In the past 20 years of surgical practice, few clinical issues have challenged me the way Body Dysmorphic Disorder (BDD) has. BDD is a body-image disorder characterized by persistent and intrusive preoccupations with an imagined or slight defect in one’s appearance. It is believed that 2% of the population is afflicted.

People with BDD can dislike any part of their body. In reality, a perceived defect may be only a slight imperfection or nonexistent. But for someone with BDD, the flaw is significant and prominent, often causing severe emotional distress and difficulties in daily functioning. Patients who have a tendency towards BDD are good at painting a picture of intelligence, research, and understanding. They research their procedures well and are often active participants in the treatment that is about to be offered. It is almost universal that they clearly understand the informed consent process and they verbalize their understanding of the limitations of what we can do as plastic surgeons.

Then, the sentinel event- Plastic Surgery. At this point a cascade of symptoms come about that makes interactions with these patients difficult at best. Slightest imperfections become heightened and the patient become socially reclusive and faults the procedure and us as the culprit of their “Dysmorphic” appearance. Financial issues are often brought up, and we are blamed for wasting their money.

Most of my colleagues agree that such scenario is the most challenging and can be somewhat dangerous for the patient and the practitioner’s well being.

As qualified board certified plastic surgeons we have an obligation to see patients who are there fro our advice. But, we also have a moral and clinical obligation to say “NO”. If a patient is demonstrating some of the signs and symptoms of BDD we must do whatever it takes to dissuade the patient to have any operative procedure. No amount of genuine interest for providing service, or no amount of money is worth the trouble of an irrational patient who will simply not accept the “beauty” of his or her imperfections.

I try so very hard to turn people away from my practice at the slightest hint of a tendency for BDD. As, my private practice experience is reaching its 15-year mark, and as it reaches its time tested experiential maturity, I am more inclined to err on the side of safety and will turn these patients away. It’s the right thing to do. It’s the safe thing to do.

“Have no fear of perfection – you’ll never reach it.”

Salvador Dali

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