134 JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS Regarding the influence of cosmetics on self perception, psychological benefits were reported by those who use facial make-up (6). It has been shown that physical attractiveness correlates with positive self perception (7, 8). Since cosmetics improve attractiveness (3), their use should engender enhanced self perception. The work of Graham and Jouhar (6) indeed supports this judgment. Since the 1950s in Great Britain, cosmetic treatments by trained volunteers have been used as adjunctive therapy. The British Red Cross administers a program which provides hair and nail care, massage and cosmetics for the sick, the elderly, and the depressed. Individuals receiving these cosmetic attentions feel better and report being boosted psychologically. The Red Cross program has been strengthened by the knowledge derived from controlled studies of the favorable influences of cosmetics on mental and physical health (9). The Red Cross program has been eminently successful and the services are being expanded (10, 11). With this as background, we thought it likely that individuals would rate themselves more favorably after a dramatic cosmetic intervention, namely the professional make- over. Make-overs are designed to produce immediate enhancement of facial appearance. Skill, training, and artistry are required. In this study, one professional performed all the make-overs. The procedure entails a sequence starting with cleansers, toners and mois- turizers, tinted facial foundation, blusher on cheeks, face powder, and eyebrow pencil then decorative embellishments are applied generally in the following order: colored eye shadow, eye liner, mascara, and finally lip pencil and lipstick. A complete make-over may also include hair care, such as shampooing, coloring, cutting, and restyling. We did not undertake hair care in this study. Graham and Kligman (12) found that physically attractive and unattractive elderly females perceived themselves differently. The former viewed themselves as healthier and had a more positive outlook on life. They estimated that they were more optimistic, less depressed, and better adjusted. They,were also more satisfied with their lot in life, and were more involved and more realistic. The purpose of the current study was to obtain objective data in support of the claims being made for the efficacy of make-overs, in physically attractive and unattractive elderly women. We also evaluated whether the type of make-over might influence the outcome. It seemed likely that additional benefits might accrue if make-over training was included to permit continued cosmetic care at home. HYPOTHESES H•: That make-overs of elderly women would have beneficial effects on self-perceived psychological well being and subsequent cosmetic care. H2: That physically attractive and unattractive elderly women might differ in the benefits obtained. H3: That make-over training might produce more beneficial effects than a passive make-over.

COSMETIC THERAPY FOR THE ELDERLY 135 METHOD PRELIMINARY STUDY Selection of subjects was based on a study in which stimulus photographs of 48 elderly female volunteer subjects, aged 54 to 96, were rated on 7-point scales of physical attractiveness by 10 male and 10 female similarly aged subjects. Details have been described elsewhere (12). We used the same subjects in this study. SUBJECT SELECTION Thirty-two make-overs were conducted on 16 individuals from the high range of phys- ical attractiveness (ratings 4.15 to 5.35, mean = 4.75 -+ 0.37) and 16 from the low range (ratings 2.4 to 3.9, mean = 3.17 - 0.45). The values are the combined scores of female and male judges, since these did not differ significantly. The median (4.15) was the dividing point between the attractive and unattractive, the two groups being significantly different in attractiveness (F = 119.14 1,30 d.f., p 0.001). For the attractive the age range was 65 to 87 (mean 75.8 -+ 5.6), and for the unattractive the ages ranged from 59 to 96 (mean 77.1 _+ 9.6). We also ensured that the two make- over groups did not differ significantly with respect to age. For the passive make-over group the ages ranged from 70 to 96 (mean - 79.8 -+ 8.2) for the training group the ages ranged from 59 to 87 (mean = 74.4 _+ 7.5). Thus, there were no significant age differences among these groups. Of those that remained of the original group of 48 subjects, 8 were randomly selected with respect to physical attractiveness, to serve as control subjects. STUDY DESIGN Eight of the sixteen attractive subjects were randomly allocated to the passive make- over group and eight to the make-over training group. The unattractive were divided in the same way. For the control group a specially devised "cosmetic color preference task" replaced the make-over. All the subjects completed 7-point rating scales of self- perception immediately before and after the make-over or control task. Subjects were also photographed before and after. MAKE-OVERS Passive make-overs were conducted by an expert male cosmetician. In the make-over training sessions, the emphasis was on teaching the subjects how to apply make-up. Further, they were given cosmetics and told how to use them in daily practice. The cosmetician conducted all the make-overs in a room • designed and equipped for the purpose. He was instructed to behave as consistently as possible with each subject in terms of giving attention, showing interest, etc. He also imparted a positive attitude, • Three make-overs were conducted in the hospital because although none of the subjects had been hospitalized at the time of the preliminary study, three of the subjects selected for the two attractiveness groups happened to be suffering from physical disorders at the time of the make-over sessions.