The Surgeon’s Blind Spot: A Narrative Review of Psychological Risks and Assessment Strategies in Invasive Aesthetic Surgery Patients

Abstract

Cosmetic surgery aims to enhance appearance and psychological well-being, and its popularity is rapidly increasing. Cosmetic surgery patients are much more likely to report mental health concerns than other surgical groups, yet clinicians often lack understanding of psychological outcomes and assessment strategies. A literature search was performed using PubMed, MEDLINE (Medical Literature Analysis and Retrieval System Online), and Google Scholar with the keywords "cosmetic surgery", "aesthetic surgery", "self-esteem", "anxiety", and "body dysmorphia" to evaluate the psychological effects of invasive cosmetic procedures. Additionally, this review evaluates the use of pre-operative psychological assessments within the United Kingdom cosmetic surgery practices. Most studies showed cosmetic surgery improved body image but had limited or no effect on self-esteem. Depression often persisted or worsened postoperatively. Women undergoing breast augmentation were two to three times more likely to die by suicide than other cosmetic surgery patients. Individuals with body dysmorphic disorder (BDD) consistently experienced no improvement or a decline in psychological well-being after surgery. Pre- and post-operative psychological assessment is essential but underused, with over half of the plastic surgeons in the United Kingdom not routinely screening patients. Standardised assessment guidelines are urgently needed to mitigate psychological harm.