Plastic Surgery: Snip and trim makes one happy

26. April 2013

Bored millionaire wives or people with disturbed self-esteem: To the public these represent the typical clientele for cosmetic surgery. A recent study has been able to show that the reality is quite different.

Cosmetic surgery is booming. According to the International Society for Aesthetic Plastic Surgery, in 2011 about 8.5 million people worldwide went under the knife for the sake of aesthetics. The desire for a better appearance usually occurs with younger people with incomes slightly above average. Being beautiful is apparently still more important for women than for men because aesthetic improvement of women made up 87% of all cosmetic surgery during 2011. But does going under the knife really make one happier?

First large study on satisfaction after plastic surgery

Anyone who has an oblique nose, protruding ears or excessively small breasts puts up with that, believing that only inner values count anyway, would be capable of living happier when allowing cosmetic surgeons to correct them just a little. This is what Prof. Dr. Jürgen Margraf, Alexander von Humboldt Professor of Clinical Psychology and Psychotherapy at the University of Bochum, in cooperation with colleagues from the University of Basel, found out in a survey of 550 patients. “The large number of respondents gives us for the first time a comprehensive picture of patient satisfaction after various cosmetic surgery procedures”, explains Prof. Margraf about how his study stands apart from those previously carried out.

Important mark of quality: a control group

Prof. Margraf and his colleagues examined whether patients who undergo plastic surgery differ systematically from other people, which objectives they set before the OP, and whether they then achieve them. The researchers compared 544 first-time operated patients aged between 18 to 65 years with two other groups: one with 264 people who had previously desired plastic surgery but then decided against it, the other with around 1,000 people from the general population who had never been interested in such an operation. “Only through a control group can we also ensure validity of the insights that we have gained with the patient group”, explains Prof. Margraf. But this was not quite as easy to produce as it was with other studies. “Since we cannot make random assignments in cosmetic surgery, as is done with many other studies, for example, where placebos are possible, we have selected people who are interested in cosmetic surgery, but have not yet opted for it”, adds Margraf. The contact data was obtained by the study authors from the address file of a support clinic for plastic cosmetic surgery. In addition, Prof. Margraf and his team wanted to find out whether people who are interested in or opt for cosmetic surgery differ from the average general population. “As a clinical psychologist I had the impression that many people who use surgical operations to enhance their beauty suffer from mental health problems”, says Prof. Margraf.

With the interviews the psychologist came to her first surprising result: Psychological problems obviously play no role in cosmetic surgery, because there were in total between the three studied groups no significant differences in psychological and health variables, such as mental health, life satisfaction and depression.

Before the operation the subjects were able to clearly formulate their five most important personal expectations and desires. “This distorts the results less than if we would have offered pre-formulated answers to each question”, says Margraf. The patients expressed wishes such as “to feel better”, “to eliminate blemishes” and “to develop more self-confidence”. On a scale of 0 to 100%, study participants highlighted the extent to which these have been dealt with or fulfilled by plastic surgery. In addition, subjects answered questions about their well-being, their attitudes toward and their quality of life. Further questions gave the researchers information on the fears, depression and social phobias of their study participants. Overall, all subjects were surveyed before surgery as well as 3, 6, and 12 months thereafter.

“We asked all participants how attractive they feel compared to other people”, says Margraf. The subjects were to assess their attractiveness on a scale. The numerical value of 100 corresponded in the survey to beautiful, the value 0 to an ugly person. There the scientists discovered a second remarkable fact: “Our representative survey showed that the majority of Germans assess themselves as above average compared to others”, says the clinical psychologist. This is a fact which already mathematically cannot correspond to reality. “We know the phenomenon of self-overevaluation from other areas of psychology, where people, for example, overestimate their health and their income”, adds Margraf. This kind of self-deception may help us to better get through the day, psychologists suspect.

Among the subjects who want to undergo plastic surgery it was almost exactly the same, only that they graded the body part to be improved as below average in attractiveness. “After the operation, this value recovered to the level of ordinary overestimation, i.e. about 75%,” says Prof. Margraf. The self-perceived overall attractiveness of patients changed only slightly through the plastic surgery. “Patients who undergo cosmetic surgery therefore see themselves overall as precisely as attractive as does the rest of the population. Only the blemish removed from its confined area affects their enjoyment of life, their self-confidence and their satisfaction”, summarises Prof. Margraf.

Apparently lasting happiness

And now comes the third remarkable finding of the study: psychologists tested the patients before surgery and after three, six and twelve months afterward. The significantly improved satisfaction of the operated patients remained stable over the entire follow-up period of 12 months after surgery. “That’s unusual”, says Prof. Margraf, “since we otherwise almost always get used to everything”. The habituation of which Prof. Margraf speaks is also known as hedonistic treadmill, or hedonistic adaptation. It refers to the tendency of people, after a strongly positive or negative life event, to relatively quickly return to a relatively stable level of happiness. “For financial reasons we had to quit after 12 months of studying, unfortunately”, says Prof. Margraf lamenting the fact that he was no longer able to pursue studies beyond this point.

Realistic expectations and the high pressure of suffering

To understand why the happiness that the patient related to their operational change even after a year still felt just as intense as it did immediately after the surgery led the psychologists led under Professor Margraf to conduct individual interviews with patients. “For one very body-conscious hairdresser for example his eyelid slippage, of which I had not even heard until now, was a large beauty flaw. Long after the surgery he still felt great satisfaction every time he looks in the mirror”, says Margraf.

Using their data, the psychologists under Prof. Margraf cannot explain the effect of long-term satisfaction conclusively, they can only speculate: “The people who undergo plastic surgery have a clearly delimited, subjectively perceived deficiency. If this is resolved, they feel much better. Unrealistic expectations of the surgical results are rare. Only 12 per cent of respondents in the survey gave unrealistic standard targets such as ‘All my problems will be solved’ and ‘I will be a completely new man’. “One reason for the long-term satisfaction could therefore be that people get exactly what they expect from a cosmetic surgery procedure. Moreover, they have usually already been carrying their perceived stigma with them for a very long time before they opt for a surgery, something bringing great relief after surgery”, says Margraf.

The study nonetheless only looked at people who underwent plastic surgery for the first time. “For people who do it several times the result probably would look different”, says Prof. Margraf. He also stresses that people with dysmorphophobia, i.e. a cognitive disorder in interpreting one’s own body, were excluded from the study. The researchers did not establish negative effects of plastic surgery. So: Should you get yourself to the operating table for some bigger breasts, narrower hips or a straighter nose? Numerous studies have indeed shown that beautiful people get through life easier. However people with less symmetric faces seem to be more generous than their prettier, more symmetrical counterparts as a study from 2010 showed. And giving does also make one noticeably happier.

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Medicine, Surgery

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