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The Desire for Cosmetic Facial Surgery may reflect a Personality Disorder

A 10/2000 study suggests that a few patients who seek facial plastic surgery have a personality disorder. Surgery may benefit some of these patients, but others remain discontented and may seek legal recourse from their surgeon.

A person's self-image plays a key role in the development of personality. Young men and women with a subjective negative impression of their self image develop defense mechanisms to cope with low esteem. Later in life, they may request cosmetic surgery to "normalize" a perceived abnormal appearance.

These patients may, in fact, not need cosmetic surgery to address patterns of behavior found in certain personality types. Following surgery, conflict may arise between patient and surgeon. The researchers contend that facial plastic surgeons may encounter this problem. Their study attempts to describe the personality disorders of patients seeking facial plastic surgery to allow the specialist to make an informed decision to treat, or not to treat.

The research was carried out by a team led by Henri Gaboriau MD, from the Department of Otolaryngology--Head and Neck Surgery, Tulane University, New Orleans, LA, and H. Devon Graham III MD, from the Alton Ochsner Medical Foundation, New Orleans, LA. The findings were presented on April 28,1999 at a meeting of the American Academy of Facial Plastic and Reconstructive Surgery.

Methodology: The researchers reviewed a wide range of retrospective and prospective studies as well as anecdotal reports. Literature included reports pertaining to plastic surgery, head and neck surgery, psychiatry and physiology (specifically addressing personality disorders, dysmorphophobia, psychological outcomes of facial plastic surgery, and psychiatry of cosmetic surgery).

Results: A review of the literature regarding patient physical self-esteem revealed the head and neck region constitutes 42 to 92 percent of cosmetic plastic surgeries with 21-32 percent correcting the nose. Preoperative assessments of patients revealed 44-50 percent with clinical depression, 70 percent with anxiety, 20 percent with substance abuse, and 23-29 percent had attempted suicide.

Further analysis of 133 patients revealed that 29 percent did not meet any criteria for personality disorders. However, 25 percent were categorized as narcissistic; 12 percent as dependant; ten percent, histrionic; nine percent were borderline; four percent were diagnosed as obsessive-compulsive; three percent were anti-social/passive-aggressive; and the remainders listed schizotypal (one and one-half percent), schizoid (one and one-half percent), avoidant (one and one-half percent) and one percent, paranoid.

Within that group of 133, post-operative patient satisfaction was found highest in avoidant personalities followed by those without a personality disorder. Narcissistic, antisocial, obsessive-compulsive, and paranoid personalities expressed low patient satisfaction scores for their surgeries.

The researchers also recommend that following pre-screening of patients, physicians might utilize different strategies when communicating with the patient with a personality disorder.*

In summary, the study reveals that plastic surgery will not replace psychiatric treatments but in carefully selected patients, may benefit their overall mental health

---American Academy of Facial Plastic and Reconstructive Surgery

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