Facial Identity and Self-Perception: An Examination of Psychosocial Outcomes in Cosmetic Surgery Patients

June 2017 | Volume 16 | Issue 6 | Original Article | 617 | Copyright © June 2017

Benjamin Slavin BA PAa and Jacob Beer BA PAb

aUniversity of Miami School of Medicine, Miami, FL bUniversity of Pennsylvania, Philadelphia, PA


The psychosocial health of patients undergoing cosmetic procedures has often been linked to a host of pre-existing conditions, including the type of procedure being performed. Age, gender, and the psychological state of the patients also contribute to the perceived outcome. Specifically, the presence or absence of Body Dysmorphic Disorder (BDD) has been identified as an independent marker for unhappiness following cosmetic procedures.1 However, no study has, to our knowledge, identified a more precise indicator that is associated with higher rates of patient dissatisfaction from cosmetic procedure. This review identifies facial identity and self-perception as potential identifiers of future patient dissatisfaction with cosmetic procedures. Specifically, we believe that patients with a realistic facial identity and self-perception are more likely to be satisfied than those whose self-perceptions are distorted. Patients undergoing restorative procedures, including blepharoplasty, rhytidectomy, and liposuction, are more likely to have an increased outcome favorability rating than those undergoing type change procedures, such as rhinoplasty and breast augmentation. Age, which typically is an independent variable for satisfaction, tends to be associated with increased favorability ratings following cosmetic procedures. Female gender is a second variable associated with higher satisfaction. The authors believe that negative facial identity and self-perception are risk factors for patient dissatisfaction with cosmetic procedural outcomes. Based on this assumption, clinicians may want to focus on the face as a particular area of psychosocial concern.

J Drugs Dermatol. 2017;16(6):617-620.


The prevalence of cosmetic surgical procedures in the United States has grown by 115% since 2000.2 This suggests that Americans possess some degree of dissatisfaction with their appearance. Furthermore, 71% of a global population of women surveyed3 believe the media should portray a broader range of physical traits and appearances as being representative of cultural beauty norms. Multiple studies have examined the relationship between psychosocial well-being and patient satisfaction with cosmetic procedural outcomes.1,4,5 Many of these studies conclude that procedure type, age, gender, and the potential presence of Body Dysmorphic Disorder (BDD) contribute to a patient’s overall satisfaction level. However, the potential for facial identity and self-perception, rather than generalized BDD,6 to predict satisfaction with cosmetic procedural outcomes has not received adequate attention.The current body of literature suggests that cosmetic practitioners should be cognizant of risk factors that can increase the likelihood of patient dissatisfaction with the procedural outcome. At the present time, these risks are known to include the following: type-change procedures, male gender, youth, and signs of BDD.1 Despite these risk factors, there has been very little research regarding their interplay and correlation with each other. Most studies advise cosmetic practitioners to pre-screen for these risk factors. These suggestions fail to recognize that while age and gender are easier to identify, many psychiatric disorders such as generalized BDD are not recognized by the cosmetic practitioner until it is too late. BDD’s broad definition states that fixation can occur anywhere in the body,6 further complicating the ability of practitioners to pinpoint the disorder. Thus, the cosmetic practitioner is often resigned to discover BDD only after they have performed procedures on their patients.This article reviews some of the risk factors for patient dissatisfaction with cosmetic procedures, including procedure type, age, gender, and the presence of BDD.1,4,5 The goal of this information is to help physicians identify patients who may be predisposed for lower satisfaction with procedural outcomes. By exploring some of the most commonly mentioned pre-surgical risk factors for patient dissatisfaction with cosmetic procedures, it is possible to highlight the face as a particular area of high risk for patient dissatisfaction.1,4,5 Consideration is also given to the face’s central role in the establishment of human identity.7 Facial identity and self-perception may be potential areas of focus during pre-surgical evaluations rather than the more common focus on generalized BDD.1,4,5,8


We reviewed the Pubmed, Google Scholar, and ProQuest databases using search terms that included: cosmetic surgery,