Jeffrey E. Cassisi

Aesthetic Medicine is advanced as an integrated, evidence-based framework for patient-centered care that unites physical, psychological, social, and aesthetic dimensions of health. Drawing on Clinical Health Psychology, the paper introduces Aesthetic Health Psychology as a specialization that embeds psychological theory, assessment, and intervention within aesthetic medicine and surgery, emphasizing interdisciplinary collaboration rather than professional mistrust. The paper argues that integrating Aesthetic Health Psychology into aesthetic medicine can enhance ethical practice, improve patient-reported outcomes, and support equity-focused implementation across diverse procedures and settings. It further suggests a practical framework for implementation. Three interrelated models are proposed: the Aesthetic Biopsychosocial Model, which conceptualizes aesthetics as a distinct health domain alongside biological, psychological, and social factors; the Aesthetic Health Care Process Model, which structures care as a five-stage journey supported by systematic screening for body dysmorphic disorder and the routine use of patient-reported outcome measures; and the Aesthetic Health Systems Model, which situates aesthetic care within institutional, policy, and cultural contexts. Idealized but clinically grounded vignettes from elective cosmetic, reconstructive, and gender-affirming settings illustrate how these models address non-linear trajectories of adaptation, evolving expectations, complications, and stigma. These concepts jointly define both the motivation for Aesthetic Health Psychology and its practical implications, from the use of brief, selective aesthetic screening during primary health care visits to the design of equity-focused implementation strategies across aesthetic procedures and settings.

Body image dissatisfaction, particularly related to breast appearance, plays an important role in cosmetic breast surgery (CBS) decisions and psychological wellbeing. However, existing measures are often lengthy, overlook healthy women considering CBS, and fail to adequately address the nipple–areola complex (NAC), a critical component of breast satisfaction. This study introduces the 12-item Breast Appearance Concerns Scale (BACS), a brief screening tool developed to address existing gaps and to document breast-specific body image concerns among women considering CBS. Data were collected from a diverse sample of 589 young adult women who completed the BACS along with measures of related constructs such as self-esteem and anxiety. Exploratory and confirmatory factor analyses supported a two-subscale structure: NAC Satisfaction and General Breast Satisfaction. The BACS total score demonstrated strong internal consistency (α = 0.785) and test–retest reliability (r = 0.741). Predictive validity analyses revealed that the General Breast Satisfaction subscale effectively distinguished women who had considered CBS from those who had not (classification accuracy = 72.1%). Receiver Operating Characteristic (ROC) analysis was conducted with the General Breast Satisfaction subscale to establish a preliminary cutoff score. This cutoff provides initial support for use of this subscale as a screening tool to help classify individuals based on their consideration of CBS. Although clinically important, the NAC subscale is still in an early stage of development and requires additional research before cutoff scores can be established to inform surgical decision-making and evaluate patient-reported satisfaction outcomes. Both subscales require further investigation in older populations and clinical settings to support their use as screening tools. These findings position the BACS as a promising screening tool for assessing breast-specific body image concerns, particularly general breast satisfaction, with potential applications in clinical, pre-surgical settings.

Background Studies indicate that physical appearance changes affect a significant proportion of breast cancer survivors, often leading to post-surgical distress. Both reconstructive surgery and medical tattoos are associated with patient-reported satisfaction, yet further research is necessary to understand their combined impact on aesthetic outcomes from the patient perspective. This study examined how breast cancer survivors evaluated the cosmetic and decision satisfaction of other patients who made various cosmetic intervention choices post-mastectomy. Methods Breast cancer survivor support networks (n = 180) across 20 states agreed to share information about the online survey to their members. Participants (n = 251) rated the cosmetic outcome and decision satisfaction of images depicting other patients who had received mastectomy with three types of intervention: reconstruction alone, medical tattooing alone (flat closure), and reconstruction and medical tattooing combined. Results A factorial MANOVA produced significant within-subjects effects indicating participants consistently rated images of patients with a combination of reconstruction and medical tattooing highest in cosmetic quality, lowest in scar visibility, and highest in treatment decision satisfaction. Conclusions The findings suggest that medical tattooing serves as a valuable complementary cosmetic intervention, with many survivors expressing interest and recognizing potential benefits once informed about the option. However, the study’s limitations, such as the need for a more diverse range of patient images for evaluation, should be acknowledged. Future research should address these gaps by incorporating photographs of patients across varying demographics, including age, body weight, disease severity, and surgical procedures, to minimize bias. Despite these limitations, this study highlights the significant role that medical tattooing can play in enhancing aesthetic outcomes after surgery, particularly from a patient-centered perspective. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://link.springer.com/journal/00266.

Purpose A review of the literature revealed a high incidence of body-image distress among breast cancer survivors who had surgery. This cross-sectional study examined the relationship between medical tattooing as a complementary cosmetic intervention and body-image distress and mental health outcomes among breast cancer survivors following surgery. Methods We examined 330 post-surgical breast cancer survivors collected through a nationwide online survey in the U.S., pursuing two main objectives. First, we investigated body-image distress, depression and anxiety symptoms, and perceived stress in survivors who underwent breast cancer surgery, comparing those with medical tattooing (n = 89) and those without (n = 226). Second, we assessed the influence of the participant’s surgery type on body-image distress, depression and anxiety symptoms, and perceived stress. Additionally, we evaluated whether individual factors, such as appearance investment, satisfaction with decision, and cosmetic expectation discrepancy, predicted the participant’s body-image distress. Results Findings suggest that participants with medical tattoos reported significantly lower body-image distress, depression and anxiety symptoms, and perceived stress compared to those without medical tattoos. The participant’s surgery type did not significantly predict body-image distress, depression or anxiety symptoms, or perceived stress. However, participants who reported greater appearance investment endorsed higher body-image distress. Participants who reported higher satisfaction with their treatment decisions and lower cosmetic expectation discrepancy endorsed lower body-image distress. Conclusion Medical tattooing may be a valuable tool in improving body-image distress and mental health for those who wish to pursue it, but more research is needed. Empirical studies supporting the mental health benefits of medical tattooing among survivors are crucial to standardize insurance coverage and promote its inclusion as a complementary intervention across insurance providers nationwide. This complementary intervention should be considered using a patient-centered approach that aligns with the patient’s values and preferences.

This study investigated attitudes that young adults have toward individuals with amputation of the upper limb (AUL). Previous studies have found that people tend to feel sympathy toward these individuals, but they are also perceived as less competent in various situations. However, it is unclear if these perceptions are influenced by factors such as the cause of amputation, the gender of the amputee, whether they use a prosthesis or not, or the type of prosthesis. The survey included 469 participants from a university in the Southeastern United States. Participants rated pictures of individuals with or without amputation, and with and without prostheses after reading a brief background scenario. Images were rated using a semantic differential for competence and warmth, and a scale of functional ability. Factorial analysis of variances produced significant main effects indicating individuals with AULs who used prostheses were rated with higher competence and ability than individuals with AULs who did not use prostheses. Females were rated with lower competence and ability, and higher warmth regardless of AULs status. Higher ability ratings were obtained for individuals with advanced technology prostheses as compared to body-powered prostheses. Our research shows that people generally hold positive attitudes toward individuals with AUL when they use prostheses. However, traditional stereotypes persist for those who do not. Negative biases toward women should be accounted for in disability stigma studies. The cause of amputation did not influence ratings. Prostheses that appear to be advanced technology positively influenced ratings of functional ability when compared to traditional body-powered types. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Background: Women experience more severe gastrointestinal (GI) symptoms compared to men. The onset of puberty and the menstrual cycle may influence these differences. Additionally, health anxiety is an important construct that has been shown to play a role in increased symptomatology across many medical conditions. Using standardized clinical measures often employed to assess disorders of gut-brain interaction (DGBI) we aimed to identify differences of GI functioning across menstrual cycle phases and to evaluate the role of health anxiety in this relationship. Methods: Six hundred three participants completed a survey including functional GI assessment scales (PROMIS-GI®), an abdominal pain scale and map, and a health anxiety measure. They were grouped by menstrual cycle phases (Menses, Follicular, Early-Luteal, and Premenstrual) based on self-reported start date of most recent period. Multivariate analyses of covariance were conducted to identify differences between menstrual cycle phase and scores on the symptom scales. Heath anxiety was included as a covariate in all analyses. Results: No significant differences were found between menstrual cycle group and PROMIS-GI scores. Higher GI-symptom and pain levels were found as health anxiety increased. Pain in the hypogastric region of the abdomen was significantly higher during the Menses phase when compared to Early-Luteal and Premenstrual phases. A subset of participants with DGBI diagnoses demonstrated significantly higher GI-symptom severity on several PROMIS-GI scales when compared to matched controls who did not have those diagnoses. In addition, participants with DGBI diagnoses reported significantly greater pain across multiple abdominal regions than their non-diagnosed counterparts. Conclusions: GI symptom levels as measured by the PROMIS-GI scales in otherwise healthy women were not dependent on menstrual cycle phase. Yet, the PROMIS-GI scales were sensitive to symptom differences in women with DGBI diagnoses. Overall, this study demonstrated that the PROMIS-GI measures are unlikely to be affected by gynecological functioning in healthy young women. We argue that the abdominal pain map is an essential addition to classification and diagnosis.

The gut–brain connection refers to communication between the brain and gastrointestinal (GI) system. Disorders of gut–brain interaction (DGBI) are characterized by GI symptoms that accompany distress and disability. Epidemiological research has suggested DGBI rates in emerging adults are increasing. This study investigated the relationship between GI health, distress, and disability in emerging adults across time. Emerging adults were recruited. A repeated‐measure design with a 1‐month time lag was used to collect data via an online survey ( N = 861) across five academic semesters (Spring 2019 to Summer 2020). Measurement equivalence across time was established and a cross‐lagged panel model (CLPM) was specified. Distress at Time 1 predicted GI symptoms at Time 2 ( β = .206, SE = .084, p < .05). GI symptoms at Time 1 predicted disability at Time 2 ( β = .117, SE = .039, p < .01). Higher disability at Time 1 predicted distress at Time 2 ( β = .092, SE = .027, p < .01). The cross‐lagged design offers stronger causal inferences than cross‐sectional studies used to study the effects of GI symptoms. Findings provide initial evidence of a directional pathway between brain and gut rather than a bidirectional network. Findings highlight the importance of psychogastroenterology.

Background: Medical tattooing is often applied in the context of plastic, aesthetic, and reconstructive surgery to help achieve the best cosmetic outcome. Objectives: This article reviews various conditions that medical tattooing has been empirically studied in terms of patient satisfaction outcomes, makes practice recommendations, and suggests future directions for research. Methods: This review was performed following the PRISMA guidelines. Studies were included if the tattooing application was associated with a medical condition and if outcome data were provided using at least a case series methodology. Where no cohort or clinical series exist, case examples are used from the literature and the author’s practice to illustrate emerging medical tattooing applications that need further evaluation. Results: Eighteen studies met the inclusion criteria and addressed the following conditions: baldness, vitiligo, scars from incisions, lacerations or burns, and nipple-areola complex reconstruction. Conclusions: The application of medical tattooing has shown high levels of patient satisfaction across conditions. The practice recommendation grade is “B” or recommend since the level of evidence for these interventions ranged from III to IV according to the American Society of Plastic Surgeons guidelines. This means clinicians can consider this treatment alternative, but they should be alert to new information and be sensitive to patient preferences. Recommendations are made for reporting future research including clearly describing procedural details, identifying the professional performing the procedure, increased use of standardized outcome measures, and that satisfaction ratings be assessed by someone independent of the health service provider. Further research using randomized controlled trial methodology with waitlist controls is needed. Level of Evidence: 4: