Psychiatric evaluation of patients seeking rhinoplasty.

The number of people requesting cosmetic surgery has been increasing. Both objective and subjective motivational factors are involved. Since the face is the most important physical representative of our emotions and the nose isthe most prominent part of the face, not infrequently subconscious and unconscious personality factors are equated with some real or imaginary anatomical defect of the nose or face. Most commonly inadequacy feelings are involved in individuals with predominantly subjective complaints and are often intimately involved in the indivudual's sexuality and "identity." The nose may become a scapegoat for these confused feelings. Three categories of patients whose emotional state and personality should be recognized are: the hysterical personality, the depressed menopausal female, and the paranoid personality. Motivational patterns may be divided into two groups: (1) external motivations (including the need to please others), career or social ambitions, and the need to avoid cultural conflicts (e.g. avoidance of alien stereotype) and (2) internal motivation, including paranoid ideation, long standing feelings of deficiency in one's physical appearance, general inadequacy or low self-esteem in one's worth or ability, resentment of aging, or actual lack of a special identity due to conflicting parental identification. In selecting a patient for thinoplasty, an evaluation of medical, sociocultural, psychological, and environmental factors should be considered.