Evidence-Based Dermatology
November 2013

Influence of Surgical and Minimally Invasive Facial Cosmetic Procedures on Psychosocial OutcomesA Systematic Review

Author Affiliations
  • 1Department of Medicine, University of Pennsylvania, Philadelphia
  • 2Department of Dermatology, University of Pennsylvania, Philadelphia
  • 3Department of Psychiatry, University of Pennsylvania, Philadelphia
  • 4Department of Surgery, University of Pennsylvania, Philadelphia
  • 5Edwin & Fannie Gray Hall Center for Human Appearance, University of Pennsylvania, Philadelphia
  • 6Division of Plastic Surgery, University of Pennsylvania, Philadelphia
  • 7The Value Institute, Christiana Care Health System, Newark, Delaware
  • 8Department of History and Sociology of Science and Medicine, University of Pennsylvania, Philadelphia
  • 9Division of Dermatologic Surgery, University of Pennsylvania, Philadelphia

Copyright 2013 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Dermatol. 2013;149(11):1325-1333. doi:10.1001/jamadermatol.2013.6812

Importance  Millions of surgical and minimally invasive cosmetic procedures of the face are performed each year, but objective clinical measures that evaluate surgical procedures, such as complication rates, have limited utility when applied to cosmetic procedures. While there may be subjective improvements in appearance, it is important to determine if these interventions have an impact on patients in other realms such as psychosocial functioning. This is particularly important in light of the Patient Protection and Affordable Care Act and its emphasis on patient-centered outcomes and effectiveness.

Objectives  To review the literature investigating the impact of facial cosmetic surgery and minimally invasive procedures on relevant psychological variables to guide clinical practice and set norms for clinical performance.

Evidence Review  English-language randomized clinical trials and prospective cohort studies that preoperatively and postoperatively assessed psychological variables in at least 10 patients seeking surgical or minimally invasive cosmetic procedures of the face.

Findings  Only 1 study investigating minimally invasive procedures was identified. Most studies reported modest improvement in psychosocial functioning, which included quality of life, self-esteem, and body image. Unfortunately, the overall quality of evidence is limited owing to an absence of control groups, short follow-up periods, or loss to follow-up.

Conclusions and Relevance  The current literature suggests that a number of psychosocial domains may improve following facial cosmetic surgery, although the quality of this evidence is limited (grade of recommendation 2A). Despite the dramatic rise in nonsurgical cosmetic procedures, there is a paucity of information regarding the impact of chemodenervation and soft-tissue augmentation on psychosocial functioning.