title: Negative predictors for satisfaction in patients seeking facial cosmetic surgery: a systematic review.
abstract: BACKGROUND
  Facial cosmetic surgery is becoming more popular. Patients generally indicate they are satisfied with the results. Certain patient characteristics, however, have been described as negative predictors for satisfaction. Psychopathology such as body dysmorphic disorder and personality disorders are notorious. Psychosocial and cultural factors are more difficult to distinguish. This systematic review defines the predictors, other than body dysmorphic disorder, of an unsatisfactory outcome after facial cosmetic surgery. The authors are also interested in whether valid preoperative assessment instruments are available to determine these factors.
  
  
  METHODS
  An extensive systematic PubMed/MEDLINE and Cochrane Library search was performed. In addition, relevant studies from the reference lists of the selected articles were added. There were no publication-year restrictions, and the last search was conducted on July 20, 2014. All factors described as negative predictors for patient satisfaction after facial cosmetic surgery were identified.
  
  
  RESULTS
  Twenty-seven articles were analyzed, including 11 prospective studies, two retrospective studies, one case study, eight reviews, and five expert opinions. The following factors were identified: male sex, young age, unrealistic expectations, minimal deformities, demanding patients, "surgiholics," relational or familial disturbances, an obsessive personality, and a narcissistic personality.
  
  
  CONCLUSIONS
  This review indicates the possible demographic and psychosocial predictors for an unsatisfactory outcome of facial cosmetic surgery. A brief personality assessment tool that could be used to address predictors preoperatively was not found. The authors suggest use of the Glasgow Benefit Inventory to assess patient satisfaction postoperatively. Further research is being undertaken to develop such an instrument.
authors.affiliation: Nijmegen, The Netherlands From the Department of Otorhinolaryngology, Head and Neck Surgery; and the Department of Medical Psychology, Radboud University Medical Center.
authors.forename: Jasmijn M
authors.initials: JM
authors.lastname: Herruer
authors.forename: Judith B
authors.initials: JB
authors.lastname: Prins
authors.forename: Niels
authors.initials: N
authors.lastname: van Heerbeek
authors.forename: Godelieve W J A
authors.initials: GWJA
authors.lastname: Verhage-Damen
authors.forename: Koen J A O
authors.initials: KJAO
authors.lastname: Ingels
mesh_terms: D000328:Adult; D000368:Aged; D004954:Esthetics; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D012060:Rejuvenation; D012225:Rhinoplasty / Q000379:methods* / Q000706:statistics & numerical data; D015361:Rhytidoplasty / Q000379:methods* / Q000706:statistics & numerical data; D018570:Risk Assessment; D013518:Surgery, Plastic / Q000379:methods / Q000706:statistics & numerical data