David L. Harris

The DAS24: A short form of the Derriford Appearance Scale DAS59 to measure individual responses to living with problems of appearance

OBJECTIVES To develop a psychometrically robust and widely applicable short form of the Derriford Appearance Scale, (DAS59), which (1) will reliably and validly assess the distress and difficulties experienced in living with problems of appearance, (2) is acceptable to clinical and non-clinical populations, and (3) facilitates research and clinical decision-making through good standardization and sensitivity. DESIGN Cross-sectional survey designs using clinical (out-patient and in-patient) and general population samples. METHOD Twenty-five items were selected initially from the 59 items of the original DAS59. These were refined to 24 through item analyses and the scale was standardized on 535 patients with a range of problems of appearance and on a representative general population sample (N=1, 107). RESULTS All 24 items contributed well to the total score and internal consistency was high (alpha=.92). Test-retest reliability (6 months) was good (0.82), and criterion validity, with the DAS59, was excellent (0.88). Good construct validity was demonstrated in differences between (1) patient and general population samples, (2) members of the general population concerned and not concerned about their appearance, and (3) in patterns of convergent and divergent correlations with a range of established scales. The general population data revealed widespread concerns about appearance. CONCLUSION The DAS24 provides a widely applicable and acceptable short form of the original DAS59. It is psychometrically robust and discriminates well between patient groups, between clinical and non-clinical populations, and within the general population between those concerned, and those not concerned, about their appearance.

The Derriford Appearance Scale (DAS-59): A new scale to measure individual responses to living with problems of appearance

Objectives. To develop a reliable and valid self-report scale which (1) will assess the distress and difficulties experienced in living with a problem of appearance; (2) can be used with clinical and non-clinical populations; and (3) facilitates clinical decisionmaking and research through good standardization, sensitivity and discrimination. Design.Cross-sectional survey designs using clinical and non-clinical populations and a pre-post intervention design using plastic surgery patients. Method. A large initial item set was refined through a controlled pre-post surgery study and a cross-sectional study of a plastic surgery waiting list (606). The resulting 59-item scale was administered to 1740 patients with problems of appearance and to a representative general population sample (1001). Results. Principal component and factor analyses identified a stable five-factor structure accounting for 63.5% of the variance, with a primary factor of self-consciousness of appearance. Internal consistency was high (alpha= .98) and test-retest reliabilities (three months) were good (.75 (general population); .86 (patients)). Correlations with existing tests showed appropriate criterion validity (.74-.62). Good construct validity was evidenced in pre- and post-operative changes, in differences between patients and controls and in convergent and divergent correlation patterns. The general population data reveal widespread concerns about appearance. Conclusions. The DAS-59 provides a widely acceptable, psychometrically robust, factorial self-report scale to assess distress and dysfunction in problems of appearance across the full range of ‘visibility’ and aetiologies. It is sensitive to therapeutic change and discriminates well between patient groups.

The symptomatology of abnormal appearance: an anecdotal survey

From a systematic analysis of 54 anecdotal accounts written by patients with various abnormalities of appearance, a common pattern of experience has been discovered which is divisible into six parts: induction and development of self-consciousness, defence mechanisms, unavoidable distressing activities, downgrading of self-concept, difficulties with interpersonal relationships, and rationalisation. This scheme of symptomatology is presented as a basis for history-taking and as a base-line for future comparative studies of different types of abnormal appearance.

Psychological change after aesthetic plastic surgery: A prospective controlled outcome study

Aesthetic plastic surgery has been long practiced for primarily psychological rather than physical benefit to patients. However, evaluation of the psychological impact of aesthetic plastic surgery has often been of limited methodological rigor in both study design and appropriate measurement. This study is intended to evaluate the psychological impact of aesthetic surgery on patients seeking such intervention in regard to concerns about breasts, nose or upper limbs using standardised psychometric instruments. Participants were recruited through the Plastic Surgery Unit (Patients) and general surgery, ENT surgery and Maxillo-facial surgery (Comparisons) at a UK General Hospital. Outcome measures included the Crown–Crisp Experiential Inventory anxiety scale, Beck Depression Inventory and Derriford Appearance Scale-24, a valid and reliable measure of distress and dysfunction in relation to self-consciousness of appearance. Data were collected pre-operatively (T1) and 3 months post-operatively (T2) for both groups. Longitudinal appearance adjustment for the plastic surgery group was also assessed at 12 months (T3). Both groups were less depressed and anxious post-operatively. The improvement in anxiety was significantly greater in the plastic surgery group. Body site specific appearance distress was significantly improved for the plastics group only, and the level of improvement was related to the body site affected.

Cosmetic surgery—where does it begin?

“Cosmetic surgery: the undertaking of an operation plastic or otherwise which will improve appearance, or the avoidance of one which will having a disfiguring effect.” Butterworth’s Medical Dictionary (1978). In contradistinction to other fields of surgery plastic surgery has dual objectives: to restore function and to restore and preserve normal appearance. The plastic surgeon has the latter objective in view in all that he does, be it the repair of a cleft lip, the treatment of a burn injury, the augmentation of hypoplastic breasts or the reconstruction of a defect left after excision of a malignant lesion. Cosmetic surgery began with the plastic surgeon’s sympathy with the lot of the disfigured. The abnormalities of appearance that are dealt with by cosmetic surgery can be classified aetiologically as those resulting from: (i) congenital malformation; (ii) disease and injury; (iii) physiological processes such as carbohydrate storage, reproduction and ageing; (iv) disproportionate development of bodily and facial features. But such a classification is of little value to an understanding of cosmetic surgery, the purpose of which is to relieve and prevent the distress that is suffered by those who are self-conscious of abnormal appearance. Experience has taught plastic surgeons that the amount of distress caused by abnormal appearance varies from one person to another and bears little relationship either to its aetiology or to the degree of abnormality as judged by the observer. One person may be only slightly distressed by an extensive port wine stain of the face whilst another may be severly distressed by a relatively insignificant hump on the nasal bridge. In contrast to other branches of surgery, the application of cosmetic surgery should be judged, not on the grossness of the abnormality but on the degree of emotional distress that an abnormality of appearance produces. Cosmetic surgery is psychotherapeutic. To understand the raison d3tre of cosmetic surgery (the question posed by the title of this essay) it is necessary to understand the rBle of appearance in society, the factors which determine the distress suffered by those who are selfconscious of abnormal appearance and the attitudes of their observers.

A long term review of hypospadias repaired by split preputial flap technique (Harris)

A long term review of hypospadias patients repaired over 10 years ago by the split preputial flap technique of Harris was evaluated in 35 patients aged 13 and over. The urinary and sexual function was assessed as well as the psychological status and aesthetic appearance. The long term complications are discussed.

Splitting the prepuce to provide two independently vascularised flaps: a one-stage repair of hypospadias and congenital short urethra

The operative details of a one-stage procedure to repair hypospadias and congenital short urethra are presented. The prepuce is split from its distal margin to provide two independently vascularised flaps for the reconstruction of the penile urethra and its overlying skin. The results of the first 50 patients so treated are described. The use of a silicone rubber tile on which to stabilise the penis during operation and a self-adhering foam pad as a post-operative dressing are described.