title: Satisfaction with facial appearance and its determinants in adults with severe congenital facial disfigurement: a case-referent study.
abstract: BACKGROUND
  Patients with severe congenital facial disfigurement have a long track record of operations and hospital visits by the time they are 18 years old. The fact that their facial deformity is congenital may have an impact on how satisfied these patients are with their appearance. This study evaluated the level of satisfaction with facial appearance of congenital and of acquired facially disfigured adults, and explored demographic, physical and psychological determinants of this satisfaction. Differences compared with non-disfigured adults were examined.
  
  
  METHODS
  Fifty-nine adults with a rare facial cleft, 59 adults with a facial deformity traumatically acquired in adulthood, and a reference group of 201 non-disfigured adults completed standardised demographic, physical and psychological questionnaires.
  
  
  RESULTS
  The congenital and acquired groups did not differ significantly in the level of satisfaction with facial appearance, but both were significantly less satisfied than the reference group. In facially disfigured adults, level of education, number of affected facial parts and facial function were determinants of the level of satisfaction. High fear of negative appearance evaluation by others (FNAE) and low self-esteem (SE) were strong psychological determinants. Although FNAE was higher in both patient groups, SE was similar in all three groups.
  
  
  CONCLUSIONS
  Satisfaction with facial appearance of individuals with a congenital or acquired facial deformity is similar and will seldom reach the level of satisfaction of non-disfigured persons. A combination of surgical correction (with attention for facial profile and restoring facial functions) and psychological help (to increase SE and lower FNAE) may improve patient satisfaction.
authors: Department of Plastic and Reconstructive Surgery, Erasmus Medical Center, Postbox 2040, 3000 CA Rotterdam, the Netherlands. s.versnel@erasmusmc.nl
authors: S L
authors: SL
authors: Versnel
authors: H J
authors: HJ
authors: Duivenvoorden
authors: J
authors: J
authors: Passchier
authors: I M J
authors: IM
authors: Mathijssen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001828:Body Image; D019465:Craniofacial Abnormalities / Q000523:psychology* / Q000601:surgery; D003430:Cross-Sectional Studies; D004522:Educational Status; D005151:Facial Injuries / Q000523:psychology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires