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Psychological Assessment & Cosmetic (Aesthetic) Surgery

Dr Lucy Kozlowski, Clinical Psychologist

Aesthetic surgery (some times referred to as cosmetic or plastic surgery) refers to surgical procedures that change the appearance, structure, characteristics or position of parts of the body. People seek such surgery for many reasons - to improve their physical appearance, to feel better about their body image or to treat a medical condition. Whatever the reasons for undertaking aesthetic surgery, it is important for both the patient and medical team to ensure that the surgery is the right course of action at the right time and ultimately that it is in the patients best interests.

The decision to undergo aesthetic surgery is a big decision. It is rare to receive such treatment via the NHS, therefore many patients are required to self-fund the surgery. On top of the financial considerations there are also the physical considerations of undertaking a major medical procedure. Surgery places a significant toll on the body and any surgery is not without risks or uncertainty. Further, such procedures are often accompanied by pain or discomfort and require a significant period of recovery, which can bring physical and practical disruptions to daily life. 

In addition to the physical impact, there are a number of psychological issues that may occur throughout the aesthetic surgery process. Firstly, medical procedures can be daunting. Anxiety, fear, panic and stress reactions are common leading up to surgery. In our practice we have supported many people with various phobias including anaesthesia phobias, needle phobias and medical setting phobias, which have previously interfered with undertaking medical procedures and, in some cases, resulted in the cancelling of procedures altogether.

Secondly psychological and mental health issues such as depression, anxiety, low self-esteem, body image and self-identity issues are common in patients seeking aesthetic surgery. Such difficulties can be a motivating factor for the procedure, leading patients to seek surgery to improve their self-perceptions, solve life problems and enhance overall wellbeing. However, these are often unrealistic expectations of surgery and, when pursued for inappropriate reasons, can lead to dissatisfaction with outcomes and further distress.

Mental health and psychological issues are common in patients seeking aesthetic surgery and can lead to poorer outcomes such as lowered patient satisfaction with the procedure, adjustment issues and heightened distress

Linked to this, a third psychological issue that can arise following aesthetic surgery is ‘Post Surgical Dissatisfaction Syndrome’ (PSDS). Some patients find that their psychological needs have not been achieved through the physical alterations and they feel that their pre-surgery expectations do not match up with the post-operative results. Some report that that they dislike the changes despite the surgery being a success, which understandably can be very distressing. 

For some patients, whilst they may have achieved their aim of improving their physical appearance, they may not feel psychologically content with the outcome

An often unexpected side-effect of body altering procedures is that some patients report that they feel disconnected to the part of the body that has changed, that they no longer feel like themselves or that they feel they have lost connection to their family of origin - coined 'loss of identity syndrome'. We have worked with many patients who have felt very distressed about feeling as though they ‘do not belong’ any more and need to grieve the changes in their appearance.

Whilst it is common for most patients to go through some form of an adjustment process as they adapt to the changes in the body’s appearance on their sense of identity and sense of self, for the majority this is mostly a positive experience. Many patients report high levels of satisfaction with the outcomes and experience positive psychological effects including enhancements in self-esteem, body image, confidence, relationships, social functioning and general quality of life.

PSDS and adjustment issues are more likely to occur in patients who experience mental health and psychological difficulties prior to surgery, which is why psychological screening and assessment is recommended as a standard part of the aesthetic surgery consultation process by The Royal College of Surgeons. Psychological screening and assessment provides the patient with a safe and supportive space to explore the driving factors for surgery, ensuring that their motivations for, and expectations of, the procedure are realistic and reasonable. It also provides a space to consider psychological risks factors that may create barriers to pre and post surgery processes, and to to identify coping strategies, resources and support available.

Many patients referred to us often worry that a psychology referral indicates that their surgeon will refuse to undertake the procedure. This is rarely the case. Psychological assessment is most often requested to ensure that both the medical team and the patient are satisfied that surgery is in the patients best interests and that any barriers to pre and post operative processes are identified and addressed, thus ensuring maximal surgical outcomes.

Psychological assessment and support seeks to support patients to identify and remove any barriers to undertaking cosmetic surgery, ensuring maximal outcomes for patients

Assessment may aid with identifying unhelpful worry thoughts that fuel feelings of anxiety or low mood and that lead to unhelpful behaviours such as avoidance of or less effective engagement in pre-operative preparation and post-operative recovery tasks. Such thoughts, feelings and behaviours can also increase physical arousal through increased cortisol (the body's stress hormone) and blood pressure. All of these processes can negatively impact surgery outcomes, therefore identifying the patients thoughts, feelings and behaviours can aid with targeting psychological treatment and support to tackle barriers to successful outcomes.

If a mental health or psychological issue is identified, support can be offered to enhance readiness and preparation for surgery to ensure the best outcomes for the patient. Psychological approaches have long be used to support patients with a wide-range of medical procedures including general surgery and aesthetic surgery. Support typically involves providing a reflective and emotional processing space to process unhelpful thoughts and feelings, thus lowering emotional and physical arousal. It may also involve a skills-building component to support the patient to develop tools and techniques to manage both physical and psychological symptoms linked to the procedure, as well as to develop helpful behavioural coping strategies.

We have supported people with a range of psychological issues pre and post surgery, including anxiety, phobias, depression, low self-esteem, negative body image (including body dysmorphic disorder) and identity issues. Having a space to talk through such issues has enabled patients to approach aesthetic surgery with confidence, ensuring the best possible outcome for them post procedure.

If you are considering undertaking aesthetic surgery or are adjusting to the impact of undertaking a procedure and feel you would benefit from psychological assessment or support then please do get in touch here. Our team of specialist clinical psychologists and counsellors are experienced in supporting patients throughout the aesthetic surgery journey.


About the Author

Dr Kozłowski is a clinical psychologist by professional background and the service lead for Third Wave Psychologist, a highly specialist online clinical psychology and counselling practice. Dr Kozlowski has worked in physical and mental health services for over 20 years. She specialises in physical health; supporting patients to adjust and adapt to living with long-term conditions, facilitating the development of self-management strategies and supporting with their pre-operative and post-operative journey. She also provides consultation and training to multi-disciplinary teams, supporting physical health professionals to deliver psychologically-informed care. 

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