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Good Psychological Function Found in Adults with Congenital Facial Disfigurement

Surgery to Improve Appearance, Psychological Support May Improve Adjustment

People born with severe facial disfigurement have generally good psychological adjustment in adulthood, according to a study in the January issue of  Plastic and Reconstructive Surgery®the official medical journal of the  American Society of Plastic Surgeons (ASPS).

"Improving satisfaction with facial appearance (by surgery), enhancing self-esteem or lowering fear of negative appearance evaluation (by psychological support) may enhance long-term psychological functioning," concludes the new study led by Dr Sarah L. Versnel of Erasmus University Medical Center, Rotterdam, Netherlands.

'Relatively Normal' Adjustment in Adults with Congenital Facial Disfigurement
The researchers administered a standard set of psychological, physical and demographic questionnaires to 59 adults with severe congenital facial disfigurement caused by rare, extensive facial cleft syndromes.  At the time they completed the questionnaires, the participants' average age was 34.

For comparison, the same questionnaires were given to 59 adults with facial disfigurement caused by trauma and 120 adults with no disfigurement.  Long-term psychological functioning was compared between groups, along with factors affecting adjustment.

The results show "relatively normal" psychological functioning in the adults with congenital facial disfigurement.  They tend to have a higher rate of internalizing problems—such as anxiety and depression—compared to people with no facial disfigurement.

However, adults with congenital facial disfigurement were no more likely to have a clinical level of depression or anxiety.  They had lower rates of physical problems than the comparison group with facial disfigurement caused by trauma.  The group with traumatic disfigurement also had no increase in clinical depression or anxiety.

Assessed objectively by doctors, the severity of congenital facial deformities was unrelated to psychological functioning.  However, patients who were less satisfied with their facial appearance tended to have more problems with psychological adjustment. Among participants with congenital disfigurement, problems with psychological functioning were also more common in people with low self-esteem and those who were concerned about how others would judge their appearance.

Historically, few studies have examined long-term psychological adjustment among people born with severe facial disfigurement.  The new results suggest that, among adults with severe facial cleft syndromes, psychological function is relatively similar to that of people without facial deformities.

Psychological adjustment doesn't seem to be affected by the severity of the facial disfigurement, but rather by the person's perceptions and feelings about his or her appearance. That's an important consideration for plastic and reconstructive surgeons operating on patients with congenital facial disfigurement, Dr. Versnel and coauthors believe:  "During treatment, patients' realistic wishes and expectations regarding their facial appearance should be taken into account."

Counseling to help improve low self-esteem, when present, may also have beneficial effects.  "Psychological support…should be focused on training patients to rely less on the opinions of others," the researchers suggest.

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of  Wolters Kluwer Health.

About  Plastic and Reconstructive Surgery
For more than 60 years,  Plastic and Reconstructive Surgery® ( has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons,  Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, and cosmetic surgery, as well as news on medico-legal issues.

About ASPS
The American Society of Plastic Surgeons (ASPS) is the world's largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery. For more information, please visit

About Lippincott Williams & Wilkins
Lippincott Williams & Wilkins (LWW) is a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the  LWW brand, as well as content-based sites and online corporate and customer services.

LWW is part of  Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of  Wolters Kluwer, a market-leading global information services company with 2010 annual revenues of €3.6 billion ($4.7 billion).