Background. Most studies examining psychosocial changes after cosmetic surgery have short follow-up periods and provide therefore limited information about long-term effects of such surgery. Moreover, we lack studies identifying whether pre-existing patient characteristics are associated with poor psychosocial outcomes after cosmetic surgery. The current study provides information about both these issues.

Methods. Questionnaire data from 130 female Norwegian cosmetic surgery patients were obtained prior to and five years after surgery. The questionnaire consisted of measures on appearance satisfaction, self-esteem, psychological problems, and patients' evaluation of the outcome of surgery. Data from a representative sample of 838 Norwegian women, aged 22 to 55, were used for comparison purposes.

Results. Analyses revealed an improvement in both general appearance satisfaction and satisfaction with the body part operated on five years after surgery. A small increase in self-esteem was observed as well. High rates of pre-operative psychological problems and low self-esteem were related to more negative changes in some of the psychosocial measures after surgery compared to patients with better psychological health. Furthermore, factors associated with the actual decision to undergo surgery were related to changes in psychological health and patients' evaluation of the outcome of surgery.

Conclusions. The study indicates that cosmetic surgery has positive long-term effects on appearance-related variables. Surgeons should however be particularly aware of patients with psychological problems as this may compromise their satisfaction with the effects of cosmetic surgery. Factors affecting the decision itself to undergo cosmetic surgery may as well be relevant for subsequent psychosocial outcomes.