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Sheet: FACI

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[NAME],  MD, DMD, MBA  Jefferson Medical College |  |  | I greatly appreciate the work by [NAME] et al recently reported in The Archives of Facial Plastic Surgery (1). But 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 employed (e.g. medication, electroconvulsive therapy, psychotherapy etc) make it imperative that the facial plastic surgeon have a complete history and a confirmed diagnosis before recommending treatment. One assumes that each patient in this study and in the authors' practices received a complete history and physical examination, and that the nature, severity and treatment of depression (plus all other medical problems) were documented in the medical record. Unfortunately, the authors were unable to corroborate patients' reports of a history of depression. The lack of a confirmed diagnosis invalidates any analysis, observations or conclusions because the disease is not even known to be present.   Even if one accepts the accuracy of the diagnosis, the data do not support the conclusion. Two measures around a single interval do not define a trend, which is widely defined as a general tendency. Further, those patients reporting current treatment for depression were statistically no more satisfied than the rest of the study population. The mean score for overall satisfaction was 7.6 (SD=2.4) for the 53 subjects in their study and was 8.5 (SD=2.46) for the 10 patients who reported being treated for depression at the time of the procedure. A simple unpaired T-test shows the 2-tailed P value for the difference between these to be 0.2828, leaving the apparent difference without statistical significance. The mean satisfaction score and standard deviation of the sample absent the depressed patients was not reported but would have to have been below 6.8 for the apparent difference to achieve significance. From the data presented, this does not appear to have been the case.   Of greatest concern is the fact that the statement, "[P] atients treated for depression show a trend toward greater satisfaction from facial plastic surgical procedures than those not treated for depression" could result in recommendations for surgery on patients ill equipped to deal with untoward outcomes. Providing elective surgery for appearance to patients with emotional illness is frought with peril and requires extensive knowledge, skill and experience. Many studies (2-11) show that patients with psychosocial abnormalities may respond positively to surgery for appearance But those studies and that of [NAME] et al include no depressed patients who experienced untoward outcomes. Despite a positive attitude and approach during interview and treatment planning, many depressed patients (whether treated for it or not) become quite volatile in the face of unexpected results and are likely to suffer exacerbations of their emotional illness in response to what they perceive as an adverse outcome. The probability of occurrence may be low but the consequences can be severe.   The above is based on my having evaluated dozens of such patients in consultation for revision following ill-advised but well done facial plastic surgical procedures by others. Most patient complaints were dramatically out of proportion to the minor irregularities and inconsistencies observed, and almost all patients attributed the need for more intensive depression management to their procedures. Most therapists were of great help in management. If the patient is or has been under the active care of a therapist, communication and cooperation with that person is essential to identify those patients likely to deal badly with adversity and to optimize postoperative care. A patient's refusal to permit such communication is, to me, a contraindication to elective surgery for appearance.   1. Predictors of Satisfaction With Facial Plastic Surgery: Results of a Prospective Study [NAME], [NAME], [NAME], [NAME], [NAME]. 2010; 12(3):192- 196.   2. [NAME], [NAME], Terino EO. More than skin deep: A self- consistency approach to the psychology of cosmetic surgery. Plast Reconstr Surg. 1985;76:270.   3. [NAME], [NAME], [NAME] surgery and psychotherapy in the treatment of 100 psychologically disturbed patients. Plast Reconstr Surg. 1991;88:594.   4. [NAME], [NAME]. Anxiety disorders in plastic surgery. Plast [NAME]. 1997;100:535-542.   5. Sarwer DB, Pertschuk MJ, Wadden TA, [NAME]. Psychological investigations in cosmetic surgery: A look back and a look ahead. Plast Reconstr Surg. 1998;101:1136.   6. Goin MK, Goin JM. Psychological effects of aesthetic facial surgery. [NAME]. 1986;15:84-107.   7. Meyer L, [NAME] The predictive validity of psychosocial factors for patients' acceptance of rhinoplasty. [NAME]. 1986;17:513-520.   8. Goin MK, [NAME]. A prospective study of patients' psychological reactions to rhinoplasty. [NAME]. 1991;27:210.   9. Rohrich RJ. The who, what, when and why of cosmetic surgery: Do our patients need a preoperative psychiatric evaluation? Plast Reconstr Surg. 2000;106:1605-1607.   10. [NAME], Rankin M, [NAME] complications in 281 plastic surgery practices. Plast [NAME]. 1999;104: 1241-1246.   11. Honigman RJ, [NAME], Castle DJ. A review of psychosocial outcomes for patients seeking cosmetic surgery. Plast [NAME]. 2004;113:1229-1237.   I HAVE NO RELEVANT CONFLICTS OF INTEREST. | NR |  |  |  | 12 | 3 | 192
[NAME],  96 Degrees  Visitor |  |  | These course have provided a great deal of information to people. Facial plastic surgery can be a very scary situation for people. The more we educate, the better we will be.  Here is a great site that shows a few before and after photos  Boston Eyelid Surgery http://www.bostoneyelids.com/ | NR |  |  |  | 5 | 4 | 359