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Journal of Plastic, Reconstructive & Aesthetic Surgery (2007) 60, 915e921

Quality of life following aesthetic plastic surgery:
a prospective study
N.A. Papadopulos a,*, L. Kovacs a, S. Krammer a,b, P. Herschbach c,
G. Henrich c, E. Biemer a
a

Department of Plastic and Reconstructive Surgery, Klinikum rechts der Isar, Technical University of Munich,
Ismaningerstrasse 22, D-81675 Munich, Germany
b
Department of Abdominal Surgery, University Hospital of Regensburg, Regensburg, Germany
c
Institute of Psychosomatic Medicine, Psychotherapy and Medical Psychology, Klinikum rechts der Isar,
Technical University of Munich, Munich, Germany
Received 1 August 2006; accepted 30 January 2007

KEYWORDS
Quality of life;
Patients’ satisfaction;
Questionnaires;
Aesthetic surgery;
Body image;
Social behaviour

Summary 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 followup evaluation (T2). The testing instrument included a standardised self-assessment test on
satisfaction and quality of life (FLZM), 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 FLZM 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.

* Corresponding author. Privat Dozent Dr. Med. NIkolaos A. Papadopulos, MD, Department of Plastic and Reconstructive Surgery, Klinikum
rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, D-81675 Munich, Germany. Tel.: þ49 89 4140 2171; fax: þ49 89 4140 4869.
E-mail address: n.papadopulos@lrz.tum.de (N.A. Papadopulos).
1748-6815/$ - see front matterª 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjps.2007.01.071

916

N.A. Papadopulos et al.
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.
ª 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by
Elsevier Ltd. All rights reserved.

Life quality has become an important factor in health
management. The World Health Organization defined
health since 1949 as ‘complete physical, mental and social
well-being and not merely the absence of disease or
infirmity’.1
This overall well-being should be the primary target of
any field of medicine, including plastic surgery. For reconstructive plastic surgery patients, we already accept
their seeking not only successful technical outcomes, but
also increased ‘mental or emotional satisfaction’2 by means
of ‘elective’ operations. However now, the aesthetic,
‘healthy’, plastic surgery patients increasingly claim their
right to physical and psychological well-being through socalled ‘cosmetic surgery’. These patients accept a variation
of potential complications in order to gain more physical
attractiveness. Schopenhauer’s dictum that ‘Beauty is
a greater recommendation than any letter of introduction’3e5 has become more and more present.
The objective of this study was to examine the psychological and physical effects after aesthetic plastic surgery,
to evaluate if aesthetic surgery can increase quality of life,
as well as to further compare the results with an existing
norm data of a previously evaluated random sample.
Quality of life (QoL) is defined as a multidimensional
construct that includes physical, social, psychological,
emotional, or spiritual domains to arrive at an assessment
of a patient’s state of being.6,7 Previous studies have shown
preoperative levels of psychological distress and dysfunction in plastic surgery patients that are significantly higher
than in the general population.8e11 As for the postoperative
evaluation the studies claimed an improvement in the measured quality of life.8,10e13
Most of the reports come from English speaking countries, USA, UK or Canada. Norms of beauty, being a product
of cultural and social attitudes, though, vary widely
between societies.14 This should also be considered when
contemplating every patient’s individual quality of life.
Quality of life has to be measured as a combination of importance and satisfaction with the different aspects named
above. The importance every individual patient attaches to
a specific area of life has to affect the degree to which the
estimated satisfaction with the same area will influence the
patient’s global life satisfaction. The FLZM by Herschbach
and Henrich15 considers this specific dependency and motivated us to determine the subjective life satisfaction preand postoperatively on aesthetic plastic surgery patients
from German-speaking countries.

Material and methods
The examination was designed as a prospective study at
the Department of Plastic and Reconstructive Surgery of
the Technical University Munich in Germany between 2001

and 2004. Approximately 400 inpatients between the ages
of 16 and 70 undergoing aesthetic surgery fulfilled the
inclusion criteria for this study. Malign and benign tumours,
breast reconstruction after mamma carcinoma, capsula
fibrosis and trauma were excluded from the study, as well
as all outpatients and non-accessible patients. Three
hundred and twenty one patients were contacted and
228 agreed to participate preoperatively (T0). Postoperative questionnaires were mailed to the patients at 3 (T1)
and 6 (T2) months follow up. Non-respondents were
reminded by phone twice and were sent another copy of
the missing questionnaire when they had agreed to
continue the study. Nevertheless, the response rate for
T2 stayed critically low. One hundred and thirty two
patients returned at least one of the two follow-up
questionnaires. Only 36% completed the investigation until
6 months postoperatively.
The preoperative and the two postoperative testing
instruments included the standardised self-assessment
test on life satisfaction (FLZM) by Herschbach and Henrich
together with a specified part on body-image. Preoperatively, additional questions on demographic details and socioeconomic status were included. Postoperatively, the
FLZM was sent along with a questionnaire that evaluates
satisfaction with the aesthetic result, complications and
the after effects in the social and economic field (complication questionnaire).
The FLZM evaluates subjective quality of life (weighed
satisfaction). It claims validity and is standardised for German-speaking countries. The questionnaire consists of two
modules, ‘General Life Satisfaction’ and ‘Satisfaction with
Health’. Each module contains eight items. The patient is
asked to rate every item first for its subjective importance
and second for its subjective degree of satisfaction on a 5
point scale (not important/not satisfied Z 0, rather unimportant/unsatisfied Z 1, rather important/satisfied Z 2,
quite important/satisfied Z 3, very important/satisfied Z 4).
The eight areas of the general section are: ‘friends/
acquaintances’, ‘leisure time/hobbies’, ‘health’, ‘income/
financial security’, ‘occupation/work’, ‘housing/living condition’, ‘family life/children’ and ‘partner relationship/
sexuality’. Further, it contains an additional question on
global satisfaction. The health section includes ‘physical
condition/fitness’, ‘ability to relax/stay on an even keel’,
‘energy/zest for life’, ‘mobility’, ‘vision and hearing’,
‘freedom from anxiety’, ‘freedom from aches and pains’
and ‘independence from help/care’.
Quality of life is a subjectively rated matter. In order to
give a statistically valuable judgment, we have to objectify
this subjective rating.
Each aspect of quality of life has different importance
for every individual. Therefore every aspect’s influence on
the overall quality of life can vary. A weighting is necessary.16 This weighting has to be undertaken subjectively by

Quality of life following aesthetic plastic surgery

917

the individual.17 In order to gain such ‘weighed satisfaction
(wS)’ Herschbach and Henrich use a specific formula:
I*S Z wS Z importance rating [(2 satisfaction rating)
3], provided both ratings are made on scales ranging from
zero to four.15
This will prevent a negative or positive affection of the
end sum score by any unimportant area of life.18 In addition, the sum of the I*S values can be calculated for each
module.16
The preoperative results were compared to the postoperative data and a control group representing the
German ‘healthy’ population at the age of 16e90 (consisting of n Z 2534 for the module ‘general satisfaction’ and
n Z 2218 for the second module ‘satisfaction with health’).
For this evaluation the unpaired t-test was used.
The specified body-image questionnaire is structured in
similar way to the FLZM. It contains 22 items describing different body parts including an additional question on the
global satisfaction with the entire body. Unfortunately it
has not been evaluated so far. With this questionnaire we
examined the patients’ postoperative change of body image, by means of the paired t-test.
The complication questionnaire sent along with the FLZM
at T1 includes 19 questions on patient satisfaction with
the aesthetic result, presence and duration of pain and
haematomas, loss of fitness, influence on social contacts,
ability to work, hospitalisation, recommendation of the
operation, etc.
The Software ‘SPSS 13.0 for Windows’ (SPSS Inc.,
Chicago, USA) was used for all statistical analysis. First
the data distribution of each variable was evaluated using
the one-sample Kolmogorov-Smirnov test’. For all tests the
overall statistical level of significance was set at P < 0.05.

Results
Only 9% of our study group was male, 91% female. Approximately 72% were younger than 45 and nearly equally
distributed within the three first age groups (16e25, 26e35,
36e45). Only 3% of our group were older than 65. Surgery on
the breast was the predominant operation, comprising more
than 50% of the cases: 54 breast reductions, 27 breast
augmentations, 18 breast reductions or mastopexies by

Table 1

breast asymmetries, six mastopexies; also, 26 liposuctions,
33 abdominoplasties, 26 face and neck rhytidectomies, 17
rhinoplasties, nine dermlipectomies, six subcutaneous mastectomies by gynecomastia. This was to be the first aesthetic
plastic surgery for more than 70% of the patients.
Almost one-fifth of our study group was underweight
(BMI < 20), another fifth overweight (BMI 25e30), and only
7% could be classed as adipose (BMI > 30). Regarding social
status: 47% of the patients were married, more than
one-third single. Forty-seven per cent were childless.
Over 50% completed apprenticeship training and only 13%
achieved a university degree.

Evaluation of the FLZM
According to the manual, we calculated the weight satisfaction for each item and the sum scores of the two
modules (Tables 1 and 2).
In the next step we compared the weighed satisfactions
and the sum scores of the preoperative questioning with
those of the second survey T1 by means of analysis of
variances of depending samples. For the first module
‘general life satisfaction’ there was no significant difference in quality of life after the aesthetic plastic surgery
(Table 1).
However for the second module ‘satisfaction with
health’ we did see a highly significant improvement in
quality of life, not only within the individual aspects
[mobility (P Z 0.03), freedom from anxiety (P Z 0.00),
freedom from pain (P Z 0.01) and independence from
help (P Z 0.04)], but also for the sum score where there
were significant positive changes (P Z 0.02) (Table 2).
The evaluation of the new module ‘satisfaction with the
appearance’ was analogous to the previous questionnaires
(Table 3).
We found significant improvement in satisfaction with
the following items: breast (P < 0.000), stomach
(P Z 0.011) and hip (P Z 0.041). With regard to the sum
score we can state a very high improvement in this part
of quality of life (P Z 0.002; Table 3).
In a last step we compared the scores of weighted
satisfaction of our study group with those of a random
sample. For the module ‘general life satisfaction’ data of

Weighted satisfaction for the module ‘general satisfaction’
T0
Mean

T1
SD

Analysis of variances
of depending samples

Mean

SD

n

Mean

SD

Significance

Friends
Hobbies
Health
Income
Work
Living conditions
Family life
Partner relationship

8.6
6.7
9.4
6.2
6.3
9.9
10.4
7.7

6.4
5.8
7.3
6.4
6.3
6.1
8.4
9.1

8.6
5.8
9.6
6.5
6.9
9.4
11.4
8.4

6.6
4.7
7
5.9
6.6
5.9
13.1
7.9

129
130
130
130
124
129
126
127

0.023
0.9
0.2
0.346
0.532
0.45
0.944
0.622

5.919
6.077
6.444
5.704
6.501
5.805
12.981
9.557

0.964
0.094
0.724
0.49
0.364
0.381
0.416
0.465

Sum score

65.3

32.1

66.5

33.3

130

1.235

30.178

0.642

No statistical significant differences (paired t-test: P < 0.05).

918
Table 2

N.A. Papadopulos et al.
Weighted satisfaction for the module ‘satisfaction with health’
T0

T1

Mean

SD

Analysis of variances
of depending samples
N

Mean

Fitness
Ability to relax
Energy
Mobility
Vision and hearing
Freedom from anxiety
Freedom from pain
Independence from help

7.7
5.1
7.8
11.8
11.8
7
8.7
14.8

6.5
6.9
7.2
5.7
6.9
7.7
7.2
6.6

Mean
7.5
5.6
8.4
13.1
11.2
9.3
10.5
16.1

SD
5.7
6.6
7
6.2
7.3
7.6
7.4
5.6

128
130
129
130
130
129
129
128

0.22
0.44
0.6
1.24
0.59
2.31
1.78
1.34

SD
6.55
6.82
6.58
6.5
6.11
7.36
7.26
7.41

0.71
0.47
0.30
0.03*
0.27
0.00**
0.01*
0.04*

Significance

Sum score

74.6

36.8

81.8

36.5

129

7.13

33.11

0.02*

Significant differences at *P < 0.05 and **P < 0.01 (paired t-test).

The second evaluation, though, showed decisive differences. In contrast to the results above, the sum score of our
study group (81.8) is significantly higher than the norm data
(74.39; P Z 0,049; Table 5).
Even though only 82 patients completed the evaluation
until T2 (6 months postoperative), we took a closer look at
these data. For the first module ‘general satisfaction’ we
could not find any significant change in sum scores, neither
comparing T0 with T2, nor T1 with T2 (Table 6). For the second module ‘satisfaction with health’ however, we can
state that the significant increase of quality of life we found

n Z 2534 is available from 1994 and for the module ‘satisfaction with health’ we can revert to data of 2218 individuals from 1996.
Similar to our results above, we found neither preoperative nor postoperative differences of the sum scores
within the first module ‘general satisfaction’. Only for some
of the individual aspects could we state significantly higher
values for our study group (Table 4).
Comparing the module ‘satisfaction with health’ with
the norm data, we cannot state any difference in quality of
life preoperatively (Table 5).

Table 3

Weighted satisfaction for the module ‘satisfaction with appearance’
T0

T1

Mean

SD

Hair
Ears
Eyes
Nose
Mouth
Teeth
Facial hair
Chin/neck
Shoulders
Breast
Stomach
Waist
Hip
Penis/vagina
Bottom
Thighs
Feet
Hands
Skin
Body hair
Height
Weight

6.86
7.89
9.82
6.88
11.28
7.68
5.93
5.69
6.13
2.38
1.72
3.42
2.57
6.06
4.12
2.56
5.31
7.91
7.28
4.88
5.15
3.82

6.42
5.45
6.22
7.03
21.34
6.8
6.95
5.79
4.98
14.21
8.17
7.32
6.72
5.48
6.89
6.94
6.02
5.75
6.93
6.3
5.4
7.56

Sum score

121.04

81.41

Mean

Analysis of variances
of depending samples
SD

N

Mean

SD

Significance

7.09
7.98
10.35
7.27
9.37
8.49
6.19
8.4
6.18
7.87
3.57
4.32
3.84
5.95
4.41
3.48
5.51
7.93
6.95
7.66
5.44
4.84

6.57
5.65
6.38
5.98
5.54
6.93
5.87
21.3
4.69
7.66
6.9
6.87
6.2
5.24
5.99
6.7
5.65
6.72
7.25
16.59
5.31
8.2

130
130
130
130
130
129
120
130
130
129
127
129
127
122
129
130
130
129
129
127
128
130

0.23
0.09
0.53
0.38
1.92
0.81
0.27
2.71
0.05
10.25
1.85
0.9
1.28
0.11
0.29
0.92
0.2
0.02
0.33
2.78
0.29
1.02

5.15
6.08
7.04
6.76
20.69
5.7
6.72
22.22
5.26
16.6
8.11
7.22
6.96
5.21
6.97
6.85
6.59
5.78
6.97
16.9
5.52
7.44

0.61
0.863
0.392
0.517
0.293
0.111
0.664
0.167
0.907
0.00**
0.011*
0.16
0.041*
0.822
0.641
0.13
0.7
0.976
0.588
0.066
0.554
0.122

144.13

86.49

130

23.09

84.08

0.002**

Significant differences at *P < 0.05 and **P < 0.01 (paired t-test).

Quality of life following aesthetic plastic surgery
Table 4

919

Comparison of the norm data with the study group or ‘general satisfaction’ at T0 and T1
Study group T0

Study group T1

Norm data ’94

Mean

N

Mean

SD

Mean

6.4
5.8
7.3
6.4
6.3
6.1
8.4
9.1

129
130
130
130
124
129
126
127

8.6
5.8
9.6
6.5
6.9
9.4
11.4
8.4

6.6
4.7
7
5.9
6.6
5.9
13.1
7.9

8.08
6.31
8.06
6.49
5.45
8.33
9.84
7.9

6.33
6.26
7.51
7.27
7.3
6.4
6.94
7.69

32.1

130

66.5

33.3

60.49

37.31

Friends
8.6
Hobbies
6.7
Health
9.4
Income
6.2
Work
6.3
Living condition
9.9
Family life
10.4
Partner relationship 7.7
Sum score

65.3

SD

t-test T0

SD

N

t

df

t-test T1
p

t

2536
0.9 2663 0.391
0.9
2531
0.6 2659 0.544 1
2542
2
2670 0.045
2.3
2537 0.5 2665 0.644
0.1
2462
1.3 2584 0.183
2.1
2533
2.7 2660 0.008
1.9
2519
0.9 2643 0.357
2.3
2509 0.2 2634 0.83
0.7
2534

1.4 2662 0.149

df

p

2663
2659
2670
2665
2584
2660
2643
2634

0.374
0.318
0.021*
0.94
0.034*
0.061
0.022*
0.503

1.8 2662 0.07

Significant differences at *P < 0.05 and **P < 0.01 (unpaired t-test).

and behaviour towards others. Especially in social sciences
literature, it is often stated that physical beauty is usually
psychologically and socially gifted.3,19,20 If so, can aesthetic
surgery help to increase the lacking quality of life and is it
worth taking the risk of an elective surgery?
The results of our study confirmed the hypothesis that
surgery evokes positive changes in quality of life. The
patients do not profit through the operation in their
friendships, families or relationships. They rather feel
healthier and more satisfied with their appearance. Cole
et al. underlined this fact in 1994. Their results showed an
improvement in quality of life for 73% of patients. But the
largest positive changes were found in the breast reduction
group.8 By means of the generic SF-36, Klassen et al. (1996)
found that aesthetic surgery leads to health gains in aspects
of social, psychological and physical functioning.9 Meningaud et al. (2003),21 examining outcomes after cosmetic
surgery, confirmed the impression shared by the majority
of studies: aesthetic surgery improves psychological wellbeing. Rankin et al. described an improvement in composite quality of life scores in the early 1-month postoperative
evaluation and state that this significant difference not only
persisted at six months but showed further improvement.10
We cannot confirm these results without limitation. Although we found a significant increase of satisfaction scores
within the two modules ‘satisfaction with health’ and ‘satisfaction with appearance’ three months postoperatively,

from T0 to T1 is persistent at T2, 6 months postoperative,
as well as for the new module ‘satisfaction with appearance’ (Table 7).
As a last step we evaluated the complication questionnaire. The results are as follows:
Sixty-eight per cent of the study group was satisfied or
very satisfied with the aesthetic result of the operation,
with only 11% rather dissatisfied. Twenty four per cent
complained about tolerable to severe pain. Thirty-nine per
cent were free from haematomas in the direct postoperative period. More than half of the patients reported none or
only very little decrease in physical fitness or reduced social
contacts for an average of 2e3 weeks. However, nearly 75%
claimed to be unable to work, 66% for even up to 2e3
weeks. The patients stayed an average of 6 days in hospital,
the shortest period being 24 h and the longest a total of 44
days (due to impairment of wound healing after an abdominoplasty). Eighty-four per cent would undergo the same
treatment again, 78% would further recommend the procedure they had undergone, and over two-thirds do not plan
any correctional surgery.

Discussion
The idea of beauty comes from self-appreciation and
reaches its pinnacle with the social acceptance of an
individual. Beauty influences our perception, attitude,

Table 5

‘Satisfaction with health’ comparison of the norm data with the study group at T0 and T1
Study group T0

Study group T1

Norm data ’96

t-test T0

Mean SD

n

Mean

Mean SD

n

t

df

P

128
130
129
130
130
129
129
128

7.50
5.60
8.40
13.10
11.20
9.30
10.50
16.10

5.70
6.60
7.00
6.20
7.30
7.60
7.40
5.60

8.09
7.40
9.14
9.07
11.03
8.10
9.10
12.45

2220
2214
2215
2210
2217
2204
2217
2215

0.60
3.90
2.30
4.50
1.30
1.80
0.60
3.80

2346
2342
2342
2338
2345
2331
2344
2341

0.54 1.00 2346 0.34
0.00** 3.10 2342 0.00**
0.02* 1.30 2342 0.19
0.00**
6.40 2338 0.00**
0.21
0.30 2345 0.74
0.07
2.00 2331 0.05*
0.56
2.10 2344 0.04*
0.00**
6.10 2341 0.00**

74.60 36.80 129 81.80

36.50

Fitness
7.70
Ability to relax
5.10
Energy
7.80
Mobility
11.80
Vision and hearing
11.80
Freedom from anxiety
7.00
Freedom from pain
8.70
Independence from help 14.80
Sum score

6.50
6.90
7.20
5.70
6.90
7.70
7.20
6.60

SD

7.01
6.50
6.53
6.96
7.03
6.71
7.39
6.72

74.39 41.54 2218

Significant differences at *P < 0.05 and **P < 0.01 (unpaired t-test).

t-test T1

0.10 2345 0.95

t

df

P

2.00 2345 0.05*

920
Table 6

N.A. Papadopulos et al.
Comparison of the module ‘general satisfaction’ at T0 to T2 and T1 to T2
T0

T1

T2

Analysis of variances
of depending samples T1-T2

Analysis of variances
of depending samples T0-T2

Mean SD

Mean SD

Mean SD

Mean

df

Sig

Mean

SD

df

Sig

Friends
Hobbies
Health
Income
Work
Living condition
Family life
Partner relationship

9.30
6.90
10.20
6.10
5.60
9.60
11.30
8.50

10.20
6.20
9.90
6.40
6.80
9.70
11.00
8.90

10.20
8.00
10.30
6.60
7.10
9.30
11.10
8.30

1.04
1.30
0.39
0.46
1.48
0.30
0.26
0.43

7.07
9.85
7.10
5.87
6.85
6.02
7.14
9.05

79.00
79.00
79.00
79.00
76.00
79.00
77.00
78.00

0.19
0.24
0.63
0.48
0.06
0.66
0.75
0.67

0.40
1.92
0.19
0.08
0.29
0.27
0.22
0.55

4.92
10.25
5.89
4.17
5.80
5.59
5.31
8.25

74.00
74.00
74.00
74.00
71.00
74.00
72.00
72.00

0.48
0.11
0.78
0.87
0.67
0.68
0.73
0.57

Sum score

67.30 33.60 69.30 32.30 70.90 31.70 3.80

32.28

79.00

0.30

0.69

27.36

74.00

0.83

6.20
5.60
7.20
6.40
6.60
6.50
8.80
8.90

6.00
4.70
6.60
6.10
6.80
6.50
7.90
8.20

6.10
9.50
6.50
6.40
6.10
5.90
7.40
7.80

SD

No statistical significant differences (paired t-test: P < 0,05).

the initial values were by no means lower than those of the
random sample. Therefore we do not reinforce the opinion
that aesthetic plastic surgery patients suffer more from distress, social and psychological pain than others.
In our opinion the existing testing instruments were
either too generic for the aesthetic plastic surgery field or
only limited to body image. Cole et al., for example, used
the Health Measurement Questionnaire (HMQ), a generic
self-report instrument, mainly orientated towards somatic
limitations and psychological distress. Klassen et al. evaluated quality of life after aesthetic plastic surgery by
means of various questionnaires including the SF-36. The
validity and reliability of the SF-36 in evaluating general
quality of life is well established.22 It was designed to estimate disease burden and to compare disease-specific
benchmarks with general population norms. The SF-36
seems to be sensitive to changes in the breast reduction
population.7,9,23e25 But concerning procedures that are
predominantly cosmetic in nature the SF-36 is unable to
detect significant changes.7,9 Meningaud instead used the
European quality of life 5 dimensions (EQ-5D), also a very
generic test instrument. None of the used test instruments
above included a rating of the items’ individual importance
or a consideration of this rating in the total score of quality
of life.15 But there is now a broad consensus in expert

Table 7

circles that two elements are essential: multidimensionality and subjectivity.26 Hence our idea of individually
weighed quality of life seems to be on the right track, as
quality of life is a subjective construct consisting of several
dimensions including weighting for the relative importance
of each dimension for the individual concerned.15 The FLZM
is the only test instrument considering this fact.
The after-effects of the surgery itself were lower than
expected. Pain, haematomas and other limitations were
very well tolerated. Complications were limited to wound
healing and the satisfaction with the aesthetic result was
extraordinarily high. Therefore we can state that aesthetic
surgery is a recommended procedure.
We hypothesised that aesthetic surgery has a positive
influence on the patients’ quality of life. By means of
weighted satisfaction we cannot confirm this hypothesis
without restrictions.
Aesthetic surgery increases two of the three analysed
aspects of quality of life significantly: health [T0: 74.6 to
T1: 81.8 (P Z 0.02)] and appearance [T0: 121 to T1: 144.1
(P Z 0.002)]. For the module ‘general satisfaction’ there
was no significant increase in quality of life [T0: 65.3 to
T1: 66.5 (P Z 0.0642)]. Although we found higher values
for some of the individual items of the FLZM modules of
the norm data in comparison to our study group, we cannot

Comparison of the module ‘satisfaction with health’ at T0 to T2 and T1 to T2
T0

T1

T2

Analysis of variances
of depending samples T0eT2

Analysis of variances
of depending samples T1eT2

Mean SD

Mean SD

Mean SD

Mean

Fitness
Ability to relax
Energy
Mobility
Vision and hearing
Freedom from anxiety
Freedom from pain
Independence from help

7.4
5.5
8.3
12
11.9
7
8.7
14.1

7.3
6.1
8.8
13.5
11.8
10.3
10.9
16.1

7.6
6.5
8.5
13.6
12.2
9.9
10.4
15.7

0.19
1.81
0.55
2.01
0.45
2.83
1.32
1.72

Sum score

74.9 38.1 84.9 35.8 84.4 31.6 10.88

6.3
6.8
6.9
5.7
7.5
8
7.4
7.4

5.9
6.5
6.4
6.3
7.4
7.3
6.6
5.5

5.6
6.3
6.4
6.3
6.1
5.2
7.1
5.9

Significant differences at *P < 0.05 and **P < 0.01 (paired t-test).

SD

df

Sig

Mean

6.29
6.72
6.75
6.77
7.23
7.41
7.49
7.25

77
77
77
77
77
77
77
77

0.79
0.02*
0.47
0.01*
0.59
0.00*
0.12
0.04*

0.22
0.67
0.49
0.08
0.49
0.44
0.58
0.44

34.71

77

0.01*

0.5

SD

df

Sig

4.71
4.57
5.67
6.16
6.45
6.11
6.27
6.22

72
72
72
71
72
72
72
72

0.69
0.21
0.46
0.91
0.52
0.54
0.44
0.55

26.17

72

0.87

Quality of life following aesthetic plastic surgery
confirm a general preoperative lower level of quality of life
of the aesthetic surgery patients, even though this is assumed in many studies.
We can further conclude that aesthetic surgery is very
well tolerated with a relatively low complication rate and
a very high contentedness with the aesthetic result.
With the FLZ we have found an adequate Quality of Life
test instrument, suitable for the field of aesthetic surgery.
Therefore we do recommend further the continuation of
validating its accessory module ‘satisfaction with
appearance’.
Despite the limitations of our study, which occurred by
evaluating various surgical procedures in a relatively short
follow up time, we do further support its continuation for
every operative indication separately, for the better
understanding of the effect of aesthetic surgery on our
patients.

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