The effects of cosmetic surgery on body image, self-esteem, and psychological problems.

BACKGROUND: This study aims to investigate whether cosmetic surgery has an effect on an individual's body image, general self-esteem, and psychological problems. Further tests were conducted to assess whether the extent of psychological problems before surgery influenced improvements in postoperative psychological outcomes. METHODS: Questionnaire data from 155 female cosmetic surgery patients from a plastic surgery clinic were obtained before and approximately 6 months after surgery. The questionnaire consisted of measures on body image, self-esteem, and psychological problems. Pre- and postoperative values were compared. Pre- and postoperative measures were also compared with the data compiled from a representative sample of 838 Norwegian women, aged 22-55, with no cosmetic surgery experience. RESULTS: No differences in psychological problems between the presurgery patient and comparison samples were found, whereas differences in body image and self-esteem between the sample groups were reported in an earlier publication. Analyses further revealed an improvement in body image (satisfaction with own appearance) after surgery. A significant but rather small effect on self-esteem was also found, whereas the level of psychological problems did not change after surgery. Postoperative measures of appearance satisfaction, self-esteem, and psychological problems did not differ from values derived from the comparison sample. Finally, few psychological problems before surgery predicted a greater improvement in appearance satisfaction and self-esteem after surgery. CONCLUSIONS: The study provides evidence of improvement in satisfaction with own appearance after cosmetic surgery, a variable that is thought to play a central role in understanding the psychology of cosmetic surgery patients. The study also points to the factors that surgeons should be aware of, particularly the role of psychological problems, which could inhibit the positive effects of cosmetic surgery.

Acute erosions of the gastric mucosa in burned rats: effect of sucralfate.

The effect of intragastric sucralfate on development of gastric erosions in burns was studied in 20 rats anaesthetised with midazolam/fentanyl/fluanisone. Gastric blood flow was measured by radioactive microspheres immediately before, and 20, 40, and 120 minutes after the rats had been burned. Significantly fewer erosions were found in the 10 rats treated with sucralfate (less than 2% of the gastric mucosal surface was affected) compared with the controls (16% of the mucosa affected). There was no difference in the rate of gastric blood flow in any part of the stomach between the rats treated with sucralfate and the controls. We conclude that sucralfate is effective in preventing gastric erosions in burned rats, but that other mechanisms of action than increase gastric blood flow are responsible for its protective effect.

Aesthetic treatment of progressive hemifacial atrophy (Romberg's disease): use of a pedicled platysma muscle flap.

Several methods have been described for anesthetic correction of Romberg's disease. We have used the platysma muscle flap as the only procedure in four cases of severe to moderate disease. The platysma flap was transected at the clavicular level, turned at the mandibular margin, and spread subcutaneously on the affected side from the nasolabial fold up to the orbital margin and laterally to the anterior part of the ear. The flap masked the atrophy relatively well, and no complications were seen during or after the procedure. The procedure can be combined with orthognathic surgery if required.

Alkalisation of lignocaine-adrenaline reduces the amount of pain during subcutaneous injection of local anaesthetic.

A double blind, randomised controlled trial was performed to compare the amount of pain experienced after subcutaneous infiltration of lignocaine with adrenaline, and the same anaesthetic buffered to pH 7.1-7.3, in patients undergoing liposuction (n = 8), blepharoplasty (n = 7), mammaplasty (n = 6), and in volunteers (n = 10). A linear analogue pain scale was used to access pain. In all four groups the buffered solution caused significantly less pain (p < 0.001 except for mammaplasty--p = 0.02).

Effect of preoperative inflammation of the wound bed on survival of skin flaps in rats.

Pedicled dorsal flaps were raised and resutured on the backs of 20 rats. Aseptic inflammation of the bed of the wound flap was induced one week before the operation in 10 rats by scratching with a needle; the other 10 acted as controls. A week after the operation the extent of necrosis was estimated by computer assisted planimetry. Blood flow in the four quarters of the flap and in normal skin was estimated using the microsphere technique. A larger mean area of the skin flaps survived in rats in which the wound bed had been scratched (71%) compared with the controls (61%) (p < 0.05); blood flow in the flaps was also higher (p < 0.0005). We conclude that the most likely explanation for these results was preoperative angiogenesis in the wound bed.

[Are silicone breast prostheses dangerous?]. / Er silikonfylte mammaproteser helsefarlige?

Since 1964 silicone breast prostheses have been implanted in 5 million women for breast reconstruction after cancer operations, to correct congenital deformities and for cosmetic reasons. There is no evidence in the literature of a correlation between silicone implants and breast cancer. Some authors claim that silicone implants reduce the reliability of mammography. Autoimmune diseases in patients with silicone mammary implants are reported in less than 40 cases. Most of these are localized or systemic scleroderma. An association with silicone implants has been suggested, but this suggestion has not been confirmed by scientific data.

Clinical results in 87 patients treated for asymmetrical breasts. A follow-up study.

A retrospective study was made of 87 patients operated on between 1984 and 1990 for asymmetrical breasts. Thirty-two patients had 36 implants (13 also had breast reduction or mastopexy of the contralateral breast). Capsular contraction, Baker grade II-IV, was found in a third of the implants. The remaining 54 patients underwent reduction mammaplasty or mastopexy alone. 90% of the patients were satisfied with the result. There was no significant difference in the overall satisfaction between the patients who did or did not have implants. We nevertheless think that mammary implants should be avoided whenever possible in the correction of breast asymmetry. Even though there is no difference in patients' satisfaction, it is our experience that those with implants have more frequent follow-up consultations and are subject to more postoperative procedures than those corrected without implants.

The effects of infiltration with adrenaline on blood loss during reduction mammaplasty.

Between March and November 1990 a prospective study of the effect of an infiltration of diluted adrenaline on bleeding during and after reduction mammaplasty was carried out in 12 consecutive patients. There was a significant reduction in blood loss to less than 50% of that from the non-infiltrated breasts. There was no signs of increased postoperative bleeding or reduced flap viability as a result of infiltration of adrenaline.

The effect of preoperative needle abrasion of the recipient site on survival of autologous free fat grafts in rats.

Pads of fat ranging from 670-1758 mg in weight were taken from the right groins of 20 rats and implanted subcutaneously over their right pectoral muscles. One week previously the recipient site on the thorax had been abraded with a needle in 10 of the rats. After three months the transplanted fat was taken out, weighed, and examined histologically by light microscopy. Regional tissue blood flow in the transplanted fat and in the fat from the left groin was measured by the microsphere technique. The amount of surviving fat and blood flow in the fat transplanted to an abraded recipient site was significantly higher than in the control group after three months. We conclude that preoperative needle abrasion of the recipient site may increase the chance of revascularisation and survival of the transplanted fat in rats.

[Prevention of scars. A controlled long-term study of the effect of hydrocolloid occlusive bandages after thoracic surgery in children]. / Profylaktisk arrbehandling. En kontrollert langtidsstudie av effekten av hydrokolloid okklusiv bandasje etter thoraxkirurgi hos barn.

We examined the development of hypertrophic scarring in 38 children undergoing thoracic surgery. The patients were observed for average 14 months. A treatment group receiving hydrocolloid occlusive bandage (DuoDERM ConvaTec, Squibb) was compared with a control group. Although the difference between the groups did not reach statistical significance there was a clear tendency towards better prevention of hypertrophic scarring in the group treated with hydrocolloid occlusive bandage.

Distribution of cardiac output during pentobarbital versus midazolam/fentanyl/fluanisone anaesthesia in the rat.

Differences in effects on central haemodynamics, organ blood flow, and serum corticosterone were studied in 11 rats anaesthetized with midazolam/fentanyl/fluanisone (MFF) and 11 other rats anaesthetized with sodium pentobarbital. Compared with pentobarbital, MFF reduced aortic blood pressure by 25%, increased heart rate by 20%, and increased cardiac output by 80%. Unlike most tissues, MFF produced a fivefold increase in blood flow to skeletal muscle, and decreased adrenal blood flow compared to pentobarbital anaesthesia. Initial serum corticosterone levels were lower in rats given MFF anaesthesia, indicating better stress protection. This study also indicates that MFF anaesthesia is preferable to pentobarbital because tissue perfusion generally was better preserved.

Acute erosions of the gastric mucosa in burned rats: effect of gastric acidity and fluid replacement.

Early changes in the morphology of the gastric mucosa after the skin had been burned were studied using a standardised model in rats. A full thickness burn was inflicted by exposing about 20% of the total body surface area to hot water (99 degrees C) for 10 s. Intragastric acidity was kept at pH 1.0 or pH 7.4 in six experimental groups of eight rats. Rats were subjected to burns with the stomach irrigated at pH 1.0 or pH 7.4. Parallel groups received fluid replacement with a solution of human albumin, and two uninjured groups served as controls. Lesions of the gastric mucosa were measured by planimetry of photographs, and light microscopy was used for histological examination. At an intragastric pH of 1.0, the burned rats developed mucosal erosions covering an average of 13% of the total glandular mucosa; the remaining groups had only minimal mucosal lesions. Erosions of the gastric mucosa after the skin had been burned could be prevented in two ways--either by establishing an alkaline (pH 7.4) milieu in the gastric lumen, or by replacing sufficient fluid to maintain aortic blood pressure at the pre-experiment level. Fluid replacement prevented mucosal erosions even if the intragastric pH was kept at 1.0. Thus both luminal acidity and local tissue blood flow are possible mechanisms for gastric epithelial damage following burns of the skin.