Body dysmorphic disorder in nose surgery and nose jobs

Why it is important for body dysmorphic disorder patients to get psychological help

Body dysmorphic disorder (BDD) is a body-image disorder characterised by persistent and intrusive preoccupations with an imagined or slight defect in one’s appearance.

People with BDD can dislike any part of their body, although they often find fault with their hair, skin, nose, chest, or stomach. In reality, a perceived defect may be only a slight imperfection or nonexistent. But for someone with BDD, the flaw is significant and prominent, often causing severe emotional distress and difficulties in daily functioning.

The central position of the nose in the face makes the nose one of the most common areas of concern in patients with BDD. Thus, aesthetic rhinoplasty (i.e. a nose job) is suspected to be one of the most frequently requested and performed surgical procedures in this population. (Source)

Retrospective outcome studies suggest that persons with body dysmorphic disorder typically do not benefit from cosmetic procedures. Pharmacotherapy and cognitive-behavioural psychotherapy, in contrast, appear to be effective treatments for body dysmorphic disorder.

In order to protect patients and surgeons, sound screening for BDD preoperatively should become the routine. The first screening tool for a surgeon to identify BDD is obtaining a thorough history.

The following signs can help the aesthetic plastic surgeon identify patients suffering from BDD:

• excessive requests for aesthetic surgery
• dissatisfaction with previous surgeries
• expectations that surgery will solve all of their problems
• preoccupation with one defect
• psychiatric history
• unusual motivation for surgery, or
• demanding behaviours
• lack of understanding of others and no empathy with others

Other tools at the disposal of nose surgeons are structured questionnaires exploring motivation for surgery or evaluation by a mental health professional before any intervention. Once screened, if a surgeon suspects a patient has BDD, the proper course of action is to refer the patient to follow up with a psychiatrist. Mental health professionals such as psychologists or psychiatrists can serve as a safety and screening measure to help identify potentially dangerous patients with BDD. Source.