Experiences of living with a visible difference and social support among individuals seeking appearance-altering surgery

This study explored the psychosocial experiences of living with a visible difference and social support among individuals seeking appearancealtering surgery. Appearance-altering surgery is a common intervention for individuals with visible differences and research is important for helping services better understand and respond to the experiences of serviceusers. This study employed a mixed-methods approach, including questionnaires and semi-structured interviews. Participants were recruited from a Plastic and Reconstructive Surgery department within an NHS Trust Hospital during a five-month period. 11 participants who met the inclusion criteria for the study completed questionnaires. Due to the small sample, it was only possible to conduct a descriptive analysis of the questionnaire data; this indicated variation between participants' experiences of living with a visible difference and social support. Eight participants who completed questionnaires also participated in semi-structured interviews. Thematic analysis was used to analyse interview data. Findings from the thematic analysis are presented in terms of four main themes and 11 sub-themes. These suggested appearance-related thoughts and feelings are triggered by particular circumstances, including when people reacted to participants' visible differences and when participants thought that people might react. Participants attempted to manage appearance-related concerns and difficulties through concealment, social avoidance and seeking surgery. Participants described barriers to accessing support from others, such as concerns about the risks associated with talking to others and the view that visible difference is a problem with physical appearance that cannot be resolved through social support. Despite barriers, participants valued some forms of social support, including others looking beyond their visible difference, support being available when needed, understanding from others regarding their experiences of living with a visible difference and seeking surgery and finally, affirmation of the decision to seek surgery. These findings are sample-specific and cannot be generalised to other populations. However, the considerable variation between participants' experiences suggests that plastic surgery services need to tailor assessments and interventions to the diverse needs of their service-users. The findings are discussed with reference to previous theory and research. Clinical and research implications are considered