Despite the rapid rise in facial cosmetic procedures, there are few studies that investigate their psychological impact on patients, especially among those who undergo minimally invasive procedures using botulinum toxin and fillers to address wrinkles. According to a systematic literature review by researchers with the Perelman School of Medicine at the University of Pennsylvania published in JAMA Dermatology, limited research does suggest that a number of psychosocial areas improve after patients undergo facial cosmetic procedures. However, those studies often lacked control groups or failed to follow patients over time, weakening the study validity.

Minimally invasive procedures account for an increasing majority of the more than 12 million facial cosmetic procedures being performed in the United States each year. Surgical procedures like nose jobs and eye lifts decreased nearly 40 percent over the past ten years, as botulinum toxin injections increased by 621 percent in the same time period.

"With the limited amount of well-performed studies, it is certainly premature to conclusively state that facial cosmetic procedures will not only make patients 'look better' but also 'feel better'," said senior study author Joseph F. Sobanko, MD, assistant professor of Dermatology. "We as dermatologic surgeons, plastic surgeons, dermatologists, and others in the appearance-based specialties need more rigorously performed studies so we can properly advise patients and provide evidence to help determine who is likely to benefit the most from these aesthetic procedures.”

Out of thousands of studies the researchers analyzed, only 16 studies met the authors’ strict inclusion criteria and reported on the psychological impact of facial cosmetic procedures. Half of the included studies combined results from facial and body contouring surgeries like breast augmentation. For surgical facial cosmetic procedures such as face lifts or nose jobs, quality of life and self esteem improved. The single study that investigated a non-surgical procedure revealed an increase in self-esteem and quality of life after botulinum toxin injections. And in the only study to look at a procedure-specific impact on body image, nose jobs significantly improved body image.

Dr. Sobanko noted that Penn is currently enrolling patients in a prospective large-scale study examining psychological changes in patients receiving soft tissue filler and botulinum toxin. 

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