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Original Investigation |

Self-esteem, Self-efficacy, and Appearance Assessment of Young Female Patients Undergoing Facial Cosmetic Surgery  A Comparative Study of the Chinese Population

Zhuming Yin, MD1; Dafang Wang, BNurs1; Yan Ma, MMSc2; Shuwei Hao, MD2; Huiwen Ren, PhD3; Tingting Zhang, PhD4; Wenlin Chen, MD1; Jincai Fan, MD1
[+] Author Affiliations
1Ninth Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
2Department of Medical Psychology, Institute of Medical Humanities, Peking University Health Science Center, Beijing, China
3Department of Pharmacology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
4Peking University Sixth Hospital, Peking University Institute of Mental Health, National Clinical Research Center for Mental Disorders , Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
JAMA Facial Plast Surg. 2016;18(1):20-26. doi:10.1001/jamafacial.2015.1381.
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Importance  The psychological traits of cosmetic surgery patients (CSP) are important for selecting patients and postoperative patient satisfaction. A patient’s self-esteem, self-efficacy, and self-assessment affect his or her motivation for cosmetic surgery, but the association among these traits remains unclear, especially in the Asian population.

Objective  To clarify the association of a patient’s psychological traits, decision to undergo cosmetic surgery, and the effectiveness of facial cosmetic surgery on the psychological conditions of young, female Chinese patients.

Design, Setting, and Participants  Three different groups of young women (aged 18-30 years) from the Plastic Surgery Hospital, Chinese Academy of Medical Sciences, and 7 universities were enrolled from January 1, 2012, through December 31, 2014: CSPs (n = 161), general population controls (GPCs) (n = 355), and facial appearance raters (FARs) (n = 268). The last date of follow-up was January 20, 2015. Patient data from questionnaires were obtained preoperatively and 6 months postoperatively, and the data from the control groups were obtained immediately after enrollment. Front-view facial images of the study participants were taken and then shown to independent raters to assess the participants’ facial appearances on a rating scale.

Main Outcomes and Measures  Evaluation of self-esteem and self-efficacy, subjective and objective assessment of facial appearance, and structural equation models.

Results  A total of 163 CSPs and 387 GPCs were recruited for the study, and complete and valid data were obtained from 161 CSPs and 355 GPCs. All responses from the 268 FARs met the criteria for subsequent analysis. Of the questionnaires issued to the CSPs 6 months postoperatively, 126 valid responses were returned (response rate, 78.3%). Self-esteem and self-efficacy decreased significantly in preoperative patients compared with controls (P < .001) (mean [SD] scores, 22.60 [1.80] for CSPs and 27.39 [2.11] for GPCs for self-esteem and 21.50 [2.40] for CSPs and 28.59 [4.23] for GPCs for self-efficacy) and were found to be at nearly normal levels 6 months postoperatively (mean [SD] scores, 25.88 [3.65] and 26.38 [2.45] for self-esteem and self-efficacy, respectively). The patients’ objective assessments of facial appearance did not differ significantly from those of the control group participants (mean [SD] scores, 4.51 [0.77] and 4.55 [0.74] for CSPs and GPCs, respectively; P = .86); however, a significant decrease in patient self-assessment was noted (mean [SD scores], 6.45 [1.15] and 7.31 [1.42] for CSPs and GPCs, respectively; P = .01). Moreover, the structural equation models revealed a path from low self-esteem and self-efficacy after decreased self-assessment to decision for cosmetic surgery.

Conclusions and Relevance  Self-esteem and self-efficacy mediate the negative effects of self-assessment on the decision of young women to undergo facial cosmetic surgery. The impairment of self-esteem and self-efficacy may indicate the need for preoperative psychological intervention. Facial cosmetic surgery can have positive effects on self-esteem and self-efficacy.

Level of Evidence  2.

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Structural Equation Models by Path Analysis

For the hypothesized path model, the hypothesis that self-assessment is a mediator of the effect of self-esteem and self-efficacy on the decision for cosmetic surgery was rejected because of poor model fit. For the final path model, the model with good-fit coefficients reveals that self-esteem and self-efficacy mediate the negative effect of self-assessment on the decision for cosmetic surgery. For the path model for psychotherapeutic effect of cosmetic surgery, the model indicates that young women undergoing facial cosmetic surgery tend to develop enhanced self-esteem and self-efficacy in our cohort. β Values refer to standardized direct effects on the downstream variables, and the R value refers to the correlation coefficient. The solid lines with single arrow represent significant parameter estimates, the solid line with double arrows represents statistical correlation, and the dotted lines represent nonsignificant parameter estimates. Marital status is coded as 1 for married, 2 for unmarried partner, and 3 for single. Error variances and covariances are not shown.

aP < .05.

bP < .01.

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