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.
New issues
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."
Study particulars
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
post-op 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.
Results
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 may be 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."
Typical scenario
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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