The Mirror of Culture: A Systematic Review and Meta-Analysis of the Prevalence of Body Dysmorphic Disorder in Asian Rhinoplasty Seekers

Chua NYM, Gao EZ, Loh SBJ, Yong CL, Pierro FD, Ong SPM, Ng CL.

PubMed 40907540 Publisher (DOI)

What this paper says

Pooling 15 studies with 1,977 Asian rhinoplasty candidates, 30.0% screened positive for body dysmorphic disorder, with the rate depending heavily on the tool used (36% by questionnaire versus 18% by DSM-5 criteria).

Overview

Body dysmorphic disorder (BDD) predicts dissatisfaction after cosmetic surgery and is meant to be screened for before rhinoplasty. Its prevalence in Asian populations was known only from small series. The Singapore authors searched five databases to March 2025 following PRISMA, pooled prevalence with a random-effects model, and assessed quality and publication bias.

Sections of note

15 studies, 1,977 patients.
Pooled BDD prevalence 30.0% (95% CI 26.8-35.7).
Body Dysmorphic Disorder Questionnaire: 36%; DSM-5 criteria: 18%.
Substantial heterogeneity was observed and addressed.
The authors call for standardised diagnostic protocols and culturally sensitive assessment.

What it means for a patient

Nearly one in three Asian rhinoplasty seekers in these studies met a screening threshold for BDD; screening questionnaires flag about twice as many people as a formal diagnosis.
A positive screen is not a diagnosis, but it is a reason for a fuller assessment before surgery.
Surgery in BDD is associated with poor satisfaction regardless of the technical result.

Why this paper matters

It is the first pooled estimate of BDD among Asian rhinoplasty candidates and highlights how much the number depends on the measurement tool. Limits: heterogeneity, screening versus diagnostic inconsistency, possible regional differences.

Terms

Body dysmorphic disorder (BDD): preoccupation with a perceived flaw that others see as slight, causing distress or impaired function.
Body Dysmorphic Disorder Questionnaire (BDDQ): a short screening tool.
DSM-5: the American Psychiatric Association's diagnostic manual.
Prevalence: the proportion of a population with a condition at a given time.
Random-effects model: a pooling method that allows for real differences between studies.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“Body dysmorphic disorder (BDD) is a condition to be assessed preoperatively prior to cosmetic rhinoplasty, as it may influence patient outcomes and satisfaction. The prevalence of BDD in Asians is not well-studied, and the literature consists predominantly of smaller case series. Objectives: This systematic review and…”

Excerpt; the full abstract is on PubMed.