People with congenital facial disfigurement have 'relatively normal' psychological functioning

People born with severe facial disfigurement have generally good psychological adjustment in adulthood, according to a study in the January issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

"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," concludes the new study led by Dr Sarah L. Versnel of Erasmus University Medical Center, Rotterdam, Netherlands.

'Relatively Normal' Adjustment in Adults with Congenital Facial Disfigurement
The researchers administered a standard set of psychological, physical and demographic questionnaires to 59 adults with severe congenital facial disfigurement caused by rare, extensive facial cleft syndromes. At the time they completed the questionnaires, the participants' average age was 34.

For comparison, the same questionnaires were given to 59 adults with facial disfigurement caused by trauma and 120 adults with no disfigurement. Long-term psychological functioning was compared between groups, along with factors affecting adjustment.

The results show "relatively normal" psychological functioning in the adults with congenital facial disfigurement. They tend to have a higher rate of internalizing problems—such as anxiety and depression—compared to people with no facial disfigurement.

However, adults with congenital facial disfigurement were no more likely to have a clinical level of depression or anxiety. They had lower rates of physical problems than the comparison group with facial disfigurement caused by trauma. The group with traumatic disfigurement also had no increase in clinical depression or anxiety.

Assessed objectively by doctors, the severity of congenital facial deformities was unrelated to psychological functioning. However, patients who were less satisfied with their facial appearance tended to have more problems with psychological adjustment. Among participants with congenital disfigurement, problems with psychological functioning were also more common in people with low self-esteem and those who were concerned about how others would judge their appearance.

Historically, few studies have examined long-term psychological adjustment among people born with severe facial disfigurement. The new results suggest that, among adults with severe facial cleft syndromes, psychological function is relatively similar to that of people without facial deformities.

Psychological adjustment doesn't seem to be affected by the severity of the facial disfigurement, but rather by the person's perceptions and feelings about his or her appearance. That's an important consideration for plastic and reconstructive surgeons operating on patients with congenital facial disfigurement, Dr. Versnel and coauthors believe: "During treatment, patients' realistic wishes and expectations regarding their facial appearance should be taken into account."

Counseling to help improve low self-esteem, when present, may also have beneficial effects. "Psychological support…should be focused on training patients to rely less on the opinions of others," the researchers suggest.