Article "The Psychological Benefits of Cosmetic Surgery" explores how cosmetic surgery can positively impact mental health

Abstract: This review aims to explore the existing literature on the psychological effects of invasive cosmetic surgery and discuss its implications for future research and clinical practice. Articles published up until October 2021 were analyzed to address the question: "Does cosmetic surgery enhance a patient's overall psychological health?" The psychological aspects examined include body image, self-esteem, anxiety, and depression. The findings indicate that while cosmetic surgery may improve patients' body image, its impact on other key aspects of psychological well-being, such as self-esteem, anxiety, and depression, varies. Factors like preoperative mental health, education level, type of procedure, postoperative recovery time, sex, and age significantly influence the psychological outcomes after surgery. However, limitations exist, including a lack of diversity in study populations and the potential impact of body dysmorphic disorder. Overall, researchers agree that cosmetic surgery improves body image but remains divided on its effects on self-esteem, anxiety, and depression.

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Key Words: Body image, cosmetic surgery, psychological distress, anxiety, depression, self-esteem

Cosmetic surgery, often referred to as "body image surgery," primarily aims to reduce patients' dissatisfaction with their bodies, with the expectation that physical changes will lead to psychological improvement (Pruzinsky and Edgerton, 1990). Despite this common motivation, medical professionals have limited understanding of how cosmetic surgery affects patients' psychological well-being. Since the 1960s, research in cosmetic surgery psychology has shown that individuals seeking cosmetic surgery tend to have lower self-esteem and higher levels of anxiety and depression compared to those undergoing non-cosmetic or functional surgeries and the general population (Meningaud et al., 2001; Petrie and Greenleaf, 2011). As a result, psychologists and cosmetic surgeons have collaborated to investigate the potential psychological benefits of cosmetic surgery for this vulnerable group.

This review aims to assess the psychological benefits of cosmetic surgery, focusing on body image, self-esteem, anxiety, and depression. The review includes only invasive cosmetic surgeries, excluding non-invasive procedures (e.g., Botox) or reconstructive surgeries for functional purposes. While there is no universally accepted definition of invasive cosmetic surgery, this review defines it as a procedure that alters normal body features by cutting into the skin to achieve a more desirable appearance (Cousins et al., 2019; Dean et al., 2018). Conversely, non-invasive cosmetic surgery involves using energy-based devices and injectables without breaking the skin (Cousins et al., 2019).

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METHODS

A literature search was conducted using PubMed and Google Scholar with key terms related to cosmetic surgery, including postoperative outcomes, rhinoplasty, and mammoplasty, in connection with body image, self-esteem, anxiety, depression, psychological distress, and body dysmorphia. The search was limited to articles published in English up to October 2021. The review includes relevant studies that measured both preoperative and postoperative scores on body image, self-esteem, anxiety, and depression.

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Defining Psychological Outcomes of Cosmetic Surgery

Before delving into the psychological factors, it is important to understand that body image, self-esteem, anxiety, and depression are interrelated. For instance, body image heavily influences self-esteem, particularly in adolescents, though it may have a lesser impact on younger and older age groups, where self-esteem is more influenced by social roles and daily functioning (Cash and Smolak, 2011). Negative body image is also strongly associated with lower self-esteem, depression, and anxiety (Mayo Clinic, 2018). While this review discusses body image separately from other psychological factors, these elements should not be viewed in isolation. The factors influencing the decision to undergo cosmetic surgery are described below.

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Body Image

Body image is typically assessed using the Multidimensional Self-Relations Questionnaire (MBSRQ) and encompasses beliefs, thoughts, and feelings about one’s physical appearance, fitness, and health (Cingi et al., 2011).

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Self-Esteem

Self-esteem is often measured using the 10-item Rosenberg Self-Esteem Scale (RSES). Rosenberg (1965) defines self-esteem as an individual's overall evaluation of their own worth, which can be quantitatively measured (Hosogi et al., 2012).

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Depression

Depression is characterized by a persistent depressed mood and/or a loss of interest or pleasure in activities that were once enjoyable (American Psychiatric Association, 2017). Additional symptoms may include feelings of worthlessness or guilt, suicidal thoughts, difficulty concentrating, fatigue, and significant changes in weight, either loss or gain.

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Anxiety

Anxiety symptoms typically include excessive fear, worry, or nervousness; difficulty concentrating; feelings of weakness or fatigue; avoidance of anxiety triggers; increased heart rate; hyperventilation; and a sense of impending doom (Mayo Clinic, 2018).

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Body Dysmorphic Disorder

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), Body Dysmorphic Disorder (BDD) is characterized by an intense preoccupation with one or more perceived flaws in physical appearance that are either minor or not observable to others. This condition often leads to severe mental distress, anxiety, or depression related to the perceived flaw, and may result in repetitive behaviors (e.g., mirror checking, seeking reassurance) or mental preoccupations (e.g., comparing oneself to others, obsessive thoughts) focused on the perceived defect (Perrotta, 2020).

DISCUSSION

Impact of Cosmetic Surgery on Anxiety and Depression

Studies have yet to reach a consensus on the positive effects of cosmetic surgery on anxiety and depression. Interestingly, researchers who examined both mental health components found that anxiety and depression tended to change in the same direction (Murphy et al., 2009; von Soest et al., 2009; von Soest et al., 2012). This correlation may be explained by the comorbidity and interconnectedness of these conditions.

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Early research identified a significant reduction in anxiety, as measured by the anxiety subcomponent of the Derogatis Stress Profile (DSP), following surgery (Sheard et al., 1996). Similarly, rhinoplasty patients reported a notable decrease in the anxiety and depression domains of the European Quality of Life Questionnaire (EQ) (Cingi et al., 2011). Although promising, the DSP and EQ primarily measure general stress and overall quality of life, respectively, and may lack the specificity required to assess anxiety alone. Using an anxiety-specific questionnaire, further studies supported these findings, showing that rhinoplasty patients experienced both short-term (6 months) and long-term (5 years) reductions in anxiety (Ercolani et al., 1999). Additionally, a study that combined psychometric assessments with semi-structured clinical interviews found that mammoplasty patients exhibited substantial decreases in both state- and trait-anxiety (state anxiety refers to temporary changes in response to specific situations, while trait-anxiety reflects a more general tendency to experience anxiety) after breast reduction surgery (Chahraoui et al., 2006).

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Researchers have also emphasized the importance of healing time, suggesting that psychological improvements may be related to specific body areas (Moss and Harris, 2009). For example, the appearance improvements from procedures like rhinoplasty (Cingi et al., 2011; Moss and Harris, 2009; Sheard et al., 1996) and mammoplasty (Chahraoui et al., 2006) are visible within 3 months, while other surgeries, such as upper limb operations, may take longer. Nevertheless, the overall conclusion was that patients, regardless of the type of procedure, experienced reductions in depression and anxiety postoperatively. These findings were also extended to blepharoplasty and rhytidectomy patients, suggesting that anxiety and depression outcomes are not dependent on the specific type of surgery—contrary to Moss and Harris's initial speculations (2009)—but rather are linked to the patients' dissatisfaction with their body image.

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On the other hand, significant evidence suggests a lack of postoperative improvement in anxiety and depression. In a large cohort of adolescent females who underwent various cosmetic procedures, anxiety and depressive symptoms remained relatively stable before and after surgery (von Soest et al., 2012). The researchers proposed that pre-existing negative psychological states not only predicted the desire for cosmetic surgery but also appeared to worsen after the procedures. In other words, while cosmetic surgery may enhance satisfaction with specific body parts, it carries the risk of exacerbating existing mental health issues. It is noteworthy that although this particular study population tended toward higher levels of psychopathology (von Soest et al., 2012), other studies have shown that even patients with minimal or no preoperative depressive symptoms did not experience significant psychological improvement (Sarwer et al., 2008). This finding seems to contradict the idea that fewer preoperative psychological problems predict greater psychological benefits (von Soest et al., 2009). However, due to the quasi-experimental or cross-sectional nature of studies in this field, many potential moderating factors—such as family dynamics, relationships, and postsurgical complications—that could explain these outcomes remain undetected (Sarwer et al., 2008; von Soest et al., 2009; von Soest et al., 2012).

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Despite the inconclusive results, the evidence suggests that patients may not experience improvements in overall psychological well-being after surgery. Consequently, it is crucial to raise awareness and provide training for cosmetic surgeons on how to screen psychological symptoms during clinical interviews.

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Additionally, it is important to collaborate with clinical psychologists and psychiatrists in practice. Given that individuals seeking cosmetic surgery are often more psychologically vulnerable, increasing access to mental health support may have substantial benefits. Researchers are beginning to challenge the notion that cosmetic surgery only impacts physical appearance.

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The research above was partially taken from the full version of research, please find the attached link to read the full version here: https://www.researchgate.net/publication/355887704_The_Psychological_Benefits_of_Cosmetic_Surgery