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Rhinoplasty Seekers Should Be Screened for Mental Disorder


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More than a third of patients seeking cosmetic nose surgery have symptoms of body dysmorphic disorder, according to a preoperative study of 226 patients at a Belgian university hospital.

"This study shows that the prevalence of body dysmorphic disorder symptoms in a cosmetic rhinoplasty population is high and that the severity of symptoms has a clearly negative effect on daily functioning," wrote Dr. Valerie A. Picavet of University Hospitals Leuven (Belgium), and her associates.

©Amir Niknam Pirzadeh/

Beauty and deformity are in the eye of the beholder: Rhinoplasty candidates’ assessment of their own nose shape did not match the evaluation by objective observers.



The link between body dysmorphic disorder (BDD) and cosmetic surgery seekers is well documented (Body Image 2004;1:99-111; Br. J. Plast. Surg. 2003;56:546-51), but Dr. Picavet and her team focused on its prevalence among rhinoplasty seekers.

In collaboration with the psychiatric department of University Hospitals, the team conducted preoperative interviews with patients at a referral center for nasal disease. These patients were over age 16 years and seeking rhinoplasty for aesthetic and/or functional reasons. The same interviews were conducted in a 65-person control group not seeking rhinoplasty (Plast. Reconstr. Surg. 2011;128:509-17).

The researchers used the DSM-IV definition of BDD by which individuals have a preoccupation with an imagined or slight physical defect.

Individuals with this disorder devote a significant amount of time each day focused on their perceived defect, have daily distress about this concern, and suffer social impairment as a result of their preoccupation.

For this study, patients were given questionnaires to establish a clinical profile and evidence of BDD symptoms. They were asked to evaluate their nasal shape on a visual analog scale. In addition, they were given the Yale-Brown Obsessive Compulsive scale modified for BDD to rate BDD-related thoughts and behaviors. Social impairment was assessed with the Sheehan Disability Scale and the Derriford Appearance Scale.


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Should Disorder Be Contraindication to Cosmetic Surgery?

In a commentary accompanying this study, David B. Sarwer, Ph.D., wrote that few individuals are completely content with their own body image, and a degree of body dissatisfaction is often the motivating force behind weight loss, physical activity, and cosmetic surgery. His own research indicates that body image dissatisfaction falls on a continuum.

Dr. Sarwer wrote that while the work of Dr. Picavet and colleagues advances the literature on the extreme end of the continuum – BDD – "of equal importance will be the article that reports on the psychological outcomes of rhinoplasty patients with BDD symptoms. Studies in the literature to date suggest that the great majority of persons with the disorder who undergo appearance-enhancing procedures report either no change or worsening of their disorder symptoms after these treatments." More conclusive evidence of these outcomes would lend support to recommendations that "BDD be considered a psychiatric contraindication to cosmetic surgery."

Dr. Sarwer is a clinical psychologist at the University of Pennsylvania Center for Human Appearance in Philadelphia. He reported that he has grant support from the National Institutes of Health, several medical societies, and Ethicon Endo-Surgery. He also has consulting relationships with Allergan, Enteromedics, and Ethicon Endo-Surgery (

Plast. Reconstr. Surg. 2011;128:518-9</a>). </i>

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