Plastic Surgeons Should Be Aware of Patients with 'Excessive Concern' about Appearance

ARLINGTON HEIGHTS, Ill. - Moderate to severe symptoms of body dysmorphic disorder (BDD) - excessive concern about appearance that interferes with daily life - are found in 33 percent of patients seeking plastic surgery to improve the appearance of their nose, reports a study in the August issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Symptoms of BDD are especially common in patients with previous plastic surgery or mental health issues, according to the study by Dr. Valerie A. Picavet of University Hospitals Leuven, Belgium, and colleagues. They conclude, "This study shows that the prevalence of BDD symptoms in a cosmetic rhinoplasty population is high and that the severity of symptoms has a clearly negative effect on daily functioning."

Study Shows Rates and Risk Factors for BDD in Rhinoplasty Patients
Over a 16-month period, researchers distributed a BDD questionnaire and other surveys to 266 patients seeking rhinoplasty. Results suggested 33 percent of patients had moderate to severe symptoms of BDD. The figure rose to 43 percent for patients who were seeking rhinoplasty solely for aesthetic reasons (versus at least partly for functional reasons). By comparison, moderate to severe BDD symptoms were found in just two percent of patients undergoing nasal surgery for medical reasons.

Twenty percent of patients had a previous rhinoplasty, and were more likely to have high BDD symptom scores. Symptoms of BDD were also more frequent among patients with a history of psychiatric problems.

The severity of BDD symptoms was unrelated to an objective evaluation of the nasal shape; many patients who were highly concerned about their appearance had a normal-looking nose or only minor defects. Patients with higher BDD symptom scores had lower quality of life and more problems in several areas of daily functioning, including relationships and self-esteem.

Plastic surgeons routinely assess the motivations and mental health of patients seeking aesthetic surgery. However, few studies have examined the role of BDD - the only psychiatric diagnosis that directly considers body image concerns.

The study highlights the high rate of moderate to severe BDD symptoms in patients seeking aesthetic rhinoplasty, according to Dr. Picavet and colleagues. They conclude, "Large-scale and long-term prospective outcome studies investigating the influence of BDD symptoms on outcomes are imperative, as they will help us in the establishment of guidelines concerning patient selection in aesthetic surgery."

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

About ASPS

The American Society of Plastic Surgeons (ASPS) is the world's largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery. 

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