Maladaptive appearance perfectionism and psychosocial distress among cosmetic dermatology patients

Cosmetic dermatology is expanding rapidly, yet the psychological mechanisms underlying distress in treatment-seeking patients remain insufficiently characterized. This study examines the associations of maladaptive and adaptive appearance perfectionism with key psychological outcomes and tests whether appearance stress functions as an indirect pathway linking maladaptive perfectionism with adverse psychosocial status.

A single-center hospital-based cross-sectional survey was conducted in the Dermatology Department of Chengdu Seventh People's Hospital. Adult patients seeking elective cosmetic dermatology care were recruited consecutively before consultation or treatment. Data were collected through a Wenjuanxing electronic questionnaire using established Chinese-language psychometric scales assessing appearance perfectionism, appearance stress, appearance self-esteem, appearance satisfaction, social appearance anxiety, and body image concern. Multiple linear regression models were used to evaluate adjusted associations. Bias-corrected bootstrapping with 5,000 resamples was used to estimate indirect effects.

Of 346 patients approached, 328 were included in the final analytic sample after data cleaning. Mean age was 30.01 ± 6.99 years, and 80.2% were female. Maladaptive appearance perfectionism was significantly associated with lower appearance self-esteem (B = -0.483, β = -0.516, p < 0.001), lower appearance satisfaction (B = -0.338, β = -0.396, p < 0.001), higher social appearance anxiety (B = 0.460, β = 0.530, p < 0.001), and higher body image concern (B = 0.468, β = 0.542, p < 0.001). Adaptive appearance perfectionism was positively associated with appearance self-esteem (B = 0.147, p = 0.002) and appearance satisfaction (B = 0.230, p < 0.001), but not with social appearance anxiety or body image concern. Maladaptive appearance perfectionism was strongly associated with appearance stress (r = 0.638, p < 0.001). Significant indirect effects through appearance stress were observed for appearance self-esteem, appearance satisfaction, social appearance anxiety, and body image concern.

Maladaptive appearance perfectionism is a prominent psychological correlate of distress among cosmetic dermatology patients, and appearance stress appears to be an important indirect pathway through which such perfectionism relates to poorer psychosocial outcomes. Screening for maladaptive appearance perfectionism and appearance-related stress may have clinical value in cosmetic dermatology settings.