Association of Patient Self-esteem With Perceived Outcome After Face-lift Surgery

JAMA Facial Plast Surg. 2016 Jan-Feb;18(1):42-6. doi: 10.1001/jamafacial.2015.1460.


Importance: It is well understood that optimal psychological health is imperative to success in aesthetic surgical procedures. Self-esteem is a very sensitive psychological factor that can influence patients' motivations for seeking surgery as well as their perceptions of outcomes.

Objective: To use the Rosenberg Self-Esteem Scale (RSES) to correlate the outcome of rhytidectomy as perceived by the patient to further understand the association of self-esteem and the results of aesthetic facial rejuvenation.

Design, setting, and participants: A prospective study was conducted of 59 consecutive patients undergoing rhytidectomy performed by a single surgeon at a private practice from July 1 to October 31, 2013. The RSES was used to establish preoperative baseline scores and scores at a 6-month postoperative follow-up. A paired t test was used to compare statistical data before and after surgery. Change in self-esteem and the patient's evaluation of the surgical outcome was assessed. Analysis was conducted from July 1 to December 1, 2014.

Main outcomes and measures: Patients' change in self-esteem level after rhytidectomy, as assessed by the RSES.

Results: Of the 59 patients, 50 completed a 6-month postoperative questionnaire; mean age was 58 years (range, 37-73 years); 48 were women; and 44 were nonsmokers. The mean difference between baseline and 6-month scores showed an increase of 0.3 (baseline, 24.3; 6-month follow-up, 24.6), which was not statistically significant (P = .69). Subdivision of patients into groups by self-esteem level showed a statistically significant improvement in self-esteem after surgery in the group with low self-esteem, with a mean difference in the RSES score of 3.7 (P = .01), whereas the group with high self-esteem showed a decrease in the RSES score of -3.1 (P = .03) and the group with average self-esteem showed a nonsignificant increase of 0.5 in the RSES score (P = .59). The perceived change in youthful appearance (mean, 8.9 years) did not correlate with self-esteem changes.

Conclusions and revelance: Patient's self-esteem before surgery may partially determine the quality-of-life outcome after surgery. Patients with low preoperative self-esteem saw an increase in self-esteem after surgery, those with average preoperative self-esteem experienced no change, and those with high preoperative self-esteem experienced a decrease in self-esteem after surgery. In our study, self-esteem measurements did not correlate directly with the positive effect of the surgical outcome, as patients showed no mean change in self-esteem, but patients thought that they appeared a mean of 8.9 years younger after their face-lift surgery. These findings underscore the complex nature of the human psyche as it relates to aesthetic surgery and demonstrates that patients exhibit a wide spectrum of psychological reactions after face-lift surgery.

Level of evidence: 2.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Patient Outcome Assessment*
  • Patient Satisfaction*
  • Prospective Studies
  • Quality of Life
  • Rhytidoplasty / psychology*
  • Self Concept*
  • Surveys and Questionnaires