James L. Baker

A prospective, multi-site investigation of patient satisfaction and psychosocial status following cosmetic surgery

BACKGROUND Although several studies have investigated patient satisfaction and changes in body image following aesthetic plastic surgery, few have investigated more specific dimensions of body image, including dysphoric emotions that occur in specific social situations or body image quality of life. In addition, few studies have investigated changes in body image that may occur in concert with changes in more general areas of psychosocial functioning, such as depressive symptoms and self-esteem. OBJECTIVE This prospective, multi-site study investigated postoperative satisfaction and changes in psychosocial status following cosmetic surgery. METHODS One hundred patients recruited from 8 geographically diverse surgical practices completed psychometric measures of body image, depressive symptoms, and self-esteem prior to surgery. Seventy-two patients completed the 3-month postoperative assessment, 67 completed the 6-month assessment, and 63 completed the 12-month assessment. All statistical tests on changes after surgery were conducted using the sample of 72 patients who completed the 3-month assessment. A Last Observation Carried Forward analysis was used to account for patients who did not complete the subsequent follow-up assessments. In addition, they reported their postoperative satisfaction as well as self-rated attractiveness at the 3 postoperative assessment points. RESULTS Eighty-seven percent of patients reported satisfaction with their postoperative outcomes. Patients also reported significant improvements in their overall appearance, as well as the appearance of the feature altered by surgery, at each of the postoperative assessment points. Patients experienced significant improvements in their overall body image, their degree of dissatisfaction with the feature altered by surgery, and the frequency of negative body image emotions in specific social situations. All of these improvements were maintained 12 months after surgery. CONCLUSIONS These results add to a growing body of literature documenting improvements in body image following cosmetic surgery.

Two-Year Results of a Prospective, Multi-Site Investigation of Patient Satisfaction and Psychosocial Status Following Cosmetic Surgery

BACKGROUND The number of cosmetic surgical and nonsurgical procedures performed in the United States has increased by 500% over the past 10 years. Most studies of psychosocial functioning following aesthetic procedures have reported high levels of patient satisfaction and improved functioning; however, nearly all these studies focused only on changes during the first posttreatment year. OBJECTIVE This paper reports on the 2-year results of a prospective, multi-site investigation of postoperative satisfaction and changes in psychosocial status following cosmetic surgery. METHODS One hundred patients from 8 surgical practices completed psychometric measures of body image, depressive symptoms, and self-esteem before surgery. Patients completed the same measures again at 3, 6, 12, and 24 months postoperatively. In addition, they reported their postoperative satisfaction as well as self-rated attractiveness at the 4 postoperative assessment points. RESULTS Patients reported improvements in their overall appearance and body image, the appearance of and their degree of dissatisfaction with the feature altered by surgery, and the frequency of negative body image emotions in specific social situations through 24 months after surgery. These improvements were first evident at 3 months postoperatively and were maintained, without deterioration, through 2 years following surgery. CONCLUSIONS Patients reported high rates of satisfaction and improvements in body image within the first 3 months of cosmetic surgery. These improvements were well maintained through the first 2 postoperative years.

Choosing breast implant size: a matter of aesthetics

The author chooses breast implant volume by balancing the patients preferences with the limitations imposed by her body type. To achieve the best results, he relies on his aesthetic sense rather than complex measurements, but he recommends general guidelines.

Lateral Subcutaneous Brow Lift: Updated Technique

Age-related changes affecting the periorbital area and resulting in eyebrow ptosis have a greater impact on the lateral eyebrow; correction of this deformity is a common request from patients seeking periorbital rejuvenation.1 Various techniques have been utilized to address eyebrow ptosis, including the coronal brow lift, endoscopic technique, anterior hairline approach, transpalpebral lift, midforehead lift, and direct brow lift. Furthermore, arguments for dissection in each of the different tissue planes—subcutaneous, subgaleal, or subperiosteal—have all been discussed. Each of these approaches has specific indications, risks, and benefits, and should be selected after comprehensive evaluation of the patient.2-4 In our experience, a full coronal incision often results in an obvious midline scar in the central forehead, increases the risk of elongating the vertical height of the forehead, and can result in paresthesias posterior to the hairline, a symptom that is very bothersome to patients. Endoscopic brow lifts require additional equipment with increased operative time, and the deeper dissection involved in this technique results in suboptimal brow elevation compared to the subcutaneous approach. Furthermore, not all patients are appropriate candidates for endoscopic brow lifts, including those with significant convex frontal bones, high or receding hairlines, deep transverse rhytides, or significant brow ptosis. In patients presenting with lateral brow descent, the temporal or lateral subcutaneous brow lift has produced consistent and effective results. This technique has been well described in the literature, and has several advantages, including shorter operative time, feasibility under local anesthesia, decreased …

Response to “Comments on ‘Lateral Subcutaneous Brow Lift: Updated Technique’”

No screw fixation is used in our technique,1 nor is it in the original article by Miller.2 Only a single layer closure of 4-0 nylon is utilized. Dr Tjong Joe Wai states that there is a possibility of rupture in this static solution, resulting in recurrence of eyebrow ptosis.3 In well over 100 consecutive patients utilizing our technique,1 and in the …

Smooth implants placed subglandularly produce the best cosmetic result

James L. Baker, Jr., MD Winter Park, FL I have used only smooth implants since January 1992, and I place them on top of the muscle. I believe significant cosmetic benefits are achieved with this approach. I always discuss the various options for implant type and placement with my patients. I tell patients that if they want textured implants, these should be placed subpectorally because wrinkling can be expected. Wrinkling may occur on the lateral and inferior poles and medially in the upper cleavage area. So I believe that textured implants must be placed completely submuscularly to …