Most people looking to get a nose job, or rhinoplasty, hope for a better-looking nose, but a new study found that 33 percent of them show signs of body dysmorphic disorder, or BDD, a chronic mental illness characterized by excessive worry over appearance that interferes with daily life. The condition does not improve after plastic surgery, and oftentimes, symptoms worsen post-surgery.
The study, published in the journal Plastic and Reconstructive Surgery, surveyed more than 250 Belgian patients seeking plastic surgery to improve the appearance of their nose. Researchers found that one-third of those patients had moderate to severe symptoms of BDD.
Symptoms of BDD include extreme self-consciousness, excessive grooming, frequent examination in the mirror or avoiding mirrors all together and steering clear of social situations because of one's appearance.
"This study shows that the prevalence of BDD symptoms in a cosmetic rhinoplasty population is high and that the severity of symptoms has a clearly negative effect on daily functioning," the authors concluded.
People who already had one nose job and sought a second one were even more likely to have self-image issues. Also of note, the shape of a person's nose did not relate to the severity of BDD symptoms.
"Almost everybody is going to have some degree of unhappiness with their appearance, but when concern becomes excessive and interferes with day-to-day functioning, where the person can't stop thinking about it, that's when we start to worry about body dysmorphic disorder," said David B. Sarwer, a Philadelphia-based psychologist who wrote an editorial about the study.
"When somebody comes in, especially for a nose, it's important to ask that patient about their psychological history," said Dr. Malcolm Roth, director of plastic surgery at Maimonides Medical Center in Brooklyn.
Roth said rhinoplasty is the most difficult plastic surgery procedure to perform, but along with the procedure's complexity, the nose also holds importance for another reason.
"When you look in the mirror, it's the first thing you see," said Roth. "If someone is unhappy with aspects of their current life situation, the nose is often the first thing they're going to see and they may blame the nose for their having social or work issues."
Experts say the study highlights the need to be particularly aware of this psychological condition during the screening and consultation.
"It's important to express to the patient that this is a significant change and a serious decision," continued Roth. "Sometimes it's appropriate to suggest that the patient speak with a psychologist to discuss what exactly it is they want and why they want it."
And if doctors find that a patient shows too many symptoms of BDD to follow through with the procedure, Roth said, "I always tell surgeons, you never regret the operations you didn't do."
American Society of Plastic Surgeons President Dr. Phillip Haeck said he was confident that board certified surgeons screened patients thoroughly, but it's the thousands of noncertified surgeons who still offer the same services that he worries about.
"Hopefully board certified surgeons are perceptive enough to turn these people down for surgery, but there are a lot of people who are not board certified, and my concern is that these people will shop around until someone will do their surgery," said Haeck. "The lesson here is for plastic surgeons to remember to say 'no.'"