Rhinoplasty Outcomes in Patients With Symptoms of Body Dysmorphia

Overview

People with symptoms of body dysmorphia often seek aesthetic rhinoplasty, and recent evidence suggests some experience increased satisfaction after surgery. The authors measured the psychological effect using a screening questionnaire administered both before and after the operation. They retrospectively reviewed patients operated on by a single surgeon from June 2021 to April 2023 who had complete questionnaire sets.

Sections of note

• Design: retrospective chart review, single surgeon. 115 patients met inclusion criteria, 88 percent female.
• Instruments: the Body Dysmorphic Disorder-Aesthetic Surgery questionnaire, SCHNOS for obstruction and appearance, and a visual analog scale, all completed before and after surgery.
• 83 percent of patients who screened positive before surgery no longer screened positive afterward.
• A positive screen, before or after surgery, correlated with worse aesthetic satisfaction, all p less than 0.002.
• No patient reported outcome measure predicted which patients screening positive before surgery would resolve afterward.
• Stated conclusion: resolution of a positive screen correlated with improved aesthetic satisfaction, pointing to a possible positive psychological effect.
• Screening positive on this questionnaire is not the same as a formal psychiatric diagnosis.

What it means for a patient

• Most patients who screened positive for these symptoms before surgery no longer did a year or so afterward.
• Screening positive at any point went with lower satisfaction with appearance, so the symptoms and the dissatisfaction move together.
• Nothing measured before surgery predicted who would improve, so the screen does not identify who will benefit.
• Limits: retrospective, one surgeon, no control group, questionnaire screening rather than psychiatric diagnosis, and no stated follow up length.

Why this paper matters

Whether surgery helps or harms people with body dysmorphia symptoms is unresolved, and the conventional position treats them as poor candidates. Measuring the screen before and after surgery tests that directly. The inability to predict who resolves means the finding cannot yet be turned into a selection rule.

Terms

• Body dysmorphia: preoccupation with a perceived flaw in appearance.
• BDDQ-AS: a screening questionnaire for body dysmorphic symptoms in aesthetic surgery patients.
• SCHNOS: a validated questionnaire scoring both nasal appearance and nasal blockage.
• Screening questionnaire: a tool that flags possible cases, not a diagnostic test.
• Visual analog scale: a line on which severity or satisfaction is marked.