Patients who have suffered from domestic violence, or who have underlying psychological issues, are more likely to undergo cosmetic surgery. But their conditions may also actually worsen rather than improve following
surgery, according to a new study from the Institute of Education

The study, from the Institute of Education – a systematic review of all available research evidence — comes in the wake of last year’s PIP (Poly Implant Prothese) breast implant controversy. Concerns over the safety and well-being of women having these procedures, and the increase in all other types of cosmetic surgery, prompted the Department of Health (DH) to establish a commission, headed by Sir Bruce Keogh, calling for evidence to support the
clinical safety and regulation of these treatments.

A team of researchers from the IOE’s Evidence for Policy Information and Co-ordinating Centre (EPPI Centre) were commissioned to carry out a systematic review of research into cosmetic surgery procedures. They examined
192 studies, including 13 systematic reviews in order to draw conclusions based on the best available evidence.

The research found that those who had undergone cosmetic surgery were significantly more likely to have been in an abusive relationship, or to have other relationship issues – but it was not possible to determine whether this was the factor that led to the patient seeking surgery.

Patients who had surgery were also found to be significantly more likely to suffer from psychological issues such as depression, and in particular Body Dysmorphic Disorder (BDD).

The study indicated that cosmetic surgery often did not improve these conditions, and in some cases there were was evidence to suggest they had worsened following surgery. Psychological and medical treatments such as anti-depressants or Cognitive Behavioural Therapy (CBT) were shown to be more effective at reducing depression and other mental health problems in those with BDD – highlighting the importance of offering alternative treatments to those seeking cosmetic surgery to deal with these issues.

Ginny Brunton from the research team said:

“These issues must be discussed with patients before they undergo treatments such as face lifts or nose reconstruction. It is crucial that at-risk patients are aware that their mental health may be affected for the worse,
rather than the better. Doctors must be aware of issues underlying requests forcosmetic surgery, who is at risk of poor outcomes, and explore fully with patients the reasons for seeking cosmetic procedures, all potential results,
and possible alternative solutions”.

A further cause for concern was evidence of an increased risk post-operative mortality, including suicide, in studies of patients undergoing breast enhancement surgery. This finding merits further well-designed research.

Ms. Brunton said: “It should be emphasised that while theevidence did not allow us to conclude that the surgery had caused these problems, or that the relationship or mental health issues were what led the patient to seek cosmetic procedures, the findings are strong enough to suggest the need for further investigation.