Adams, Naomi Joy; (1997) Long-term psychological outcome of facial reconstructive surgery. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

This paper presents a study which examines the long term psychological adjustment of maxillofacial patients following surgery. Hypotheses, generated from previous research, were tested and new hypotheses generated through the development of a new theory. This was attempted using two research methods: a) quantitative and b) qualitative. a) 32 participants, aged 16 to 33, with the congenital conditions of hemifacial microsomia and Treacher Collins were assessed from between 0.2 to 13 years post- operatively, on measures of self-esteem, body satisfaction and general psychological well-being. Participants were found to have significantly poorer mean psychological adjustment than the normal population on each of these three measures. However, adjustment was significantly better than that displayed by clinical populations, indicating that the maxillofacial population has low grade chronic difficulties. Psychological adjustment was not predicted by any of the following factors; age now, age at surgery; time since surgery, number of operations; sex, appearance before surgery, appearance after surgery; change in appearance following surgery. This study also found no evidence for any change in attractiveness following surgery, as assessed by independent observers. b) 14 participants were also asked to take part in a telephone interview to gather simple qualitative information about their views of their surgical decision, expectations of surgery, surgical outcome and psychological support. 64% felt their expectations had been met with respect to changes in appearance, 79% stated they would repeat the procedure but 93% said they would have found psychological input helpful. 6 participants were interviewed face-to-face to generate qualitative data for a Grounded Theory analysis. The resulting theory describes a process of personal evaluation, dependent on themes of identity, awareness and management strategies. The findings are discussed in relation to previous literature, clinical implications and future research questions.

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