Psychological difficulties amongst plastic surgery ex-patients following surgery to the face: a survey

Qualitative accounts suggest that social difficulties are a major source of psychological disturbance to disfigured people. However, there have been few systematic investigations of their psychological and social difficulties, and those which do exist are usually small studies with methodological difficulties. Social skills training and cognitive-behavioural therapy are promising interventions, particularly if it can be demonstrated that anxiety is a major element of the psychological difficulties experienced by disfigured people. A postal survey was sent to all ex-patients at a plastic surgery clinic who received plastic surgery to the face between 6 months and 5 years 6 months prior to the date of the survey. Of these, 105 ex-patients returned questionnaires, representing a 41.8% response rate. Respondents did not differ from non-respondents according to age, sex or diagnosis. The majority of respondents were not experiencing psychological difficulty, but GHQ caseness, HAD anxiety and HAD depression scores were generally higher than in general population samples. Their levels of social phobia appeared higher than prevalence in the general population, although direct comparison is hampered by the different instruments used. Women showed greater disturbance than men on many of the scales used, and patients who had undergone surgery for revision of scars showed greater disturbance than those who had undergone surgery for cancer. The current study may be considered more representative of disfigured people than previous surveys, since its subjects were neither awaiting nor receiving treatment, although the response rate was still low. Contrary to assertions in previous studies, standardised measures detected dysphoria in this sample. Anxiety, particularly in social situations, with associated phobic avoidance, was the most frequently reported difficulty, with depression considerably less common. Given the success of cognitive-behaviour therapy in addressing such difficulties, both via formal therapy and self-help methods, there are clear implications for treatment from this finding.