SUMMARY AND COMMENT | DERMATOLOGY
January 10, 2014
Psychosocial Effects of Cosmetic Dermatology Intervention
Murad Alam, MD, MSCI Reviewing Imadojemu S et al., JAMA Dermatol 2013 Nov 149:1325
Overall, the evidence suggests that psychological well-being may improve after facial cosmetic procedures.
These authors sought to investigate the effect of facial cosmetic surgery and minimally invasive procedures on relevant psychological variables to produce findings that could guide clinical practice and set norms for clinical performance. Sobanko and colleagues conducted a systematic review of randomized, controlled trials and prospective cohort studies published in English concerning cosmetic interventions that also assessed psychological variables and included at least 10 patients. In particular, they were interested in psychosocial outcomes such as quality of life (QoL), self-esteem, and body image.
Only 16 studies satisfied the inclusion criteria, and the studies were too heterogeneous in design and outcome measures to allow quantitative pooling of data for meta-analysis. The authors therefore provide a critical analysis of the evidence for each psychosocial variable. A total of 9 facial cosmetic procedures were included in the analysis. Most studies (11 of 16) examined rhinoplasty individually or aggregated with other cosmetic procedures. Modest evidence showed improved quality of life after rhinoplasty. Significant improvement was found in some aspects of QoL during the 3 month follow-up period after botulinum toxin injection and 6 months after rhytidectomy. The authors point out the relevance of assessing satisfaction at the proper time, once swelling and other effects resolve. Overall, the evidence suggests that psychological well-being may improve after facial cosmetic procedures.
Comment
One presumed benefit of cosmetic dermatologic surgery is that it makes patients feel happier, less self-critical, and more socially confident. Although the available evidence suggests that this is the case, more research needs to be done to clarify the degree of these benefits and the precise interventions that induce such benefits. A related issue not discussed in this study is that nonmelanoma skin cancer excision and repair is rarely lifesaving but often improves facial structure and function; again, these psychological effects and potential benefits need to be further studied.
Editor Disclosures at Time of Publication
Disclosures for Murad Alam, MD, MSCI at time of publication
Grant / research support
Medicis; OptMed; Valeant
Editorial boards
Archives of Dermatology; Dermatologic Surgery; Journal of Cosmetic Dermatology; Lasers in Medical Science; Skin Therapy Letter
Leadership positions in professional societies
American Academy Of Dermatology (Chair, Health Care Finance Committee); American College of Mohs Surgery (Board of Directors); American Society for Dermatologic Surgery (Board of Directors); American Society for Lasers in Medicine and Surgery (Chair, Scientific Program)
Citation(s):
Imadojemu S et al. Influence of surgical and minimally invasive facial cosmetic procedures on psychosocial outcomes: A systematic review. JAMA Dermatol 2013 Nov; 149:1325. ( http://dx.doi.org/10.1001/jamadermatol.2013.6812 )
Do you believe that you have benefited psychologically from your procedures, Dudley? I know that you have written in other threads that you find the improvement of your acne scarring to be close to perfect. I believe you wrote 90% improvement, or somewhere around there. Correct me if I'm wrong.
I am curious to know how you have been impacted from an emotional and psychosocial standpoint since having had your procedures. Do you think they have improved your quality of life?
Thanks.
My confidence level soared to the point where I am comfortable in most situations. My improvement is really about 80%. I use confidence with the opposite sex as a determinant of my real progress. I can't get any real feedback from other guys so I rely on girls reactions.
Since it's been nearly three years since your last procedure, do you believe that the improvement level of your scarring subsided a bit? Or was the improvement at 80% right after healing from the last procedure?
What type of scarring did you have initially? It was mostly on the cheeks, correct?
It's wonderful that you describe your confidence as having "soared" after your procedures. I hope to one day be able to say that about myself. 
I am trying to factor in the element of aging. If anything I would say there has been improvement in the scars over time, but there has been accompanying aging. I am probably the oldest poster on these forums so my next step will be plastic surgery. My lack of laser activity was actually caused by increased social activity. There have been times where I have been run ragged.
I am trying to factor in the element of aging. If anything I would say there has been improvement in the scars over time, but there has been accompanying aging. I am probably the oldest poster on these forums so my next step will be plastic surgery. My lack of laser activity was actually caused by increased social activity. There have been times where I have been run ragged.
That's so great to hear.
And you think that your increased social activity is a direct result of the effects of your procedures?
Rob, negativity is a huge turn off. Being a bad boy is good, being negative is bad.
Cherry, it has definitely made a huge difference. I have a very upbeat personality and that really helps.
Having an upbeat personality certainly does help. Sometimes, I think the fact that I'm caring, friendly and still have a pretty decent social life is one of the things that carries me through the self-consciousness I continue to feel as a result of my acne scarring.
And you're right. Negativity is a turn-off!
One of my best friends is an amazingly outgoing, happy girl with acne scarring that looks similar to mine. I'd much rather hang out with her than someone with flawless skin who is a constant downer, and perpetually negative.
Do you plan on getting any more lasering in the near future, Dudley?
Also, do you believe that your dermabrasion procedure contributed to the repair of your scarring? I'm curious, because I've read that it was basically ineffective from several people on the forums who have had it.
