Aging Skin: Some Psychosomatic Aspects

Abstract

A request for cosmetic procedures for aging skin is typically emotionally or psychosocially motivated as such procedures are usually life enhancing versus life saving. The primary responsibility of the clinician is to ensure that (i) he or she can accomplish what the patient desires and that (ii) the patient is satisfied with treatment outcome. Both of these points can be significantly influenced by psychosomatic factors. Overall trends indicate an increasing number of younger individuals in the 13--29 years age group, and mainly women are seeking cosmetic treatments for facial rejuvenation, especially the minimally invasive procedures. This has important implications as two-thirds of patients with body dysmorphic disorder (BDD), which is considered a contraindication for cosmetic procedures, experience symptoms prior age 18 years. In addition to BDD, younger age, male gender, minimal deformities, unrealistic expectations, and narcissistic and obsessional personality traits are some of the major negative predictors for patient satisfaction with outcome of cosmetic procedures. A slim and well-toned body is typically a feature of a youthful appearance, and in some individuals fear of aging can culminate in excessive drive for thinness and an eating disorder. Several studies suggest that patients seeking cosmetic procedures should be screened for depressive symptoms with a special focus on recent significant losses such as bereavement and divorce. A direct enquiry about abuse history can be psychiatrically destabilizing and heighten suicide risk in patients who may seek cosmetic procedures as an unconscious attempt to ``fix'' a body that is perceived as tainted by childhood sexual abuse.