Facelift Not Necessarily Tied to a Lift in Self-Esteem

A study in JAMA Facial Plastic Surgery suggests that rhytidectomy procedures don’t necessarily lead to increases in self-esteem for patients. The study “underscore[s] 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,” the study authors note.

The findings are potentially important, because the overall success of aesthetic surgical procedures goes beyond the objective success of the surgery to the more subjective measures of optimal patient psychological health. The study authors observe that self-esteem is a very sensitive psychological factor that can influence patients’ motivations for seeking surgery as well as their perceptions of outcomes.

The study used the Rosenberg Self-Esteem Scale (RSES) to correlate the outcome of rhytidectomy as perceived by 59 rhytidectomy patients, both before and 6 months after their surgeries. 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.

Before the face-lift procedures, the patients’ average self-esteem score was 24.3, at the high end of what is considered “normal.” But post-surgery, the average score had increased only 0.3 points on the RSES scale -- to 24.6, which was not statistically significant (P =  .69). Interestingly, patients who had entered the procedure with lower self-esteem scores showed a statistically significant improvement in self-esteem after surgery. But patients with average self-esteem showed only a small, statistically insignificant increase in self-esteem. Patients who started with the highest self-esteem showed a decrease in the RSES score of —3.1 (P = .03).

One possible explanation for the lack of increase in the self-esteem scores is the belief from some patients that the surgery did not meet its objectives. But that doesn’t seem to be the case: survey respondents thought they appeared a mean 8.9 years younger after their face-lift surgery than before.

The researchers note that other factors that may contribute to overall self-esteem, including body mass index, history of psychiatric treatment, and whether other surgeries were performed at the same time were related to self-esteem measures after the operation.