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Key points
- Some people seem to compulsively alter their appearance through multiple surgical interventions.
- Many patients who use cosmetic surgery compulsively have Body Dysmorphic Disorder.
- It's important for surgeons to screen for, identify, and help patients who have a psychiatric disorder before proceeding with surgery.
In our appearance-driven society, it is common for people to have a few things that they don’t like or would change about their looks. For some, this can translate into seeking out procedures like rhinoplasty, botox and fillers. However, for a subset of these individuals, no amount of cosmetic intervention will satisfy the picture of perfection they have in mind.
This unattainable desire can lead to plastic surgery addiction—not a clinical diagnosis, but a compulsion to continuously alter one’s appearance with cosmetic surgery. Researchers have found that the majority of people who are addicted to plastic surgery suffer from Body Dysmorphic Disorder (BDD), a relatively rare condition with obsessive behaviors that plastic surgeons must always keep in mind.
BDD is a relatively rare psychiatric condition that is characterized by persistent and intrusive preoccupations with an imagined or small defect in one’s appearance. BDD only affects about 1% to 2% of the general population but has been found to be up to 15 times more prevalent in those seeking plastic surgery (Ribeiro 2017). The severity of the disorder varies. In some people, it causes severe emotional distress and can have a devastating impact on quality of life.
Patients suffering from the disorder often engage in obsessive-compulsive behaviors, including mirror gazing, comparing physical features, skin picking, and reassurance seeking. People with BDD may spend hours every day trying to hide their displeasing physical features with makeup, clothing, or accessories to disguise the feature.
Many people who suffer from BDD turn to plastic surgery as they believe that surgically altering their appearances will remedy their negative perceptions of self. Not surprisingly, surgery rarely resolves symptoms of the disorder as it does not address the underlying psychological issue. Plastic surgery can actually leave patients with new scars and imperfections which propagate the cycle of dissatisfaction. These patients will often continue to go under the knife, spending thousands of dollars to correct the new imperfections created by each of their prior procedures.
How do surgeons determine whether BDD is behind a person’s interest in cosmetic surgery? Other than being unhappy with prior surgical outcomes that appear objectively satisfactory, patients with BDD often have unrealistic expectations when discussing their goals for surgery or “suddenly realize” another feature is unacceptable and desire additional surgery on another feature or part of the body after initially wanting to address a different area.
Many surgeons use screening questionnaires to help determine to what degree a patient’s concern about his appearance is impacting his life. A perception from an individual that their appearance is moderately or severely affecting their relationship with others indicates that exploration into the possibility of BDD is warranted.
More than ever, people are focused on their appearance and what they can do to help themselves feel better about their looks. The line between normal and extreme preoccupation with one’s looks is getting blurrier. However, if the question is raised about whether BDD could be the motivation for seeking cosmetic enhancement, patients should always be referred to a psychologist or behavioral therapist with experience diagnosing and treating the condition. The ability to help patients with BDD get treatment for their condition is as important to the plastic surgeon’s repertoire as their surgical skills are.
