why people put themselves under the knife

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Why People Put Themselves Under the Knife: Plastic Surgery Makes People HappyMar. 11, 2013 In a long-term study, Prof. Dr. Jrgen Margraf, Alexander von Humboldt Professor forCln!al Psy!"ology and Psy!"ot"era#y at t"e $%&, nvestgated t"e #sy!"olog!al effe!ts of #last!surgery on a##roxmately ''( #atents n !oo#eraton )t" !olleagues from t"e %nversty of &asel.Patents demonstrated more en*oyment of lfe, satsfa!ton and self-esteem after t"er #"ys!ala##earan!e "ad been surg!ally altered.+"e results of t"e )orlds largest ever study on t"s ssue are re#orted by t"e resear!"ers n t"e *ournal Clinical Psychological Science.The aim of the research+"e resear!"ers examned )"et"er #atents )"o undergo #last! surgery are systemat!ally dfferent from ot"er #eo#le, )"at goalst"ey set t"emselves before t"e surgery, and )"et"er t"ey a!"eve t"ese after)ards. +"e resear!"ers !om#ared ' frst-tme surgery

#atents )t" t)o ot"er grou#s on t"e one "and )t" /0 #eo#le )"o "ad #revously )anted #last! surgery and t"en de!ded aganstt, and on t"e ot"er "and, )t" around 1((( #eo#le from t"e general #o#ulaton )"o "ave never been nterested n su!" o#eratons.+"e desre for a better a##earan!e for aest"et! reasons usually o!!urs n younger #eo#le )t" slg"tly above-average n!omes.2omen re#resent 34 5 of all #atents )"o o#t for !osmet! surgery. 6verall, t"ere )ere no sgnf!ant dfferen!es among t"e t"reegrou#s studed n terms of #sy!"olog!al and "ealt" varables, su!" as mental "ealt", lfe satsfa!ton and de#ressveness.Most patients do not expect the impossile from surgery%sng a #sy!"olog!al nstrument, t"e so-!alled 78oal Attanment 9!alng,7 t"e resear!"ers examned )"at goals t"e #atents )antedto a!"eve )t" !osmet! surgery. Alongsde o#en :uestons, ten standard goals )ere offered, also n!ludng t)o )"!" )ere !learlyunrealst! 7All my #roblems )ll be solved7 and 7Ill be a !om#letely ne) #erson.7 6nly 1/ 5 of t"e res#ondents s#e!fed t"eseunrealst! standard goals. In t"e o#en :uestons, t"e #atents ans)ered on t"e )"ole more realst!ally, ex#ressng )s"es su!" as to7feel better,7 7elmnate blems"es7 and 7develo# more self-!onfden!e.7!ong"term improvements in psychological variales after surgery+"e #sy!"ologsts tested t"e #atents before surgery, as )ell as t"ree, sx and t)elve mont"s after)ards. 6n average, t"e #art!#ants

!lamed to "ave a!"eved t"er desred goal, and to be satsfed )t" t"e results n t"e long-term. Com#ared to t"ose )"o "ad !"osennot to "ave #last! surgery, t"e #atents felt "ealt"er, )ere less anxous, "ad develo#ed more self-esteem and found t"e o#eratedbody feature n #art!ular, but also t"er body as a )"ole, more attra!tve. ;o adverse effe!ts )ere observed. +"us, t"e resear!"ers)ere able to establs" a "g" level for t"e average treatment su!!ess of t"e !osmet! surgery, also n terms of #sy!"olog!al!"ara!terst!s.

J. Margraf, A. H. Meyer, , from "tt#@@))).s!en!edaly.!om@releases@/(1>@(>@1>(>11(11/1."tm

Plast! 9urgery Doesnt &oost 9elf-Esteem

+eenage grls )"o get !osmet! surgery arent any "a##er after)ards

Publs"ed on De!ember 1(, /(1/ by+emma E"renfeldn 6#en 8ently

Four teenage daug"ter )ants a nose *ob. And lets say you !an see "er #ont"er nose snt "er best feature. +"eres no argung t"atgood loos !onfer great advantages n lfe.

Maybe "er nose loos fne to you but ts mang "er un"a##y and you )ant to gve "er a boost n a !onfden!e.

Dont !ount on t.

A ne) study see !taton belo)B seems to !onfrm t"e dea t"at at least at younger ages, #last! surgery #atents are a more troubledgrou#and t"e surgery ddnt "el#. +"s study s m#ortant be!ause t follo)ed more t"an 1,'(( teenage grls for 1> years, and t"eresear!"ers ddnt no) )"o )ould a!tually "ave surgery n t"at tme. +"e 43 grls )"o dd )ere more lely to be anxous orde#ressed and "ad a greater n!rease n t"ose sym#toms over t"e #erod t"an non-#atents. 7I t"n t"s s one of t"e best studes outt"ere,7 says Gren 9)am, an ex#ert on body mageand a #sy!"ologst at t"e %nversty of 2estmnster, =ondon. 7And t"er fndngsseem :ute !lear t"ose )"o !"ose to "ave !osmet! surgery tended to "ave a "story of #oorer mental "ealt" to begn )t", but "avng!osmet! surgery dd not result n a #ostve out!ome.7

2"atever advantages a!!rue to better loos, t"ey dont seem to mae #last! surgery #atents feel better.

6t"er resear!" "as s"o)n t"at at all ages #atents tend to be "a##y )t" t"e out!ome of t"e surgeryt"eyre more satsfed )t" t"ea##earan!e of t"e area alteredbut not any "a##er overall.

+"e most !om#re"ensve of t"ese studes follo)ed 3 )omen and t)o men for t)o years but dd not "ave a !ontrol grou#. $e!rutedfrom eg"t surg!al #ra!t!es a!ross t"e %nted 9tates, t"e #atents flled out :uestonnares #robng t"er satsfa!ton, body mage, self-esteem,and sym#toms of de#resson before !osmet! surgery and agan on four more o!!asons s#read out over t"e t)o years. Ea!"sub*e!t "ad undergone at least one of fve #o#ular #ro!edures, n!ludng breast augmentatons and r"no#lasty.

As ex#e!ted, a large ma*orty3 #er!entsad t"ey )ere et"er some)"at satsfed or extremely satsfed ea!" tme t"ey flled outt"e resear!"ers :uestonnares. In fa!t, even after t)o years, 43 #er!ent sad t"ey )ere extremely satsfed and > #er!ent t"at t"ey

)ould "ave t"e surgery agan. Patents )ere "a##er )t" t"er overall a##earan!e and re#orted fe)er negatve emotons about t nvarous stuatons u# to t)o years later.

Ho)ever, t"ey re#orted no sgnf!ant !"anges n self-esteem or n sym#toms of de#resson.

Patents )"o )ere dssatsfed )t" #revous surgeres or )"o "ave a "story of de#resson or anxety are less lely to be #leased )t"t"e out!ome. And an estmated 4 to 1' #er!ent of #last! surgery #atents "ave body dysmor#"! dsorder, an obsesson )t"nonexstent or slg"t defe!ts n a##earan!e, a!!ordng to a resear!" reve).

9oest, +lmann M von?


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areas of mental and emotonal "ealt" n adoles!ent males, re#orts t"e A#rl ssue of Plastic andReconstructive Surgery, t"e off!al med!al *ournal of t"e Amer!an 9o!ety of Plast! 9urgeonsA9P9B.Even mld gyne!omasta !an "ave adverse #sy!"olog!al effe!ts n boys, a!!ordng to t"e study by A9P9 Member 9urgeon Dr. &ranI. =abo) and !olleagues of &oston C"ldrens Hos#tal. +"ey beleve t"er fndngs "ave m#ortant m#l!atons for early nterventonand treatment, n!ludng male breast redu!ton n a##ro#rate !ases.Study Sho-s Psychological )mpact of (ynecomastia in #oys+"e resear!"ers admnstered a seres of #sy!"olog!al tests to 4 "ealt"y boys, average age 10.' years, beng evaluated forgyne!omasta. +"e results )ere !om#ared to t"ose of a grou# of boys )t"out breast enlargement.9xty-t)o #er!ent of t"e gyne!omasta #atents "ad mld to moderate breast enlargement. As n #revous studes, many of t"e boys)t" gyne!omasta )ere over)eg"t or obese 0 #er!ent, !om#ared to 1 #er!ent of t"e !om#arson grou#.

Patents )t" gyne!omasta "ad lo)er s!ores on a standard :ualty of lfe assessment, nd!atng #roblems n several areas. Even afterad*ustment for )eg"t and body mass ndex &MIB, t"e #atents "ad lo)er s!ores for general "ealt", so!al fun!tonng and mental"ealt". +"ey also "ad lo)er s!ores for #"ys!al "ealt", but t"s )as attrbuted to beng over)eg"t.&reast enlargement )as also asso!ated )t" lo)er s!ores for self-esteem. +"s, along )t" m#arment n emotonal areas of :ualty oflfe, a##eared dre!tly related to gyne!omasta, rat"er t"an beng over)eg"t.&oys )t" gyne!omasta also s!ored "g"er on a test of atttudes to)ard food and eatng. Ho)ever, t"ere )as no dfferen!e n t"e rateof !ln!al eatng dsorders bet)een grou#s.Psychosocial &ffects )ndependent of (ynecomastia Severity+"e negatve #sy!"olog!al effe!ts of gyne!omasta )ere smlar for boys at dfferent levels of severty. 7Merely "avng gyne!omasta)as suff!ent to !ause sgnf!ant def!ts n general "ealt", so!al fun!tonng, mental "ealt", self-esteem, and eatng be"avors andatttudes !om#ared )t" !ontrols,7 Dr. =abo) and !oaut"ors )rte.8yne!omasta s bengn enlargement of male glandular tssue t"at s very !ommon n adoles!ent boys. Alt"oug" breast enlargementusually resolves over tme, t"e #roblem #erssts n about eg"t #er!ent of boys. +y#!ally, boys )t" gyne!omasta )"o are over)eg"t

or obese may sm#ly be advsed to lose )eg"t.Ho)ever, losng )eg"t )ont !orre!t t"e #roblem n #atents )"o "ave true glandular enlargement, or n t"ose )t" a large amount ofex!ess sn n t"e breast area. As s"o)n by t"e ne) study, #atents )t" gyne!omasta may ex#eren!e emotonal and self-esteemssues regardless of body )eg"t or t"e severty of breast enlargement.7As a result, early nterventon and treatment for gyne!omasta may be ne!essary to m#rove t"e negatve #"ys!al and emotonalsym#toms,7 Dr. =abo) and !oaut"ors state. +"ey note t"at male breast redu!ton, #erformed by a :ualfed #last! surgeon, s ty#!allya sm#le and safe #ro!edure.It may seem self-evdent t"at breast enlargement !ould "ave a #sy!"olog!al and emotonal m#a!t on teenage boys. Ho)ever,adoles!ent gyne!omasta "as "stor!ally been regarded as a 7!osmet!7 #ro!edure, not rembursed by most nsuran!e #lans. +"eresear!"ers note t"at only >' #er!ent of adoles!ent boys undergong surgery for gyne!omasta at t"er "os#tal )ere !overed bynsuran!e, !om#ared to 3' #er!ent of grls undergong breast redu!ton.76ur results nd!ate t"at !areful and regular evaluaton for gyne!omasta may beneft adoles!ents regardless of &MI status or severtyof gyne!omasta,7 Dr. =abo) and !olleagues !on!lude. +"ey !all for furt"er studes to evaluate t"e effe!ts of male breast redu!ton,n!ludng ts m#a!t on #"ys!al and #sy!"olog!al sym#toms.Plast! and $e!onstru!tve 9urgery s #ubls"ed by =##n!ott 2llams K 2lns, #art of 2olters


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#n.lais

%iteur / $u+lisher

@i$$incott 2illiams A 2ilBins, "a.erstown, M/, ET#TS*U+S (17&) (-evue)

Psychology of Plastic Surgery&y$IC< ;A%E$+ PHDSenior !e"s #ditor

$eve)ed by Jo"n M. 8ro"ol, Psy.D. on Mar!" 1/, /(1>

Despite insurance non-coverage, aesthetic surgery is experiencing a surge of popularity across all population

segments.In addition to being an out-of-pocket expense, the surgery is unique because it is initiated by the patient and not thephysician.

A new long-term study from urope has investigated the psychological effects of plastic surgery on approximately!!" patients.

#esearchers from #uhr-$niversity %ochum, in cooperation with colleagues from the $niversity of %asel, discoveredpatients reported more en&oyment of life, satisfaction and self-esteemafter their physical appearance had been

surgically altered.

Investigators examined whether patients who undergo plastic surgery are systematically different from other people,

what goals they set themselves before the surgery, and whether they achieve these afterwards.

'he researchers compared !(( first-time surgery patients with two other groups.

'he first comparison group was composed of )*( people who had previously wanted plastic surgery and then decided

against it, while the second group consisted of +,""" people from the general population who have never beeninterested in plastic surgery.

'he desire for a better appearance for aesthetic reasons usually occurs in younger people with slightly above-averageincomes, researchers explain. omen represent percent of all patients who opt for cosmetic surgery.

/verall, investigators discovered no significant differences among the three groups studied in terms of psychological

and health variables, such as mental health, life satisfaction and depressiveness.

$sing a psychological instrument, the so-called 01oal Attainment 2caling,3 the researchers examined what goals the

patients wanted to achieve with cosmetic surgery.

Alongside open questions, ten standard goals were offered, also including two which were clearly unrealistic4 0All my

problems will be solved3 and 0I5ll be a completely new person.3/nly +) percent of the respondents specified these unrealistic standard goals. In the open questions, the patients

answered on the whole more realistically, expressing wishes such as to 0feel better,3 0eliminate blemishes3 and0develop more self-confidence.3

6sychologists tested the patients before surgery, as well as three, six and twelve months afterward.

/n average, the participants claimed to have achieved their desired goal, and to be satisfied with the results in the

long term.

7ompared to those who had chosen not to have plastic surgery, the patients felt healthier, were less anxious, had

developed more self-esteem and found the operated body feature in particular, but also their body as a whole, moreattractive.

8o adverse effects were observed. As a result of these findings, researchers report a high level of physical and

psychological success accompanies most plastic surgery.

2tudy findings are found in the &ournal Clinical Psychological Science.

2ource4 #uhr-$niversity %ochum

http://psychcentral.com/news/2013/03/12/psychology-of-plastic-surgery/52507.html

Mental health problems worsen withcosmetic surgery

July 4, 2012 - 05:00

Plastic surgery does little to alleiate mental health pro!lems. "n some cases# the new loo$ een worsenssymptoms of depression and an%iety.

Keywords: osmetics,!ealth,"sychology

#end"$%"rint

&y: 'sa( )adegaard

&irls who undergo cosmetic surgery are also more li$ely to hae sustained in'ury from cutting themseles.

(hat is the conclusion in a new study !y (ilmann on )oest and colleagues at *orwegian )ocial +esearch#who loo$ed at younger women,s mental health !efore and after plastic surgery.
http://psychcentral.com/news/2013/03/12/psychology-of-plastic-surgery/52507.htmlhttp://psychcentral.com/news/author/news-editor/http://psychcentral.com/news/author/news-editor/http://psychcentral.com/news/author/news-editor/http://psychcentral.com/lib/2006/how-to-raise-your-self-esteem/http://www.ruhr-uni-bochum.de/http://psychcentral.com/news/2013/03/12/psychology-of-plastic-surgery/52507.htmlhttp://sciencenordic.com/cosmeticshttp://sciencenordic.com/category/keywords/healthhttp://sciencenordic.com/psychologyhttp://sciencenordic.com/printmail/1301http://sciencenordic.com/printpdf/1301http://sciencenordic.com/print/1301http://sciencenordic.com/content/isak-ladegaardhttp://psychcentral.com/news/2013/03/12/psychology-of-plastic-surgery/52507.htmlhttp://psychcentral.com/news/author/news-editor/http://psychcentral.com/lib/2006/how-to-raise-your-self-esteem/http://www.ruhr-uni-bochum.de/http://psychcentral.com/news/2013/03/12/psychology-of-plastic-surgery/52507.htmlhttp://sciencenordic.com/cosmeticshttp://sciencenordic.com/category/keywords/healthhttp://sciencenordic.com/psychologyhttp://sciencenordic.com/printmail/1301http://sciencenordic.com/printpdf/1301http://sciencenordic.com/print/1301http://sciencenordic.com/content/isak-ladegaard


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!out seen percent of *orwegian women !etween the ages of 1 and 5 hae undergone cosmeticsurgery# according to )tatistics *orway.

(hey found that girls who decide to undergo cosmetic surgery are on aerage more depressed and an%iousthan those who do not. (hey are also more prone to suicide.

ental health may worsen(his is !oth !efore and after the surgery# which suggests that the plastic surgery does little to alleiatemental health pro!lems. hats more# some of the symptoms of poor mental health are on aerage eenworse after the operation.

"t seems li$e those who get cosmetic surgery hae more pro!lems than others# says ssociate Professor"ngela 4undin alem# a co-author of the study. nd after the surgeries# their symptoms of depression#an%iety# eating disorders and e%cessie alcohol consumption hae increased.

alem e%plains that these women do not hae a lower self-image than others in the 6rst place - theirdecision to undergo cosmetic surgery might !e an attempt to deal with other pro!lems they hae in theirlies.

&etting plastic surgery to improe ones appearance might seem li$e a uic$ and e8cient remedy# !ut whentheir lies fail to improe# their mental health pro!lems might worsen - perhaps !ecause of thedisappointment.

9osmetic surgery doesn,t sole all pro!lems# she says. "t,s a uic$ 6% of !ody parts they,re dissatis6edwith# !ut the eects aren,t as far-reaching as some people seem to e%pect.

comprehensie study(he study is dierent from most research on cosmetic surgery. (he researchers used data from a surey ofthousands of school children !etween the ages 12-1; years and followed them up with additional uestions#two# seen and 13 years later.

(he studys design made it possi!le to measure the respondents, mental health years !efore some of theadolescents reported to hae undergone plastic surgery. (he mental health of these women was alsoassessed after the surgery was completed.

4arger !reasts# shorter lies(he uniueness of the study ma$es it di8cult to compare with preious research# !ut there is some support

for their controersial 6ndings.

"n a 2003 study#


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he outcomes for specific procedures varied to some degree.


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!owever, all of the studies suffer from at least some methodological shortcomings, including inter alia small samplesi@e,1,41

,4$ascertainment bias e.g., samples from specialist centers, high rates of refusal to participate in some studies andno accurate assessment of those who were eligible and were approached but chose not to participate, 1,1%,4*a lac( of reliableand valid measures,1A

,1,$,4&

,4*and short duration of follow-up.$1,$=nother notable difficulty is that the psychological andpsychosocial domains of functioning investigated were often not e"plicitly stated or clearly defined, ma(ing replication ofstudies impossible. For e"ample, it is unclear what is meant by terms such as 0self-image and 0self confidence, which are

broad, vague, and lac( precise meaning. :n earlier studies especially, patients were often interviewed by psychoanalyticallytrained psychiatrists whose theoretical biases may have contributed to the high levels of psychopathology. 15

,44>linicalreports of psychopathology must be viewed with caution because uncertainties as to details of interview schedules and alac( of information regarding diagnostic criteria ma(e it difficult to (now whether patients were truly psychiatricallyunwell.4:nterview studies mostly did not specify what the patients were actually as(ed, ma(ing it difficult to interpret the

results or compare the results with those from other studies or other populations.

Cesults are sometimes confusing and contradictory) for e"ample, some studies using clinical interviews reported favorablepsychological outcomes,1%

,$1,*while others observed negative conse+uences*A,4*and others noted no change or mi"edresults.$%,45:nconsistencies in findings are also evident in more recent studies using standardi@ed tests. Eoin andCees14showed favorable psychological change, while two other studies observed no change.1,4$


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were dissatisfied or very dissatisfied with the outcome of nonpsychiatric medical or surgical interventions. :n a series of $5body dysmorphic disorder patients who had undergone cosmetic procedures, Geale54reported A percent to be dissatisfiedwith the outcome. :n a .#. study of 1 adults with body dysmorphic disorder,5*1*1 had sought and 1&% had receivednonpsychiatric treatments e.g., surgical, dermatologic for their minimal or none"istent deformity) in 5* percent of cases,these treatments led to an e"acerbation of or no change in body dysmorphic disorder symptoms. wenty-three percenthad received cosmetic surgery for the perceived deformity) the most common outcome from surgery in particular was nochange in concern with the treated body part 4 percent or in overall disorder symptoms 5 percent. #eventeenpercent reported improvement in the disorder following the surgical procedure, and $4 percent reported worsening of thedisorder. Fifty-four percent of all surgeries that patients re+uested were not received, primarily because the surgeonrefused to provide it. = later .#. study by Phillips and colleagues44

assessed the nonpsychiatric medical and surgicaltreatment sought and received by $% individuals $5& adults and *% adolescents withDiagnostic and Statistical Manual

of Mental Disorders IVbody dysmorphic disorder. reatment was sought by A.4 percent and received by AA percent ofadults. 8ermatologic treatment was most often received by 45.$ percent of adults, followed by surgery $*.$ percent.hese treatments rarely improved the symptoms of the disorder, indicating that a maority of patients with the disorder

who receive nonpsychiatric treatment tend to respond poorly. = recent survey of $A5 .#. cosmetic surgeons by the=merican #ociety for =esthetic Plastic #urgery55found a high rate of awareness of body dysmorphic disorder and areluctance to operate on these patients.


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=s part of the screening process, the surgeon should attempt to determine whether the patient has body dysmorphicdisorder.,5&

,5

,5:t should be noted that although psychiatric treatments for the disorder can be very effective, manypatients do not see( psychiatric help, instead pursuing a surgical solution for a psychological problem. :ndeed, studiesindicate that percent to 15 percent of patients see(ing cosmetic surgery have the disorder. 15,5&5$o diagnose it, oneshould in+uire as to the amount of time spent each day worrying about the appearance problem, how much distress theperceived flaw causes, and whether the concern has any behavioral conse+uences for e"ample, social avoidance. :f thepatient reports being preoccupied with the perceived appearance flaw for e"ample, thin(ing about it for at least an hour aday and if the concern causes significant distress or impairment in functioning, body dysmorphic disorder may bepresent. #imilarly, if the cosmetic surgeon perceives the patient?s problem as being much more trivial than the patientperceives it to be, this should arouse suspicion of body dysmorphic disorder. /rief +uestionnaires for the disorder have

been validated for use in psychiatric5%and dermatologicA&settings) whether these instruments have ade+uate predictive

value for the diagnosis of body dysmorphic disorder in surgical settings remains to be established.

/ecause a number of studies have identified a history of depression or an"iety or a personality disorder as predictors ofpoor surgical outcome, psychiatric history and current mental state should also be evaluated. /rief +uestionnairesdeveloped for use in primary care settings e.g., the Primary >are 7valuation of 'ental 8isorders, or PC:'7-'8 A1 may beuseful. ash F, Pru@ins(y , editors. /ody

:mages3 8evelopment, 8eviance, and >hanges. ;ew Mor(3 Euilford) 1%%&. pp. $1$*A.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R8http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R8http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R8http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R50http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R57http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R57http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R57http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R58http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R15http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R15http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R50http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R52http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R59http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R59http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R60http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R61http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R62http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R10http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R10http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/http://www.ncbi.nlm.nih.gov/pubmed/9514352http://www.ncbi.nlm.nih.gov/pubmed/10718500http://www.ncbi.nlm.nih.gov/pubmed/11786842http://www.ncbi.nlm.nih.gov/pubmed/11994621http://www.ncbi.nlm.nih.gov/pubmed/8346319http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R8http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R50http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R57http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R58http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R15http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R50http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R52http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R59http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R60http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R61http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R62http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/#R10http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1762095/http://www.ncbi.nlm.nih.gov/pubmed/9514352http://www.ncbi.nlm.nih.gov/pubmed/10718500http://www.ncbi.nlm.nih.gov/pubmed/11786842http://www.ncbi.nlm.nih.gov/pubmed/11994621http://www.ncbi.nlm.nih.gov/pubmed/8346319


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. 6engle !P. he psychology of cosmetic surgery3 astle 8J, !onigman CJ, Phillips D=. 8oes cosmetic surgery improve psychosocial well-beingN 'ed J

=ust. $&&$)1A3A&1. KP'> free articleL KPub'edL

11. #arwer 8/. he obsessive cosmetic surgery patient3 = consideration of body image dissatisfaction and body

dysmorphic disorder. Plast #urg ;urs. 1%%)131%*. KPub'edL

1$. Eroenman ;!, #auer !>. Personality characteristics of the cosmetically insatiable patient. Psychother

Psychosom. 1%*)4&3$41. KPub'edL

1*. Dnorr ;J, 7dgerton ', !oopes J7. he insatiable cosmetic surgery patient. Plast Ceconstr

#urg. 1%A)4&3$5. KPub'edL

14. Eoin 'D, Cees 8. = prospective study of patients? psychological reactions to rhinoplasty. =nn Plast

#urg. 1%%1)$3$1&. KPub'edL

15. #arwer 8/, 6adden =, Pertschu( 'J, 6hita(er 9=. he psychology of cosmetic surgery3 = review and

reconceptuali@ation. >lin Psychol Cev. 1%%)131. KPub'edL

1A. 7dgerton ', Jacobson 67, 'eyer 7. #urgical-psychiatric study of patients see(ing plastic cosmetic surgery3 ;inety-

eight consecutive patients with minimal deformity./r J Plast #urg. 1%A&)1*31*A. KPub'edL

1. Dnorr ;. Feminine loss of identity in rhinoplasty. =rch free

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$5. #ha(espeare G, >ole CP. 'easuring patient-based outcomes in a plastic surgery service3 /reast reduction surgical

patients. /r J Plast #urg. 1%%)5&3$4$. KPub'edL

$A. #chnur P9, #chnur 8P, Petty P', !anson J, 6eaver =9. Ceduction mammaplasty3 =n outcome study. Plast Ceconstr

#urg. 1%%)1&&35. KPub'edL

$. Dilman PC, #attler J:, aylor J. he impact of augmentation mammaplasty3 = follow-up study. Plast Ceconstr

#urg. 1%)&3*4. KPub'edL

$. #hipley C!,


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*1. 7rcolani ', /aldaro /, Cossi ;, rombini 7, rombini E. #hort term outcome of rhinoplasty for medical or cosmetic

outcome. J Psychosom Ces. 1%%%)43$. KPub'edL

*$. 7ysenc( !J. he 'audsley Personality :nventory. 9ondon3 niversity of 9ondon Press) 1%5%.

**. ;apoleon =. he presentation of personalities in plastic surgery. =nn Plast #urg.1%%*)*131%*. KPub'edL

*4. #lator C, !arris 89. =re rhinoplasty patients potentially madN /r J Plast #urg.1%%$)453*&. KPub'edL

*5. Euyuron /, /o(hari F. Patient satisfaction following rhinoplasty. =esthetic Plast #urg. 1%%A)$&315*. KPub'edL

*A. 'eyer 7, Jacobson 67, 7dgerton ', >anter =. 'otivational patterns in patients see(ing elective plasticsurgery. Psychosom 'ed. 1%A&)$$31%*.

*. Cobin ==, >opas J/, Jac( =/, Daeser =>, homas PJ. Ceshaping the psyche3 he concurrent improvement in

appearance and mental state after rhinoplasty. /r J Psychiatry. 1%)15$35*%. KPub'edL

*. 7dgerton ', 'eyer 7, Jacobson 67. =ugmentation mammaplasty 113 Further surgical and psychiatric

evaluation. Plast Ceconstr #urg. 1%A1)$3$%. KPub'edL

*%. /eale #, !ambert E, 9isper !, , Fit@patric( C, Eoodacre . Patients? health related +uality of life before and after aesthetic

surgery. /r J Plast #urg. 1%%A)4%34**. KPub'edL

4. Fu(uda


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5. #arwer 8/, Pertschu( 'J. >osmetic surgery. :n3 Dornstein #E, >layton =!, editors.e"tboo( of 6omen?s 'ental

!ealth. ;ew Mor(3 Euildford) $&&$.

5. Pru@ins(y . >osmetic plastic surgery and body image3 >ritical factors in patient assessment. :n3 hompson JD,

editor. /ody :mage, 7ating 8isorders and .3 =P= Press) 1%%A. pp. 1&%1$.

5%. Phillips D=, =tala D8, Pope !E. 8iagnostic instruments for body dysmorphic disorder. ;ew Cesearch Program and

=bstracts3 Proceedings of the =merican Psychiatric =ssociation 14th =nnual 'eeting.) 'iami. 'ay 1$, 1%%5) p. 15.

A&. 8ufresne CE, Phillips D=, Gittorio >>, 6il(el >#. = screening +uestionnaire for body dysmorphic disorder in a

cosmetic dermatologic surgery practice. 8ermatol #urg.$&&1)$345. KPub'edL

A1. #pit@er C9, Droen(e D, 6illiams J/. Galidation and utility of a self-report version of PC:'7-'83 he P!H primary

care study. Primary >are 7valuation of 'ental 8isorders Patient !ealth Huestionnaire. J='=. 1%%%)$$31*. KPub'edL

A$. >astle 8J, Phillips D=. 8isordered body image in psychiatric disorders. :n3 >astle 8J, Phillips D=, editors. 8isorders of

/ody :mage. Gol. *4. !ampshire, nited Dingdom3 6rightson /iomedical) $&&$. pp. 1&11$&.

1omparison of psychological aspects and patient satisfaction follo-ingreast conserving surgery+ simple mastectomy and reast reconstruction

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+. 1arner D9. %ody image survey. Psychol Today+>> @"4 @"-(.

). 7astle DB, 6hillips CA, editors. Disorders of body image. =ampshire, $C4 rightson %iomedical, )"").

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(. 1latt %2, 2arwer D%, /F=ara D, et al. A retrospective study of changes in physical symptoms and body image

after reduction mammaplasty. Plast Reconstr Surg+>>> +"@4 *-!. 6ub9edE

!. dgerton 9', ebb G, 2laughter #, 9eter . 2urgical results and psychosocial changes following

rhytidectomy. Plast Reconstr Surg+>*( @@4 !"@-!)+. 6ub9edE

*. right 9#, right C. A psychological study of patients undergoing cosmetic surgery.Arch Otolaryngol +>!+"+4 +(!-+!+. 6ub9edE

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(4 @@!-@(*.

+". %eale 2, =ambert 1, Gisper =, et al. Augmentation mammaplasty4 the surgical and psychological effects of theoperation and prediction of the result.Ann Plast Surg+>! +(4 (@-(>@. 6ub9edE

++. =ollyman BA, Gacey B=, hitfield 6B, ilson B26. 2urgery for the psyche4 a longitudinal study of women

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group of 2wedish women.Scand J Plast Reconstr Surg+> )+4 +>>-)".

+@. #obin AA, 7opas B%, Back A%, et al. #eshaping the psyche4 the concurrent improvement in appearance andmental state after rhinoplasty.Br J Psychiatry+> +!)4 !@>-!(@. 6ub9edE

+(. Classen A, Hitpatrick #, Benkinson 7, 1oodacre '. 2hould breast reduction surgery be rationedJ A comparison ofhealth status of patients before and after treatment4 postal questionnaire survey. BMJ+>>* @+@4 (!(-

(!. 6ub9edE

+!. Classen A, Benkinson 7, Hitpatrick #, 1oodacre '. 6atientsF health related quality of life before and after aesthetic

plastic surgery. Br J Plast Surg+>>* (>4 (@@-(@. 6ub9edE

+*. 2arwer D%, adden 'A, 6ertschuk 9B, hitaker GA. 'he psychology of cosmetic surgery4 a review and

reconceptualiation. Clin Psychol Rev+>> +4 +-)). 6ub9edE

+. 6ruinsky ', dgerton 9'. %ody-image change in cosmetic plastic surgery. In4 7ash 'H, 6ruinsky ', editors. %ody

images4 development, deviance, and change. 8ew Kork4 1uildford 6ress, +>>"4 )+-)@*.

+. %eale 2, =ambert 1, Gisper =, et al. Augmentation mammaplasty4 the surgical and psychological effects of the

operation and prediction of the result.Ann Plast Surg+>! +(4 (@-(>@. 6ub9edE

+>. 6hillips CA, 9clroy 2G, Ceck 6 Br, et al. %ody dysmorphic disorder4 @" cases of imagined ugliness.Am J

Psychiatry+>>@ +!"4 @")-@".6ub9edE

)". 6hillips CA. 'he broken mirror4 understanding and treating body dysmorphic disorder. 8ew Kork4 /xford

$niversity 6ress, +>>*.)+. 2arwer D%, adden 'A, 6ertschuk 9B, et al. %ody image dissatisfaction and body dysmorphic disorder in +""

cosmetic surgery patients. Plast Reconstr Surg+>> +"+4 +*((-+*(>. 6ub9edE

)). Ishigooka B, Iwao 9, 2uuki 9, et al. Demographic features of patients seeking cosmetic surgery. Psychiatry Clin

Neurosci+>> !)4 )@-).6ub9edE

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