Thirty-seven studies (the total number of participants is unclear), of which 11 used controls, were included in the review. The sample size ranged from 8 to 486.
Methodological problems included: small sample size; ascertainment bias; lack of reliable and valid outcome measures; short duration of follow-up; poorly defined outcome measures; and lack of control groups.
All studies of women undergoing reduction mammaplasty (6 studies, n=711) reported high rates of satisfaction (86 to 97%) with the surgical procedure. Improvements were also reported in psychological health, including enhanced body image and diminished distress. Where reported, reductions in physical symptoms associated with large breasts were also recorded. Similarly, high levels of overall satisfaction (78 to 90%) with the surgical procedure were also reported for augmentation mammaplasty (8 studies, n=769). Self-esteem, social confidence, attractiveness and satisfaction with body image were also reported to be improved.
High rates of satisfaction along with enhanced social confidence were also reported in the majority, but not all, rhinoplasty studies.
One study of face lift patients (n=71; mean age 48 years) reported high rates of satisfaction and an ‘improved sense of well-being’. However, a subsequent study of older patients (n=50; mean age 56 years) found high rates of psychological disturbance after surgery, with transient depression experienced by one third of the patients. The outcome data were limited to 6 months post-surgery so the longer-term outcomes of the patients were not reported.
Nine studies reported improvements in social functioning, relationships and general quality of life after cosmetic surgery procedures. A number of studies also reported no changes in personality profiles after surgery.
Fourteen studies specifically investigated predictors of poor outcome after surgery, but none used rigorous methods or assessed the degree of variance. However, overall, there was some agreement that the following factors were associated with a poor outcome: being male (3 studies); being younger (3 studies); history of depression or anxiety (6 studies); dysmorphophobia (1 study); narcissistic or borderline personality disorder (3 studies); belief that surgery would save a relationship or a disagreement between partners (3 studies); unrealistic expectations of surgery (3 studies); dissatisfaction with a previous surgical procedure (3 studies); and minimal deformity (1 study).