Preoperative symptoms of body dysmorphic disorder determine postoperative satisfaction and quality of life in aesthetic rhinoplasty

Overview

Earlier work from the same group found that a third of rhinoplasty candidates had at least moderate body dysmorphic disorder (BDD) symptoms. This prospective study asks whether those symptoms predict how patients feel about the result, using validated questionnaires before surgery and at 3 and 12 months after.

Sections of note

• 1-year prospective study of 166 adults having cosmetic rhinoplasty at a tertiary referral center.
• BDD symptom severity: modified Yale-Brown Obsessive Compulsive Scale.
• Satisfaction: visual analog scale for nasal shape and the Rhinoplasty Outcome Evaluation; quality of life: Sheehan Disability Scale; appearance-related disruption: Derriford Appearance Scale-59.
• Preoperative BDD scores correlated inversely with satisfaction at 3 months (VAS rho = -0.43; ROE rho = -0.48) and 12 months (rho = -0.40 and -0.41), all p < 0.001.
• BDD scores correlated positively with disability at 3 months (rho = 0.43) and 12 months (rho = 0.32) and with appearance-related disruption at both points (rho = 0.48), all p < 0.001.
• The authors call it the first evidence of BDD symptoms harming subjective outcomes after rhinoplasty.

What it means for a patient

• How preoccupied a person is with their nose before surgery predicts dissatisfaction afterward, independent of the surgical result.
• The effect persisted at one year, so it is not a matter of early swelling or adjustment.
• Correlations of about 0.4 are moderate; many patients with symptoms were still satisfied, and the abstract does not give a threshold score.

Why this paper matters

It supplies the outcome evidence behind recommendations to screen for BDD before cosmetic rhinoplasty. Whether treating BDD before surgery, or declining surgery, improves outcomes is not tested.

Terms

• Body dysmorphic disorder (BDD): preoccupation with a slight or imagined appearance flaw.
• Modified Yale-Brown Obsessive Compulsive Scale: a clinician-rated scale of BDD symptom severity.
• Rhinoplasty Outcome Evaluation: a six-question patient questionnaire on nasal appearance and function.
• Sheehan Disability Scale: a brief questionnaire on how symptoms impair work, social and family life.
• Derriford Appearance Scale-59: a questionnaire on how appearance concerns disrupt daily living.
• Rho: Spearman's correlation coefficient, from -1 to 1.