IntroductionEvaluating patient-reported outcomes (PROMs) helps optimize preoperative counseling and psychosocial care for patients who underwent cranioplasty.Research questionThis study aimed to evaluate cosmetic satisfaction, level of self-esteem, and fear of negative evaluation (FNE) of patients who underwent cranioplasty.Material and methodsPatients who underwent cranioplasty from 1 January 2014 to 31 December 2020 ​at University Medical Center Utrecht and a control group consisting of our center’ employees were invited to fill out the Craniofacial Surgery Outcomes Questionnaire (CSO-Q), consisting of an assessment of cosmetic satisfaction, the Rosenberg Self-Esteem Scale (RSES), and the FNE scale. To test for differences in results, chi-square tests and T-tests were performed. Logistic regression was used to study the effect of cranioplasty-related variables on cosmetic satisfaction.ResultsCosmetic satisfaction was seen in 44/80 patients (55.0%) and 52/70 controls (74.3%) (p ​= ​0.247). Thirteen patients (16.3%) and 8 controls (11.4%) had high self-esteem (p ​= ​0.362), 51 patients (63.8%) and 59 controls (84.3%) had normal self-esteem (p ​= ​0.114), and 7 patients (8.8%) and 3 controls (4.3%) had low self-esteem (p ​= ​0.337). Forty-nine patients (61.3%) and 39 controls (55.7%) had low FNE (p ​= ​0.012), 8 patients (10.0%) and 18 controls (25.7%) had average FNE (p ​= ​0.095), and 6 patients (7.5%) and 13 controls (18.6%) had high FNE (p ​= ​0.215). Cosmetic satisfaction was associated with glass fiber-reinforced composite implants (OR 8.20, p-value ​= ​0.04).Discussion and conclusionThis study prospectively evaluated PROMs following cranioplasty, for which we found favorable results.