Thinking about having a nose job or facelift? You may be more pleased with the results if you're older—or if you're being treated for depression, a new study suggests

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By Anne Harding

MONDAY, MAY 17 ( — Thinking about having a nose job or facelift? You may be more pleased with the results if you’re older—or if you’re being treated for depression, a new study suggests.

Gauging patient expectations—and managing them, if necessary—is an important task for cosmetic surgeons. It’s also a tricky one, since the patient’s opinion of the outcome is highly subjective.

To learn more about what makes patients pleased (or not) with the results of their surgery, cosmetic surgeons at the University of Michigan surveyed 35 women and 16 men before and after they underwent facial surgery. The researchers assessed a range of patient characteristics, such as marital status, education, medical history, and personality.

Two-thirds of the patients said they were very satisfied with the results of their surgery, ranking their satisfaction an 8 or above on a scale of 1 to 10. Nearly one-quarter judged the results to be a perfect 10. (Interestingly, the surgeons tended to rate their work slightly lower than the patients did.)

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The 20 patients who were taking antidepressants or in therapy for depression rated the surgery results a full point higher, on average, than those who weren’t—the opposite of what the researchers expected.

“I’m not sure exactly what that means,” says the lead author of the study, Jeffrey Moyer, MD, a cosmetic surgeon at the University of Michigan at Ann Arbor. “I think it speaks to how complex depression is.”

Steven B. Hopping, MD, past president of the American Academy of Cosmetic Surgery, says that most of the patients he sees at his practice in Washington, D.C., are on antidepressants. “A lot of people are taking these medications, and maybe it does help their response,” he says.

Cosmetic-surgery patients often experience a “sort of letdown” five to 10 days after the surgery, says Dr. Hopping, who was not involved in the new study. This can happen with any highly anticipated event, such as a wedding or the birth of a baby, but cosmetic-surgery patients may also experience a tinge of buyer’s remorse, he says. Antidepressants may help with this letdown, he suggests.

If they’re not already being treated, depressed people should consider antidepressants, therapy, or both before having cosmetic surgery, Dr. Moyer says.

Dr. Moyer and his colleagues also found that people who were older than 53 (the average age of the patients) were more satisfied with their results than younger people. This could be because younger patients tend to be more emotionally invested in the surgery, says Dr. Hopping.

“Patients who are a little older generally have more realistic expectations,” he says. “Whether they have their face lifted or their eyes tightened, it’s not going to make or break their life. For younger patients, there’s often a lot more riding on this.”

Another explanation may be that plastic surgery usually has a bigger effect on the looks of older people than it does on younger people. “If someone who’s 65 and has a lot of laxity has a facelift, those changes are a lot more dramatic,” says Dr. Moyer, using the polite medical term for loose, wrinkly skin.

The data turned up some other trends that were not statistically significant (meaning they could have been due to chance) but that the researchers say should be explored further. Men, optimists, first-time cosmetic-surgery patients, and singles and widowers all appeared to be more pleased with the outcome of their surgery than their counterparts, according to the study, published in the Archives of Facial Plastic Surgery.

Anything that narrows the gap between expectations and reality will help people—and their surgeons—decide whether a cosmetic procedure is right for them, says Dr. Hopping. He advises people who are considering cosmetic surgery to ask to see photos of a surgeon’s average and not-so-good results, not just their best “before and afters.” In his experience, the patients who tend to be most pleased with their surgery “aren’t looking for perfection.”

Before a patient goes under the knife, the patient and surgeon need to be “on the same page about what they want to achieve,” says Dr. Moyer. This includes understanding a patient’s motivations for having the procedure, as well as his or her expectations.

“It really comes down to talking and developing a really good relationship with your surgeon,” he says.