Comparison of Aesthetic and Functional Rhinoplasty Outcomes Between Patients with Body Dysmorphic Disorder and Normal Individuals

Moosaie F, Javankiani S, Mansournia MA, Rahavi S, Najeeb ZJ, Mohammadi S, Saedi B.

PubMed 38575764 Publisher (DOI)Free full text (PMC)

What this paper says

Among 209 rhinoplasty candidates, 18.66 percent screened positive for body dysmorphic disorder, and those patients were significantly less satisfied with the appearance result than 39 matched patients who screened negative.

Overview

Body dysmorphic disorder is the most common mental health condition among rhinoplasty candidates. The authors measured its prevalence and compared satisfaction with both appearance and breathing after surgery between patients who screened positive and negative. From 209 candidates screened, 39 were positive, and 39 of the remaining 170 negatives were randomly selected as controls.

Sections of note

Design: cross sectional comparative study. Level of evidence III.
Prevalence of a positive screen: 18.66 percent of 209 candidates. Average age of positive patients 31.41 years.
Appearance was assessed with the Rhinoplasty Outcome Evaluation and the SCHNOS cosmesis subscale; breathing with NOSE and the SCHNOS obstruction subscale.
Rhinoplasty Outcome Evaluation was significantly lower, meaning less satisfaction, in the positive group: 15.69 versus 19.08, p equal to 0.001, independent of age, sex and marital status.
SCHNOS cosmesis was higher, meaning less satisfaction: 47.01 versus 34.96, p equal to 0.021, with five times the odds of severe aesthetic concern afterward.
NOSE scores were higher, meaning less satisfaction with breathing: 49.74 versus 37.82, p equal to 0.012.
SCHNOS obstruction showed no significant association, p equal to 0.053, and the breathing associations did not survive adjustment for confounders.

What it means for a patient

Patients who screened positive were less satisfied with how their nose looked after surgery, and that difference held after accounting for age, sex and marital status.
The apparent difference in breathing satisfaction disappeared once confounders were accounted for, so the effect is specific to appearance.
Nearly one in five candidates screened positive, higher than some other reported figures, though screening questionnaires flag possible cases rather than diagnose them.
Limits: 39 patients per group, cross sectional, one centre, and screening rather than psychiatric diagnosis.

Why this paper matters

Whether body dysmorphic symptoms predict dissatisfaction after rhinoplasty bears directly on how candidates should be assessed. Comparing matched groups on four validated instruments makes the appearance specific finding credible. What it does not show is whether screening and counselling would change the outcome.

Terms

Body dysmorphic disorder: preoccupation with a perceived flaw in appearance.
BDDQ: a screening questionnaire for body dysmorphic symptoms.
Rhinoplasty Outcome Evaluation: a patient questionnaire scoring satisfaction with the nose.
SCHNOS: a validated questionnaire with subscales for nasal appearance and blockage.
Confounder: a background factor that could explain an apparent association.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Background: Rhinoplasty is among the top five most popular cosmetic surgical procedures worldwide. Among rhinoplasty candidates, the most common mental health disorder is body dysmorphic disorder. (BDD). The present study aimed to assess the prevalence of BDD among rhinoplasty candidates, its association with the patient's self-assessment of aesthetic outcome and nasal functional, post-rhinoplasty compared to applicants with negative screening for BDD.

Methods: The following study is a cross-sectional, comparative study. Out of the 209 rhinoplasty candidates screened by the BDDQ questionnaire, 39 were positive for BDD. From the remaining 170 patients who screened negative for BDD, 39 participants were randomly selected as the control group for the comparative analysis. Rhinoplasty outcome evaluation (ROE) and standardized cosmesis and health nasal outcomes survey-cosmetic (SCHNOS-C) questionnaires were used for assessment of patient satisfaction with the cosmetic outcome of rhinoplasty. Nasal obstruction symptom evaluation (NOSE) and standardized cosmesis and health nasal outcomes survey-obstruction (SCHNOS-O) were used for the assessment of satisfaction with functional outcomes between groups of patients screened positive and negative for BDD.

Results: The prevalence of BDD was 18.66% among rhinoplasty candidates. The average age of patients screened positive for BDD was 31.41. The mean ROE score was significantly lower (i.e. lower satisfaction) in patients screened positive for BDD (15.69 versus 19.08, P = 0.001), regardless of confounding variables, such as age, sex, and marital status. SCHNOS-C score was higher (i.e. less satisfaction) among patients with BDD (47.01 versus 34.96, P = 0.021) and was significantly associated with higher odds of severe aesthetic concern post-rhinoplasty (OR (95%CI) = 5.000 (1.135-22.022), P = 0.033). Patients screened positive for BDD had significantly higher NOSE scores (i.e. less satisfaction with functional outcome) compared to participants negative for BDD (49.74 versus 37.82, P = 0.012). SCHNOS-O score had no significant association with BDD (P = 0.053). Furthermore, there was no significant association between BDD and NOSE or SCHNOS-O score after adjustment for the confounders.

Conclusion: Patients screened positive for BDD were significantly less satisfied with the cosmetic outcome of the rhinoplasty compared to those screened negative for BDD. Assessment of BDD among rhinoplasty candidates before surgery, could potentially be beneficial for both patients and surgeons.

Level Of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).