Does severity predict distress? The relationship between subjective and objective measures of appearance and psychological adjustment, during treatment for facial lipoatrophy.

The intuitive or lay belief that the severity of a disfiguring condition predicts psychological distress is not demonstrated in clinical practice, nor in research studies. This within group study used standardised measures repeated at six month intervals, to investigate the relationship between subjective and objective measures of appearance and psychological adjustment in 51 patients undergoing treatment for facial lipoatrophy using a synthetic filler, Newfill. Results demonstrate a dissociation between objective and subjective measures with only subjective assessment predicting psychological outcomes. It is recommended that Moss's (2005) hypothesis of discrete group membership (normal/not normal) should be adapted to include an internal standard for comparison, and that all evaluations of treatment modifying disfigurement should include a standardised subjective measure of appearance.