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FGCS procedures also found that, for those who had received either labiaplasty or clitoral hood reduction, 97 per cent reported “overall satisfaction”. This figure dropped slightly to 83 per cent for those who had vaginoplasty or perineoplasty.43 A Chilean study investigating the results of using lasers for labiaplasty also examined recipient satisfaction in 55 cases: 91 per cent of participants were very satisfied with aesthetic outcomes (9% were satisfied); and 100 per cent were very satisfied with functional outcomes.44 The contrasting issue of regret was explored by a UK study of 49 recipients of labiaplasty. This study found very low levels of regret: only one participant regretted her decision to have the procedure.45 41 Alter GJ (2008) Aesthetic labia minora and clitoral hood reduction using extended central wedge resection Plastic and Reconstructive Surgery 122(6): 1780-9. 42 Cihantimur B, and Herold C (2013) Genital beautification: a concept that offers more than reduction of the labia minora Aesthetic Plastic Surgery 37(6): 1128-33. 43 Goodman MP, Placik OJ, Benson III RH et al. (2010) A large multicenter outcome study of female genital plastic surgery The Journal of Sexual Medicine 7(4): 1565-77. 44 Pardo J, Solà V, Ricci P, and Guilloff E (2006) Laser labioplasty of labia minora International Journal of Gynecology & Obstetrics 93(1): 38-43. 45 Veale D, Naismith I, Eshkevari E et al. (2014) Psychosexual outcome after labiaplasty: a prospective case-comparison study International Urogynecology Journal 25(6): 831-9. 11 Psychological and social explanations of satisfaction Section summary Several sub-categories of psychological and social explanations of satisfaction with cosmetic procedures are identified. Improvements to self-confidence / self-esteem are noted frequently. Although sample sizes for many of these studies are small, and also address self-esteem in response to different ‘types’ of cosmetic procedure, most conclude similarly that these improvements indicate satisfaction with the outcome. Other studies conclude that a significant number of research participants feel more attractive and have improved body image as a result of their procedure, and that high levels of satisfaction are recorded for research participants who indicate pleasing aesthetic outcomes or positive changes to their appearance. More broadly, although the literature overall concludes that recipients who take part in research indicate “improvements to mental health”, measures of such improvements vary, which necessitates conclusions to be drawn conservatively. Improvements to quality of life (including health-related QOL) are noted for participants who have received a variety of procedures, but particularly strong indications are observed for recipients of breast procedures (particularly breast reduction). Changes in others’ perceptions are also indicated as a contributor to positive responses. These perceptions include receiving positive comments from people, and feeling less self-conscious / embarrassed in front of others (noted, for example, by studies which include breast reduction recipients). Limited qualitative evidence is also identified, which suggests that research participants may be satisfied with their procedure because it has enabled them to regain a ‘past self’ or to feel like a different person. Improved self-confidence / self-esteem “My self-esteem raised, I got to be a lot more comfortable with my body… I had big ones, they were too cumbersome, I, you know, got little ones, and now I’m perfectly fine.” 46 “Being inside a body that is a gelatinous prison kills a tiny piece of you every moment of your life… When I woke up after the surgery and looked down, I felt strong and confident as a man should. I could never, ever in my life, speak to anyone about how much 46 Adams J (2010) Motivational narratives and assessments of the body after cosmetic surgery Qualitative Health Research 20(6): 755-67. 12 being heavy hurt me emotionally, and now I don’t have to… Surgery is the best psychotherapy offered on the market.” 47 “It’s [surgery] done wonders with my sort of general confidence in myself, my self-esteem, it’s this self-esteem bit, this self-image thing, it’s actually done a lot for that.” 48 “At work, the collateral effect of self-confidence from surgery was tremendous. Got a great job soon thereafter.” 49 A relatively large number of studies identify improvements to self-esteem or selfconfidence as contributors to high levels of satisfaction among individuals who have received cosmetic procedures. Again, the literature can be sub-divided according to the cosmetic procedure each study focuses on. Although each of these sub-categories contain relatively few studies on self-esteem, its role in eliciting positive responses from study participants on the outcomes of their procedures arises frequently and strongly across the literature. Unspecified / various cosmetic procedures A small number of studies which do not specify the type of procedure their (small-sized) samples have undergone highlight the role of self-esteem as an indicator of satisfaction with results. Of studies identified, small increases in self-esteem were observed: for example, in a Norwegian study of 130 women who had undergone various cosmetic procedures mean self-esteem scores increased by a small amount five years after surgery,
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