Psychometric Test for Cosmetic Surgery

Name

Age: 55 years

Procedures Select the procedures of interest.

Questions

1) What is your main reason for considering this procedure?

To improve my physical appearance

To feel more confident about myself

Because someone suggested it or encouraged me to do it

I believe it will significantly change my life

2) How long have you been considering this procedure?

More than a year

6–12 months

3–6 months

Less than 3 months

3) What do you expect will change in your life after the procedure?

Primarily an aesthetic improvement

Mainly feeling more confident

Improvement in my social life or relationships

A major change in my life

4) If the result improves your appearance but is not perfect, how would you feel?

Satisfied

I would accept it

Somewhat disappointed

Very frustrated

5) How often do you think about the feature you would like to improve?

Occasionally

Several times a day

Many times a day

Constantly

6) Does this concern affect your social activities (photos, beach, gatherings, etc.)?

Sometimes it makes me uncomfortable

I avoid certain situations

I avoid many situations

7) How much does your self-esteem depend on your physical appearance?

Little or not at all

A little

Quite a bit

Almost completely

8) How would you describe your emotional state over the past few weeks?

Stable

Somewhat stressed

Frequently anxious

Frequently sad or depressed

9) Have you had cosmetic procedures before?

Yes, and I was satisfied

Yes, and I was partially satisfied

Yes, and I was dissatisfied

10) If the surgeon recommends NOT proceeding with surgery, what would you most likely do?

Accept the recommendation

Take time to think about it

Seek another professional opinion

Look for another surgeon until someone agrees

I voluntarily agree to complete this questionnaire and authorize the use of this information for medical evaluation prior to cosmetic surgery. I understand that it is intended only as a screening tool for guidance.

Breast Contour

Body Contour

Facial Contour

Bariatric Surgery