Author(s)
Kyle S. Kimura MD, Ahmed El Abany MD, Ahmed S. Abdelhamid MD, Eric Wei MD, Steven Losorelli MD, Cherian Kandathil MD, Sam P. Most MD
Affiliation(s)
Stanford University;
Abstract:
Background:
Body dysmorphic disorder (BDD) is a psychiatric condition defined by an obsession with perceived defects to one’s appearance out of proportion to reality. These individuals often seek consultation for aesthetic surgery, including rhinoplasty. The body dysmorphic disorder questionnaire – aesthetic surgery (BDDQ-AS) was created to identify these patients during surgical consultation. While historically, surgery was not recommended for these patients, recent literature has suggested that certain quality of life metrics may improve in this population after surgery, making them more suitable surgical candidates.
Learning
Objectives:
Discuss rhinoplasty outcomes in patients with BDD
Study
Objectives:
Determine how rhinoplasty outcome measures differ in patients with BDD
Design Type:
Retrospective review
Methods:
Patient reported outcome measures were collected and reviewed for all patient visits at a single surgeon’s office including BDDQ-AS, Standardized Cosmesis and Health Nasal Outcomes Survey – Obstruction and Cosmesis (SCHNOS-O and SCHNOS-C), and visual analog scale – Obstruction and Cosmesis (VAS-O and VAS-C)
Results:
Twenty-nine percent of patients undergoing rhinoplasty screened positive for BDD. These patients were younger (31.5 vs 36.4, p=.035) and trended towards more likely to be male, pursue cosmetic surgery, have a reported psychiatric history, and have had previous rhinoplasty.
There was a positive correlation to SCHNOS-C, SCHNOS-5, and VAS-C scores and BDDQ-AS positivity (p<.001), with worse pre-operative scores associated with BDDQ-AS positivity.
Postoperatively the majority (83%) of patients who screened positive for BDD preoperatively had resolution with improved BDDQ-AS scores. Those that remained BDDQ-AS positive had significantly lower post-op SCHNOS-C and SCHNOS-5 scores.
Conclusions:
While previous literature has demonstrated a higher risk of dissatisfaction and a higher revision rate in patients with BDD, this study demonstrates that these patients can exhibit improvement in PROMs after rhinoplasty and should be considered potential candidates in the correct setting.