Does Cosmetic Surgery Boost Your Self-Esteem?

Consultant Psychiatrist, Dr Raj Persaud, examines some new research with surprising implications



Many view those who opt for cosmetic surgery as merely vain and self-obsessed – but new evidence challenges this presumption

Does Cosmetic Surgery Boost Your Self-Esteem?


Dr Raj Persaud FRCPsych


I suspect I am not alone in never failing to being impressed by those amazing slides my cosmetic and aesthetic colleagues show at various conferences, demonstrating impressive before and after results. However, I do wonder, if those smiling faces could talk, what would they actually say about how they now feel? They might look, in our opinion, better to before – but has it actually made a difference to their lives?


This is a much more complex issue to assess, than simply observing physical change, as you might expect a psychiatrist to maintain.


In polite society it’s not customary to make much detailed or even accurate comment on another’s appearance, so how do we confirm how we look? The issue isn’t of course just how we look to ourselves, but how we appear to the outside world as well. The issue of appearance is such a taboo that everyone knows everyone else is busy giving compliments but maybe thinking something else entirely.


No one who has ever treated sufferers from body image disorders such as Imagined Ugliness Syndrome, or Body Dysmorphic Disorder, will be unaware of how much these have chosen to infer from subtle, or entirely imagined, feedback. That’s because that group – perhaps way over on one extreme of the spectrum – share with cosmetic surgery patients the possible tendency to regard appearance as important, and to have a clear evaluation of how they compare to others on this front. It’s this crucial combination of scoring high on ‘body image orientation’ (how important it is in life) combined with low evaluation (low satisfaction with personal appearance) which delivers a motivation to seek an alteration.


Now some new scientific research fills the gap in this area and provides extremely useful feedback to cosmetic professionals about the psychological impact of their work. The study conducted by a team led by Dr Skilleborg based in Norway, used a questionnaire to study 155 female cosmetic surgery patients. The investigation was published in the Journal of Plastic, Reconstructive and Aesthetic Surgery, and compared responses before surgery to six months after and with a representative sample of over 800 Norwegian women with no cosmetic surgery experience.


The procedures the women undertook included mainly breast enlargements, breast lifts, liposuctions, abdomino-plasties and eyelid operations. The results revealed high scores on satisfaction with the actual procedures, with 91% reporting post-operatively, that they would still choose to have surgery if they had to make the choice again.


There were no differences between the comparison non-surgery group and those having surgery in prevalence of psychological problems, which is interesting given the stubborn public perception which remains in some quarters, that to opt for a procedure is a sign of something problematic psychologically. Intriguingly however, those who had surgery but scored high on psychological problems before the procedure, ended up being much less satisfied than average with surgical results.


It was also notable that those without psychological problems before surgery ended up much more positive change in body image evaluation and raised self-esteem post surgery.


Overall, self-esteem in general went up following surgery, but psychological problems remained un-ameliorated. This result is kind of what experienced surgeons and psychiatrists probably already knew, surgery is not a solution for deeper psychological problems. The issue here is that the simple lowered self-esteem that those who go for cosmetic surgery appear to suffer, according to this study, could be confused by the uninitiated with deeper problems, which really aren’t there.


The key take home message, in my opinion, from this important study, is that the increase in body image evaluation in the operative group was such that patients after surgery no longer differed from the ‘normative’ sample.  In other words the surgery kind of made them feel normal again. The crucial point here is that many people undertaking cosmetic surgery are not so much vain or seeking some kind of unfair advantage over the rest of us on the appearance stakes, it’s more that they simply want to feel ‘normal’ or like the rest of us. The evidence from this study is that cosmetic surgery for many people works in this way.


If as a surgeon you want your patients to end up scoring high on satisfaction with your surgery, you need to keep your eye on those who score high on psychological problems beforehand, because this group are much less likely to end up feeling positive about the procedure afterwards.


It was also notable that there were no statistically significant differences between the different kinds of surgery in terms of positive body image and satisfaction with surgery. However there was a trend for breast augmentation to be particularly associated with more positive body image evaluation post surgery. It is important to note that rhinoplasty did not feature in this study.


Cosmetic surgery did improve the patients’ self-esteem, but this was a relatively small change. Yet there was a definite improvement on average in satisfaction with appearance. Post-operative measures of appearance satisfaction, self-esteem and psychological problems did not differ from the comparison sample. Surgery appears to make people feel normal again rather than making them feel better than normal.


Perhaps this tells us that this motivation – the desire for superior results than average – for cosmetic surgery may be an ominous predictor of a less than satisfactory outcome in the longer-term.


The effects of cosmetic surgery on body image, self-esteem, and psychological problems  Journal of Plastic, Reconstructive & Aesthetic SurgeryVolume 62, Issue 10October 2009Pages 1238-1244 T. von Soest, I.L. Kvalem, H.E. Roald, K.C. Skolleborg