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 im-plications 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. Australian and New Zealand Journal of Psychiatry 1989; 23:249-254 Recent years have witnessed an increasing demand for facial surgery. Technological advances in operat-ing technique such as microsurgery now permit major reconstructive procedures on facial congenital de-formities considered inoperable less than a decade ago. Furthermore, increasing social pressure for an attractive appearance is resulting in an increasing number of requests for cosmetic procedures. The individuals asking for facial surgery have dif-ferent needs. At one extreme is the patient who is dissatisfied with a normal appearance, while at the other is the patient with a gross deformity from trauma, cancer, bums or congenital abnormalities. The more severe abnormalities may affect both appearance and function (chewing, speech, smell, and vision), whil