Depression, anxiety and quality of life: outcome 9 months after facial cosmetic surgery.
OBJECTIVE
The request for cosmetic surgery is of a psychological nature. Very few studies have quantitatively assessed whether or not this psychological need was actually satisfied, and more precisely, which psychic components were satisfied.


METHODS
This is a multicentric, prospective cohort study. One hundred and three patients scheduled for facial cosmetic surgery from three different hospitals were examined before and after surgery using four assessment scales validated using European populations. The Montgomery and Asberg depression rating scale (MADRS) measured the existence and intensity of depression, the self-assessment test of thoughts in social interaction (SISST) measured the positive or inhibitory thoughts in the context of social relationships, and the European quality of life 5 dimensions (EQ-5D) (generic test) measured the quality of life. In addition, a semi-directive interview was specially created by our team. For statistical analysis, ANOVA and Student's t test were applied.


RESULTS
Twenty-four patients were lost to follow-up. Although the initial MADRS index was high (p<0.05), it did not change after surgery (p>0.1). SISST+ (positive thoughts): the social anxiety of the individual examined was significantly greater than that of the control group (p<0.005) and improved after surgery (p<0.01). The SISST- (inhibitory thoughts) did not change (p>0.1). The EQ-5D visual analogue scale (VAS) did not reveal any difference (p>0.1) while the descriptive EQ-5D demonstrated over-representation of anxiety/depression (p<0.01), and an improvement of this (p<0.05) postoperatively. The mean subjective satisfaction index was 8.1 (scale of 1-10) without sharing any influence of the complications suffered (65% of the patients made self-assessments).


CONCLUSIONS
The best indications for facial cosmetic surgery seem to be a lack of self-confidence associated with a desire for social interaction, and a request focused on a specific physical feature. The results presented add documentary confirmation to the impression shared by the majority of cosmetic surgeons. However, it was also confirmed that cosmetic surgery is not limited to its technical components, but remains a medical act which must consider the overall effect on the whole patient.
Meningaud
Jean-Paul
JP
Service Chirurgie Maxillo-Faciale, CHIV, Villeneuve, France. meningaud@noos.fr
Benadiba
Laurent
L
Servant
Jean-Marie
JM
Herve
Christian
C
Bertrand
Jacques-Charles
JC
Pelicier
Yves
Y
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001007:Anxiety / Q000145:classification / Q000523:psychology*; D015331:Cohort Studies; D003863:Depression / Q000145:classification / Q000523:psychology*; D004954:Esthetics; D005145:Face / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000523:psychology*; D012649:Self Concept; D012647:Self-Assessment; D013223:Statistics as Topic; D016896:Treatment Outcome