Body dysmorphic disorder can lead to cycle of seeking excessive cosmetic surgery
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For the most part, cosmetic surgeons treat patients with reasonable goals who want to look better, refreshed or rejuvenated.
“Fortunately for our work, we tend to see high patient satisfaction. We see an improvement in psychosocial functioning, body image and improvement in depressive symptoms and quality of life. But sometimes, unfortunately, there’s a darkness that drives the desire to change, and that is based on dysfunctional beliefs,” Wendy W. Lee, MD, the Baylis Cosmetic Surgery Award lecturer, said at the virtual American Society of Ophthalmic Plastic and Reconstructive Surgery annual meeting.
As much as 1% to 2% of the general population, equally male and female, are affected by body dysmorphic disorder, with the highest incidence in people seeking rhinoplasty, which can be as high as 21%, according to Lee. Associated with body dysmorphic disorder (BDD) is major depression, occurring in 60% of these patients in the clinical setting, she said.
“The lifetime risk for major depression in this population is 80%. Up to 29% of patients with BDD will attempt suicide, and this risk tends to be higher in women with perceived facial defects,” Lee said.
Signs of body dysmorphic disorder can include unusual, demanding behavior, excessive requests for aesthetic procedures, dissatisfaction with previous surgical procedures and an expectation that an aesthetic procedure will solve all problems.
“If you decide to do surgery on them, some will do well with surgery, but 70% of patients are dissatisfied with the result,” Lee said. “And in 80% of cases, the patient will destabilize psychologically, and the patient will find new defects.”
There is consequently an increased likelihood that these dissatisfied patients will turn to litigation. One survey of 265 cosmetic surgeons found 84% refused to operate on a patient they suspected of having body dysmorphic disorder. Of those who did operate on such patients, 29% reported they had been threatened with legal action.
“There is a need for more awareness and identification of patients with body dysmorphic disorder for the benefit of both the patient and the surgeon,” Lee said. “Physicians can easily become enablers of patients’ self-disruptive behavior. Most patients with BDD are not aware of their psychiatric disease, so they won’t seek help. So, it’s important to be aware of the status of a patient’s mental health and refer to a mental health specialist if you’re suspicious.”
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Lee W. Henry I. Baylis Cosmetic Surgery Award Lecture. Beauty and the beast: What drives some toward aesthetics. Presented at: American Society of Ophthalmic Plastic and Reconstructive Surgery annual meeting; Nov. 20-22, 2020 (virtual meeting).
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