1. A prospective controlled outcome study of psychological change following plastic surgery
Mr David Harris
Consultant Plastic Surgeon
Derriford Hospital
Plymouth
Acknowledge Rhona Slater and Tony Carr
Dr Tim Moss
Chartered Health Psychologist
Centre for Appearance Research
UWE (Bristol)

2. Overview Evidence of plastic surgery benefits? Design and measures
Participants and attrition
Outcomes
Depression
Anxiety
Appearance adjustment
Purposes of plastic surgery – physical and psychological. Challenge own prejudice about therapy vs surgery

3. Evidence of plastic surgery success
Honigman et al 2004 review
Mixed methodologies
Patient satisfaction good
Bolton et al (2003)
Abdominoplasty, pre- and post-op
B.I. satisfaction increased
B.I. investment, general psych function not improved
Sarwer et al (2005)
General aesthetic plastic surgery
Satisfaction with surgery and ‘feature’ change over 12 months

4. Methodological issues
Measures
Sarwer (1998)
Interviews demonstrate psychopathology in cosmetic surgery patients
Standardised general measures not identify this
Designs - comparison groups . . .
Dissonance
Hawthorn effect
Demand

5. Our study: Design Prospective, Controlled, quasi-experimental
Plastic surgery patient group
T1 (pre op), T2, (3 months post op), T3 (12 months post op)
Comparison surgery group
T1 and T2
Participants
Adults, English speaking
Patients:
Plastic surgery admissions – nose, breasts, upper limb
Comparison group:
Non-appearance altering surgery group
General surgery, ENT, Maxillofacial surgery
Randomly allocated “nose”, “breasts”, “upper limb”

6. Measures Generic psychological functioning
Crown Crisp Experiential Inventory- Anxiety
Beck Depression Inventory
Test-retest reliability high
Good internal validity
Criterion validity with other measures and clinical observation high

7. Derriford Appearance Scale 24
Measures
Derriford Appearance Scale 24
24 items examine frequency of avoidant behaviours and distress related to appearance concern
Example items:
I feel self conscious of my appearance
I avoid going to pubs/restaurants
Psychometric properties
Internal consistency; Cronbach's = 0.92
Test-retest r = 0.68 (6 months)
Moderate correlations (r=0.5) with NA, social anxiety, shame

8. Participant numbers

9. Participants by condition

10. Participant by sex (% Female)
Gender similar across times and patient group

11. Age comparable across groups and conditions
Participant age
Age comparable across groups and conditions

12. Neither age nor sex differentially affected by attrition
Impact of Attrition
Neither age nor sex differentially affected by attrition

13. Depression Time x feature x group F(2,77) = 1.3, p=0.28
Depression reduction not significantly greater in plastics
F(1,77)=2.3, p=0.13

14. Anxiety Time x group x feature
F(2,75)=3.1, p>0.05
Anxiety reduction post op greater in plastics patients
F(2,75)=3.3, p=0.02

15. Derriford Appearance Scale 24
Time x feature x group
F(2,77)= 10.2, p<0.005
Group X time
F(1,77) = 69.8, p<0.005
Plastics patients significantly better DAS post op

16. Derriford Appearance Scale by feature
Feature x time
F(2,23)=7.1, p<0.005
DAS improvements post op only significant for rhino and breasts at T2

17. Patients only: DAS at T2 - T3
Stability of adjustment levels rhino and breasts
Delayed improvement in upper limb adjustment: significant T2 – T3 change

18. Criticisms of design Quasi-experimental design
Potential confounding of group
Limitation of plastics patient conditions impacts on generalisability
Groups numbers reduce analytical power

19. Conclusions
Plastic surgery: psychological benefits for the three conditions studied
Plastic surgery specific, not generalised surgical intervention effect
Not demonstrated in depression
Small and significant effect in anxiety
Clear effect detected for DAS24
Delayed benefit for upper limb
Use of appearance specific measures preferable to generic?

20. Further work
Components of poor appearance adjustment benefiting from surgery?
Relationship between anxiety/DAS24/depression and Patient Satisfaction?
Impact of surgery on components of (multidimensional) BI - and which of these mediate outcome variables above?