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Psychological Evaluation of Patients Undergoing Cosmetic Procedures

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Psychological Evaluation of Patients Undergoing Cosmetic Procedures Psychological evaluation of patients undergoing cosmetic procedures Practice guide Acknowledgements We would like to acknowledge the following people who provided their expert review of the content of this practice guide: Dr Gemma Sharp MAPS Dr Ben Buchanan MAPS Dr Ryan Kaplan MAPS Australian Psychological Society. (2018). Psychological evaluation of patients undergoing cosmetic procedures. Melbourne, Vic: Author. Disclaimer and Copyright This publication was produced by The Australian Psychological Society Ltd (APS) to guide psychologists in best practice in the assessment of individuals seeking to undergo a cosmetic procedure. The information provided does not replace clinical judgment and decision-making. While every reasonable effort has been made to ensure the accuracy of the information, no guarantee can be given that the information is free from error or omission. The APS, their employees and agents shall accept no liability for any act or omission occurring from reliance on the information provided, or for the consequences of any such act or omission. The APS does not accept any liability for any injury, loss or damage incurred by use of, or reliance on, the information. Such damages include, without limitation, direct, indirect, special, incidental or consequential. Any reproduction of this material must acknowledge the APS as the source of any selected passage, extract or other information or material reproduced. For reproduction or publication beyond that permitted by the Copyright Act 1968, permission should be sought in writing. Copyright © 2018 The Australian Psychological Society Ltd Table of Contents Introduction ...................................................................................................................................... 4 Consultations and external review....................................................................................................... 4 De nition of cosmetic procedures as covered in this practice guide ..................................... 4 Procedures not considered ‘cosmetic’ and not covered in this practice guide ................... 5 Limitations ...................................................................................................................................................... 5 Background ....................................................................................................................................... 6 Prevalence of people seeking cosmetic procedures or surgery ................................................. 6 Potential adverse outcomes .................................................................................................................... 6 Patient characteristics associated with adverse outcomes ....................................................... 7 Psychosocial assessment of adults ............................................................................................... 9 Aims and outcomes of an assessment ............................................................................................... 9 Assessment step-by-step .......................................................................................................................... 9 Rating scales and assessment measures ........................................................................................ 13 Concluding the assessment ................................................................................................................. 14 Psychosocial assessment of specic populations .................................................................... 15 Assessment of transgender individuals .......................................................................................... 15 Assessment of minors ............................................................................................................................. 15 Summary ........................................................................................................................................ 17 References ..................................................................................................................................... 18 psychology.org.au 3 Introduction In October 2016, the Medical Board Consultations and external review of Australia issued the ‘Guidelines for A draft version of this practice guide was reviewed registered medical practitioners who by experts in the area (please see the section perform cosmetic medical and surgical ‘Acknowledgements’ for a list of these experts). procedures’.1 The Medical Board of Australia The writing and editorial team revised the guide in guidelines make clear that some patients response to reviewer suggestions. may be unsuitable for cosmetic surgery and Reviewers were asked to review and provide feedback mandate the referral of patients of concern on the guide, including a focus on the following four questions for each section: for a psychological evaluation to establish • Are there significant gaps (in the coverage of this their suitability for the intended procedure. topic, the literature, other)? • Are there errors in the content? • Is the structure logical and easy to use? Under the Medical Board of Australia guidelines, a patient is considered to require an assessment prior to undergoing Definition of cosmetic procedures a cosmetic procedure if they are: as covered in this practice guide • under the age of 18 and seeking a major cosmetic procedure; or The ‘Guidelines for registered medical • an adult or a minor displaying indicators practitioners who perform cosmetic of significant underlying psychological medical and surgical procedures’ provide problems which may make them an the following definitions for cosmetic unsuitable candidate for any cosmetic procedures and these have been adopted in procedure. this practice guide: Cosmetic medical and surgical procedures: These are operations and other procedures that This practice guide has been developed by the revise or change the appearance, colour, texture, Australian Psychological Society (APS) to provide structure or position of normal bodily features guidance to APS member psychologists undertaking with the dominant purpose of achieving what assessments of individuals intending to undergo a the patient perceives to be a more desirable cosmetic procedure, for their psychological suitability appearance or boosting the patient’s self-esteem. for such a procedure. Major cosmetic medical and surgical procedures This practice guide reviews and synthesises current (‘cosmetic surgery’): These procedures involve evidence about best practice in the assessment of cutting beneath the skin. Examples include; such individuals. breast augmentation, breast reduction, rhinoplasty, surgical face lifts and liposuction. Minor (non-surgical) cosmetic medical procedures: These procedures do not involve cutting beneath the skin, but may involve piercing the skin. Examples include: non-surgical cosmetic varicose vein treatment, laser skin treatments, use of CO2 lasers to cut the skin, mole removal for purposes of appearance, laser hair removal, dermabrasion, chemical peels, injections, microsclerotherapy and hair replacement therapy. 4 Psychological evaluation of patients undergoing cosmetic procedures Procedures not considered ‘cosmetic’ This practice guide applies to plastic surgery when it is and not covered in this practice guide performed only for cosmetic reasons. It does not apply to reconstructive surgery or surgery considered to be The ‘Guidelines for registered medical practitioners medically justied. who perform cosmetic medical and surgical In practice, this can be a grey area with some patients procedures’ provide the following denitions for reporting the motivation to be functional or physical procedures not considered cosmetic and so not whilst also desiring surgery for cosmetic reasons.2 included in this practice guide: Regardless, determining whether a procedure is Procedures which are medically justied: Surgery or a medically justied ultimately falls to the treating procedure may be medically justied if it involves the medical practitioner. For the psychologist, of primary restoration, correction or improvement in the shape concern in the evaluation is the client’s state of mind, and appearance of body structures that are defective emotional and cognitive preparedness, and their or damaged at birth or by injury, disease, growth or psychological tness to undergo the procedure. development for either functional or psychological reasons. Surgery and procedures that have a medical justication and which may also lead to improvement Limitations in appearance are excluded from the denition. While every effort has been made to provide the Reconstructive surgery: The medical specialty of reader with current, up to date information on the plastic surgery includes both cosmetic surgery and assessment of this client group, research is ongoing reconstructive surgery. Reconstructive surgery differs and relevant new original studies and systematic from cosmetic surgery as, while it incorporates reviews may be published after this practice guide has aesthetic techniques, it restores form and function as been nalised. As such, clinicians need to continue well as normality of appearance. to update their knowledge and skills and use their professional judgement when evaluating clients. Medical Board of Australia GUIDELINES FOR REGISTERED MEDICAL PRACTITIONERS WHO PERFORM COSMETIC MEDICAL AND SURGICAL PROCEDURES 1 October 2016 MBA1608 03 psychology.org.au
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