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According to the American Society for Aesthetic Plastic Surgery Between 2003 and 2004 the number of cosmetic procedures increased by 44 percent,. Plastic surgeons conducted a record 11.9 million procedures last year, including nonsurgical procedures like Botox injections and surgical procedures like breast augmentation or liposuction.
How Do Cosmetic Procedures Affect Patients Psychologically? A recent analysis was made on 37 studies of patients' psychological and psychosocial functioning before and after cosmetic surgery by social worker Roberta Honigman and psychiatrists Katharine Phillips, MD, and David Castle, MD. Their analysis suggests positive outcomes for these patients, including improvements in body image and possibly a quality-of-life boost. But the same research–published in the April 2004 issue of Plastic and Reconstructive Surgery (Vol. 113, No. 4, pages 1,229-1,237)–also found several predictors of poor outcomes, especially for those who hold unrealistic expectations or have a history of depression and anxiety. The researchers found that patients who are dissatisfied with surgery may request repeat procedures or experience depression and adjustment problems, social isolation, family problems, self-destructive behaviors and anger toward the surgeon and his or her staff.
Overall, there are more questions than answers regarding the psychological effects of cosmetic surgery: there are few longitudinal studies (studies of the same patients over a long period of time) and many contradictory findings in this type of study, researchers note. "We really need good, large prospective studies of representative samples of patients, using well-established research instruments," says Dr. David Castle, a professor and researcher at the Mental Health Research Institute of Victoria in Victoria, Australia. "While most people do well in terms of psychosocial adjustment after such procedures, some do not, and the field needs to be aware of this and to arrange screening for such individuals."
In particular, the extent to which cosmetic surgery affects patients' relationships, self-esteem and their quality of life in the long-term offers many research opportunities for psychologists, says psychologist Diana Zuckerman, PhD, president of the National Research Center for Women and Families, a think tank that focuses on health and safety issues for women, children and families. "These are fascinating issues for psychologists to look at – from the cultural phenomena to the interpersonal phenomena to the mental health and self-esteem issues," Zuckerman says.
Many psychologists agree that there is an equally pressing need for research that sheds light on plastic surgery's psychosocial effects. To help fill in the gaps, researchers suggest further studies on the following question.
Does plastic surgery make patients feel better? Studies have shown that people report increased satisfaction with the body part they had surgery on, but results are mixed on whether plastic surgery boosts their self-esteem, quality of life, self-confidence and interpersonal relationships in the long term.
However, Dr. David Castle's team found in their literature review, besides some positive outcomes, a link between plastic surgery and poor post-surgical outcomes for some patients. These negative findings were particularly prevalent for patients with a personality disorder, those who thought the surgery would save a relationship and those who held unrealistic expectations about the procedure.
Some studies have even gone as far as linking dissatisfaction with cosmetic surgery procedures to suicide. For example, in a 2001 study, the National Cancer Institute found that women with breast implants were four times more likely to commit suicide than other plastic surgery patients of the same age. Dr. Diana Zuckerman, in testimony to the Food and Drug Administration (FDA), urged the FDA to deny approval of silicone gel breast implants because of a lack of longitudinal research (repeated observation of the same patients over time) ensuring their safety. The other three studies on the topic found the suicide rate to be two to three times greater. Neither study, however, identified a causal relationship between breast implants and suicide. Some researchers speculate that some surgery recipients may hold unrealistic expectations of it or have certain personality characteristics that predispose them to suicide.
On one of Fox's reality TV makeover show, a woman who thought she looked too masculine morphed into a beauty queen after a slew of plastic surgery. The Fox show gives contestants plastic surgery and then has them compete in a beauty pageant. This and similar shows, including ABC's "Extreme Makeover" and MTV's "I Want a Famous Face," are gaining steam, but some psychologists are concerned about the psychological impact on those who undergo such drastic cosmetic surgery--and also on those who don't and may feel inadequate as a result. While such radical transformations are rare, some psychologists plan to investigate the surge in cosmetic procedures and whether these surgeries have any lasting psychological consequences.
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