Associations between skin scars and body image - A systematic review and meta-analysis

While many factors influence body image, the association between scarring and body image has not been systematically synthesized. This systematic review and meta-analysis evaluated person- and scar-specific prognostic factors associated with body image outcomes. The review was registered prospectively in PROSPERO (CRD42024224822). MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science were searched. Risk of bias was assessed using QUIPS, and certainty of evidence was rated with GRADE. Sixty-seven studies (n = 8,307) were identified, spanning surgical, post-burn, and mixed-etiology scar populations. Across these, 18 body image assessment tools were applied. Thirty-seven variables were evaluated; those assessed in ≥7 studies were synthesized meta-analytically. Pooled analyses showed that female gender (ES = -0.38, 95 % CI -0.58 to -0.19), greater number and size of scars (ES = -0.92, 95 % CI -1.43 to -0.40), and increased scar visibility (ES = -0.59, 95 % CI -1.08 to -0.11) were consistently associated with poorer body image outcomes. Age showed no consistent association. Psychosocial factors, including symptoms of depression, anxiety, and post-traumatic stress disorder, were also consistently associated with poorer body image. Risk of bias was mostly moderate, and certainty of evidence ranged from low to moderate. As nearly all studies were cross-sectional, findings reflect associations rather than causal effects. Understanding these associations may help clinicians anticipate which patients are at risk of body image disturbance and guide holistic approaches that address both physical and psychosocial concerns.