Are More Educated People Less Interested in Cosmetic Surgery? Psychosocial Predictors of an Interest in Cosmetic Surgery Among Young Norwegian Women: A Population-Based Study

Background: Proper patient selection is among the major determinants of satisfaction, or the lack thereof, following esthetic surgery. Effective communication between patient and surgeon is also crucial. Understanding the patient's psychosocial attributes and circumstances assists the surgeon with both selection and communication. Objective: To shed light on those psychosocial parameters that foster interest in esthetic surgery. In this way, the authors hope to assist the surgeon to better evaluate patients as candidates for surgery. Design/Participants: The paper reports the results of a psychosocial polling instrument administered to 3500 Norwegian women. The women were randomly selected from the female population of the 2 most northern Norwegian towns and were restricted to the 18 to 35 age group. Methods: Data were obtained from a questionnaire mailed to the selected women. With 208 questionnaires returned as a result of inaccurate addresses, only 3292 questionnaires were delivered to the intended subjects. Variables related to body dysmorphic disorder, personality attributes, self-esteem, body image, social history, eating disorders, and socio-demographic circumstances, among others, were measured. They were then analyzed to determine the possible correlation with the central question concerning "interest in cosmetic surgery." Statistical methods were used to estimate significance. Results: 1862 of 3292 (56%) subjects returned completed questionnaires. Variables that were positively correlated with interest in cosmetic surgery were body dysmorphic-like symptoms, body image orientation, having children, being teased for appearance, knowing someone who had cosmetic surgery, and being recommended for cosmetic surgery. Variables with negative correlation were: agreeability, body image evaluation, higher education level, and quality of relationship with parents. Conclusions: This study confirmed widely accepted predictors of interest in cosmetic surgery such as body dysmorphic disorder, low self-esteem, poor body image, eating disorders, and specific personality traits. New variables, such as having children or a history of teasing, were also positive predictors. Higher levels of education and good relationship with parents were negative predictors. Reviewer's Comments: Potential criticisms of the study are myriad, and beyond this brief review. It offers little of direct and immediate applicability to clinical cosmetic practice. However, it does remind us that some important truths are worth emphasis. Most patient dissatisfaction with cosmetic surgery is based on failures of communication and patient selection, and not on technical faults. While personality and psychological testing may be impractical and even offensive, some form of evaluation, beyond just the anatomical, is invaluable. Concepts of personality and circumstances, as enumerated in this paper, assist the clinical surgeon, even in an unstructured interview, to evaluate patients as candidates for cosmetic surgery. (Reviewer-Norman V. Godfrey, MD).