{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T20:33:29Z","timestamp":1792096409456,"version":"4.4.0"},"reference-count":53,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Victor Babes University of Medicine and Pharmacy, Timisoara, Romania"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: This systematic review investigates the relationship between preoperative psychological disorders and postoperative satisfaction among patients undergoing aesthetic surgery. While aesthetic procedures can enhance self-image, growing evidence indicates that underlying mental health conditions, particularly BDD, depression, and anxiety, may compromise surgical outcomes. Materials and Methods: A comprehensive literature search was performed in PubMed, the Cochrane Library, and Google Scholar between January 2010 and December 2024. Eligible observational studies assessed preoperative psychological conditions\u2014primarily body dysmorphic disorder, depression, and anxiety\u2014using validated instruments, such as the Body Dysmorphic Disorder Questionnaire (BDDQ), Body Dysmorphic Disorder Examination (BDDE), Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), and structured clinical interviews, and reported postoperative patient-reported satisfaction following aesthetic surgery. Study quality was evaluated using an adapted QUIPS framework. Results: Across the 13 included studies, six reported a negative association between moderate-to-severe preoperative psychological symptoms and postoperative satisfaction, five found no significant association, and two described positive or conditional associations. Methodological heterogeneity in psychological assessment tools and satisfaction measures was a major source of divergence across studies. Despite these differences, the evidence underscores the need for standardized, validated psychological evaluation protocols in aesthetic surgery. Incorporating mental health screening into routine surgical planning can enhance ethical practice, reduce dissatisfaction, and improve long-term patient outcomes. Conclusions: These findings advocate for a multidisciplinary approach that includes psychological assessment as an essential component of patient care in aesthetic medicine.<\/jats:p>","DOI":"10.3390\/medicina62020389","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T12:37:28Z","timestamp":1771245448000},"page":"389","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Psychological Disorder and Patient Satisfaction in Aesthetic Surgery\u2014A Systematic Review"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2185-3008","authenticated-orcid":false,"given":"Lavinia","family":"Hogea","sequence":"first","affiliation":[{"name":"Neuroscience Department, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Neuropsychology and Behavioral Medicine Center, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda","family":"Bernad","sequence":"additional","affiliation":[{"name":"Neuroscience Department, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Neuropsychology and Behavioral Medicine Center, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amalia","family":"Marinca","sequence":"additional","affiliation":[{"name":"Center for Studies and Research in Psychology, Faculty of Psychology, \u201cTibiscus\u201d University, Lasc\u0103r Catargiu 4-6, 300559 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Corsaro","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Universit\u00e0 Campus Bio-Medico di Roma, Via \u00c1lvaro del Portillo, 21, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8952-3486","authenticated-orcid":false,"given":"Iuliana","family":"Costea","sequence":"additional","affiliation":[{"name":"Psychology Department, West University of Timisoara, 300223 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2187-289X","authenticated-orcid":false,"given":"Nina","family":"Ivanovic","sequence":"additional","affiliation":[{"name":"Dermatology Department, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Doctoral School of Medicine, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teodora","family":"Anghel","sequence":"additional","affiliation":[{"name":"Neuroscience Department, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Neuropsychology and Behavioral Medicine Center, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"49","DOI":"10.34239\/ajops.v1i1.29","article-title":"Defining Cosmetic Surgery","volume":"1","author":"Dean","year":"2018","journal-title":"Australas. J. Plast. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.15537\/smj.2020.10.25380","article-title":"Screening for Body Dysmorphic Disorder Among Patients Pursuing Cosmetic Surgeries in Saudi Arabia","volume":"41","author":"Mortada","year":"2020","journal-title":"Saudi Med. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s43045-023-00283-8","article-title":"The Association between Comorbid Body Dysmorphic Disorder and Depression: Moderation Effect of Age and Mediation Effect of Body Mass Index and Body Image Among Pakistani Students","volume":"30","author":"Haider","year":"2023","journal-title":"Middle East Curr. Psychiatry"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.31579\/2637-8892\/159","article-title":"Prevalence of Body Dysmorphic Disorder Among Female Patients Seeking Cosmetic Procedures","volume":"6","author":"Almuhanna","year":"2022","journal-title":"JPMHC"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.bodyim.2016.07.003","article-title":"Body Dysmorphic Disorder in Different Settings: A Systematic Review and Estimated Weighted Prevalence","volume":"18","author":"Veale","year":"2016","journal-title":"Body Image"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.2147\/CCID.S410621","article-title":"Cosmetic Surgery and the Diversity of Cultural and Ethnic Perceptions of Facial, Breast, and Gluteal Aesthetics in Women: A Comprehensive Review","volume":"16","author":"Arian","year":"2023","journal-title":"Clin. Cosmet. Investig. Dermatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e5963","DOI":"10.1097\/GOX.0000000000005963","article-title":"Using Microeconomic Spending Traits to Inform Trends in Utilization of Cosmetic Procedures by Race and Ethnicity","volume":"12","author":"Rhee","year":"2024","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Loureiro, S.M.C., and Panchapakesan, P. (2016, January 21\u201324). It Is All About Desires! Motivation to Engage in Medical Tourism Practices and Subjective Well-Being. Proceedings of the 2016 Global Marketing Conference, Hong Kong, China.","DOI":"10.15444\/GMC2016.07.09.06"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s00238-022-01987-6","article-title":"The Effect of Cosmetic Surgery on Self-Esteem and Body Image: A Systematic Review and Meta-Analysis of Clinical Trial Studies","volume":"46","author":"Kazeminia","year":"2022","journal-title":"Eur. J. Plast. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1097\/01.PRS.0000110214.88868.CA","article-title":"A Review of Psychosocial Outcomes for Patients Seeking Cosmetic Surgery","volume":"113","author":"Honigman","year":"2004","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1097\/NMD.0000000000001477","article-title":"The Psychological Benefits of Cosmetic Surgery","volume":"210","author":"Kam","year":"2022","journal-title":"J. Nerv. Ment. Dis."},{"key":"ref_13","first-page":"e99284","article-title":"The Surgeon\u2019s Blind Spot: A Narrative Review of Psychological Risks and Assessment Strategies in Invasive Aesthetic Surgery Patients","volume":"17","author":"Jagpal","year":"2025","journal-title":"Cureus"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1097\/SAP.0000000000003682","article-title":"Prevalence of Psychiatric Disorders in Aesthetic Surgery","volume":"91","author":"Mendes","year":"2023","journal-title":"Ann. Plast. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"264","DOI":"10.7326\/0003-4819-151-4-200908180-00135","article-title":"Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement","volume":"151","author":"Moher","year":"2009","journal-title":"Ann. Intern. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s13643-021-01626-4","article-title":"The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews","volume":"10","author":"Page","year":"2021","journal-title":"Syst. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s41512-019-0050-0","article-title":"Elaborating on the Assessment of the Risk of Bias in Prognostic Studies in Pain Rehabilitation Using QUIPS\u2014Aspects of Interrater Agreement","volume":"3","author":"Grooten","year":"2019","journal-title":"Diagn. Progn. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1097\/PRS.0b013e3182818f02","article-title":"Preoperative Symptoms of Body Dysmorphic Disorder Determine Postoperative Satisfaction and Quality of Life in Aesthetic Rhinoplasty","volume":"131","author":"Picavet","year":"2013","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/j.bjps.2014.01.002","article-title":"Patients with Mild to Moderate Body Dysmorphic Disorder May Benefit from Rhinoplasty","volume":"67","author":"Felix","year":"2014","journal-title":"J. Plast. Reconstr. Aesthetic Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1093\/asj\/sjae045","article-title":"Rhinoplasty Outcomes in Patients with Symptoms of Body Dysmorphia","volume":"44","author":"Losorelli","year":"2024","journal-title":"Aesthetic Surg. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1097\/PRS.0000000000000552","article-title":"Why Some Patients Are Unhappy","volume":"134","author":"Constantian","year":"2014","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1093\/asj\/sjad252","article-title":"The Effect of Preoperative Diagnosis of Depression and\/or Anxiety on Patient-Reported Outcomes Following Chest Wall Masculinization Surgery","volume":"44","author":"Morgenstern","year":"2023","journal-title":"Aesthetic Surg. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1097\/PRS.0b013e31822213f0","article-title":"Psychosocial Changes after Cosmetic Surgery","volume":"128","author":"Kvalem","year":"2011","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1177\/2167702612471660","article-title":"Well-Being From the Knife? Psychological Effects of Aesthetic Surgery","volume":"1","author":"Margraf","year":"2013","journal-title":"Clin. Psychol. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1097\/SAP.0b013e3181d50e54","article-title":"The PreFACE\u2014A Preoperative Psychosocial Screen for Elective Facial Cosmetic Surgery and Cosmetic Dentistry Patients","volume":"66","author":"Honigman","year":"2011","journal-title":"Ann. Plast. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1001\/archfaci.2009.69","article-title":"Predictors of Satisfaction with Facial Plastic Surgery","volume":"12","author":"Hessler","year":"2010","journal-title":"Arch. Facial Plast. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.1093\/asj\/sjae089","article-title":"Correlation Between Medically Diagnosed Anxiety and Depression Disorder and Self-Reported Breast Implant Illness","volume":"44","author":"Bresnick","year":"2024","journal-title":"Aesthetic Surg. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1093\/asj\/sjv213","article-title":"Prevalence of Body Dysmorphic Disorder Symptoms and Body Weight Concerns in Patients Seeking Abdominoplasty","volume":"36","author":"Nahas","year":"2016","journal-title":"Aesthet. Surg. J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1089\/fpsam.2023.0212","article-title":"Prevalence and Characteristics Associated with Positive Body Dysmorphic Disorder Screening Among Patients Presenting for Cosmetic Facial Plastic Surgery","volume":"26","author":"Wei","year":"2024","journal-title":"Facial Plast. Surg. Aesthetic Med."},{"key":"ref_30","first-page":"889","article-title":"Body Image Dysphoria and Quality of Life Among Women Who Apply for Cosmetic Surgery","volume":"17","author":"Gabrielyan","year":"2015","journal-title":"Eur. Health Psychol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"008","DOI":"10.1055\/s-0040-1721868","article-title":"Psychiatric Assessment and Management of Clients Undergoing Cosmetic Surgery: Overview and Need for an Integrated Approach","volume":"54","author":"Bascarane","year":"2021","journal-title":"Indian J. Plast. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"ojac077","DOI":"10.1093\/asjof\/ojac077","article-title":"The Psychological Impact of Aesthetic Surgery: A Mini-Review","volume":"4","author":"Jones","year":"2022","journal-title":"Aesthetic Surg. J. Open Forum"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1177\/1359105318754645","article-title":"Mental Health and Psychosocial Characteristics of Breast Augmentation Patients","volume":"25","author":"Torgersen","year":"2020","journal-title":"J. Health Psychol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"S823","DOI":"10.1016\/j.jcot.2020.06.037","article-title":"Early Patient Satisfaction Following Orthopaedic Surgery","volume":"11","author":"Howard","year":"2020","journal-title":"J. Clin. Orthop. Trauma"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1177\/30499240251322304","article-title":"Psychological Determinants of Patient Satisfaction in Aesthetic Surgery: The Impact of Preoperative Screening and Counselling","volume":"1","author":"Gupta","year":"2025","journal-title":"Int. J. Aesthetic Plast. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1097\/PSN.0b013e31823ef115","article-title":"Psychological Characteristics and Outcomes of Elective Cosmetic Surgery Patients: The Influence of Cosmetic Surgery History","volume":"31","author":"Dowling","year":"2011","journal-title":"Plast. Surg. Nurs."},{"key":"ref_37","first-page":"e862","article-title":"Quality of Life and Aesthetic Plastic Surgery: A Systematic Review and Meta-Analysis","volume":"4","author":"Dreher","year":"2016","journal-title":"Plast. Reconstr. Surg.\u2014Glob. Open"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"S556","DOI":"10.51253\/pafmj.v1i1.7931","article-title":"Aesthetic Surgery: Impact on Quality of Life","volume":"71","author":"Khan","year":"2021","journal-title":"PAFMJ"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1007\/s10006-010-0212-2","article-title":"Perception of Improvement After Orthognathic Surgery: The Important Variables Affecting Patient Satisfaction","volume":"14","author":"Rustemeyer","year":"2010","journal-title":"Oral Maxillofac. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1001\/jamafacial.2016.1535","article-title":"Prevalence of Body Dysmorphic Disorder and Surgeon Diagnostic Accuracy in Facial Plastic and Oculoplastic Surgery Clinics","volume":"19","author":"Joseph","year":"2017","journal-title":"JAMA Facial Plast. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1177\/0004867421998753","article-title":"Is the Needle as Risky as the Knife? The Prevalence and Risks of Body Dysmorphic Disorder in Women Undertaking Minor Cosmetic Procedures","volume":"55","author":"Pikoos","year":"2021","journal-title":"Aust. N. Z. J. Psychiatry"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1055\/a-2244-1066","article-title":"An Evidence-Based Pathway for Body Dysmorphic Disorder in Facial Aesthetics","volume":"40","author":"Mandavia","year":"2024","journal-title":"Facial Plast. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"62","DOI":"10.12968\/joan.2019.8.2.62","article-title":"Body Dysmorphic Disorder and Aesthetic Procedures","volume":"8","author":"Gorbis","year":"2019","journal-title":"J. Aesthetic Nurs."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1007\/s00266-011-9808-7","article-title":"A Comprehensive Screening, Education, and Training Tool for the Psychological Assessment of Patients Seeking Aesthetic Surgery: \u201cDESIRABLE OP?\u201d","volume":"36","author":"Rees","year":"2012","journal-title":"Aesthetic Plast. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1007\/s00266-020-01752-9","article-title":"Elective, Non-Urgent Procedures and Aesthetic Surgery in the Wake of SARS\u2013COVID-19: Considerations Regarding Safety, Feasibility and Impact on Clinical Management","volume":"44","author":"Kaye","year":"2020","journal-title":"Aesthetic Plast. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Yurtsever, I., Matusiak, \u0141., and Szepietowski, J.C. (2022). To Inject or to Reject? The Body Image Perception Among Aesthetic Dermatology Patients. JCM, 12.","DOI":"10.3390\/jcm12010172"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2843","DOI":"10.1111\/jocd.16358","article-title":"Aesthetic Management of Lips and Perioral Region with Hylacross\u00ae and Vycross\u00ae Hyaluronic-acid Based Fillers: A Document of Recommendations","volume":"23","author":"Hospido","year":"2024","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"263","DOI":"10.2500\/ajra.2011.25.3649","article-title":"Outcomes Research in Rhinoplasty: Body Image and Quality of Life","volume":"25","author":"Cingi","year":"2011","journal-title":"Am. J. Rhinol. Allergy"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e47","DOI":"10.4172\/plastic-surgery.1000777","article-title":"Factors That Motivate People to Undergo Cosmetic Surgery","volume":"20","author":"Furnham","year":"2012","journal-title":"J. Plast. Surg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2243","DOI":"10.1097\/PRS.0b013e3181f445ae","article-title":"Psychology of Plastic and Reconstructive Surgery: A Systematic Clinical Review","volume":"126","author":"Shridharani","year":"2010","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.bjps.2011.09.038","article-title":"Psychopathology Symptoms in a Sample of Female Cosmetic Surgery Patients","volume":"65","author":"Mulkens","year":"2012","journal-title":"J. Plast. Reconstr. Aesthetic Surg."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e13727","DOI":"10.1111\/dth.13727","article-title":"Psychological Aspects of Aesthetic and Cosmetic Surgery: Clinical and Therapeutic Implications","volume":"33","author":"Jafferany","year":"2020","journal-title":"Dermatol. Ther."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"349","DOI":"10.54254\/2753-7048\/2\/2022487","article-title":"Dependent Personality Disorder and Its Gender Differences","volume":"2","author":"Wei","year":"2023","journal-title":"LNEP"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/2\/389\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T13:08:43Z","timestamp":1771247323000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/2\/389"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,16]]},"references-count":53,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["medicina62020389"],"URL":"https:\/\/doi.org\/10.3390\/medicina62020389","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,16]]}}}