Clinical decision guidelines for NHS cosmetic surgery: analysis of current limitations and recommendations for future development.

Because of increasing demand for publicly funded elective cosmetic surgery, clinical decision guidelines have been developed to select those patients who should receive it. The aims of this study were to identify: the main characteristics of such guidelines; whether and how they influence clinical decision making; and ways in which they should be improved. UK health authorities were asked for their current guidelines for elective cosmetic surgery and, in a single plastic surgery unit, we examined the impact of its guidelines by observing consultations and interviewing surgeons and managers. Of 115 authorities approached, 32 reported using guidelines and provided sufficient information for analysis. Guidelines mostly concerned arbitrary sets of cosmetic procedures and lacked reference to an evidence base. They allowed surgery for specified anatomical, functional or symptomatic reasons, but these indications varied between guidelines. Most guidelines also permitted surgery 'exceptionally' for psychological reasons. The guidelines that were studied in detail did not appreciably influence surgeons' decisions, which reflected criteria that were not cited in the guidelines, including cost of the procedure and whether patients sought restoration or improvement of their appearance. Decision guidelines in this area have several limitations. Future guidelines should: include all cosmetic procedures; be informed by a broad range of evidence; and, arguably, include several nonclinical criteria that currently inform surgeons' decision-making.     

The psychological and social characteristics of patients referred for NHS cosmetic surgery: quantifying clinical need.

PURPOSE: Elective cosmetic surgery is expanding in the UK in both the public and private sectors. Because resources are constrained, many cosmetic procedures are being excluded within the National Health Service. If guidelines on who can receive such surgery are to be evidence-based, information is needed about the level of dysfunction in patients referred for elective surgery and whether this is related to their degree of physical abnormality. METHOD: Consecutive patients referred to a regional plastic surgery and burns unit for assessment for elective cosmetic surgery completed standardised measures of physical and psychosocial dysfunction, and indicated their perception of the degree of their abnormality and their preoccupation with it. We distinguished between patients referred for physical reasons or appearance reasons only, and compared levels of physical and psychosocial dysfunction in each with published values for community and clinical samples. Surgeons indicated patients' degree of objective abnormality, and we identified the relationship of dysfunction with perceived and objective abnormality and preoccupation. RESULTS: Whether patients sought surgery for physical or appearance reasons, physical function was normal. Those seeking surgery for appearance reasons only had moderate psychosocial dysfunction, but were not as impaired as clinical groups with psychological problems. Patients seeking the correction of minor skin lesions for purely appearance reasons reported excellent physical and psychosocial function. Level of function was related (negatively) to patients' preoccupation with abnormality rather than to their perceived or objective abnormality. CONCLUSIONS: In general, patients referred for elective cosmetic surgery did not present with significant levels of dysfunction. Moreover, levels of functioning were related to preoccupation rather than to objective abnormality. Therefore, for most patients, whether surgical treatment is generally appropriate is questionable. Future guidelines must seek to identify the small minority who do have a clinical need for surgery.     

Outcomes from psychological assessment regarding recommendations for cosmetic surgery.

Demand for cosmetic surgery is on the increase; in the public sector this places dual pressure upon psychological services to conduct relevant pre-surgical assessments and also upon medical services to conduct indicated surgeries. If psychological needs are identified at assessments, this creates 'on-costs' for psychological services, in terms of providing the necessary and indicated psychological interventions. The current study attempted to investigate clinical outcomes from psychological assessments for cosmetic surgery, through identifying the rate and range of possible outcomes and examining factors associated with such outcomes. The sample consisted of 62 females seeking cosmetic surgery concerning the appearance of either their breasts or their stomachs; 23 sought breast augmentation, 23 sought breast reduction and 18 sought abdominoplasty. Participants were seen for psychological assessment, during which a clinical screening interview was performed and various validated self-report measures completed. Results indicate that women seeking breast augmentation were more likely than women in the other groups to be recommended to receive either psychological treatments prior to surgery or psychological treatments alone. Lower levels of psychological distress were associated with recommendations for surgery. The results are discussed in terms of identified methodological short-comings of the study and the potential role of psychological assessments in the care pathway of people seeking cosmetic surgery.     

Perioperative considerations for patient safety during cosmetic surgery �C preventing complications

Maintaining patient safety in the operating room is a major concern of surgeons, hospitals and surgical facilities. Circumventing preventable complications is essential, and pressure to avoid these complications in cosmetic surgery is increasing. Traditionally, nursing and anesthesia staff have managed patient positioning and safety issues in the operating room. As the number of office-based procedures in the plastic surgeon’s practice increases, understanding and implementing patient safety guidelines by the plastic surgeon is of increasing importance.A review of the Joint Commission’s Universal Protocol highlights requirements set forth to prevent perioperative complications. In the present paper, the importance of implementing these guidelines into the cosmetic surgery practice is reviewed. Key aspects of patient safety in the operating room are outlined, including patient positioning, ocular protection and other issues essential for minimization of postoperative morbidity. Additionally, as the demand for body contouring surgery in the cosmetic practice continues to increase, special attention to safety considerations specific to the obese and massive weight loss patients is mandatory.After review of the present paper, the reader should be able to introduce the Joint Commission’s Universal Protocol into their daily practice. The reader will understand key aspects of patient positioning, airway management and ocular protection in cosmetic surgery. Finally, the reader will have a better understanding of the perioperative care of unique populations including the morbidly obese, massive weight loss patients and the elderly. Attention to detail in these aspects of patient safety can help avoid unnecessary complication and significantly improve the patient’s experience and surgical outcome.     

Psychiatric assessment of patients with self-inflicted lacerations to the wrist and forearm admitted to a nonpsychiatric ward: the experience of a regional plastic surgery unit.

In 1984, the Department of Health (DoH) recommended that all patients with deliberate self-harm (DSH) must have a mental assessment before discharge. DSH patients, especially those with lacerations to wrist and forearm, are a regular source of admission to plastic surgery units. In Northern Ireland, the regional plastic surgery service is provided at the Ulster Hospital, which does not have an on-site psychiatric department. Consequently, it was often difficult to arrange a psychiatrist assessment for these patients on the ward even when the assessment was required urgently. The objective of this study was to develop and validate a protocol that would ensure that these patients were assessed and followed up for their mental health as recommended by the DoH. In the absence of clear guidelines from the DoH and utilising the existing arrangement between Accident and Emergency (A&E) and the psychiatric services, all referring A&E departments were instructed at the time of referring patients with DSH to wrist and forearm to arrange a psychiatric examination before transferring the patient to the plastic surgery unit. Data were collected retrospectively (August 2002-October 2002) and prospectively (November 2002-October 2003) and comprised demographic features, previous history of self-harm, conduct of the patient in A&E and the ward, length of stay in the hospital and various aspects of psychiatric assessment and follow-up. In total, 42 referrals were made during the period studied. The average age was 28 years with a male to female ratio of 2:1. The average hospital stay was two days. Despite difficulties, our practice was found effective in ensuring psychiatry assessment and follow-up without risking the patient's physical health. The study also highlighted the need for collaboration between plastic surgeons and psychiatrists to improve services in regards to DSH patients.     

整体护理服务模式在眼部整形手术患者中的应用效果

目的 探讨整体护理服务模式在眼部整形手术患者中的应用效果。方法 选取2021年10月-2022年 10月于我院行眼部整形手术的60例患者为研究对象,采用随机数字表法分为研究组和对照组,每组30例。 对照组采用常规护理模式,研究组采用整体护理服务模式,比较两组心理状态、手术效果、并发症发 生情况及护理满意度。结果 研究组干预后SAS评分、SDS评分均低于对照组（P＜0.05）;研究组美容效 果、眼睑形态及眼部功能评分均高于对照组（P＜0.05）;研究组并发症发生率为3.33%,低于对照组的 20.00%（P＜0.05）;研究组护理满意度为96.67%,高于对照组的76.67%（P＜0.05）。结论 整体护理服务 模式在眼部整形手术患者中的应用效果确切,能够有效改善患者的身心状态,保证整形手术效果,且术后 并发症发生率较低,应用安全性较高,可提升患者对护理工作的满意度,值得临床应用。 【关键词】整体护理服务模式;眼部整形手术;美容效果;眼睑形态;眼部功能     

Surgery for the psyche: a longitudinal study of women undergoing reduction mammoplasty

This study suggests that surgery is effective in relieving the psychological distress of women requesting reduction mammoplasty for minimal deformity. Eleven young women who applied for operation on the NHS completed measures of psychoneurosis, mood, self-esteem and body perception. Prior to operation they had a distorted body image, low self-esteem and abnormal psychoneurotic profiles. Following surgery body image returned to a normal range; their self-confidence, and view of their femininity and sexual attractiveness were also enhanced. Improvement was maintained during 6 months of follow-up. These results have implications for the NHS provision of cosmetic surgery for such patients.     

Ethical issues in plastic and reconstructive surgery

Plastic, reconstructive, and cosmetic surgery refers to a variety of operations performed in order to repair or restore body parts to look normal or to enhance a certain structure or anatomy that is already normal. Several ethical considerations such as a patient’s right for autonomy, informed consent, beneficence, and nonmalfeasance need to be given careful consideration. The principal objective of the medical profession is to render services to humanity with full respect for human dignity. Plastic surgeons should merit the confidence of patients entrusted to their care, rendering to each a full measure of service and devotion. They require an extensive amount of education and training. The increases in demand for aesthetic plastic surgery and the advocacy of practice in the media have raised concerns about the circumstances under which cosmetic surgery is ethical and permissible. Innovative research, and new technologies derived from such research, almost always raises ethical and policy concerns. Medical ethics regulate what is, and what is not, correct in promoting plastic surgery to the public. It is essential to create an educated and informed public about the ethical issues in the plastic and reconstructive surgery field. Plastic surgeons need to carefully evaluate the degree of deformity, physical and emotional maturity, and desired outcome of patients who request plastic surgery procedures. Science is a powerful force for change in modern society and plastic surgeons have a responsibility to shepherd that change with thoughtful advocacy and careful ethical scrutiny of their own behavior.     

A comparison of the cosmetic and psychological outcome of breast reconstruction, breast conserving surgery and mastectomy without reconstruction

METHOD: The cosmetic and psychological outcomes of patients who underwent reconstructive surgery, conservative surgery or simple mastectomy for breast cancer between 1995 and 2002 were compared. RESULTS: There was a significant correlation between good psychological adjustment and good cosmetic outcome scores (p=0.01-0.05). There was no difference in cosmetic outcome between different reconstruction methods. Reconstruction patients rated their cosmetic outcome better than conservative surgery patients, and conservative surgery patients better than mastectomy patients. There were no differences in psychological outcome between patient groups. CONCLUSION: Good perception of cosmetic outcome is associated with good psychological adjustment. There is no cosmetic advantage of one type of reconstruction over another. Reconstruction patients have a better body image compared with other treatment groups but there are no other psychological advantages of one type of treatment over another.     

Psychological issues in cosmetic surgery: a functional overview

The relevance of psychological issues in cosmetic surgery has been well established in the literature. Early articles considered psychopathology to be prevalent in the plastic surgery population, whereas more recent views consider the typical cosmetic surgery candidate to be more psychologically stable. Despite these changes, the potential for psychopathology continues to be recognized. Consequently, screening for psychopathology during the preoperative interview has remained essential. To facilitate a working knowledge of psychological issues that may be useful in preoperative screening, this article reviews the current literature on the psychology of plastic surgery. In addition to discussing the psychological impact of cosmetic surgery, patient's motivations and expectations for surgery are discussed in the context of self-image. After reviewing potential types of psychopathology, various preoperative screening techniques are discussed.     

Aesthetic plastic surgery: Some caveats

Aesthetic plastic surgery requires particular expertise in determining the patient's potential postoperative satisfaction. As the demand for this surgical specialty increases, so too do the possible psychological hazards associated with patient selection. Because the complaints of patients with minimal defects and their evaluation of the cosmetic results tend to be highly subjective—in contrast to the more objective and realistic complaints of those with marked disfigurement—careful interviewing of candidates is essential. In special need of skillful screening are those patients who, although they may present some correctable imperfection, are not only vague as to what they think they want done and what they expect but also are unaware of the underlying causes of their self-discontent. Such individuals, once accepted for surgery, can present management problems that may lead to outcomes detrimental to themselves, to the surgeon, or to both.     

整形美容受术者术后心理并发症发生情况分析及其意义

目的：整形美容外科由于受术群体的特殊性因而术后心理并发症发生率可能更高,发生情况可能更为严重,因此,了解整形美容受术者的心理特征和术后心理并发症的发生情况,有助于提高整形美容外科医护人员对受术者术后心理并发症的认识,加强应对措施。方法：采用问卷调查法,调查统计自2009年1月～2010年9月在我院接受5种整形美容外科手术的314例受术者,分析其主要的心理并发症发生情况。结果：除手术引起的非特异性生理并发症如瘀血、瘀斑、不确定的身体不适外,其它较严重的手术并发症发生率均较低。受术者术后心理并发症发生情况的调查结果显示,术后心理并发症发生率高于生理并发症,主要表现为焦虑、抑郁、睡眠障碍、失望。其中面部除皱术受术者焦虑发生率最高为85.7%;隆鼻术、眼部整形术受术者术后失望的发生率较高,分别为67.1%、65.6%;而隆乳术受术者抑郁和睡眠障碍发生率最高,分别为86.8%、92.1%;受术者术后心理并发症的发生率与受术者年龄之间关系的调查统计结果显示：35～55岁的受术者心理并发症发生率最高为88.1%;其次是21～34岁的受术者;20岁以下受术者心理并发症发生率最低为57.1%。结论：整形美容外科手术不同于其它外科手术,术后的心理问题需要给予高度关注,整形美容受术者的心理并发症发生情况与手术种类、年龄等因素有关。     

整体护理在眼部整形手术患者中的应用效果

探究眼部整形手术中应用整体护理的临床价值。方法 选取2021年1月-2023年3月于我院 行眼部整形手术的70例患者为研究对象，按随机数字表法分为常规组和整体组，各35例。常规组采用常规 护理，整体组采用整体护理，比较两组恢复时间、恢复效果、眼部整形效果、护理满意度及情绪状况。 结果 整体组住院时间、创口愈合时间、疼痛消失时间、眼部分泌物消失时间均短于常规组（P ＜0.05）； 整体组情感状态、生理舒适性、自理能力、心理支持、疼痛评分均优于常规组（P＜0.05）；整体组美容效 果、眼睑形态、眼部功能评分均高于常规组（P ＜0.05）；整体组对健康教育、心理护理、舒适护理、整体 感受的满意度评分均高于常规组（P＜0.05）；整体组护理后正性情绪评分高于常规组，负性情绪评分低于 常规组（P ＜0.05）。结论 整体护理应用于眼部整形手术患者中，有助于促进患者的康复，提升患者整形 效果和患者满意度，改善患者情绪状态，具有积极的临床应用价值。     

Cosmetic results in 242 patients treated by conservative surgery for breast cancer.

The surgery of breast cancer has changed lately in favour of breast conserving treatment, the main purpose of which is to provide good cosmetic results together with radical resection of the tumour. In this paper we describe the cosmetic results obtained in 242 patients treated by conservative surgery (226 quadrantectomies, 93%, and 16 lumpectomies, 7%) for low risk breast cancer. Several of these resections were combined with plastic surgical techniques for residual breast reshaping. The technique chosen depended on the site of tumour, width of resection, and breast volume. The cosmetic assessment was made by the patient and the physician. Our data suggest that better cosmetic results may be obtained when plastic surgical procedures are combined with conservative surgery for breast cancer.     

Self-Perception and Self-Esteem of Patients Seeking Cosmetic Surgery

Cosmetic surgery represents a particular application of plastic surgery, in which the operative competence of the discipline is focused not on the correction of pathological disorders, but on the correction of some morphologic traits not accepted by the patients, or not adherent with the aesthetic canons of the time, although they are absolutely compatible with the norm. As a consequence, cosmetic surgery recognizes subjective indications. According to a particular literature on the subject, patients seeking these interventions would live a dualism between (their own) body image and inner self-image. Very psychotic case histories would come out of this. A base psychological approach adopted by the surgeon, competent both in the surgical and the psychological level, is absolutely needed. In this study, the psychological features of patients seeking cosmetic surgery were explored in an attempt to define common profiles or prevalent characteristics, and to isolate major psychiatric disorders. Patient self-esteem and physical self-perception also were investigated.     

体像障碍在整形美容外科中的认识与研究进展

体像障碍（BDD）指自身躯体外观无明显缺陷而自己臆想出丑陋畸形的痛苦心理病症,是一种 扭曲认知的病态心理。有研究显示5%~15%寻求整形手术的人都患有BDD。然而,伴有BDD的患者盲目进 行整形美容手术容易引发医疗纠纷。本文将对体像障碍的概念、流行病学特征、临床特点等方面进行综 述,以便临床医生在诊疗过程中初步了解患者的心理状态,针对不同的患者采取个性化策略,提高术后满 意度,减少医疗纠纷。     

Attitudes to cosmetic surgery amongst primary care physicians: a cross-sectional survey

How much involvement do primary care physicians (PCPs) have and want with cosmetic surgery? How do their attitudes influence the referral of patients who are considering cosmetic surgery? An electronic survey of all PCPs in Worcestershire was done. Email addresses were identified via National Health Service (NHS) and practice websites. Results were electronically correlated. All Worcestershire PCPs were emailed (189), 69 completed the questionnaire (response rate 37%). NHS rationing was thought too strict (18%), about right (72%) and rarely too lenient (7%). Each PCP saw an average of one to two patients per month. The probability of referral depended on the patient's problem. In purely cosmetic cases, 54% would not refer. Commercial websites were rarely or never recommended. Fewer than 30% were aware of the BAAPS website. PCPs (>90%) wanted to be informed postoperatively about a patient's private cosmetic surgery. Most PCPs had encountered patients with complications after cosmetic surgery and more than half thought this was inappropriate. Thirty-one percent had encountered cosmetic surgery tourists. This study gives useful insights into primary care physicians' attitudes which may facilitate education and information provision. This is the first study to publish primary care physicians' attitudes to cosmetic surgery and the effects on referral.     

全面护理管理在整形美容门诊手术室患者中的应用效果

目的 观察对整形美容门诊手术室患者行全面护理管理的效果。方法 选取2022年8月-2023年 8月于我院整形美容门诊手术室行手术治疗的68例患者为研究对象,以随机数字表法分为对比组和干预 组,每组34例。对比组采用常规护理管理,干预组采用全面护理管理,比较两组心理状态、护理满意 度、感染发生情况、手术室护理管理质量及疼痛程度。结果 干预组护理后SAS评分、SDS评分均低于对 比组（P ＜0.05）;干预组护理满意度为97.06%,高于对比组的79.41%（P ＜0.05）;干预组感染发生率为 5.88%,低于对比组的23.53%（P ＜0.05）;干预组护理管理质量评分高于对比组（P ＜0.05）;干预组VAS 评分低于对比组（P＜0.05）。结论 全面护理管理在整形美容门诊手术室患者中的应用效果确切,可有效 调节患者的心理状态,减轻其疼痛程度,同时能够提升手术室护理管理质量,有利于提高患者满意度,实 现良好的感染防控效果。     

Psychological issues in patient outcomes

This article provides an overview of the psychological issues of facial plastic surgery patients. It begins with a review of the research on the preoperative psychological characteristics of cosmetic surgery patients. Results from the studies assessing postoperative changes in psychological status are reviewed. The psychological issues of specific patient groups, including adolescents and male patients, are discussed. Individuals who undergo plastic surgical procedures as a result of craniofacial anomalies or facial injuries often face a myriad of psychosocial challenges. These issues are outlined in brief. The article concludes with a discussion of two psychiatric conditions, body dysmorphic disorder and posttraumatic stress disorder, that may be frequently encountered by facial plastic surgeons.     

基于人文关怀的细节化护理在颌面部外伤行美容整形术患者中的应用效果

分析对颌面部外伤行美容整形术患者采用基于人文关怀的细节化护理的效果。方法 选取 2021年8月-2022年8月于广东医科大学附属医院整形外科行美容整形手术治疗的51例颌面部外伤患者作为 研究对象，随机分为参照组（n =26）与研究组（n =25）。参照组实施常规护理，研究组实施基于人文关 怀的细节化护理，比较两组负性情绪、瘢痕情况及美学效果满意度。结果 研究组护理后SAS评分、SDS评 分均低于参照组，差异有统计学意义（P ＜0.05）；研究组护理后VSS评分低于参照组，差异有统计学意义 （P＜0.05）；研究组美学效果满意度为96.00%，高于参照组的69.23%，差异有统计学意义（P＜0.05）。结 论 基于人文关怀的细节化护理在颌面部外伤行美容整形术患者中的应用效果确切，可有效减轻患者的心 理负担，促进瘢痕修复，有利于提高美学效果满意度。