<h4 style="margin-left:0cm;text-align:justify;">Doing another surgery and body&nbsp;dysmorphic disorder: any chance to satisfy with the treatment results?</h4>&nbsp;Various studies have described patients who struggle to be satisfied with the outcome of their treatment, even when the results are objectively acceptable, as “insatiable,” “overly anxious,” “polysurgical addicts,” or “psychiatrically ill.” These terms suggest an internal or psychological issue, where patients may feel chronically dissatisfied with themselves or never good enough. Existing literature associates these insatiable patients with borderline personality organization, which is characterized by unstable and intense relationships, identity disturbances, impulsivity, difficulty with anger regulation, overdependency, and diffuse chronic anxiety. On less frequent occasions, psychological instability is linked to narcissistic personality disorder traits, where an overwhelming preoccupation with power, beauty, and specialness plays a dominant role.&nbsp;In any case, patients of this nature may struggle to accept a surgeon's refusal to perform additional procedures, may resist undergoing psychiatric evaluations, and are often inclined to consult multiple surgeons in pursuit of further treatments. It is also suggested that most of these patients suffer from comorbid body dysmorphic disorder<a href="#_ftn1">[1]</a> (BDD; also known as dysmorphophobia), which is characterized by a distressing and impairing preoccupation with a non-existent or minor flaw in appearance.&nbsp;Research has consistently shown that individuals seeking aesthetic surgery have a higher prevalence of body dysmorphic disorder compared to the general population. Several studies have found that even "moderate dysmorphophobia" is linked to adverse psychological reactions to aesthetic surgery, particularly rhinoplasty. It is also well-documented (Blackburn &amp; Blackburn, 2008; Phillips et al., 2001) that symptoms of body dysmorphic disorder often remain stable or worsen after surgery. For example, a study by Ercolani et al. (1999) found that patients with moderate dysmorphophobia maintained high scores on Neuroticism and Anxiety scales even five years after surgery.&nbsp;While some studies report positive psychological effects, such as increased extraversion after rhinoplasty, these effects are often seen as an initial euphoric response rather than a lasting personality change. Overall, this data suggests that rhinoplasty may not be an effective solution for addressing preexisting psychological problems. Therefore, patients with minimal defects and moderate dysmorphophobia should prioritize psychological preparation—either individually or with a professional—to better understand the psychological implications of their request.&nbsp;A significant issue with body dysmorphic disorder and aesthetic surgery is the progression of the disorder, which can result in the patient shifting their focus from one perceived defect to another or even developing delusional thinking. In severe cases, the perceived defect can lead to significant distress, impairment in social and occupational functioning, and, in extreme cases, suicidal ideation.&nbsp;Research has shown that body dysmorphic disorder can be effectively treated with psychotherapy, medication, or a combination of both. It is well-established that combining Cognitive Behavioral Therapy (CBT) with selective serotonin reuptake inhibitors (SSRIs) is more effective in treating BDD than using either treatment alone.&nbsp;There is another category of insatiable patients referred to as "overly anxious patients." In the context of aesthetic surgery, anxiety is very common and can be heightened due to the fear of possible complications and concerns that the results may not meet expectations for their desired self-image. A study by Rankin and Borah (1997) documented instances of panic attacks and post-traumatic stress disorder related to intraoperative and postoperative anxiety. Special attention should also be given to victims of sexual abuse, as they may perceive the surgeon as a potential abuser and experience retraumatization if inappropriate behavioral cues are made.&nbsp;Thus, any form of psychopathology in the presurgical period can be linked to psychological decompensation post-surgery, leading to significant personal deterioration, adaptation challenges, and communication problems with the surgeon and healthcare staff. This is because patients with psychological issues often seek aesthetic surgery not to look better, but to feel better, which is an inappropriate expectation for surgical intervention.&nbsp;Overall, for patients with serious internal and external issues, achieving a positive outcome from surgical changes may be difficult. A stable psychological state is closely tied to existing psychological structures, and surgery will not help build the necessary psychological foundations or regulate critical psychological assets such as self-esteem or self-worth. This can result in severe disappointments, depression, social isolation, repeated surgical attempts, or even legal actions.&nbsp;<h4 style="text-align:justify;">How to self-recognize existing body dysmorphic disorder</h4>&nbsp;To self-assess whether you may have body dysmorphic disorder, consider asking yourself the following questions:&nbsp;<ul><li style="text-align:justify;">How much time do I spend each day worrying about my appearance?</li><li style="text-align:justify;">Do I view my appearance as problematic?</li><li style="text-align:justify;">How much distress do I experience over the perceived appearance flaw?</li><li style="text-align:justify;">Is this concern about my appearance affecting my behavior or social functioning?</li></ul>&nbsp;If you find yourself excessively focused on a perceived appearance issue (thinking about it for more than an hour per day), and this worry leads to significant distress or impairs your psychosocial functioning, body dysmorphic disorder might be present. In this case, it's important to understand that psychiatric or psychotherapeutic treatments for this disorder can be highly effective and provide long-lasting relief. Instead of seeking unnecessary surgical solutions, it’s recommended to seek professional psychiatric or psychotherapeutic help.&nbsp;References&nbsp;Blackburn, V. F., &amp; Blackburn, A. V. (2008). Taking a history in aesthetic surgery: SAGA–the surgeon's tool for patient selection.&nbsp;Journal of plastic, reconstructive &amp; aesthetic surgery,&nbsp;61(7), 723-729.&nbsp;Ercolani, M., Baldaro, B., Rossi, N., &amp; Trombini, G. (1999).&nbsp;Five-year follow-up of cosmetic rhinoplasty.&nbsp;Journal of psychosomatic Research,&nbsp;47(3), 283-286.&nbsp;Phillips, K. A., Grant, J., Siniscalchi, J., &amp; Albertini, R. S. (2001).&nbsp;Surgical and nonpsychiatric medical treatment of patients with body dysmorphic disorder.&nbsp;Psychosomatics,&nbsp;42(6), 504-510.&nbsp;Rankin, M., &amp; Borah, G. L. (1997). Anxiety disorders in plastic surgery.&nbsp;Plastic and reconstructive surgery,&nbsp;100(2), 535-542. &nbsp;<hr><a href="#_ftnref1">[1]</a>&nbsp;Body dysmorphophobia entails features as frequent mirror checking, excessive hair care, trying to hide perceived defect and comparing the defectedness with others. Body dysmorphophobia is often associated with depression, obsessive-compulsive disorder, social avoidance and isolation, low self-esteem, introversion, feelings of inadequacy and shame, avoidant personality disorder, and dysfunctional interpersonal relationships.

<span style="color:rgb(64,64,64);font-family:Inter, system-ui, -apple-system, &quot;system-ui&quot;, &quot;Segoe UI&quot;, Roboto, &quot;Noto Sans&quot;, Ubuntu, Cantarell, &quot;Helvetica Neue&quot;, Oxygen, &quot;Open Sans&quot;, sans-serif;">Explore the link between Body Dysmorphic Disorder (BDD) and aesthetic surgery. Learn why some patients struggle with satisfaction, the psychological risks of repeated procedures, and how therapy can offer lasting relief. Essential reading for plastic surgery patients.

Body Dysmorphic Disorder and Aesthetic Surgery: Understanding the Psychological Challenges and Treatment Implications

Explore the link between Body Dysmorphic Disorder (BDD) and aesthetic surgery. Learn why some patients struggle with satisfaction, the psychological risks of re

Body Dysmorphic Disorder and Aesthetic Surgery: Understanding the Psychological Challenges and Treatment Implications author: Neringa Bagdonaite, Medical Psychologist. Explore the link between Body Dysmorphic Disorder (BDD) and aesthetic surgery. Learn why some patients struggle with satisfaction, the psychological risks of re

Body Dysmorphic Disorder and Aesthetic Surgery: Understanding the Psychological Challenges and Treatment Implications

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