focused on the five most common plastic surgery procedures: rhinoplasty, breast augmentation, liposuction, blepharoplasty and facelift.
They found that 87 percent of patients reported being satisfied with their cosmetic surgery outcomes. A year after surgery, 97 percent reported that they would recommend surgery to others and 93 percent say they would have the surgery again.
"(Patients) also reported a significant reduction of the degree of negative emotions in social situations related to their appearance," Dr. Sarwer says.
The results help to confirm the notion that patients come in for these procedures because they are unhappy with their appearance and not necessarily because of some deep-seated psychological problem, according to Dr. Sarwer.
Quality of life
The researcher says that quality of life is a multifaceted construct.
"If you think about an individual's quality of life, it is influenced by a variety of factors--physical health, family relationships, employment issues, among others. Body-image quality of life is looking at the specific and unique contribution about our beliefs about our appearance to quality of life," Dr. Sarwer says. "We found improvements in body-image quality of life, but they were not statistically significant."
Dr. Sarwer says the lack of impact on body-image quality of life could be explained in several ways. One implication of the finding is that psychosocial improvement resulting from cosmetic surgery might be limited to specific thoughts about one's appearance, and it might be unrealistic to think that most patients are going to report significant improvement in their global self-esteem or depressive symptoms.
"The clinical implications maybe that patients who are coming in assuming that by changing their appearance with cosmetic surgery they are going to experience a 'Cinderella-like' transformation in their lives might be setting themselves up for disappointment."
A typical scenario, according to Dr. Sarwer, is a woman who is unhappy with her nose and says it makes her self-conscious during business meetings and social events. Post-surgery, that woman might report far less discomfort in those kinds of social situations.
According to Louis P. Bucky, M.D., F.A.C.S., a plastic surgeon practicing in Philadelphia and an associate professor, division of plastic surgery, University of Pennsylvania School of Medicine, breast augmentation is a straightforward procedure sought by patients who desire larger breasts, are concerned about having small breasts or are uncomfortable with looking good in clothes and have a self-esteem issue. They get immediate improvement with the surgery and tend to have positive feelings, ridding themselves of their negative body image concerns.
Surgery has limits
As positive as the results were, the study also seemed to point to the limits of what cosmetic surgery can do.
The finding that patients did not have a decrease in depressive symptoms after cosmetic surgery should be the focus of additional research. However, according to Dr. Sarwer, participants in the study were not depressed prior to surgery.
Overall, Dr. Bucky says, the study confirms what many physicians have always sensed about cosmetic surgery.
"(The researchers) are giving credibility to what plastic surgeons (have known all along) and the reasons why they are in this field: Patients, after (undergoing) good, appropriate cosmetic surgery, feel good about themselves," he says.
Disclosure: This research was funded by a grant from the Aesthetic Society Education and Research Foundation.
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