Plastic surgeons know that many of their prospective patients will have deep-seated emotional issues tied-in to their concerns about their appearance. It is very important that these issues are considered and understood by both doctor and patient alike. Psychological factors weigh in on goals, expectations, and recovery issues– even the advisability itself of actually proceeding with any cosmetic procedure. Some patients are inappropriate candidates for cosmetic procedures because these psychological factors are quite prominent and call into question the state of their mental health – an issue that Plastic Surgeons and their office staff must be sensitive to.
BDD–Body Dysmorphic Disorder–is a dysfunctional and obsessive preoccupation with a “problem” with one’s appearance which others perceive to be very slight or even unnoticeable. A BDD patient will spend an average of 3 – 8 hours a day on repetitive behaviors such as mirror checking,comparing, camouflaging, excessive grooming,reassurance seeking, and skin picking while studying and thinking about the “defect”. Social interactions and activities will be avoided in favor of these obsessive activities. Their inescapable preoccupation also commonly interferes with work and other responsibilities. Although obsessed with their perceived flaws, BDD is fundamentally different from Obsessive- Compulsive Disorder (OCD): BDD patients commonly have much less insight and much more delusional thinking regarding their “deformity” than those with OCD. While just 2 – 3 % of the population may have BDD, it is more common in women and among those already under psychiatric care.
BDD patients will ultimately see most of the cosmetic physicians in a given geographic area in consultation and frequently will have had several procedures as well. It is estimated that up to 10 -15% of those seeking cosmetic surgery could have BDD. But BDD is a true psychiatric disorder; even the most successful cosmetic procedures will not alleviate the obsessions of someone afflicted with BDD. Patients with BDD are never really satisfied with their procedure results because the problem that they perceive is actually happening neurochemically (at the level of the brain) and is not physically real. Multiple physicians and procedure after procedure over the years are typical, but since they have expectations that are out of sync with reality, the goals of those with BDD are never realized.
Plastic surgeons must be keenly aware of the possibility that a prospective patient might have BDD and protect them accordingly by withholding surgery and referring them for proper psychiatric evaluation. BDD patients need expert psychiatric help– not cosmetic surgery, which could actually end up aggravating the disorder. Recent alarming data indicates that about 30% of BDD patients suffer from recurrent panic attacks and nearly 50% have suicidal ideations– higher rates than for those with major depression or bipolar disorder. Treatment options showing promise include therapy and medication, although as of yet, there is no medication which has been formally approved for the treatment of BDD.
Dr. Lyle Back is originally from New York City, receiving his medical and surgical training at Rutgers Medical School, Cooper Hospital – University Medical Center, and Ohio State. He is Board Certified in General Surgery (ABS) and Plastic Surgery (ABPS). He is a Fellow of the American College of Surgeons (ACS), the American Academy of Cosmetic Surgery (AACS), and a longstanding member of the premier American Society of Plastic Surgeons (ASPS). He served as a Professor of Plastic Surgery at Temple University and St. Christopher’s Hospital for Children and performed reconstructive surgery with “Operation Smile” in Vietnam. He specializes in the full range of the most modern and state of the art cosmetic surgery procedures for the body and non-surgical cosmetic enhancement techniques available today.
