Factors associated with patient satisfaction following aesthetic surgery

Factors associated with patient satisfaction following aesthetic surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Factors associated with patient satisfaction following aesthetic surgery Vanessa Marron Mendes, Sara Poggi, Martin Schils, Michela Schettino, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7340124/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Oct, 2025 Read the published version in European Journal of Plastic Surgery → Version 1 posted 7 You are reading this latest preprint version Abstract Background: Postoperative satisfaction in aesthetic surgery can be assessed using validated outcome measures such as the BREAST-Q, BODY-Q, and FACE-Q. While these instruments are widely utilized, the determinants underlying satisfaction scores remain insufficiently explored in the literature. The present study aims to identify and characterize the variables that influence patient satisfaction following aesthetic surgical procedures. Methods: We conducted a prospective, non-interventional, multicenter study involving 162 patients over a six-month period. A custom-designed questionnaire was administered, and clinical as well as demographic data were collected for each participant. Demographic, preoperative, and postoperative variables were analyzed for their association with overall satisfaction rates using appropriate statistical methods. Results: Based on our inclusion criteria, we selected 78 patients who underwent aesthetic surgery procedures: 27 breast surgery, 25 abdominoplasty, 13 liposuction, 10 rhinoplasty and 3 other aesthetic interventions. The overall average satisfaction rate was 69%. Among the demographic variables, two showed a statistically significant association (p < 0.05): history of psychiatric disorders and smoking status. No significant correlation was observed for age, gender, ethnicity, employment status, alcohol consumption, or history of cosmetic surgery. Regarding preoperative factors, three variables were highly significant (p < 0.001): quality of contact with the surgeon, quality of given information, and psychological malaise related to physical appearance and low self-esteem. Postoperatively, three factors were also highly significant (p < 0.001): sensibility evolution, scar management, and improvement in sexual life. Conclusions: Our results suggest that understanding patient satisfaction in aesthetic surgery is a multifactorial topic in which several variables play a specific role. Their evaluation could be the key to achieve better results in terms of patient satisfaction. aesthetic surgery cosmetic surgery patient satisfaction perception surveys and ques-tionnaires prospective studies Figures Figure 1 Introduction Aesthetic surgery is a unique surgical discipline in which success depends not only on technical excellence but also on meeting patients’ expectations for appearance, psychosocial well-being, and overall quality of life. Patients seeking cosmetic procedures often present with strong motivational profiles, sometimes described as the “overmotivation phenomenon,” reflecting a profound desire to address physical concerns that may be closely linked to psychological distress [ 1 , 2 ]. In this context, aesthetic surgery can serve as an important mechanism for improving self-image, enhancing social interaction, and promoting psychological well-being [ 3 , 4 ]. Importantly, patient satisfaction is often determined less by the attainment of an objective ideal of “beauty” and more by the restoration of harmony, confidence, and functional integration into daily life [ 5 , 6 ]. In contemporary society, aesthetic goals have expanded beyond purely morphological improvements to include enhancements in psychosocial functioning and quality of life [ 7 ]. This shift underscores the necessity for surgeons to employ robust and validated tools to systematically measure patient satisfaction after aesthetic interventions. Validated patient-reported outcome measures (PROMs) such as the BREAST-Q, BODY-Q, and FACE-Q have been specifically developed to assess satisfaction and health-related quality of life in patients undergoing breast, body, and facial aesthetic surgery [ 8 , 9 ]. These tools provide standardized, reproducible data and enable meaningful comparisons across studies [ 10 ]. Nevertheless, one limitation is their reduced ability to fully capture deeper psychological factors—such as self-esteem, body image perception, and preoperative expectations—that may influence satisfaction scores [ 11 , 2 ]. The aim of the present study is to identify and characterize demographic, preoperative, and postoperative factors associated with patient satisfaction after aesthetic surgery. Our questionnaire also incorporated psychological and social dimensions often underrepresented in conventional satisfaction tools, enabling a more comprehensive assessment of the bio-psycho-social profile and its potential role in predicting postoperative dissatisfaction. Méthodology A prospective, non-interventional, multicenter study was conducted including all patients who presented to the outpatient plastic surgery clinic of Brugmann University Hospital and Erasme Hospital University Hospitals in Bruxelles from January 1, 2019 to June 30, 2019. Inclusion criteria included: patients of either sex (male or female), age over 18 years, patients who had undergone aesthetic surgery (rhinoplasty, cervico-facial lift, otoplasty, blepharoplasty, breast augmentation or reduction, mastopexy, gynecomastia treatment, abdominoplasty). Exclusion criteria included: refused to participate via telephone interview, a follow-up period of less than 6 months and incomplete or inaccurate clinical records. We evaluated patient characteristics of all participants using electronic medical records. The pertinent demographic data include age, ethnic group, employment status, comorbidities (Alcohol, smoking status, psychiatric history or drugs, previous aesthetic surgeries). Data were collected by sending an email containing the online questionnaire (developed with RedCap software) to patients who had given their consent by telephone. The study received approval from the joint institutional review board of the participating hospitals (approval number: P2021/345/B4062021000181). All procedures involving human participants were conducted in accordance with the ethical standards of the institutional and/or national research committees, as well as the 1964 Helsinki Declaration and its later amendments or comparable ethical standards Questionnaire Currently, no standardized instrument exists for the comprehensive assessment of satisfaction in aesthetic surgery. Given that satisfaction is a multidimensional construct, it is essential to evaluate its various facets; therefore, we developed a study-specific questionnaire. The primary objective of this study was to assess patient satisfaction and to identify the factors that may influence it. The design of our instrument was informed by previously validated, procedure-specific questionnaires for body contouring, breast, and facial surgery—namely, the BODY-Q, BREAST-Q, and FACE-Q [ 12 – 14 ]. Our questionnaire comprised two sections. The first collected general personal and demographic information through open- and closed-ended questions. The second consisted of procedure-specific, closed-ended questions aimed at evaluating patient satisfaction. This latter section was organized into nine thematic domains, each including multiple items rated on a 10-point Likert scale (1 = “totally disagree” to 10 = “totally agree”) (Fig. 1 ). For each item, mean scores were calculated on a 10-point scale and expressed as a percentage out of 100. Statistical analysis The data were entered anonymously into an Excel spreadsheet (Microsoft Excel © 2023 Version 16.80) and then processed by statistical testing using SPSS software (IBM SPSS ® 2022 Version 29.0). We used descriptive methods and comparison tests to produce our statistics. Additional tests were performed to try to identify a relationship between some population characteristics (linear regression, chi-square, anova). P values were considered statistically significant if less than 0.05 and highly statistically significant if less than 0.001. Results A total of 162 patients were prospectively followed between January 1 and June 30, 2019. After applying the exclusion criteria (refusal to participate in the telephone interview, follow-up of less than 6 months, or incomplete/inaccurate clinical records), 78 patients were included in the final analysis. Of the total study population, 73 patients were women (93.6%) and 5 were men (6.4%). The mean age was 46 years (range, 20–65 years). Postoperative follow-up ranged from 6 to 40 months, with a mean of 26 months. The prevalence of psychiatric disorders, based on medical history and/or psychoactive medication use, was 42.3% (n = 33), while active smoking was reported in 20.5% (n = 16). Demographic characteristics and comorbidity factors are summarized in Tables 1 and 2 . Among the demographic variables, only history of psychiatric disorders and smoking status demonstrated a statistically significant association (p < 0.05). No significant correlation was found for age, gender, ethnicity, employment status, alcohol consumption, or prior cosmetic surgery. The procedures performed included breast surgery (augmentation or reduction mammaplasty) in 27 patients (34%), abdominoplasty in 25 patients (32%), liposuction and/or liposculpture in 13 patients (17%), rhinoplasty in 10 patients (12.8%), and other aesthetic interventions in 3 patients (3.9%). The overall mean satisfaction rate for the cohort was 69%. By procedure, satisfaction rates were highest among patients who underwent breast surgery (77%), followed by other interventions (76%), abdominoplasty (72%), liposuction/liposculpture (58%), and rhinoplasty (51%). The results are presented in Table 3 . These findings should be interpreted with caution given the limited size of certain subgroups. In this study, we formulated research hypotheses considering both preoperative and postoperative variables. We hypothesized that specific anamnestic factors could influence postoperative satisfaction. This was confirmed by a statistically significant association between overall satisfaction (S_global) and psychological distress related to physical appearance combined with low self-esteem ( p < 0.05). We then examined the relationship between satisfaction and the quality of surgeon–patient contact as well as the adequacy of preoperative information. Both factors demonstrated a highly significant association with overall satisfaction ( p < 0.001). Postoperative factors were also evaluated. Better pain management and favorable changes in sensory function in the operated area were strongly associated with higher satisfaction levels ( p < 0.001). Similarly, effective scar management and greater perceived postoperative aesthetic improvement were both closely linked to satisfaction ( p < 0.001 for each). Finally, we assessed the potential impact of changes in sexual well-being on satisfaction. A highly significant correlation was observed between overall satisfaction and self-reported improvement in sexual life ( p < 0.001). Discussion Undergoing aesthetic surgery can serve as a powerful means of enhancing quality of life and addresses an evolving societal demand in which patients increasingly seek not only improvements in the morphological appearance of their bodies but also enhancements in psychological well-being and social interaction [ 15 ]. While the technical aspects of aesthetic surgery are important, patient satisfaction remains the ultimate determinant of success; even technically flawless results may be perceived as failures if the patient is dissatisfied. Most studies on postoperative satisfaction in plastic surgery report acceptable satisfaction rates ranging from 70–90% [ 16 , 17 ]. Several investigations have highlighted the impact of both functional and aesthetic outcomes on postoperative satisfaction [ 18 , 19 ], as well as the influence of factors such as preoperative motivation, improved self-image, and greater social engagement [ 20 ]. The importance of comprehensive medical support, clear preoperative information, and alignment of patient expectations with realistic surgical outcomes has also been emphasized [ 21 , 22 ]. Patients who approach surgery with enthusiasm for the expected results are more likely to be satisfied, provided that their expectations remain realistic [ 22 ]. Conversely, the literature also documents cases of postoperative dissatisfaction. While dissatisfaction with the surgical result and the occurrence of complications are important factors, transient postoperative issues—such as pain, infection, edema, or reduced sensitivity in the operated area—may also contribute, although they rarely provide a complete explanation [ 23 ]. Psychological dimensions have also been explored; authors such as Bradbury and Reich have identified specific characteristics in dissatisfied patients [ 24 , 25 ]. In particular, some individuals suffer from self-image disorders and expect aesthetic surgery to deliver an immediate and transformative solution to unattainable ideals, which may lead to dissatisfaction and a higher likelihood of undergoing multiple procedures [ 26 , 27 ]. In our study, the majority of participants were women (93.6%), consistent with recent data from the International Society of Aesthetic Plastic Surgery (ISAPS), which indicate that nearly 90% of aesthetic procedures are performed on women, who remain the primary demographic for such interventions [ 28 , 29 ]. The mean age of participants was 46 years, aligning with 2018 ISAPS statistics showing that individuals aged 35–50 years represent the largest proportion of patients undergoing aesthetic surgery [ 14 ]. The most common procedures in our cohort were breast surgery, abdominoplasty, liposuction/liposculpture, and rhinoplasty, a distribution consistent with trends reported by the American Society for Aesthetic Plastic Surgery (ASAPS) [ 30 ]. Among these, breast surgery yielded the highest satisfaction rate (78%), whereas rhinoplasty had the lowest, with a dissatisfaction rate of 50%. Lower satisfaction rates for rhinoplasty compared with other aesthetic procedures have been consistently reported [ 31 ], and this surgery is also among the most frequently challenged in legal disputes [ 32 ]. This is unsurprising, as rhinoplasty is widely recognized as one of the most technically demanding operations in plastic surgery, both in execution and in meeting patient expectations [ 33 ]. Goldberg and Folkins demonstrated that patients with poor self-image are at increased risk of developing psychological disorders [ 39 ], concluding that a substantial proportion of dissatisfaction with plastic surgery occurs in this patient group. Our findings reinforce the importance of careful patient profiling and selection in optimizing satisfaction. Specifically, we identified profound psychological distress and low self-esteem as significant risk factors for postoperative dissatisfaction, underscoring the need for heightened surgeon awareness. Preoperative assessment of psychological well-being is essential, as it enables the identification of patients who may not derive benefit from surgery and, in some cases, should be referred for psychological support. These results invite a reconsideration of the conceptual foundation of satisfaction in aesthetic surgery. Rather than being solely tied to the attainment of beauty, satisfaction appears more closely aligned with achieving personal well-being, harmony, and balance. Indeed, postoperative dissatisfaction often arises from an underlying constellation of psychological disequilibrium and maladjustment. Supporting this, Jang’s meta-analysis concluded that psychiatric disorders represent a significant predictor of poor postoperative outcomes in patients undergoing aesthetic surgery [ 40 ]. Similarly, Von Soest et al. demonstrated that the presence of psychopathology can negatively influence the benefits derived from aesthetic surgery [ 23 ]. Honigman et al. further reported that dissatisfaction may occur despite a clinically satisfactory result when a pre-existing psychiatric disorder is present [ 41 ]. Our study supports this observation, showing that patients with a positive psychiatric history had lower satisfaction rates (60.5% versus 75.2%). More specifically, certain psychiatric conditions—such as body dysmorphic disorder (BDD) or narcissistic personality disorder—may prevent a patient from achieving satisfaction regardless of the aesthetic outcome [ 42 ]. Individuals with such conditions often anticipate that plastic surgery will serve as a transformative or “miracle” solution to unattainable ideals, a mindset that frequently results in postoperative dissatisfaction, persistent body image distress, and an increased likelihood of undergoing multiple procedures [ 26 , 27 ]. The challenge for surgeons, therefore, lies in identifying, during preoperative assessment, those patients who are at high risk of poor psychological adaptation despite technically optimal surgical results. This issue is further complicated by the fact that some patients do not disclose their psychiatric disorders, possibly due to concern about being perceived unfavorably by the surgeon—a phenomenon consistent with the bias described by Fisher and Hayas. In our study, a review of medical records revealed that 18 patients had concealed a psychiatric history, increasing the observed prevalence of psychiatric disorders from 19.2–42.3%. This finding underscores the importance of systematic preoperative psychiatric screening for candidates seeking cosmetic surgery. Enhanced psychiatric and psychological training for plastic surgeons would also be beneficial in improving detection and management of such cases. Minichino et al. reported that patients with psychiatric disorders have a higher propensity toward addictive behaviors [ 43 ], often as a means of self-regulating psychiatric symptoms. In our study, we observed the detrimental impact of tobacco use on postoperative satisfaction. Surgeons should be particularly attentive to such habits, as smoking is associated with an increased risk of complications in surgery, particularly within the field of plastic surgery [ 44 , 45 ]. Complications such as skin necrosis, infection, and delayed wound healing inevitably contribute to less satisfactory aesthetic outcomes [ 45 ]. Knobloch et al. reported that an eight-week period of smoking cessation was sufficient to reduce smoking-related postoperative complications [ 46 ]. A potential selection bias in our study would be to attribute lower satisfaction scores among smokers solely to their psychiatric comorbidities—implying that dissatisfaction might arise from their psychological profile rather than from smoking itself or its complications. However, our data refute this assumption, as tobacco use appears to exert a more detrimental effect on satisfaction than psychological factors alone. Nevertheless, we observed a statistically significant correlation between a positive psychiatric history and smoking habits [ 47 ]. It is also plausible that the more complex postoperative course associated with smoking—manifesting as wound dehiscence, infection, and delayed healing—may form a causal link between tobacco use and dissatisfaction. This suggests that the adverse impact of smoking on postoperative care may partly explain the higher dissatisfaction rates observed in smokers. With respect to surgeon–patient contact, both the preoperative and postoperative periods must be considered in terms of the quality and quantity of information provided, the discussion of expected results, and the follow-up process. In our study, we found that the quality of contact and the comprehensiveness of information provided by the surgeon were among the most influential factors affecting patient satisfaction (p < 0.001) [Table 4 ]. Reich reported that high-quality communication and interpersonal contact exert a positive influence on patients’ attitudes toward their surgical outcomes and overall experience [ 25 ]. He observed that dissatisfaction among aesthetic surgery patients was most frequently associated with negative interpersonal interactions during the preoperative, operative, and postoperative phases. According to Reich, honesty, trust, and clear communication form the foundation of a successful patient–surgeon relationship. For this reason, it is essential to establish the patient’s goals, evaluate the realism of their expectations, assess their capacity to accept an imperfect result, consider their psychological profile, and provide detailed information about the procedure, its course, and potential complications. Neil T. emphasized that patient satisfaction is influenced primarily by surgeon-related factors, including taking sufficient time to answer the patient’s questions and actively involving them in the decision-making process [ 42 ]. In our study, 23% of patients considered their involvement in surgical decision-making to be inadequate, and 14.1% expressed regret over their choice of surgeon. These findings highlight the need for “enhanced” information—delivered in a manner that ensures patient comprehension—to optimize preoperative counseling. In the postoperative phase, additional factors strongly influence the patient’s perception of their surgical experience. Our results indicate that the quality of the surgical outcome remains the most powerful predictor of satisfaction. Dissatisfaction may stem from insufficient preoperative information, as 31% of our patients reported that they had not been adequately informed about the possibility of a less-than-optimal outcome, experienced a result different from what they had envisioned, or felt that the surgeon’s presentation had created unrealistic expectations. Beyond the final aesthetic appearance, our findings also suggest that the quality of follow-up care—particularly in managing postoperative pain and scar evolution—plays a crucial role in shaping patient satisfaction. In our cohort, 28.2% of patients were dissatisfied with the evolution of sensory loss or decreased sensitivity in the operated area. In the context of breast surgery, Dahlbäck [ 21 ], and in aesthetic genital surgery, Goodman [ 47 ] and Eftekhar [ 48 ], have reported that diminished sensitivity in the operated region is a frequent source of postoperative dissatisfaction. For example, in Dahlbäck’s study, although 84% of women were satisfied with their breast surgery overall, only 67% were satisfied with the sensory outcome [ 21 ]. Improvement in sexual life is another important motivation for undergoing aesthetic surgery and may significantly influence the patient’s subjective assessment of the outcome. De Brito [ 49 ] has emphasized that sexual well-being is an integral component of quality-of-life evaluations and is closely associated with the psychological success of surgery and overall satisfaction. Conversely, Feiss R. [ 50 ] identified sexuality as a potential risk factor for psychological dissatisfaction. Based on our findings, we contend that it is essential to assess patients’ sexual expectations—or lack thereof—prior to surgery to prevent postoperative disappointment. Our data revealed a strong association between patients’ perceptions of their sexual life and their overall satisfaction (p < 0.001). Based on these findings, it is evident that preoperative contact with the surgeon—including the nature of the information provided and the quality of the consultation—is fundamental to the overall concept of patient satisfaction and must be actively addressed in clinical practice. The surgeon should dedicate a substantial portion of their efforts to preparing the patient through thorough discussion, clear and comprehensive information, and the cultivation of a strong therapeutic relationship. Equally important is the quality of postoperative management, with particular attention to pain control and strategies aimed at improving quality of life. The aim of our study was to investigate and highlight the correlations between various clinical, personal, and psychological factors and postoperative satisfaction. Several limitations should be acknowledged, presented here in order of their estimated impact to facilitate an objective interpretation by the reader. First, the sample size: to design a robust study and support external validation of the questionnaire, a larger sample and higher participation rate would have been desirable. The sample size calculation, based on an expected moderate effect (Cohen’s f² = 0.15), a power of 80%, and a significance level of 5%, indicated that at least 85 participants would be required for an adequate multiple regression analysis incorporating up to five independent variables. The final sample of 78 patients fell slightly short of this target, which we recognize as a limitation. Second, there is a potential risk of systematic selection bias, given the number of responses (n = 78) compared with the number of eligible patients (n = 221). Finally, certain subgroups within the sample were particularly small, limiting the robustness of some analyses. In summary, while these methodological limitations reduce the generalizability of our findings, they do not diminish the relevance of the correlations and influencing factors identified in this study. Conclusion Patient satisfaction after aesthetic surgery is multifactorial, influenced by both technical and psychological factors [ 50 ]. While the quality of the aesthetic result is paramount, clear communication, appropriate patient selection, and rigorous postoperative follow-up are equally critical. Comprehensive preoperative education and systematic psychological assessment can help align expectations, identify risk factors for dissatisfaction, and improve overall outcomes. Success in aesthetic surgery therefore relies not only on surgical skill but also on the surgeon’s ability to prepare, guide, and support patients throughout the entire process. Declarations Conflict of interest statement : The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Funding : The authors declare that no financial support was received for the research of this article. Ethics statement : The medical ethics committees of the three hospitals gave their agreement. Written informed consent to participate in this study was not required from the participants in accordance with the national legislation and the institutional requirements Author Contribution Author Contributions: - Conceptualization, Vanessa Marron Mendes, Luigi Losco and Giuseppe Diluiso; - Methodology, Vanessa Marron Mendes; - Software, Mirco Pozzi- Validation, Sara Poggi and Michela Schettino, Martin Schils- Formal analysis, Michela Schettino, Martin Schils- Investigation, Vanessa Marron Mendes, Mirco Pozzi, Giuseppe Diluiso and Marie Delhaye; - Resources, Vanessa Marron Mendes;- Data curation, Sara Poggi; - Writing – original draft, Sara Poggi and Giuseppe Diluiso - Writing – review & editing, Martin Schils , Sara Poggi and Luigi Losco- Supervision, Marie Delhaye- Project administration, Luigi Losco and Giuseppe Diluiso. References Bolton MA, Pruzinsky T, Cash TF, Persing JA (2003) Measuring outcomes in plastic surgery: body image and quality of life in abdominoplasty patients. 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Disponible sur: https://www.plasticsurgery.org/news/press-releases/patient-satisfaction-with- plastic-surgery-its-the-surgeon-not-the-practice Minichino A, Bersani FS, Calò WK, Spagnoli F, Francesconi M, Vicinanza R et al (2013) Smoking behaviour and mental health disorders–mutual influences and implications for therapy. Int J Environ Res Public Health 10 oct 10(10):4790–4811 Barone M, Cogliandro A, Persichetti P (2013) Plastic surgery and smoking: a prospective analysis of incidence, compliance, and complications. Plast Reconstr Surg oct 132(4):686e–7e Pluvy I, Panouillères M, Garrido I, Pauchot J, Saboye J, Chavoin JP et al (2015) Smoking and plastic surgery, part II. Clinical implications: a systematic review with meta-analysis. Ann Chir Plast Esthet févr 60(1):e15–49 Knobloch K, Gohritz A, Reuss E, Vogt PM (2008) [Nicotine in plastic surgery: a review]. Chirurg oct 79(10):956–962 Goodman MP, Placik OJ, Matlock DL, Simopoulos AF, Dalton TA, Veale D et al (2016) Evaluation of Body Image and Sexual Satisfaction in Women Undergoing Female Genital Plastic/Cosmetic Surgery. Aesthet Surg J oct 36(9):1048–1057 Eftekhar T, Hajibabaei M, Veisi F, Ghanbari Z, Montazeri A (2021) Body Image, Sexual Function, and Sexual Satisfaction Among Couples Before and After Gynecologic Cosmetic Surgery. J Family Reprod Health déc 15(4):252–257 de Brito MJA, Nahas FX, Bussolaro RA, Shinmyo LM, Barbosa MVJ, Ferreira LM (2012) Effects of Abdominoplasty on Female Sexuality: A Pilot Study. J Sex Med 9(3):918–926 Losco L, Cigna E (2018) Aesthetic Refinements in C-V Flap: Raising a Perfect Cylinder. Aesthet Surg J. ;38(2):NP26-NP28. 10.1093/asj/sjx195 . PMID: 29190322 Tables Tables 1. Patients’ demographic characteristics (chi-square χ² and indipendent t-test). Population n=78 Average of global satisfaction n % % p-value S global Age 18-24 years 4 5,10% 58,60% 0,635 25-34 years 8 10,30% 77,80% 35-44 years 25 32% 66,50% > 45 years 41 52,60% 69,70% Sex M 5 6,40% 66,20% 0,817 F 73 93,60% 69,20% Ethnic group Caucasian 44 56,40% 73,30% 0,491 North Africa 10 12,80% 67,60% Black Africa 5 6,40% 64,40% Middle East 5 6,40% 58,90% Latin American 1 1,30% 86,70% Unknown 13 16,70% 58,30% Employment status Paid employment 40 51,30% 72,90% 0,261 Student 3 3,80% 66,70% Disabled 9 11,50% 65% Unemployed 11 14,10% 50,60% Homemaker 7 9% 68,50% Retired 5 6,40% 80,60% Other 3 3,80% 78,30% Table 2 . Patients’ comorbidity (chi-square χ² and indipendent t-test). Population n=78 Average of global satisfaction n % % p-value S global Alcohol Yes 34 43,60% 72,20% 0,344 No 44 56,40% 66,40% Tobacco Yes 16 20,50% 50,90% 0,002 No 62 79,50% 73,60% Psychiatric history or drugs Yes 33 42,30% 60,50% 0,015 No 45 57,70% 75,20% Previous aesthetic surgeries 2 13 16,70% 56,80% Table 3 . Satisfaction rates according to the type of intervention). Type of intervention Average of global satisfaction Augmentation/Reductive mammaplasty 77% Others (otoplasty, blepharoplasty, gynecomastia) 76% Abdominoplasty 72% Liposuction/liposculture 58% Rhinoplasty 51% Table 4 . Satisfaction items ranked in descending order of average satisfaction. Average satisfaction per item % p-value - S global R 2 -linear Quality of contact with the surgeon 85% < 0,001 0,36 Quality of information received by the patient 79% < 0,001 0,304 Management and evolution of post-operative pain and sensitivity 74% < 0,001 0,555 Quality of the post-operative result 70% < 0,001 0,892 Management and evolution of scars 68% < 0,001 0,642 Improvement in sex life 57% < 0,001 0,606 REMINDER S global 69% Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 27 Oct, 2025 Read the published version in European Journal of Plastic Surgery → Version 1 posted Editorial decision: Revision requested 23 Aug, 2025 Reviews received at journal 23 Aug, 2025 Reviewers agreed at journal 19 Aug, 2025 Reviewers invited by journal 19 Aug, 2025 Editor assigned by journal 18 Aug, 2025 Submission checks completed at journal 18 Aug, 2025 First submitted to journal 10 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7340124","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":504683840,"identity":"91907e0e-40bd-4053-872e-255e55716887","order_by":0,"name":"Vanessa Marron Mendes","email":"","orcid":"","institution":"CHIREC Hospital, Braine-L'Alleud","correspondingAuthor":false,"prefix":"","firstName":"Vanessa","middleName":"Marron","lastName":"Mendes","suffix":""},{"id":504683841,"identity":"3454dc8f-3f85-4c4c-b8ff-e75fc223970e","order_by":1,"name":"Sara Poggi","email":"","orcid":"","institution":"University of Salerno","correspondingAuthor":false,"prefix":"","firstName":"Sara","middleName":"","lastName":"Poggi","suffix":""},{"id":504683842,"identity":"04a029ea-44a9-45d2-9870-64399b57fb7f","order_by":2,"name":"Martin Schils","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIie3OoQ7CMBCA4WsQmG7YCsIbkAyzhUCyV6FZsr0CAnGEZCj8EgjPgCLINktQI9gJxGbAgmOOsSFQZRLRX7SmX+8AdLp/bfI+GJkLmELXAvoTEPwQFJAAbUaqiwEIEjYg/eXpluUHcDvrBcpiG1MHDJmpiJ0EA+QJ8OgiMTb2MR2i6VlKInyCPISJxTjGpCSWoDZTkvO1Iu6byGJTEeepJGk9hexKIgysp6hESa4k4iHjUVouRo8BHS5M78diPjyKcOx2oiDPn7NRz2mv5F05pu7721aD9zqdTqdT9wKWVky6RMWq+wAAAABJRU5ErkJggg==","orcid":"","institution":"CHIREC Hospital, Braine-L'Alleud","correspondingAuthor":true,"prefix":"","firstName":"Martin","middleName":"","lastName":"Schils","suffix":""},{"id":504683843,"identity":"774a78a5-279f-4079-a0ae-fde068d43d25","order_by":3,"name":"Michela Schettino","email":"","orcid":"","institution":"CHIREC Hospital, Braine-L'Alleud","correspondingAuthor":false,"prefix":"","firstName":"Michela","middleName":"","lastName":"Schettino","suffix":""},{"id":504683844,"identity":"1d117a47-68f4-486f-89df-612efc2a7cbf","order_by":4,"name":"Luigi Losco","email":"","orcid":"","institution":"University of Salerno","correspondingAuthor":false,"prefix":"","firstName":"Luigi","middleName":"","lastName":"Losco","suffix":""},{"id":504683845,"identity":"4ce3aac3-b482-4496-8486-0a7a5e686bbd","order_by":5,"name":"Mirco Pozzi","email":"","orcid":"","institution":"University of Siena","correspondingAuthor":false,"prefix":"","firstName":"Mirco","middleName":"","lastName":"Pozzi","suffix":""},{"id":504683846,"identity":"a114a20a-0acd-45d4-b1aa-7ecd34d60001","order_by":6,"name":"Giuseppe Diluiso","email":"","orcid":"","institution":"CHIREC Hospital, Braine-L'Alleud","correspondingAuthor":false,"prefix":"","firstName":"Giuseppe","middleName":"","lastName":"Diluiso","suffix":""},{"id":504683847,"identity":"9b445f7e-3307-45c9-8a24-1ecb63a3f0ce","order_by":7,"name":"Marie Delhaye","email":"","orcid":"","institution":"University of Erasme","correspondingAuthor":false,"prefix":"","firstName":"Marie","middleName":"","lastName":"Delhaye","suffix":""}],"badges":[],"createdAt":"2025-08-10 16:53:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7340124/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7340124/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00238-025-02346-x","type":"published","date":"2025-10-27T15:56:50+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":90304051,"identity":"ee9f943b-e4b2-411b-ac61-4ff89281e485","added_by":"auto","created_at":"2025-09-01 09:10:32","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":196620,"visible":true,"origin":"","legend":"\u003cp\u003eOutline Questionnaire.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7340124/v1/9a914dcf544c28931cfce801.png"},{"id":95039776,"identity":"83e6b6c7-126b-4ff8-8e9a-31c3e155fda3","added_by":"auto","created_at":"2025-11-03 16:01:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":996688,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7340124/v1/c621c752-da43-4686-8352-2d81faf97978.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eFactors associated with patient satisfaction following aesthetic surgery\u003c/p\u003e","fulltext":[{"header":"Introduction ","content":"\u003cp\u003eAesthetic surgery is a unique surgical discipline in which success depends not only on technical excellence but also on meeting patients\u0026rsquo; expectations for appearance, psychosocial well-being, and overall quality of life. Patients seeking cosmetic procedures often present with strong motivational profiles, sometimes described as the \u0026ldquo;overmotivation phenomenon,\u0026rdquo; reflecting a profound desire to address physical concerns that may be closely linked to psychological distress [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In this context, aesthetic surgery can serve as an important mechanism for improving self-image, enhancing social interaction, and promoting psychological well-being [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eImportantly, patient satisfaction is often determined less by the attainment of an objective ideal of \u0026ldquo;beauty\u0026rdquo; and more by the restoration of harmony, confidence, and functional integration into daily life [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In contemporary society, aesthetic goals have expanded beyond purely morphological improvements to include enhancements in psychosocial functioning and quality of life [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This shift underscores the necessity for surgeons to employ robust and validated tools to systematically measure patient satisfaction after aesthetic interventions.\u003c/p\u003e\u003cp\u003eValidated patient-reported outcome measures (PROMs) such as the BREAST-Q, BODY-Q, and FACE-Q have been specifically developed to assess satisfaction and health-related quality of life in patients undergoing breast, body, and facial aesthetic surgery [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. These tools provide standardized, reproducible data and enable meaningful comparisons across studies [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Nevertheless, one limitation is their reduced ability to fully capture deeper psychological factors\u0026mdash;such as self-esteem, body image perception, and preoperative expectations\u0026mdash;that may influence satisfaction scores [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe aim of the present study is to identify and characterize demographic, preoperative, and postoperative factors associated with patient satisfaction after aesthetic surgery. Our questionnaire also incorporated psychological and social dimensions often underrepresented in conventional satisfaction tools, enabling a more comprehensive assessment of the bio-psycho-social profile and its potential role in predicting postoperative dissatisfaction.\u003c/p\u003e"},{"header":"Méthodology ","content":"\u003cp\u003eA prospective, non-interventional, multicenter study was conducted including all patients who presented to the outpatient plastic surgery clinic of Brugmann University Hospital and Erasme Hospital University Hospitals in Bruxelles from January 1, 2019 to June 30, 2019. Inclusion criteria included: patients of either sex (male or female), age over 18 years, patients who had undergone aesthetic surgery (rhinoplasty, cervico-facial lift, otoplasty, blepharoplasty, breast augmentation or reduction, mastopexy, gynecomastia treatment, abdominoplasty). Exclusion criteria included: refused to participate via telephone interview, a follow-up period of less than 6 months and incomplete or inaccurate clinical records.\u003c/p\u003e\u003cp\u003eWe evaluated patient characteristics of all participants using electronic medical records. The pertinent demographic data include age, ethnic group, employment status, comorbidities (Alcohol, smoking status, psychiatric history or drugs, previous aesthetic surgeries).\u003c/p\u003e\u003cp\u003eData were collected by sending an email containing the online questionnaire (developed with RedCap software) to patients who had given their consent by telephone.\u003c/p\u003e\u003cp\u003e The study received approval from the joint institutional review board of the participating hospitals (approval number: P2021/345/B4062021000181). All procedures involving human participants were conducted in accordance with the ethical standards of the institutional and/or national research committees, as well as the 1964 Helsinki Declaration and its later amendments or comparable ethical standards\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eQuestionnaire\u003c/h2\u003e\u003cp\u003eCurrently, no standardized instrument exists for the comprehensive assessment of satisfaction in aesthetic surgery. Given that satisfaction is a multidimensional construct, it is essential to evaluate its various facets; therefore, we developed a study-specific questionnaire. The primary objective of this study was to assess patient satisfaction and to identify the factors that may influence it. The design of our instrument was informed by previously validated, procedure-specific questionnaires for body contouring, breast, and facial surgery\u0026mdash;namely, the BODY-Q, BREAST-Q, and FACE-Q [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOur questionnaire comprised two sections. The first collected general personal and demographic information through open- and closed-ended questions. The second consisted of procedure-specific, closed-ended questions aimed at evaluating patient satisfaction. This latter section was organized into nine thematic domains, each including multiple items rated on a 10-point Likert scale (1 = \u0026ldquo;totally disagree\u0026rdquo; to 10 = \u0026ldquo;totally agree\u0026rdquo;) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). For each item, mean scores were calculated on a 10-point scale and expressed as a percentage out of 100.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eThe data were entered anonymously into an Excel spreadsheet (Microsoft Excel \u0026copy; 2023 Version 16.80) and then processed by statistical testing using SPSS software (IBM SPSS \u0026reg; 2022 Version 29.0). We used descriptive methods and comparison tests to produce our statistics. Additional tests were performed to try to identify a relationship between some population characteristics (linear regression, chi-square, anova). P values were considered statistically significant if less than 0.05 and highly statistically significant if less than 0.001.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 162 patients were prospectively followed between January 1 and June 30, 2019. After applying the exclusion criteria (refusal to participate in the telephone interview, follow-up of less than 6 months, or incomplete/inaccurate clinical records), 78 patients were included in the final analysis.\u003c/p\u003e\u003cp\u003eOf the total study population, 73 patients were women (93.6%) and 5 were men (6.4%). The mean age was 46 years (range, 20\u0026ndash;65 years). Postoperative follow-up ranged from 6 to 40 months, with a mean of 26 months. The prevalence of psychiatric disorders, based on medical history and/or psychoactive medication use, was 42.3% (n\u0026thinsp;=\u0026thinsp;33), while active smoking was reported in 20.5% (n\u0026thinsp;=\u0026thinsp;16). Demographic characteristics and comorbidity factors are summarized in Tables\u0026nbsp;1 and \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Among the demographic variables, only history of psychiatric disorders and smoking status demonstrated a statistically significant association (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No significant correlation was found for age, gender, ethnicity, employment status, alcohol consumption, or prior cosmetic surgery.\u003c/p\u003e\u003cp\u003eThe procedures performed included breast surgery (augmentation or reduction mammaplasty) in 27 patients (34%), abdominoplasty in 25 patients (32%), liposuction and/or liposculpture in 13 patients (17%), rhinoplasty in 10 patients (12.8%), and other aesthetic interventions in 3 patients (3.9%). The overall mean satisfaction rate for the cohort was 69%. By procedure, satisfaction rates were highest among patients who underwent breast surgery (77%), followed by other interventions (76%), abdominoplasty (72%), liposuction/liposculpture (58%), and rhinoplasty (51%). The results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e. These findings should be interpreted with caution given the limited size of certain subgroups.\u003c/p\u003e\u003cp\u003eIn this study, we formulated research hypotheses considering both preoperative and postoperative variables. We hypothesized that specific anamnestic factors could influence postoperative satisfaction. This was confirmed by a statistically significant association between overall satisfaction (S_global) and psychological distress related to physical appearance combined with low self-esteem (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). We then examined the relationship between satisfaction and the quality of surgeon\u0026ndash;patient contact as well as the adequacy of preoperative information. Both factors demonstrated a highly significant association with overall satisfaction (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Postoperative factors were also evaluated. Better pain management and favorable changes in sensory function in the operated area were strongly associated with higher satisfaction levels (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly, effective scar management and greater perceived postoperative aesthetic improvement were both closely linked to satisfaction (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for each). Finally, we assessed the potential impact of changes in sexual well-being on satisfaction. A highly significant correlation was observed between overall satisfaction and self-reported improvement in sexual life (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e"},{"header":"Discussion ","content":"\u003cp\u003eUndergoing aesthetic surgery can serve as a powerful means of enhancing quality of life and addresses an evolving societal demand in which patients increasingly seek not only improvements in the morphological appearance of their bodies but also enhancements in psychological well-being and social interaction [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. While the technical aspects of aesthetic surgery are important, patient satisfaction remains the ultimate determinant of success; even technically flawless results may be perceived as failures if the patient is dissatisfied. Most studies on postoperative satisfaction in plastic surgery report acceptable satisfaction rates ranging from 70\u0026ndash;90% [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Several investigations have highlighted the impact of both functional and aesthetic outcomes on postoperative satisfaction [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], as well as the influence of factors such as preoperative motivation, improved self-image, and greater social engagement [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The importance of comprehensive medical support, clear preoperative information, and alignment of patient expectations with realistic surgical outcomes has also been emphasized [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Patients who approach surgery with enthusiasm for the expected results are more likely to be satisfied, provided that their expectations remain realistic [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eConversely, the literature also documents cases of postoperative dissatisfaction. While dissatisfaction with the surgical result and the occurrence of complications are important factors, transient postoperative issues\u0026mdash;such as pain, infection, edema, or reduced sensitivity in the operated area\u0026mdash;may also contribute, although they rarely provide a complete explanation [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Psychological dimensions have also been explored; authors such as Bradbury and Reich have identified specific characteristics in dissatisfied patients [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In particular, some individuals suffer from self-image disorders and expect aesthetic surgery to deliver an immediate and transformative solution to unattainable ideals, which may lead to dissatisfaction and a higher likelihood of undergoing multiple procedures [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn our study, the majority of participants were women (93.6%), consistent with recent data from the International Society of Aesthetic Plastic Surgery (ISAPS), which indicate that nearly 90% of aesthetic procedures are performed on women, who remain the primary demographic for such interventions [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The mean age of participants was 46 years, aligning with 2018 ISAPS statistics showing that individuals aged 35\u0026ndash;50 years represent the largest proportion of patients undergoing aesthetic surgery [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe most common procedures in our cohort were breast surgery, abdominoplasty, liposuction/liposculpture, and rhinoplasty, a distribution consistent with trends reported by the American Society for Aesthetic Plastic Surgery (ASAPS) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Among these, breast surgery yielded the highest satisfaction rate (78%), whereas rhinoplasty had the lowest, with a dissatisfaction rate of 50%. Lower satisfaction rates for rhinoplasty compared with other aesthetic procedures have been consistently reported [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], and this surgery is also among the most frequently challenged in legal disputes [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. This is unsurprising, as rhinoplasty is widely recognized as one of the most technically demanding operations in plastic surgery, both in execution and in meeting patient expectations [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGoldberg and Folkins demonstrated that patients with poor self-image are at increased risk of developing psychological disorders [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], concluding that a substantial proportion of dissatisfaction with plastic surgery occurs in this patient group. Our findings reinforce the importance of careful patient profiling and selection in optimizing satisfaction. Specifically, we identified profound psychological distress and low self-esteem as significant risk factors for postoperative dissatisfaction, underscoring the need for heightened surgeon awareness.\u003c/p\u003e\u003cp\u003ePreoperative assessment of psychological well-being is essential, as it enables the identification of patients who may not derive benefit from surgery and, in some cases, should be referred for psychological support. These results invite a reconsideration of the conceptual foundation of satisfaction in aesthetic surgery. Rather than being solely tied to the attainment of beauty, satisfaction appears more closely aligned with achieving personal well-being, harmony, and balance. Indeed, postoperative dissatisfaction often arises from an underlying constellation of psychological disequilibrium and maladjustment. Supporting this, Jang\u0026rsquo;s meta-analysis concluded that psychiatric disorders represent a significant predictor of poor postoperative outcomes in patients undergoing aesthetic surgery [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Similarly, Von Soest et al. demonstrated that the presence of psychopathology can negatively influence the benefits derived from aesthetic surgery [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Honigman et al. further reported that dissatisfaction may occur despite a clinically satisfactory result when a pre-existing psychiatric disorder is present [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Our study supports this observation, showing that patients with a positive psychiatric history had lower satisfaction rates (60.5% versus 75.2%).\u003c/p\u003e\u003cp\u003eMore specifically, certain psychiatric conditions\u0026mdash;such as body dysmorphic disorder (BDD) or narcissistic personality disorder\u0026mdash;may prevent a patient from achieving satisfaction regardless of the aesthetic outcome [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Individuals with such conditions often anticipate that plastic surgery will serve as a transformative or \u0026ldquo;miracle\u0026rdquo; solution to unattainable ideals, a mindset that frequently results in postoperative dissatisfaction, persistent body image distress, and an increased likelihood of undergoing multiple procedures [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The challenge for surgeons, therefore, lies in identifying, during preoperative assessment, those patients who are at high risk of poor psychological adaptation despite technically optimal surgical results.\u003c/p\u003e\u003cp\u003eThis issue is further complicated by the fact that some patients do not disclose their psychiatric disorders, possibly due to concern about being perceived unfavorably by the surgeon\u0026mdash;a phenomenon consistent with the bias described by Fisher and Hayas. In our study, a review of medical records revealed that 18 patients had concealed a psychiatric history, increasing the observed prevalence of psychiatric disorders from 19.2\u0026ndash;42.3%. This finding underscores the importance of systematic preoperative psychiatric screening for candidates seeking cosmetic surgery. Enhanced psychiatric and psychological training for plastic surgeons would also be beneficial in improving detection and management of such cases. Minichino et al. reported that patients with psychiatric disorders have a higher propensity toward addictive behaviors [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], often as a means of self-regulating psychiatric symptoms. In our study, we observed the detrimental impact of tobacco use on postoperative satisfaction. Surgeons should be particularly attentive to such habits, as smoking is associated with an increased risk of complications in surgery, particularly within the field of plastic surgery [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Complications such as skin necrosis, infection, and delayed wound healing inevitably contribute to less satisfactory aesthetic outcomes [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Knobloch et al. reported that an eight-week period of smoking cessation was sufficient to reduce smoking-related postoperative complications [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. A potential selection bias in our study would be to attribute lower satisfaction scores among smokers solely to their psychiatric comorbidities\u0026mdash;implying that dissatisfaction might arise from their psychological profile rather than from smoking itself or its complications. However, our data refute this assumption, as tobacco use appears to exert a more detrimental effect on satisfaction than psychological factors alone. Nevertheless, we observed a statistically significant correlation between a positive psychiatric history and smoking habits [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. It is also plausible that the more complex postoperative course associated with smoking\u0026mdash;manifesting as wound dehiscence, infection, and delayed healing\u0026mdash;may form a causal link between tobacco use and dissatisfaction. This suggests that the adverse impact of smoking on postoperative care may partly explain the higher dissatisfaction rates observed in smokers. With respect to surgeon\u0026ndash;patient contact, both the preoperative and postoperative periods must be considered in terms of the quality and quantity of information provided, the discussion of expected results, and the follow-up process. In our study, we found that the quality of contact and the comprehensiveness of information provided by the surgeon were among the most influential factors affecting patient satisfaction (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) [Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e]. Reich reported that high-quality communication and interpersonal contact exert a positive influence on patients\u0026rsquo; attitudes toward their surgical outcomes and overall experience [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. He observed that dissatisfaction among aesthetic surgery patients was most frequently associated with negative interpersonal interactions during the preoperative, operative, and postoperative phases. According to Reich, honesty, trust, and clear communication form the foundation of a successful patient\u0026ndash;surgeon relationship. For this reason, it is essential to establish the patient\u0026rsquo;s goals, evaluate the realism of their expectations, assess their capacity to accept an imperfect result, consider their psychological profile, and provide detailed information about the procedure, its course, and potential complications.\u003c/p\u003e\u003cp\u003eNeil T. emphasized that patient satisfaction is influenced primarily by surgeon-related factors, including taking sufficient time to answer the patient\u0026rsquo;s questions and actively involving them in the decision-making process [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. In our study, 23% of patients considered their involvement in surgical decision-making to be inadequate, and 14.1% expressed regret over their choice of surgeon. These findings highlight the need for \u0026ldquo;enhanced\u0026rdquo; information\u0026mdash;delivered in a manner that ensures patient comprehension\u0026mdash;to optimize preoperative counseling. In the postoperative phase, additional factors strongly influence the patient\u0026rsquo;s perception of their surgical experience. Our results indicate that the quality of the surgical outcome remains the most powerful predictor of satisfaction. Dissatisfaction may stem from insufficient preoperative information, as 31% of our patients reported that they had not been adequately informed about the possibility of a less-than-optimal outcome, experienced a result different from what they had envisioned, or felt that the surgeon\u0026rsquo;s presentation had created unrealistic expectations. Beyond the final aesthetic appearance, our findings also suggest that the quality of follow-up care\u0026mdash;particularly in managing postoperative pain and scar evolution\u0026mdash;plays a crucial role in shaping patient satisfaction.\u003c/p\u003e\u003cp\u003eIn our cohort, 28.2% of patients were dissatisfied with the evolution of sensory loss or decreased sensitivity in the operated area. In the context of breast surgery, Dahlb\u0026auml;ck [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], and in aesthetic genital surgery, Goodman [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e] and Eftekhar [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], have reported that diminished sensitivity in the operated region is a frequent source of postoperative dissatisfaction. For example, in Dahlb\u0026auml;ck\u0026rsquo;s study, although 84% of women were satisfied with their breast surgery overall, only 67% were satisfied with the sensory outcome [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eImprovement in sexual life is another important motivation for undergoing aesthetic surgery and may significantly influence the patient\u0026rsquo;s subjective assessment of the outcome. De Brito [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e] has emphasized that sexual well-being is an integral component of quality-of-life evaluations and is closely associated with the psychological success of surgery and overall satisfaction. Conversely, Feiss R. [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e] identified sexuality as a potential risk factor for psychological dissatisfaction. Based on our findings, we contend that it is essential to assess patients\u0026rsquo; sexual expectations\u0026mdash;or lack thereof\u0026mdash;prior to surgery to prevent postoperative disappointment. Our data revealed a strong association between patients\u0026rsquo; perceptions of their sexual life and their overall satisfaction (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003eBased on these findings, it is evident that preoperative contact with the surgeon\u0026mdash;including the nature of the information provided and the quality of the consultation\u0026mdash;is fundamental to the overall concept of patient satisfaction and must be actively addressed in clinical practice. The surgeon should dedicate a substantial portion of their efforts to preparing the patient through thorough discussion, clear and comprehensive information, and the cultivation of a strong therapeutic relationship. Equally important is the quality of postoperative management, with particular attention to pain control and strategies aimed at improving quality of life.\u003c/p\u003e\u003cp\u003eThe aim of our study was to investigate and highlight the correlations between various clinical, personal, and psychological factors and postoperative satisfaction. Several limitations should be acknowledged, presented here in order of their estimated impact to facilitate an objective interpretation by the reader.\u003c/p\u003e\u003cp\u003eFirst, the sample size: to design a robust study and support external validation of the questionnaire, a larger sample and higher participation rate would have been desirable. The sample size calculation, based on an expected moderate effect (Cohen\u0026rsquo;s f\u0026sup2; = 0.15), a power of 80%, and a significance level of 5%, indicated that at least 85 participants would be required for an adequate multiple regression analysis incorporating up to five independent variables. The final sample of 78 patients fell slightly short of this target, which we recognize as a limitation.\u003c/p\u003e\u003cp\u003eSecond, there is a potential risk of systematic selection bias, given the number of responses (n\u0026thinsp;=\u0026thinsp;78) compared with the number of eligible patients (n\u0026thinsp;=\u0026thinsp;221). Finally, certain subgroups within the sample were particularly small, limiting the robustness of some analyses.\u003c/p\u003e\u003cp\u003eIn summary, while these methodological limitations reduce the generalizability of our findings, they do not diminish the relevance of the correlations and influencing factors identified in this study.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePatient satisfaction after aesthetic surgery is multifactorial, influenced by both technical and psychological factors [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. While the quality of the aesthetic result is paramount, clear communication, appropriate patient selection, and rigorous postoperative follow-up are equally critical. Comprehensive preoperative education and systematic psychological assessment can help align expectations, identify risk factors for dissatisfaction, and improve overall outcomes. Success in aesthetic surgery therefore relies not only on surgical skill but also on the surgeon\u0026rsquo;s ability to prepare, guide, and support patients throughout the entire process.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of interest statement :\u003c/strong\u003e\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding :\u003c/h2\u003e\u003cp\u003eThe authors declare that no financial support was received for the research of this article.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eEthics statement\u003c/span\u003e : The medical ethics committees of the three hospitals gave their agreement. Written informed consent to participate in this study was not required from the participants in accordance with the national legislation and the institutional requirements\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor Contributions: - Conceptualization, Vanessa Marron Mendes, Luigi Losco and Giuseppe Diluiso; - Methodology, Vanessa Marron Mendes; - Software, Mirco Pozzi- Validation, Sara Poggi and Michela Schettino, Martin Schils- Formal analysis, Michela Schettino, Martin Schils- Investigation, Vanessa Marron Mendes, Mirco Pozzi, Giuseppe Diluiso and Marie Delhaye; - Resources, Vanessa Marron Mendes;- Data curation, Sara Poggi; - Writing \u0026ndash; original draft, Sara Poggi and Giuseppe Diluiso - Writing \u0026ndash; review \u0026amp; editing, Martin Schils , Sara Poggi and Luigi Losco- Supervision, Marie Delhaye- Project administration, Luigi Losco and Giuseppe Diluiso.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBolton MA, Pruzinsky T, Cash TF, Persing JA (2003) Measuring outcomes in plastic surgery: body image and quality of life in abdominoplasty patients. 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Aesthet Surg J. ;38(2):NP26-NP28. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/asj/sjx195\u003c/span\u003e\u003cspan address=\"10.1093/asj/sjx195\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 29190322\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTables 1.\u0026nbsp;\u003c/strong\u003ePatients\u0026rsquo; demographic characteristics (chi-square \u0026chi;\u0026sup2; and indipendent t-test).\u0026nbsp;\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"698\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 190px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 254px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePopulation n=78\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 254px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAverage of global satisfaction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eS\u003csub\u003eglobal\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"45\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd height=\"45\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 698px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e18-24 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5,10%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e58,60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0,635\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003e25-34 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e10,30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e77,80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003e35-44 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e32%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e66,50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003e\u0026gt; 45 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e52,60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e69,70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 698px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e6,40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e66,20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0,817\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e93,60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e69,20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 698px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthnic group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003eCaucasian\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e56,40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e73,30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0,491\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003eNorth Africa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e12,80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e67,60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003eBlack Africa\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e6,40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e64,40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003eMiddle East\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e6,40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e58,90%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003eLatin American\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e1,30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e86,70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003eUnknown\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e16,70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e58,30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 698px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment status\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003ePaid employment\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e51,30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e72,90%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"7\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0,261\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e3,80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e66,70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003eDisabled \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e11,50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e65%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003eUnemployed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e14,10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e50,60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003eHomemaker\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e68,50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003eRetired\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e6,40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e80,60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 190px;\"\u003e\n \u003cp\u003eOther\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e3,80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e78,30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e. Patients\u0026rsquo; comorbidity (chi-square \u0026chi;\u0026sup2; and indipendent t-test).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"698\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 187px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePopulation n=78\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAverage of global satisfaction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eS\u003csub\u003eglobal\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"45\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd height=\"45\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 533px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 187px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e34\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e43,60%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e72,20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0,344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 187px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e56,40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e66,40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 533px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTobacco\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 187px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e20,50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e50,90%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0,002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 187px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e79,50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e73,60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 533px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsychiatric history or drugs\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 187px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e42,30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e60,50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0,015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 187px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e57,70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e75,20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 533px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevious aesthetic surgeries\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 187px;\"\u003e\n \u003cp\u003e\u0026lt; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e83,30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e71,40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0,071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 187px;\"\u003e\n \u003cp\u003e\u0026gt; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e16,70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e56,80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e. Satisfaction rates according to the type of intervention).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"524\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 412px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of intervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAverage of global satisfaction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"45\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd height=\"45\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 412px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAugmentation/Reductive mammaplasty\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e77%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 412px;\"\u003e\n \u003cp\u003eOthers (otoplasty, blepharoplasty, gynecomastia)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e76%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 412px;\"\u003e\n \u003cp\u003eAbdominoplasty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e72%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 412px;\"\u003e\n \u003cp\u003eLiposuction/liposculture\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e58%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 412px;\"\u003e\n \u003cp\u003eRhinoplasty\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e51%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e. Satisfaction items ranked in descending order of average satisfaction.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"698\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 283px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 344px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eAverage satisfaction per item\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e%\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-value - S\u003csub\u003eglobal\u003c/sub\u003e\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eR\u003csup\u003e2\u003c/sup\u003e-linear\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd height=\"45\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd height=\"45\" style=\"width: 0px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eQuality of contact with the surgeon\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e85%\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026lt; 0,001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cem\u003e0,36\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eQuality of information received by the patient\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cem\u003e79%\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lt; 0,001\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cem\u003e0,304\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eManagement and evolution of post-operative pain and sensitivity\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cem\u003e74%\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lt; 0,001\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cem\u003e0,555\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eQuality of the post-operative result\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cem\u003e70%\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lt; 0,001\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cem\u003e0,892\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eManagement and evolution of scars\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cem\u003e68%\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lt; 0,001\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cem\u003e0,642\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eImprovement in sex life\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cem\u003e57%\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lt; 0,001\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cem\u003e0,606\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cem\u003eREMINDER S\u003csub\u003eglobal\u003c/sub\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cem\u003e69%\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-plastic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejps","sideBox":"Learn more about [European Journal of Plastic Surgery](https://link.springer.com/journal/238)","snPcode":"238","submissionUrl":"https://submission.nature.com/new-submission/238/3","title":"European Journal of Plastic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"aesthetic surgery, cosmetic surgery, patient satisfaction, perception, surveys and ques-tionnaires, prospective studies","lastPublishedDoi":"10.21203/rs.3.rs-7340124/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7340124/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Postoperative satisfaction in aesthetic surgery can be assessed using validated outcome measures such as the BREAST-Q, BODY-Q, and FACE-Q. While these instruments are widely utilized, the determinants underlying satisfaction scores remain insufficiently explored in the literature. The present study aims to identify and characterize the variables that influence patient satisfaction following aesthetic surgical procedures.\u003c/p\u003e\n\u003cp\u003eMethods: We conducted a prospective, non-interventional, multicenter study involving 162 patients over a six-month period. A custom-designed questionnaire was administered, and clinical as well as demographic data were collected for each participant. Demographic, preoperative, and postoperative variables were analyzed for their association with overall satisfaction rates using appropriate statistical methods.\u003c/p\u003e\n\u003cp\u003eResults: Based on our inclusion criteria, we selected 78 patients who underwent aesthetic surgery procedures: 27 breast surgery, 25 abdominoplasty, 13 liposuction, 10 rhinoplasty and 3 other aesthetic interventions. The overall average satisfaction rate was 69%. \u0026nbsp;Among the demographic variables, two showed a statistically significant association (p \u0026lt; 0.05): history of psychiatric disorders and smoking status. No significant correlation was observed for age, gender, ethnicity, employment status, alcohol consumption, or history of cosmetic surgery. Regarding preoperative factors, three variables were highly significant (p \u0026lt; 0.001): quality of contact with the surgeon, quality of given information, and psychological malaise related to physical appearance and low self-esteem. Postoperatively, three factors were also highly significant (p \u0026lt; 0.001): sensibility evolution, scar management, and improvement in sexual life.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusions: Our results suggest that understanding patient satisfaction in aesthetic surgery is a multifactorial topic in which several variables play a specific role. Their evaluation could be the key to achieve better results in terms of patient satisfaction.\u003c/p\u003e","manuscriptTitle":"Factors associated with patient satisfaction following aesthetic surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-01 09:10:28","doi":"10.21203/rs.3.rs-7340124/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-23T22:30:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-23T17:59:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"169017074429273786991852274180720980521","date":"2025-08-20T03:01:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-20T00:29:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-19T03:15:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-19T03:15:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Journal of Plastic Surgery","date":"2025-08-10T16:46:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-plastic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejps","sideBox":"Learn more about [European Journal of Plastic Surgery](https://link.springer.com/journal/238)","snPcode":"238","submissionUrl":"https://submission.nature.com/new-submission/238/3","title":"European Journal of Plastic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"946240d3-f145-4b3a-864b-6fd1c6a9a0e0","owner":[],"postedDate":"September 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-03T15:59:10+00:00","versionOfRecord":{"articleIdentity":"rs-7340124","link":"https://doi.org/10.1007/s00238-025-02346-x","journal":{"identity":"european-journal-of-plastic-surgery","isVorOnly":false,"title":"European Journal of Plastic Surgery"},"publishedOn":"2025-10-27 15:56:50","publishedOnDateReadable":"October 27th, 2025"},"versionCreatedAt":"2025-09-01 09:10:28","video":"","vorDoi":"10.1007/s00238-025-02346-x","vorDoiUrl":"https://doi.org/10.1007/s00238-025-02346-x","workflowStages":[]},"version":"v1","identity":"rs-7340124","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7340124","identity":"rs-7340124","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}