Rhinoplasty update: preoperative evaluation of 4,040 cases

The psychological aspects of rhinoplasty

PURPOSE OF REVIEW

Literature on the psychological aspects of rhinoplasty is sparse compared with publications on methods and instrumentation. Understanding the psychological aspects of rhinoplasty and, more importantly, recognizing the patient who may have an unfavorable postoperative course regardless of the objective outcome is of fundamental importance to the surgeon.

RECENT FINDINGS

Several profiles of patients with a high risk of postoperative dissatisfaction have been described and the important role of body dysmorphic disorder and its treatment has been stressed. Still, these criteria can be insufficient when facing the individual patient, as reliable screening instruments for clinical practice have not been developed and the question when not to operate is subject to controversy. The role of computer imaging as a safeguard in preoperative counseling has been highlighted.

SUMMARY

The surgeon must rely on instinct and experience to avoid overlooking any signs of psychological imbalance in the patient that may herald adversity. Archetypes described in the literature should be recognized and computer imaging should be used during the preoperative consultation.

Psychiatric aspects of head and neck surgery. Part II: Body image and psychiatric intervention

Surgery of the head and neck leads to profound changes of body image, including disfigurement and difficulties with verbalization. The psychologic importance of alterations in these areas will be discussed as well as their effect on the conduct of psychiatric treatment. Psychiatric intervention in this population demands an active approach and special preparation for the therapeutic encounter is necessary.