I greatly appreciate the work by Hessler et al1 recently reported in the Archives. However, I believe that their conclusion about a possible relationship between clinical depression and patient satisfaction with facial plastic surgical procedures is not supported by their data and could lead to ill-advised surgery. The broad spectrum of severity of depression and the diverse management methods used (eg, medication, electroconvulsive therapy, psychotherapy) make it imperative that the facial plastic surgeon has a complete history and a confirmed diagnosis before recommending treatment. One assumes that each patient in this study and in the authors' practices provided a complete medical history and received a physical examination, and that the nature, severity, and treatment of depression (and all other medical problems) were documented in the medical record. Unfortunately, the authors were “unable to corroborate the reports of patients of having a history of depression beyond their self-reported history. . . . ”1(pp195-196) The lack of a confirmed diagnosis invalidates any analysis, observations, or conclusions because the disease is not even known to be present.
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