When we look in the mirror, it is normal to want a small change here or there. Changing a hair style or trying a new makeup is an easy way to get a fresh look and feel better about ourselves. But things can get complicated when we want a permanent change in our bodies.

Most patients who have plastic surgery procedures are pleased with their new appearance and get a boost in self-esteem. Women commonly report being very satisfied with body enhancements like breast augmentation, liposuction and tummy tucks. But in a small group of patients, plastic surgery can leave them unsatisfied and looking for more procedures in a futile attempt to feel better about themselves.

Body dysmorphic disorder (BDD) is condition where small and minor (or nonexistent) imperfections are perceived as major problems causing significant distress that is out of proportion to the deformity. A person with BDD who has plastic surgery is unlikely to be happy with the result, may feel more frustration and search out another doctor for more surgery.

A new study shows that in patients seeking a rhinoplasty (reshaping of the nose), the symptoms of moderate to severe BDD is high. Patients undergoing revision rhinoplasty and with a psychiatric history are particularly at risk. Furthermore, BDD symptoms significantly reduce the quality of life and cause appearance-related disruption of everyday living.

For this reason, plastic surgeons must remain on alert when meeting patients who may have BDD since offering them a procedure is not likely to make them happy. Board Certified plastic surgeons are being educated on the possibility of encountering patients with BDD in their practice but unfortunately, a good way to screen or identify such patients before surgery does not yet exist.