Do you like what you see when you look in the mirror? Many people don’t. Fortunately, the world of cosmetic enhancement provides a broad range of fixes from surgeon-performed surgery to do-it-yourself skincare.

Sadly, no amount of cosmetic enhancement in the world can help someone with a mental illness known as Body Dysmorphic Disorder (BDD), a disorder that drives some people to seek cosmetic surgery or treatment they do not need.

BDD and protocols to help surgeons and patients recognise its symptoms were on the agenda at the 11th International Symposium of Facial Plastic Surgery. Now in its eleventh year, the event was held in New York City.

The Costhetics team was there, and we’d like to share some of what we learned from our colleagues.

Body Dysmorphic Disorder Hurts

Body Dysmorphic Disorder is described as a preoccupation with a slight or perceived defect in appearance. What is it like to have Body Dysmorphic Disorder? It’s painful. The Australian Psychological Society describes the experience vividly:

“Think for a moment what it must be like to go to the mirror every morning (and perhaps, compulsively, several times throughout the night) and not like what you see; to feel ashamed, and refuse to leave the house because the thought of others seeing how hideous and how deformed, you are…is just too much to bear. Think of the self-loathing, the fear. Think then what it must be like to repeatedly examine your “defects” throughout the day, in mirrors or any suitable reflective surface, perpetuating the cycle of discontent.” The Australian Psychological Society 

When Perfect Isn’t Good Enough

Conference speaker Dr Mark B. Constantian, a third generation medical professional with more than 25 years’ experience as a plastic surgeon, explained that often trauma suffered during childhood causes the feelings of shame, inferiority, and an inescapable sense of being defective. The trauma may be conscious abuse or unconscious neglect as a result of

  • Parental mental illness
  • Parental substance abuse
  • Verbal, physical, or sexual abuse
  • Desertion/death/divorce
  • Poverty
  • Severe childhood illness

“Children who have been traumatised can have low self-worth that manifests itself as body shame,” Dr Constantian told us. “BDD patients attach their self-worth to their appearance, and that appearance is never good enough.” He also offered this diagnostic for identifying a typical BDD patient who comes in for rhinoplasty,

 “The more perfect their noses appear when they present themselves for their pre-op consultation, the more likely they are to have BDD.” – Dr. Mark B. Constantian, International Center for Rhinoplasty

Doctors Ask Questions of Patients & Themselves

Asking questions that explore whether patients are obsessively focused on how they look was a diagnostic suggestion offered by speaker Dr Jonathan Sykes who has performed more than 13,500 aesthetic, functional and reconstruction rhinoplasty surgeries on patients ranging from infants to the elderly.

“If a patient tells me they think about their appearance a hundred times a day, that needs to be looked at as a possible red flag.” – Dr Jonathan Sykes

Dr Sykes also discussed the importance of surgeons questioning themselves regarding a patient’s request for cosmetic enhancement. “Before proceeding, a surgeon should be able to answer ‘yes’ to each of the these five questions.”

  1. Do I see what the patient sees? Is my patient reality-based or delusional? 
  2. Can I fix it? Will my skill meet my patient’s expectations? 
  3. Is the patient manageable? Is the patient cooperative or making untenable demands, such as being seen on a holiday?
  4. If there is a complication, will the patient be able to cope? Is the patient emotionally stable?
  5. Do I believe the patient will accept the margin of error inherent in surgery? Are the patient’s expectations realistic?

BDD may be difficult to diagnose because many patients are too ashamed to reveal their symptoms, fearing that their concerns will be trivialised or considered vain. “Surgeons often spend too much time telling patients how good they are rather than finding out who they are,” said Dr Sykes. Please don’t let this happen to you.

If you are concerned that your perceptions may be out of kilter, even a little, let your surgeon know so you can get help and start to feel better. Good communication is the first step in every successful cosmetic enhancement procedure. 

Visit this page at The U.S. National Institute of Health website for additional information about BDD including a short checklist for diagnosing the condition

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