What is a realistic expectation?

The "realistic expectation" referred to in a candidacy assessment for an aesthetic procedure means considering the change wanted together with the result the procedure can provide.¹ This article separates the change expected in appearance from the change expected in life; it explains how research results should not be converted into a personal expectation, and how expectation is handled in an assessment.

What does a realistic expectation mean?

The NHS advises being clear, before a decision, about what is to change and why, and having explained how the procedure may affect the person.¹ Within that frame the word "realistic" describes not merely wanting a change but making clear which outcome that wish is directed at.¹ Changing the appearance of an area and expecting life as a whole to improve because of that change are not the same aim.¹

Research likewise does not treat expectation as a single positive or negative thought; in the study by Klassen and colleagues, expectations about how appearance and quality of life might change were assessed with scales separate from those for appearance-related psychosocial distress.² It therefore does not follow, from the mere fact that you want a change, how realistic that wish is or how much it affects you; in the study these are separate areas of assessment.²

The aim here is not to remove hope of a favourable result. There is research reporting that satisfaction with appearance increases; but the change those studies measure cannot be equated with all the changes a person expects in their life.³ Making an expectation concrete helps to keep clear which outcome is being spoken of; it cannot be presented on its own as a formula that determines how the result will turn out.⁴

Is a change in appearance the same as a change in life?

Appearance is one part of how a person feels about themselves; the NHS states that an aesthetic procedure should not be expected to solve every problem relating to relationships, social life or work.¹ Thinking separately about the change you want in your own appearance and the expectation that others will treat you differently is the concrete form of that distinction.¹

This does not mean that a change in appearance can provide no psychological benefit; in the review by Garbett and colleagues, short-term favourable findings were reported for self-esteem, sexual wellbeing and physical wellbeing alongside satisfaction with a particular body area.³ In the same review, the evidence for general mental health, overall body image, quality of life and social functioning is limited and not conclusive.³

Pay attention to the wording when reading these results. That an assessment of one area and general quality of life are separate outcomes in the review shows that an improvement reported in the first does not also prove the second.³ Preserving the scope of a favourable finding is not belittling it; it is stating which change was actually measured.

A person's psychological state before the procedure has also been examined in outcome research; von Soest and colleagues found that higher rates of preoperative psychological problems and low self-esteem were related to more negative change on some psychosocial measures.⁵ This does not support the assumption that the same change in appearance will mean the same thing in everyone's life.⁵

What do the satisfaction studies show?

In the study by von Soest and colleagues, 130 Norwegian women were assessed before and 5 years after aesthetic surgery.⁵ An increase was reported in satisfaction both with general appearance and with the body part operated on, and a small increase in self-esteem.⁵ Data from 838 Norwegian women aged 22 to 55 were used for comparison; these people are a separate sample from the 130 in the surgical group.⁵

The favourable finding in this research concerns the assessment of appearance after surgery; 5 years is a follow-up period, not a guarantee of persistence given to an individual.⁵ The sample, made up of women from one country, is also a limit on the finding; the result should not be read as everyone experiencing change to the same degree.⁵

Carrying out a broader assessment, Garbett and colleagues reviewed 17 controlled prospective studies.³ Marked differences between the studies' designs, comparison groups, measurement instruments and analyses were reported, and the overall quality of the research was found wanting.³ It is stated that few studies had follow-up extending beyond 6 months.³

For that reason, when reading a piece of research reporting a favourable result alongside a review saying the broader evidence is limited, separate which question each is answering. One examines the change in an assessment of appearance over 5 years, the other the whole of the available studies for different psychosocial outcomes.^3,5 Describing a measured benefit and stating the limits of the research are both parts of the same information.

Does the result of a study show your result?

In expectation research, a characteristic measured before a procedure and an outcome measured afterwards are not the same thing; the scale study by Klassen and colleagues assessed the expectations and the appearance-related distress of people seeking treatment.² A relationship between these two areas was reported in the study, and it was stated that validity in predicting outcomes could be examined in future research.² That an expectation scale has been developed does not mean it definitively determines a person's state after surgery.²

In the same study, moreover, lower scores for satisfaction with appearance in the group seeking facial aesthetic treatment were correlated with higher expectation-scale and psychosocial-distress scores; on the expectation scale, a higher score indicates more inappropriate expectations.² That finding is not a failure rate belonging to the period after a procedure; the assessment concerns the current state of people seeking treatment.² When the timing of the research changes, so does the question the figure or the relationship answers.

The instruments in that study are self-report scales; the person reports their own expectation and appearance-related distress through their own answers.² A score therefore takes its meaning both from which questions were asked and from which area the answer represents; an expectation score cannot be used in place of a value measuring the size of a physical change.² The scales being built separately also preserves that difference.²

In reading a sentence about a result, do not focus only on the words "increased" or "decreased". Who was assessed, which feature was measured and when the assessment was made have to be read together. The differences in the measurement instruments and control groups used in the Garbett review, for example, limit treating the studies as a single result.³

None of the research in this article is presented as a calculation of a result belonging to you. When a study's follow-up period, the make-up of its group or the scale it used is explained, the frame within which that information holds also becomes visible. A figure looking very precise does not change the research question or the group examined.

How is expectation handled in an assessment?

The NHS advises that, before a procedure, a person discuss with the practitioner why they want it and what they expect.⁶ The subject of that discussion is not only the name of the procedure; the change wanted and the meaning attached to that change are also within this frame.¹ What matters here is keeping the intended aim clear, rather than working through a list of questions.

The NHS also states that time to think should be given after the consultation, and that a person does not have to continue if they do not feel completely comfortable.⁶ That a consultation has taken place does not mean you have to decide in favour of the procedure.⁶ The advice about time here is not conveyed as a fixed number of days or a legal period in Türkiye. The NHS recommendation is directed at deciding whether or not to proceed after thinking over the information gained in the consultation; it supports not feeling obliged to make a choice immediately at the end of it.⁶

A particular example of appearance-related psychological distress being assessed separately from physical change is body dysmorphic disorder; the review by Bowyer and colleagues examined the outcomes of cosmetic interventions in people with this diagnosis.⁷ Evidence reporting poor outcomes for the majority stands out in the review, while it cannot be ruled out that some people with mild body dysmorphic disorder and appearance concerns limited to a particular area may benefit.⁷ The scarcity of prospective studies is also noted.⁷

This finding should not be read as a psychological diagnosis to be applied to everyone who wants to change their appearance; the group the review examined already had body dysmorphic disorder.⁷ The review also states that longitudinal research with better-characterised patient populations is needed on outcomes in this group; the available findings should not be turned into a firm rule explaining every person in the same way.⁷ No diagnosis, screening or criterion of suitability for surgery is given here. The aim is not to confuse the expectation of a physical change with the expectation that appearance-related distress will be relieved.⁷

What does it mean if the result differs from what was expected?

The NHS states that aesthetic procedures carry risks and that a result differing from what was expected can affect mental health.⁶ That the source notes this effect alongside physical complications shows that the impact of not reaching an expected result should not be limited to physical problems alone.⁶

In the study by Avcu and Metin, carried out at a single centre in 183 people undergoing primary open septorhinoplasty, a strong positive relationship was reported between expectations being met and patient satisfaction.⁴ In the same study, the preoperative expectation of the groups not satisfied with the result was found to be higher; the highest level of expectation was reported in the group operated on for cosmetic reasons who were not satisfied with the result.⁴

Taken together, these findings show that the research addressed both the initial expectation and whether that expectation was met.⁴ However, finding higher initial expectations in the groups dissatisfied with the result does not prove that reducing expectations would improve the outcome.⁴ The findings are limited to one procedure and one centre.⁴

The relationship in the study cannot therefore be made the basis for automatically telling someone dissatisfied with their result that they "expected too much"; the measured relationship does not on its own determine the cause of an individual result.⁴ In assessing a result, keeping separate which physical change was expected and what that change was hoped to provide in life is also consistent with the NHS framework for the period before a procedure.¹ Explaining an expectation clearly is part of the consultation the NHS recommends; its purpose is to make the reason for wanting the procedure, and the change expected, understandable before a decision.⁶

References

1. NHS. Is a cosmetic procedure right for me? Page last reviewed 9 May 2023. nhs.uk ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸

2. Klassen AF, Cano SJ, Alderman A, et al. Self-Report Scales to Measure Expectations and Appearance-Related Psychosocial Distress in Patients Seeking Cosmetic Treatments. Aesthet Surg J. 2016;36(9):1068-1078. doi:10.1093/asj/sjw078 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰

3. Garbett KM, Paraskeva N, White P, et al. The psychosocial outcomes following cosmetic surgery are largely unknown: A systematic review. J Plast Reconstr Aesthet Surg. 2025;104:282-297. doi:10.1016/j.bjps.2025.03.013 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹

4. Avcu M, Metin M. Evaluation of the relationship between patient expectation, patient expectation coverage rates and patient satisfaction in open primary septorhinoplasty surgery: a prospective randomized study. Eur Arch Otorhinolaryngol. 2021;278(7):2337-2346. doi:10.1007/s00405-020-06502-w ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷

5. von Soest T, Kvalem IL, Skolleborg KC, Roald HE. Psychosocial changes after cosmetic surgery: a 5-year follow-up study. Plast Reconstr Surg. 2011;128(3):765-772. doi:10.1097/PRS.0b013e31822213f0 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸

6. NHS. Before you have a cosmetic procedure. Page last reviewed 22 May 2023. nhs.uk ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷

7. Bowyer L, Krebs G, Mataix-Cols D, Veale D, Monzani B. A critical review of cosmetic treatment outcomes in body dysmorphic disorder. Body Image. 2016;19:1-8. doi:10.1016/j.bodyim.2016.07.001 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶