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Long-Term Psychological Functioning of Adults with Severe Congenital Facial Disfigurement

Versnel, Sarah L. M.D.; Plomp, Raul G. M.D.; Passchier, Jan Ph.D.; Duivenvoorden, Hugo J. Ph.D.; Mathijssen, Irene M. J. M.D., Ph.D.

Plastic and Reconstructive Surgery: January 2012 - Volume 129 - Issue 1 - p 110–117
doi: 10.1097/PRS.0b013e3182361f64
Reconstructive: Head and Neck: Original Articles
Press Release

Background: In adults with severe congenital facial disfigurement, assessment of long-term psychological impact remains limited. This study determines the long-term psychological functioning in these patients and evaluates differences compared with patients with acquired facial disfigurement and a non–facially disfigured reference group. Also explored is the extent to which psychological functioning of the congenital group is related to satisfaction with facial appearance, fear of negative appearance evaluation by others, self-esteem, and severity of the facial deformity.

Methods: Fifty-nine adults with severe congenital facial disfigurement, 59 adults with a traumatically acquired facial deformity in adulthood, and 120 non–facially disfigured adults completed standardized psychological, physical, and demographic questionnaires, including the Fear of Negative Appearance Evaluation Scale, the Rosenberg Self-Esteem Scale, the Hospital Anxiety and Depression Scale, the Achenbach Adult Self-Report, the 36-Item Short-Form Health Survey, and a visual analogue scale.

Results: Adults with severe congenital facial disfigurement had relatively normal psychological functioning but appeared more prone to internalizing problems than the non–facially disfigured adults. Compared with patients with an acquired facial deformity, the congenital group displayed fewer problems on the physical component score of quality of life only. Satisfaction with facial appearance, fear of negative appearance evaluation, and self-esteem were good predictors of the different aspects of psychological functioning, with the exception of the physical component score of quality of life.

Conclusions: Improving satisfaction with facial appearance (by surgery), enhancing self-esteem, or lowering fear of negative appearance evaluation (by psychological support) may enhance long-term psychological functioning. Future research should focus on the individual patient and risk factors for maladjustment.


Rotterdam and Amsterdam, The Netherlands

From the Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center; Department of Medical Psychology and Psychotherapy, Erasmus University Medical Center, Netherlands Institute for Health Sciences; and the Department of Psychology and Education, VU University.

Received for publication October 4, 2010; accepted July 20, 2011.

Disclosure: The authors have no potential conflicts of interest to declare.

Sarah L. Versnel, M.D.; Department of Plastic and Reconstructive Surgery, Erasmus Medical Center, Room Ee 15.91, Postbox 2040, 3000 CA Rotterdam, The Netherlands,

©2012American Society of Plastic Surgeons