Mental health problems worsen after cosmetic surgery

Are people who opt for medically unnecessary, cosmetic surgery psychologically vulnerable? Does having such surgery bring them psychological relief?

These are tricky questions. There's actually evidence of increased mental health problems among people who've undergone cosmetic surgery. But whether that's a harmful side-effect of the surgery, or a hangover from pre-operative problems, it's difficult to say.

Randomly controlled trials would help, but of course that's not possible in this situation for ethical reasons. What's needed is a large-scale prospective study that follows thousands of people up over many years. Hopefully a sub-set will opt for cosmetic surgery during that time and then it should be possible to look for any psychological vulnerabilities preceding the surgery and any changes post-surgery.

That's exactly what a team of Norwegian researchers have done. Tilmann von Soest and his colleagues began in 1992 with a sample of over 12,000 school students aged 12 to 19 years, and then surveyed them periodically for several years. Attrition of the sample left 2,890 participants at the final survey in 2005 (many participants were lost early in the study, in 1994, because they changed schools). By 2005, 106 of the participants had had at least one cosmetic surgery procedure. This included 78 women – that's 4.9 per cent of women in the sample; and 28 men – 2.2 per cent of the men in the sample.

Because of the lack of men, the researchers focused only on the women. The majority of their operations were for breast augmentation (26.8 per cent) or reduction (19.5 per cent), with other procedures including liposuctions, ear and nose modifications.

There was strong evidence that women with psychological problems were more likely to opt for surgery. The female participants who went on to have cosmetic surgery were more likely to have a history of poorer mental health, including more depression and anxiety, more illicit drug use, self-harm and suicide attempts. Unsurprisingly, the women who had breast surgery more often had a history of less satisfaction with that part of their body (although general appearance satisfaction wasn't related to undertaking surgery). By contrast, sociodemographic factors were not related to who had surgery and who didn't.

Did the surgeon's scalpel benefit the psychological health of these women? With one specific exception, it seems the answer is a categorical "no". Breast surgery was associated with increased satisfaction with that part of the body, but having cosmetic surgery of any kind was associated with increases in anxiety and depression, eating disorders, more alcohol use and more suicide attempts. Surgery didn't boost general appearance satisfaction.

The study isn't without its shortcomings, as the authors acknowledge. For instance, the apparent adverse effects of cosmetic surgery may not be specific to cosmetic procedures but could apply to having surgery of any kind. The study also relied on participants reporting their own mental health.

This study provides "no evidence that cosmetic surgery should be used to alleviate mental health problems in women dissatisfied with their appearance," the researchers concluded. "Nor do the results support the notion that cosmetic operations in exceptional cases should be covered by the public health-care system due to a potential psychotherapeutic effect for the patient."

Further reading

von Soest, T., Kvalem, I., and Wichstrøm, L. (2012). Predictors of cosmetic surgery and its effects on psychological factors and mental health: a population-based follow-up study among Norwegian females. Psychological Medicine, 42 (03), 617-626 DOI: 10.1017/S0033291711001267