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Psychosocial predictors, assessment, and outcomes of cosmetic procedures: A systematic rapid evidence assessment

Brunton, Ginny; Paraskeva, Nicole; Caird, Jenny; Bird, Karen Schucan; Kavanagh, Josephine; Kwan, Irene; Stansfield, Claire; Rumsey, Nichola; Thomas, James


Ginny Brunton

Jenny Caird

Karen Schucan Bird

Josephine Kavanagh

Irene Kwan

Claire Stansfield

James Thomas


Background: Recent breast implant complications led to a UK government policy review of the evidence concerning cosmetic interventions. We synthesised cosmetic intervention research evidence covering psychosocial factors associated with requesting procedures and psychological outcomes, effects of procedures on psychological outcomes, preintervention assessments for identifying those at risk, alternative therapy effectiveness, and issues in achieving informed consent.

Methods: Undertaking a systematic rapid evidence assessment, six databases and three journals were searched. Included studies were systematic reviews or primary studies of participants requesting cosmetic procedures; published 2002–2012; containing either psychological or psychosocial measures, a psychological outcome, or evaluation of informed consent. Reviewers independently assessed study eligibility, extracted data, and assessed quality, undertaking narrative synthesis.

Results: Methodological quality of the included 13 systematic reviews and 179 primary studies was low, with wide variation in psychosocial measures. Findings suggest several psychosocial factors (e.g., intimate partner violence) may be associated with requesting cosmetic surgery. Multiple factors (e.g., unrealistic expectations) may predict poor psychological outcomes. Current psychological screening tools focus predominantly on body dysmorphic disorder (BDD) symptoms. Psychological and pharmacological interventions are effective alternative BDD treatments. Patients and doctors bring different needs to informed consent discussions, inconsistently matched to those required by professional ethics, litigation risk, and facilitating profit.

Conclusions: Systematically reviewing this literature for UK policy has highlighted that some groups may be at risk of poor post-cosmetic procedure outcomes. Practitioners and patients must explore reasons for seeking cosmetic procedures and discuss all potential results and alternative solutions. Future research should employ more robust methodologies to identify effects in those at risk, led by consensus on a core set of psychological outcomes.

Level of Evidence III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Brunton, G., Paraskeva, N., Caird, J., Bird, K. S., Kavanagh, J., Kwan, I., …Thomas, J. (2014). Psychosocial predictors, assessment, and outcomes of cosmetic procedures: A systematic rapid evidence assessment. Aesthetic Plastic Surgery, 38(5), 1030-1040.

Journal Article Type Review
Online Publication Date Jun 25, 2014
Publication Date Oct 1, 2014
Journal Aesthetic Plastic Surgery
Print ISSN 0364-216X
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 38
Issue 5
Pages 1030-1040
Keywords systematic review, overview of reviews, cosmetic procedures, psychosocial predictors, psychological outcomes, psychosocial outcomes, informed consent, rapid evidence assessment, body image
Public URL
Publisher URL
Additional Information Additional Information : Published online: 25 June 2014