Planning a face lift? Why asking about your mental health doesn’t always hit the mark

If you walk into a cosmetic surgeon’s office, you probably wouldn’t expect to be asked about your recent break-up or how you cope with stress.

But in Australia, that has been standard practice for nearly three years.

That’s after the Australian Health Practitioner Regulation Agency introduced mandatory mental health screening before cosmetic procedures. This includes cosmetic surgery, like a facelift, and non-surgical procedures including cosmetic injections and laser treatments.

This decision was part of a series of reforms designed to help keep patients safe. But it has also made the Australian cosmetic industry one of the most tightly regulated in the world.

So how effective have these reforms been, almost three years on? And are patients any better off?

Cosmetic medicine is booming in Australia

Each year, Australians spend more than A$1 billion on more than 500,000 cosmetic procedures. That means we spend more money on cosmetic medicine per capita than the United States.

In 2023, more than a third of Australians were considering having cosmetic surgery in the next decade. Interest is particularly strong among young women, with 54% of young Australian women considering cosmetic surgery at some point in their lives. Most people seeking surgery hope these elective procedures will improve their appearance or self-esteem.

After having cosmetic surgery, about 80–90% of patients are satisfied with the results. Many also report feeling better about their appearance up to five years after the procedure. Some studies also show cosmetic surgery improves patients’ mood and quality of life.

However, some patients may regret a cosmetic procedure or feel worse afterwards. This is why identifying vulnerable patients, especially those considering irreversible procedures, is crucial.

So, what’s the link between cosmetic surgery and mental health?

Research shows examining patients’ mental health before any cosmetic procedure affects how they feel after an operation. People with heightened symptoms of psychological distress, such as anxiety and depression, are more likely to be dissatisfied with the results of a cosmetic procedure. They are also more likely to find their recovery challenging and even experience more physical complications after surgery.

Certain psychological conditions have a greater impact on patients’ mental health after surgery. One example is body dysmorphic disorder, where people often obsess over perceived flaws in their appearance. These so-called flaws can be subtle or not apparent to others. As a result, these patients may look to cosmetic surgery as a way to fix their perceived flaws.

A 2022 review of related studies found up to 20% of patients requesting cosmetic procedures had body dysmorphic disorder. And our 2025 study shows about 12% of Australian cosmetic patients either have unrealistic expectations of cosmetic surgery or show symptoms of body dysmorphic disorder or psychological distress.

Many patients with body dysmorphic disorder still feel dissatisfied with their appearance after cosmetic treatment. This is because they often focus on the same perceived flaw or a completely different one. This can negatively impact their mental health and, in some cases, may lead patients to take legal action against surgeons for not delivering the desired result.

The reason for screening

Nearly three years ago, the Australian Health Practitioner Regulation Agency changed its guidelines about cosmetic procedures.

As a result, doctors who perform cosmetic procedures must screen patients for psychological conditions, such as body dysmorphic disorder. They can do this by conducting interviews or using tools such as a written questionnaire.

If doctors identify any concerns, they must refer patients to a psychologist, psychiatrist or GP before proceeding with treatment.

However, a recent national survey suggests the cosmetic industry is not embracing these reforms. This research shows 84% of plastic surgeons referred fewer than 5% of patients. This is far less than our research would indicate have body dysmorphic disorder. About 70% of plastic surgeons interviewed say they would not continue screening if it were not mandatory.

Some surgeons have made their concerns public. In 2024, one group of surgeons even took the Australian Health Practitioner Regulation Agency to court. They sought to overturn the new guidelines or establish other protections for patients.

From a patient’s perspective, mandatory screening may mean they can’t undergo cosmetic surgery. In our 2025 study involving more than 8,000 Australian cosmetic patients, we found people were much more hesitant to report mental health symptoms in a cosmetic clinic, compared to when completing the same questionnaire anonymously for research. This is likely because they felt they needed to “pass” psychological screening tests to receive cosmetic surgery. So, the self-reporting element of current questionnaires is a major limitation.

So, is psychological screening necessary?

The purpose of screening was never to exclude people from cosmetic treatment. Rather, it was designed to help practitioners and patients make informed decisions.

Almost half of people considering cosmetic procedures report mental health concerns. For most, this does not make them unsuitable candidates. But in certain cases, they may benefit from delaying a cosmetic procedure. This would give them time to seek additional psychological support or talk to a practitioner about what they should expect from cosmetic surgery.

Importantly, screening tools should not be used alone. Instead, they should be part of a broader assessment of a patient’s motivations, goals and overall wellbeing. This includes a discussion of how cosmetic surgery may positively or negatively affect their mental health.

But researchers, like ourselves, are working on new screening questionnaires to help surgeons more accurately assess a patient’s mindset and identify any psychological concerns before they have a cosmetic procedure. But we need more research to know if these will improve outcomes for patients and practitioners.

Yes, talking about your mental health with a cosmetic surgeon may feel uncomfortable. But it helps ensure any decision to change how you look comes from a place of stability, not distress.