Surgical Rhinoplasty in Mild Forms of Body Dysmorphic Disorder: Safety, Protocols, and Long-Term Outcomes

Overview

Surgery in severe body dysmorphic disorder is considered contraindicated because patients are usually dissatisfied and symptoms rarely improve. The authors argue that mild cases may benefit. This second article in their series applies the two specialist protocol described earlier, then reports outcomes with a visual analog scale and a five point Likert scale.

Sections of note

• Design: outcome report on a selected subgroup from a 13 year practice cohort, 2010 to 2023.
• 1602 patients sought cosmetic rhinoplasty; 892 were sent for psychiatric evaluation; 22, 2.5 percent, had mild body dysmorphic disorder; 15 were considered suitable and had surgery.
• Follow up ranged from 6 to 95 months, mean 54.13 months.
• Outcomes: 5 of 15 scored 10 out of 10, 8 of 15 scored 7 to 9, and 2 of 15 scored 6 but were still described as happy.
• 3 of 15 requested revision rhinoplasty, which was not offered, as had been agreed before the original surgery. The authors state such requests are common in these cases and patients should be warned.

What it means for a patient

• With careful screening and support, patients with mild symptoms of the condition were reported to do well over a mean of more than four years.
• One in five asked for a further operation despite reporting satisfaction, which the authors treat as expected rather than as failure.
• Refusing revision was agreed in advance, which is itself part of the protocol rather than a response to the request.
• Limits: 15 patients, one practice, no control group, outcomes rated by scales the authors administered, and no measure of whether the underlying condition improved.

Why this paper matters

Whether any degree of body dysmorphic disorder permits surgery is one of the sharper ethical questions in aesthetic practice, and blanket exclusion is the conventional answer. This report argues for a graded approach with structured safeguards. Fifteen patients cannot settle the question, and symptom change was not measured.

Terms

• Body dysmorphic disorder: a condition involving preoccupation with a perceived flaw in appearance.
• Mandatory psychiatric evaluation: a required assessment by a psychiatrist before surgery is offered.
• Visual analog scale: a line on which severity or satisfaction is marked.
• Likert scale: a response format where a rater chooses along a graded range.
• Revision rhinoplasty: a second operation to correct the result of an earlier one.