The body dysmorphic disorder patient: to perform rhinoplasty or not?

By virtue of being a (primarily) aesthetic rather than a functional procedure, rhinoplasty is unique among rhinological operations. As such, it raises moral, philosophical and social issues that no other procedure does. The preoperative assessment of a rhinoplasty patient includes a number of considerations that are unique in this type of surgery; during the outpatient consultation, the patient’s motivation for surgery, stability and overall psychological evaluation, with a special emphasis on body dysmorphic disorder, have to be taken into consideration. Body dysmorphic disorder is a relatively common obsessive–compulsive spectrum disorder defined by a constant and impairing preoccupation with imagined or slight defects in appearance. Body dysmorphic disorder is associated with poor quality of life, extremely high rates of suicide and—following cosmetic surgery—high rates of dissatisfaction, occasionally manifesting as aggressiveness. A combination of psychological and medical management is the treatment of choice and this review aims to address the frequently controversial rhinoplasty indications for these patients.