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

 

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Abstract

Body dysmorphic disorder (BDD) is an obsessive–compulsive disorder concerning body image which negatively distorts the patient's perception of their appearance. In rhinoplasty, surgery on patients with severe BDD is considered contraindicated as patients are often dissatisfied and their BDD symptoms rarely improve. For patients with borderline to mild BDD, however, there has been some preliminary evidence to show that they can benefit from surgical rhinoplasty. In our first article on this series of BDD in rhinoplasty, we presented our two-specialist protocol using mandatory psychiatric evaluation (MPE) to assess patient's suitability. In this present article, we used this protocol to identify a group of borderline to mild BDD patients, performed surgical rhinoplasty on this group, and evaluated the outcome using a visual analog scale (VAS) and a five-point Likert scale. From 2010 to 2023, 1,602 patients attended our practice seeking cosmetic rhinoplasty, out of which, 892 were sent for MPE to the same psychiatrist. The MPE identified 2.5% (22/892) patients as having mild BDD, out of which, 15 were considered suitable for surgical intervention and underwent successful rhinoplasty (follow-up 6–95 months, M = 54.13 months). Five of 15 patients scored 10/10 on the VAS and were very happy, 8 of 15 patients scored 7 to 9/10 on the VAS and were happy, and 2 of 15 patients scored 6/10 on the VAS but were still happy. Although all patients were happier, 3 of 15 patients requested revision rhinoplasty which was not offered as was planned and discussed before the initial intervention. This study shows that in the presence of safe protocols, including a two-specialist model, safe outcomes can be expected even in the long term. Further, the request for revision surgery appears to be common in borderline to mild BDD cases, and we like to warn the patients against it before surgery.

Compliance with Ethical Standards

The role and safety of surgical rhinoplasty is not clear in body dysmorphic disorder (BDD). Surgery has been offered, and at times inadvertently, its role however remains unclear in literature at present. This prospective study focuses on surgical rhinoplasty in borderline or mild BDD cases before one studies its role in moderate to severe cases. In cases of borderline or mild BDD, after seeking advice from a psychiatrist and obtaining informed consent from the patient, we offered surgical rhinoplasty for alleviating suffering of such patients where it was considered from the two-specialist team safe to do so. All patients considered safe were considered for surgery. As the next step, we will make it an object of research designed to evaluate its safety and efficacy. In the present case series, as we collect data prospectively, we plan to publish the outcomes of rhinoplasty in this cohort and make it publicly available.

Publication History

Article published online:
09 February 2024

© 2024. Thieme. All rights reserved.

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