Surgery is a stressful event, with the potential for profound disturba
nce to the patient's psychological and physiologic homeostasis. Cosmet
ic surgery is a particularly in tense psychological experience because
, in addition to the usual concerns about surgical side effects, cosme
tic patients bring their hopes and expectations for improved self-imag
e, putting them at risk for the added anxiety of disappointment. High
levels of anxiety coupled with the perception of vulnerability or thre
at to self can cause significant psychological reactions complicating
care for the plastic surgical patient. This paper outlines the diagnos
tic features of the common types of anxiety, disorders seen in plastic
surgical patients, and it offers treatment strategies for the practit
ioner, delineating when referral to a mental health expert is advised.
Specific clinical case studies of panic attack, posttraumatic stress
disorder, and acute stress disorder are presented to illustrate the va
riety of abnormal anxiety responses that may be encountered in the per
ioperative setting. Interventions for the anxious patient are part sci
ence and part art. Careful questioning and psychosocial assessment can
identify those patients who are at greater risk for psychological pro
blems after surgery. However, some patients may mask or keep secret th
eir concerns, which can be manifested with resulting anger and hostili
ty. Plastic surgeons must use appropriate indicators of psychological
anxiety and measure a specific patient's reactions to surgery to make
the diagnosis of abnormal anxiety. Close follow-up by the plastic surg
ical team is an essential part of the anxiety disorder patient's psych
ological treatment, but it is imperative that these problematic patien
ts be referred promptly to a qualified mental health professional to l
imit their adverse experience and promote their well-being Patients wh
o are less anxious during the perioperative period report less emotion
al distress and fewer defensive behaviors and are likely to be more sa
tisfied with the outcome of their surgery.