July 28, 2011 -- A third of patients seeking cosmetic surgery to improve their nose have at least moderate symptoms of a mental disorder that makes them preoccupied with imagined or slight defects in appearance, a study shows.
The mental disorder is called body dysmorphic disorder (BDD).
In previous studies, up to 10% of nose job patients were found to have the problem, says Peter W. Hellings, MD, PhD, associate professor of otorhinolaryngology at University Hospitals Leuven in Belgium.
"It's higher than we thought," he tells WebMD. "We found 40% had some BDD symptoms, but 33% had at least moderate symptoms of BDD."
"They have symptoms, but not the full diagnosis," he says. "I would say half of them have the full disorder."
The study is published in Plastic and Reconstructive Surgery.
More than 252,000 nose-reshaping surgeries (rhinoplasties) were done in the U.S. in 2010, according to the American Society of Plastic Surgeons. Up to 3% of the population is thought to have BDD.
Nose Jobs and Mental Health
Hellings evaluated 226 patients who sought nose-reshaping surgery; 147 had the surgery for aesthetic reasons and 79 for functional problems. These patients were compared to 65 patients who came to the clinic because of general ear, nose, or throat problems.
Hellings gave everyone standard questionnaires to screen for BDD. Independent observers also evaluated the noses of the patients.
In those who got the surgery mainly or only for functional reasons, only 12% had moderate symptoms of BDD, compared to the overall 33% who had moderate symptoms.
When Hellings looked at only the aesthetic group, he found 43% had at least moderate BDD symptoms.
In the comparison group, only 2% had moderate symptoms.
Risk of Dissatisfaction With Surgery
Patients who have rhinoplasty are often less satisfied, in general, than those who have other cosmetic procedures, Hellings tells WebMD.
That is partially explained by the fact that the nose is so visible and important for what he calls ''facial harmony."
When a patient had BDD symptoms, he says, and asks for nose-revision surgery, the danger is that they will not only be dissatisfied but even more distressed about their body if they have the surgery.
"Whenever we do surgery in patients with BDD, they are not only dissatisfied with the results, but their quality of life deteriorates," he tells WebMD.
Doctors need to screen carefully their patients for BDD, he says.
The high percentage of BDD symptoms in nose job patients is not surprising to Arie Winograd, LMFT, a psychotherapist and director of the Los Angeles Body Dysmorphic Disorder & Body Image Clinic.
He reviewed the findings for WebMD but was not involved in the study.
"If someone wants to get rhinoplasty, chances are something is going on psychologically," he says.
He suspects the percent may be even higher than what Hellings found. Some who say they are seeking the surgery for functional reasons, he says, may actually have BDD symptoms.
However, he says, it's important to point out that "just because someone has BDD doesn't mean they get a cosmetic surgery."
In caring for BDD patients who do seek cosmetic surgery, he often suggests they delay the decision. "All I can do is educate them that perhaps right now isn't the time to make that decision," he says. He urges them to continue treatment for the BDD. Often, he finds, when they do that and feel better about their body image, they drop the idea of surgery.