Beauty and the eye of the beholder: social consequences and personal adjustments for facial patients

Comparison of the quality of life changes of patients receiving sagittal split ramus osteotomy or intraoral vertical subsigmoid osteotomy for mandibular prognathism

OBJECTIVE

To investigate and compare the effect of two orthognathic procedures for mandibular setback, namely, sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO), on oral health, mental- and physical health-related quality of life across time.

MATERIALS AND METHODS

Patients with mandibular prognathism and planned for orthognathic surgery were recruited in this study. Patients were randomized into two groups (IVRO and SSRO groups). Quality of life (QoL) was assessed with the 14-item Short-Form Oral Health Impact Profile (OHIP-14) and the 36-item Short-Form Health Survey (SF-36) preoperatively (T₀), postoperative 2 weeks (T₁), 6 weeks (T₂), 3 months (T₃), 6 months (T₄), 12 months (T₅), and 24 months (T₆). A comparison of OHIP-14 and SF-36 scores between two groups was conducted.

RESULTS

Ninety-eight patients (49 SSRO group, 49 IVRO group) participated in this study. There was no significant difference in OHIP-14 scores between SSRO and IVRO throughout the treatment process. SSRO group had significant reduction of OHIP-14 score (i.e., improving oral health-related QoL) since postoperative 2 weeks, whereas IVRO group had significant reduction since postoperative 6 weeks. Starting from postoperative 3 months, the oral health-related QoL of both groups was already significantly better than the baseline level and continued to steadily improve afterwards. For SF-36, both groups had increased physical health summary score starting from postoperative 2 weeks, indicating an early and gradual recovery of physical health-related QoL. The mental health summary score of the SSRO group began to increase from postoperative 2 weeks, but that of the IVRO group only began to increase from postoperative 6 weeks. Patient age at the time of surgery was positively correlated with OHIP scores in the postoperative period.

CONCLUSIONS

The study concludes that both SSRO and IVRO contributed to the improvement of QoL in the long term, but oral health- and mental health-related QoL of SSRO groups showed earlier improvement.

CLINICAL RELEVANCE

Undergoing orthognathic surgery at early ages is advised, as older age of patients appeared to have worse QoL.

TRIAL REGISTRATION

Clinical trial registration number: HKUCTR-1985. Date of Registration: 14 Apr 2015.

Multidisciplinary design: Creating a common perspective in complex cases

OBJECTIVE

This clinical report describes and illustrates digital treatment planning and interdisciplinary orthodontic, surgical, and prosthetic treatment in a highly complex clinical case.

CLINICAL CONSIDERATIONS

Analogue design protocols through wax ups are highly variable, technique sensitive, and operator dependent. Digital smile design and treatment planning tools facilitate simplified processes through the use of natural tooth libraries, based on the specific esthetic and functional needs of the individual patient. The vast information compiled in the virtual patient and the treatment plan consolidated in the initial digital design facilitate true interdisciplinary treatment planning and execution, with all dental specialties involved, from orthodontic to surgical and prosthetic treatment.

CONCLUSIONS

Digital protocols and design tools provide clear clinical roadmaps for increased efficiency, precision, and predictability, vastly improving the quality of interdisciplinary patient care.

CLINICAL SIGNIFICANCE

While analogue protocols are technique sensitive and largely dependent on the operator, digital smile design, and treatment planning tools offer opportunities for truly patient-centered individualized care and interdisciplinary treatment.

Perception of quality of life by children and adolescents with cleft lip/palate after orthodontic and surgical treatment: gender and age analysis

Background

The quality of life (QoL) of children and adolescents with cleft lip/palate (CL/P) has been shown to be a predictor of good psychosocial functioning in this population group. This study aimed to measure QoL, from the patient´s perception of change produced by the different surgical and orthodontic treatments carried out since early childhood, and if gender and age are modulating the outcome variables results.

Materials and methods

A cross-sectional research study was carried out. The study included 60 patients with cleft lip, cleft palate, or cleft lip/palate, aged between 8 and 18, who were in orthodontic treatment and had undergone at least one surgery. They were asked to complete the Quality-of-Life Adolescent Cleft Questionnaire (QoLAdoCleft), which allows the assessment of the QoL through self-perception of improvement after surgical and orthodontic interventions. In particular, this questionnaire (administered only once), allows the evaluation of self-perception of QoL at the present time and before orthodontic and surgical treatment. This double assessment was carried out for the domains of physical, psychological, and social health. The results were analysed by looking at the interaction of gender and age.

Results

Statistically significant differences were found in the perception of the current QoL in comparison to the retrospective perception in all the dimensions considered. The perception of QoL improved in all cases. The results also showed a moderation of gender in the relation between perception of previous behaviour and social function and actual behaviour and social function.

Conclusion

The results indicated that patients perceived their quality of life had improved as a result of the treatments received, with the highest effect sizes found in the physical health domain. Specifically, the improvement in QoL in behaviour and social function tended to be influenced to a greater extent by perception of previous QoL. In this sense, personalized preventative measures from holistic and biopsychosocial approaches are necessary.

Evolution of Aesthetic Dentistry

One of the main goals of dental treatment is to mimic teeth and design smiles in a most natural and aesthetic manner, based on the individual and specific needs of the patient. Possibilities to reach that goal have significantly improved over the last decade through new and specific treatment modalities, steadily enhanced and more aesthetic dental materials, and novel techniques and technologies. This article gives an overview of the evolution of aesthetic dentistry over the past 100 y from a historical point of view and highlights advances in the development of dental research and clinical interventions that have contributed the science and art of aesthetic dentistry. Among the most noteworthy advancements over the past decade are the establishment of universal aesthetic rules and guidelines based on the assessment of natural aesthetic parameters, anatomy, and physiognomy; the development of tooth whitening and advanced restorative as well as prosthetic materials and techniques, supported by the pioneering discovery of dental adhesion; the significant progress in orthodontics and periodontal as well as oral and maxillofacial surgery; and, most recently, the implementation of digital technologies in the 3-dimensional planning and realization of truly natural, individual, and aesthetic smiles. In the future, artificial intelligence and machine learning will likely lead to automation of aesthetic evaluation, smile design, and treatment-planning processes.

Cobbler's Technique for Iridodialysis Repair

We describe a novel “Cobbler's technique” for iridodialysis repair in the right eye of a patient aged 18 years, with a traumatic iridodialysis secondary to open globe injury with an iron rod. Our technique is simple with easy surgical maneuvers, that is, effective for repairing iridodialysis. The “Cobbler's technique” allows a maximally functional and cosmetic result for iridodialysis.

Orthodontic treatment need for adolescents in the Campania region: the malocclusion impact on self-concept

BACKGROUND

Dental malocclusions can be considered not only as an oral health problem, because they are linked to quality of life perception. Many factors related to malocclusion have strong influences on the perception of facial esthetics (eg, anterior tooth alignment, tooth shape and position, lip thickness, symmetric gingival or tooth contour, lip profile, and overjet). Many reports have shown that the perception of facial esthetics can influence psychological development from early childhood to adulthood. The aim of this study is to investigate the effect of dental malocclusion on self-esteem in a sample of adolescents.

MATERIALS AND METHODS

The study population was composed of 516 orthodontically untreated subjects (256 males) mean ages 13.75±1.977 years recruited from schools in the Campania region of Italy between January 2011 and July 2011. To evaluate the self-esteem grade in our population, all subjects filled out the Multidimensional Self Concept Scale questionnaire and attended an orthodontic clinical evaluation to estimate dental occlusal aspects.

RESULTS

Pearson's analysis shows the relationship in our sample between some occlusal characteristics (crossbite and dental crowding) and aspects of self-concept evaluation (social, competence, academic, physical, and global score) of the Multidimensional Self Concept Scale questionnaire. Moreover, logistic regression analysis shows the potential role of dental crowding (odds ratio 5.359; 95% confidence interval 3.492-8.225) and crossbite (odds ratio 6.153; 95% confidence interval 3.545-10.678) as risk factors for development of global self-concept score abnormalities.

CONCLUSION

Our findings confirm the relationship between psychosocial well-being, self-esteem, and dental malocclusion among adolescents.

Self-concept in youth with congenital facial differences: development and recommendations for medical providers

Congenital facial differences may impact a child's self-perception, activities and valuation, and what has been termed their "self-concept." This article reviews what constitutes self-concept, and its development during childhood and adolescence. The literature examining the role of physical appearance, specifically congenital facial differences on individuals' perceptions of self are reviewed in the context of psychosocial development. Positive self-concept can impact healthy behaviors, positive interactions with peers, and academic achievement. The role of mental health professionals in evaluating self-concept and objective measures of self-concept are discussed, and recommendations are made to assist medical practitioners regarding monitoring and encouragement of positive self-concept in children with congenital facial differences.

Does abdominoplasty have a positive influence on quality of life, self-esteem, and emotional stability?

BACKGROUND

In a previous prospective study, the authors evaluated the quality of life in patients undergoing aesthetic surgery. In this survey, the authors split up the operative indication and analyzed quality of life, self-esteem, and emotional stability after abdominoplasty alone.

METHODS

Sixty-three patients participated in the study. The testing instrument consisted of a self-developed questionnaire to collect demographic and socioeconomic data and a postoperative complication questionnaire developed especially for abdominoplasties. In addition, a standardized self-assessment test on satisfaction and quality of life (Questions on Life Satisfaction), the Rosenberg Self -Esteem Questionnaire, and the Freiburg Personality Inventory were used.

RESULTS

Significantly increasing values in some items of the standardized self-assessment test on satisfaction and quality of life were found: sum scores of the General Life Satisfaction showed a significant improvement (p = 0.004) and the scores of the items housing/living conditions (p = 0.000) and family life/children (p = 0.000). Within the Satisfaction with Health module, a significant improvement in the items mobility (p = 0.02) and independence from assistance (p = 0.01) was found. Values in the module Satisfaction with Appearance (Body Image) increased regarding satisfaction with the abdomen (p = 0.001). Over 84 percent were very satisfied with the aesthetic result, 93.4 percent would undergo the same treatment again, and 88.9 percent would further recommend the operation. Data revealed that participants' self-esteem was very high and their emotional stability was very well balanced.

CONCLUSIONS

This study demonstrates that abdominoplasty increases most aspects of quality of life, particularly family life, living conditions, mobility, and independency from assistance. Also, patient self-esteem and emotional stability ratings are very high postoperatively.

Nonappositional repair of iridodialysis

We describe a novel "hang-back" surgical approach for repairing an iridodialysis. Instead of repositioning the iris tightly to the sclera, the detached peripheral iris is suspended by a suture inside the normal iris insertion, reducing corectopia and avoiding inadvertent coverage of the trabecular meshwork by peripheral iris. A horizontal mattress suture is placed ab interno via a paracentesis site and tightened to bring the iris periphery to inside and under the limbus, as viewed from the frontal plane. This technique provides an excellent functional and cosmetic result.

FINANCIAL DISCLOSURE

Neither author has a financial or proprietary interest in any material or method mentioned.

Evaluation of the effects of malocclusion and orthodontic treatment on self-esteem in an adolescent population

INTRODUCTION

The purpose of this study was to evaluate the effects of malocclusion and orthodontic treatment on adolescent self-esteem.

METHODS

A total of 4509 middle school students were clinically evaluated for dental crowding. Lip protrusion was also measured with a specially designed ruler. Rosenberg's self-esteem scale was used to determine each subject's level of self-esteem.

RESULTS

The results showed that sex played a role in the relationship between self-esteem and malocclusion. For the girls, crowding of the anterior teeth had significant effects on their self-esteem; however, there was no significant difference in the boys' self-esteem. After fixed orthodontic treatment, the girls had higher self-esteem than the untreated malocclusion group. Girls with an ideal profile and good tooth alignment also showed higher self-esteem than students with crowding or protrusion.

CONCLUSIONS

This clinical study proved that malocclusion and fixed orthodontic treatment can affect self-esteem in adolescent girls.

Early, staged reconstruction in young women with severe breast asymmetry

STUDY OBJECTIVE

To retrospectively examine a cohort of young women with severe hypoplasia or asymmetric breast development who underwent breast reconstruction with tissue expansion and to determine complication rates as well as patient satisfaction.

DESIGN

Chart review.

SETTING

The University of Michigan Hospital, a tertiary care center.

PARTICIPANTS

Women less than 25 years of age who underwent staged breast reconstruction with a tissue expander between 1998 and 2006.

MAIN OUTCOME MEASURES

Complication rate and patient satisfaction.

RESULTS

The mean age of patients undergoing the procedure was 18.1 years (range 14-25 years). Of 10 patients with recorded tobacco use, 8 (80%) were noted to be nonsmokers. One of 14 patients (7.1%) was found to have a minor complication (cellulitis), and 2 of 14 (14.2%) were found to have major complications. Of the 13 patients who had at least 6 weeks of follow-up after completion of their reconstruction, 10 were subjectively documented as pleased with the result, 2 records made no mention of patient satisfaction, and 1 patient had concerns regarding her results.

CONCLUSION

Our study shows promising results for the use of tissue expanders in young women with significant breast asymmetry or unilateral/bilateral micromastia. The very important issues of short-term and long-term satisfaction and outcomes needs further study before advocating an early approach to teens with breast deformities.

Postoperative satisfaction and the patient's body image, life satisfaction, and self-esteem: a retrospective study comparing adolescent girls and boys after cosmetic surgery

BACKGROUND

Cosmetic surgery procedures are more complex for adolescents than for adults because there are more factors affecting patient satisfaction, especially psychological factors. This study was designed to find answers to four main questions: (1) whether postoperative satisfaction rates differ statistically between males and females, (2) whether postoperative satisfaction correlates significantly with the self-esteem, body image, life satisfaction trilogy, (3) what the postoperative patient satisfaction and cosmetic procedure rates are among adolescents by years, and (4) whether a statistically significant relationship exists between postoperative satisfaction and a willingness of adolescents to undergo another cosmetic surgery.

METHODS

The study enrolled 86 of 165 patients who underwent surgery between January 2001 and June 2005. A simple poll consisting of 12 simple questions was used to collect data.

RESULTS

No statistically significant difference was found in postoperative satisfaction rates between males and females. The findings show that postoperative satisfaction is significantly related to self-esteem, body image, and life satisfaction. The patient satisfaction rate was 93.83%, and there was no increase in adolescent cosmetic surgery rates over the years.

CONCLUSION

Adolescents are good candidates for cosmetic surgery, but patients must be evaluated carefully. Any suspicion about a patient's psychological status must result in a psychiatric consultation.

Representations in plastic surgery: the impact of self-image and self-confidence in the work environment

BACKGROUND

This research was initiated by the authors' conviction that many people currently pay great attention to their personal appearance, which is directly linked to their self-confidence. The external image of individuals appears to have a decisive influence on their behavior and personal choices regarding both their personal and professional lives. Accordingly, it can be assumed that appearance influences professional choices and development. Moreover, individuals associate increased self-confidence with positive social images. Therefore, the main variables used in this study were self-image, self-confidence, and work environment.

METHODS

For the purpose of this study, the authors developed a questionnaire and distributed it to a sample of 100 women who had undergone aesthetic plastic surgery. The aim of the questionnaire was to discover the opinion of these women concerning the aforementioned assumptions.

RESULTS AND CONCLUSIONS

After the data processing and analysis, the authors concluded that the aforementioned variables are statistically significant and correlated.

Quality of life following aesthetic plastic surgery: a prospective study

BACKGROUND

The objective of this study was the prospective evaluation of quality of life in patients undergoing aesthetic plastic surgery procedures. We examined pre- and postoperative changes in quality of life, and performed a comparison of our data with a representative random sample.

METHOD

228 patients agreed to participate in the present study. Measurements were taken preoperatively as well as 3 and 6 months postoperatively. One hundred and thirty two patients completed the three months postoperative evaluation (T1), 82 answered the 6 months follow-up evaluation (T2). The testing instrument included a standardised self-assessment test on satisfaction and quality of life (FLZ(M)), consisting of three modules: satisfaction with general life, health and appearance. Further, a postoperative complication questionnaire was used in order to evaluate the satisfaction with the surgical outcome and to estimate postoperative complications and side effects.

RESULTS

Significantly increasing values in two aspects of quality of life were found: health and appearance. Whereas the positive influence on health is persistent, there is a diminishing influence of appearance 6 months postoperatively. Although higher values for some of the individual items of the FLZ(M) modules of the norm data were found in comparison to our study group, a general preoperative lower level of quality of life of the aesthetic surgery patients could not be confirmed. Over 84% were satisfied or very satisfied with the aesthetic result. 85% would undergo the same treatment again and 94% of the patients would further recommend their operation. More than half of the study group did not report a decrease in physical fitness or reduced social contacts in the direct postoperative period.

CONCLUSION

Our study reveals that aesthetic plastic surgery increases most aspects of quality of life, especially regarding body satisfaction and health. It is very well tolerated by the patients and is therefore a recommended option.

Methods to evaluate profile preferences for the anteroposterior position of the mandible

INTRODUCTION

Facial profile disharmonies in the anteroposterior (AP) position of the mandible are among the most frequent reasons that patients seek orthodontic treatment. Various methods are available for assessing profile preferences, and differences between them could affect treatment decisions. The purposes of this study were to compare and contrast 3 methods of evaluating profile preferences for the AP position of the mandible.

METHODS

Facial profile preferences of white orthodontists (n = 28) and white (n = 56) and Japanese-American (n = 55) laypeople were evaluated. The esthetic significance of variations in the AP position of the mandible was investigated by using 3 methods: a traditional semantic differential scale, the Perceptometrics method (Health Programs Intl, Wellesley, Mass), and the implicit association test (IAT).

RESULTS

Findings from the semantic differential scale show that, overall, there is a general preference among orthodontists and laypeople for an orthognathic profile (P <.001). Findings from the Perceptometrics method indicate that orthodontists consider the most pleasing profile to be more forward than do lay subjects (P <.001). The IAT results show a positive bias among all 3 groups toward orthognathic profiles and a negative bias toward profiles with mandibular retrognathism or prognathism. The IAT suggested that laypeople were more tolerant of mandibular prognathism in men than in women (P <.01), and more tolerant of mandibular retrognathia in white women than in men (P = .03).

CONCLUSIONS

These results support the benefits of using both implicit and explicit methods to assess facial profile preferences.

After plastic surgery: adolescent-reported appearance ratings and appearance-related burdens in patient and general population groups

The aim of this study was to determine the effects of appearance-related surgery on psychosocial functioning during adolescence. To this end, changes in bodily attitudes and appearance-related burdens in adolescents undergoing corrective (for aesthetic deformities) and reconstructive (for congenital or acquired deformities) surgery were compared with those in a general population sample.A group of 184 adolescent plastic surgery patients (corrective, n = 100; reconstructive, n = 84), and a comparison group of 83 adolescents at random selected from three municipalities (corrective, n = 67; reconstructive, n = 16), aged 12 to 22 years, were studied at two time points with a 6-month interval. The plastic surgical patients were studied presurgically and postsurgically. Using fully structured telephone interviews and postal questionnaires, adolescents' ratings of their appearance, bodily satisfaction and attitudes, and appearance-related burdens were obtained. All patients reported a significant decrease in burdens after surgery compared with the comparison group, indicating a much more prominent improvement in the patient sample compared with the developmental changes that may be expected to occur in adolescence. The corrective patient group reported least burdens after the operation. More specifically, the "breasts" group benefited most from the operation, indicating that breast corrections are rewarding interventions. The findings of this study imply that adolescents can be regarded as good candidates for plastic surgery. They gain bodily satisfaction, and they are relieved of many appearance-related burdens. Physical, social, and psychological burdens related to appearance satisfaction improve considerably in both corrective and reconstructive adolescent patients.

Children of the Philippines: attitudes toward visible physical impairment

OBJECTIVE

This pilot study was designed to evaluate children's attitudes and understanding of physical disabilities with special reference to those with craniofacial anomalies in the Philippines. Children with and without craniofacial anomalies were studied.

DESIGN

This was a two-group correlational design with additional statistical assessment of subgroup differences. Each group was interviewed and information obtained on a standard disability preference task, attributions for playmate choice, and frequency of contact with disabilities. Parents completed a structured interview.

SETTING

Participants were 122 children recruited from Negros, Philippines.

PARTICIPANTS

Fifty-four children with craniofacial anomalies (aged 7 to 12 years) were enrolled in the study, and 68 children without any disabilities were recruited from a local school in Bacolod City, Negros, Philippines.

MAIN OUTCOME MEASURES

Participants completed a picture-ranking interview of specific physical disabilities and provided their reasons for their play choices and their contact with physical disabilities.

RESULTS

The Kendall W correlation was significant for the children with craniofacial anomalies and for those without physical disabilities. Both groups reported lower preferences for disabilities that interfere with play and social interactions. Children depicted with facial anomalies received lower preference, compared with other physical disabilities. Children with craniofacial anomalies who have experienced surgical repair reported more positive rankings for the child depicted with a facial cleft. Sex differences in disability preference were noted.

CONCLUSIONS

Children in the Philippines with and without craniofacial differences revealed similarities in preferences to children in several Western (United States) and non-Western countries. Children depicted with facial anomalies received lower preference than other visible physical differences. Children reported both positive and negative explanations for their disability play preferences. Facial differences may result in illogical and negative explanations for social avoidance among children. Similar reactions are noted in other parts of the world.

Improving self-esteem by improving physical attractiveness

Many characteristics comprise a person's personality: achievement orientation, interest to be sociable, aggressiveness, need for order, disposition, and so on. One of the most important personality characteristics in every person's life is self-esteem, which can be defined in terms of cognitive generalizations derived from past experiences. Since people are not isolated from their environment, a person's experiences impact his or her self-esteem. Since a person's physical attractiveness is known to be a major factor in his or her experiences, it is logical (as well as empirically documented) to be a substantial influence on self-esteem. The research shows that improving a physical trait improves attitude, personality, and self-esteem. Likewise, improving physical attractiveness improves interpersonal interactions. These more positive interactions are internalized intrapersonally (within a person), with direct, corresponding impact on the person's self-esteem.

The role of maternal factors in the adaptation of children with craniofacial disfigurement

This study hypothesized that maternal adjustment, perceptions, and social support would better predict child adaptation to craniofacial disfigurement than medical severity. Mothers of 77 children (ages 6-12) completed the Child Behavior Checklist, Beck Depression Inventory, Spielberger Trait Anxiety Scale, Social Support Questionnaire Revised, and Parenting Stress Index. Medical severity was assessed by the number of operations (craniofacial and other), comorbid medical conditions, and the Hay Attractiveness Scale. The children and mothers in our sample resembled a normal population in terms of their psychological functioning and quality of the mother-child relationships. Maternal adjustment and maternal perceptions of the mother-child relationship were more potent predictors of children's emotional adjustment than either medical severity or maternal social support.

Diagnosis, complications, and treatment of dentoskeletal malocclusion

The frequency of correctable malocclusion makes it imperative that the condition be diagnosed and referred for appropriate treatment. A complete dentofacial examination, which assesses facial symmetry and the dentition in the transverse, sagittal, and centric relations, is appropriate. Early diagnosis is imperative because malocclusion leads to long-term complications such as temporomandibular joint (TMJ) dysfunctions, perodontal disease, obstructive sleep apnea, psychological disorders, and articulation errors. A combination of orthodontic treatment and orthognathic surgery will correct the dentoskeletal malocclusion and prevent any long-term complications. The purpose of this case report is to describe a patient with severe dentoskeletal malocclusion who benefitted from appropriate orthodontic treatment and orthognathic surgery.

Impact of orthognathic surgery on normal and abnormal personality dimensions: a 2-year follow-up study of 61 patients

The psychological adjustments and self-concepts of 61 orthognathic surgery patients were evaluated before surgery and at 1 month, 6 months, 1 year, and 2 years after surgery. The impact of orthognathic surgery on self-concept and personality adjustment was assessed. Significant improvements in group scores were found with the use of a repeated measures ANOVA in the following subscales of personality disturbances: general maladjustment, psychosis, neurosis, personality disorder, and personality integration. A significantly positive effect was also observed in the following subscales of self-concept: self-esteem, self-satisfaction, self-identity, physical self, family self, social self, and total self-conflict. The improved changes in psychological profile two years after orthognathic surgery are encouraging.

The psychiatric assessment of the patient requesting facial surgery

Recent years have witnessed an increasing demand for cosmetic or reconstructive facial surgery. This paper addresses the pre-operative psychiatric assessment of the patient requesting facial surgery. Most patients adjust well to surgery and appreciate and accept the outcome. The psychiatrist who helps to screen difficult cases needs specific skills and must understand the body image issues involved. The psychiatrist needs to evaluate the patient's motivations, expectations and understanding of the risks and implications of surgery. Potential problem patients are described, including the minimal defect patient, the patient with secondary gain from the deformity, the older patient, the patient in crisis, the polysurgical patient, the paranoid patient, the schizophrenic patient, and the male patient. Guidelines for evaluating the patient need to be applied flexibly. The psychiatrist must communicate with the surgeon to appreciate clearly the concerns the surgeon has about each patient.

Working with facially disfigured children: a challenge in prevention

This paper reviews the growing literature on the psychology of appearance and outlines prevention principles for working with facially disfigured children, based on 15 years of psychiatric consultation to a major pediatric craniofacial team.

Self-assessment of profile and body image among orthognathic surgery patients before and two years after surgery

Ninety patients undergoing surgery at two major university hospitals completed self-ratings of their profile, perceived deviations from the ideal profile, and a measure of body image. Identical measures were obtained presurgically and two years following surgery. Patients diagnosed with mandibular hypoplasia perceived themselves significantly more prognathic on the maxillary dimension and most retrognathic on the mandibular dimension; their self-drawings reflected a shorter vertical dimension. These perceptions approached the normal range at the postsurgical assessment. Patients treated for maxillary hypoplasia, however, rated themselves in the mandibular prognathic range both before and after surgery. These patients were also more likely to perceive other deviations from the ideal in their facial features 2 years after surgical correction. Body image did not differentiate among diagnostic categories, but showed overall improvements for all patients from presurgery to postsurgery. Profile drawings appear to be the most statistically and clinically useful method of determining patients' self-assessments of deviations from normal, and their perceptions of treatment needs.