1
|
Mandavia R, D'Souza H, Rupasinghe T, Cariati M, Mandavia T. An Evidence-based Pathway for Body Dysmorphic Disorder in Facial Aesthetics. Facial Plast Surg 2024; 40:581-590. [PMID: 38216141 DOI: 10.1055/a-2244-1066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
Aesthetic procedures should be avoided in patients with body dysmorphic disorder (BDD) since they can negatively impact mental health and lead to further aesthetic dissatisfaction. There are no evidence-based patient pathways for BDD in facial aesthetics which can result in the failure to identify patients with BDD, leading to unsuitable treatments and suboptimal patient care. We aim to construct the first evidence-based patient pathway for BDD in surgical and nonsurgical facial aesthetics. A systematic review was performed and articles that discussed screening or patient pathways for BDD in field of facial aesthetics were included. We extracted relevant information from each article on screening tools and pathways for BDD. Data were synthesized by summarizing the data under column headings into a structured narrative and into new tables. Based on this synthesis, a practical pathway for BDD was constructed. Forty articles fulfilled the criteria for inclusion. Twenty-eight BDD screening tools were discussed in the included articles, and we provide an overview of these tools. Thirty-one articles discussed patient pathways for BDD, and we synthesized this information into a structured narrative. Combining these findings, we present an evidence-based patient pathway for BDD for patients presenting for facial aesthetic treatments. This systematic review has resulted in the first, evidence-based, patient pathway for BDD in surgical and nonsurgical facial aesthetics. This practical pathway can be used by aesthetic clinicians to identify patients with potential BDD and provide clear guidance for managing cases where BDD is suspected. It will help reduce the number of facial aesthetic procedures performed on patients with BDD, safeguard patient mental well-being, and prevent further aesthetic dissatisfaction.
Collapse
Affiliation(s)
- Rishi Mandavia
- Drs Tatiana+Rishi Advanced Aesthetics, Non-Surgical Aesthetics, London, United Kingdom
| | - Hanna D'Souza
- King's College London, School of Medicine, London, United Kingdom
| | - Thiara Rupasinghe
- University College London, School of Medicine, London, United Kingdom
| | - Massimiliano Cariati
- Drs Tatiana+Rishi Advanced Aesthetics, Non-Surgical Aesthetics, London, United Kingdom
| | - Tatiana Mandavia
- Drs Tatiana+Rishi Advanced Aesthetics, Non-Surgical Aesthetics, London, United Kingdom
| |
Collapse
|
2
|
Shandilya M, Bourke S, Shandilya A. Surgical Rhinoplasty in Mild Forms of Body Dysmorphic Disorder: Safety, Protocols, and Long-Term Outcomes. Facial Plast Surg 2024; 40:565-570. [PMID: 38336001 DOI: 10.1055/s-0044-1779627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024] Open
Abstract
Body dysmorphic disorder (BDD) is an obsessive-compulsive disorder concerning body image which negatively distorts the patient's perception of their appearance. In rhinoplasty, surgery on patients with severe BDD is considered contraindicated as patients are often dissatisfied and their BDD symptoms rarely improve. For patients with borderline to mild BDD, however, there has been some preliminary evidence to show that they can benefit from surgical rhinoplasty. In our first article on this series of BDD in rhinoplasty, we presented our two-specialist protocol using mandatory psychiatric evaluation (MPE) to assess patient's suitability. In this present article, we used this protocol to identify a group of borderline to mild BDD patients, performed surgical rhinoplasty on this group, and evaluated the outcome using a visual analog scale (VAS) and a five-point Likert scale. From 2010 to 2023, 1,602 patients attended our practice seeking cosmetic rhinoplasty, out of which, 892 were sent for MPE to the same psychiatrist. The MPE identified 2.5% (22/892) patients as having mild BDD, out of which, 15 were considered suitable for surgical intervention and underwent successful rhinoplasty (follow-up 6-95 months, M = 54.13 months). Five of 15 patients scored 10/10 on the VAS and were very happy, 8 of 15 patients scored 7 to 9/10 on the VAS and were happy, and 2 of 15 patients scored 6/10 on the VAS but were still happy. Although all patients were happier, 3 of 15 patients requested revision rhinoplasty which was not offered as was planned and discussed before the initial intervention. This study shows that in the presence of safe protocols, including a two-specialist model, safe outcomes can be expected even in the long term. Further, the request for revision surgery appears to be common in borderline to mild BDD cases, and we like to warn the patients against it before surgery.
Collapse
Affiliation(s)
- Munish Shandilya
- Department of Otolaryngology, UPMC Whitfield Hospital, Waterford, Ireland
- Department of Otolaryngology, Bon Secours Hospital, Dublin, Ireland
- Department of Otolaryngology, Blackrock Clinic, Dublin, Ireland
| | - Stephanie Bourke
- Department of Adult Psychiatry, Blackrock Clinic, Dublin, Ireland
| | - Avi Shandilya
- Department of Psychology, School of Psychology, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
3
|
Kim M, Matros E, Boe LA, Stern CS, Mehrara BJ, Allen RJ, Nelson JA. Predicting Postoperative Satisfaction with Breasts: How Important is the Preoperative BREAST-Q Score? Ann Surg Oncol 2024; 31:6602-6610. [PMID: 39090496 DOI: 10.1245/s10434-024-15310-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/02/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND The role that preoperative Satisfaction with Breast plays in a patient's postoperative course after postmastectomy breast reconstruction (PMBR) is not understood. The aim of this study is to understand the impact of the preoperative score on postoperative outcome as an independent variable. METHODS We examined patients who underwent PMBR between 2017 and 2021 and who completed the BREAST-Q Satisfaction with Breasts at 1 year postoperatively. Two multiple linear regression models (Model 1 with the preoperative Satisfaction with Breasts score and Model 2 without the preoperative score), likelihood ratio tests, simple t-statistics, and sample patient dataset to predict the 1 year score were performed. Multiple imputation was used to account for missing preoperative scores. RESULTS Overall, 2324 patients were included. Model 1 showed that the preoperative score is significantly associated with the postoperative score (β = 0.09, 95% confidence interval 0.04-0.14; p < 0.001). Comparing Model 1 and Model 2 demonstrated that including preoperative Satisfaction with Breasts in a regression significantly improves model fit (test statistic = 10.04; p = 0.0021). Using the absolute value of the t-statistics as a measure of variable importance in linear regression, the importance of the preoperative score was quantified as 3.39-more important than neoadjuvant radiation, mastectomy weight, body mass index, bilateral prophylactic mastectomy, and race, but less than adjuvant radiation, reconstruction type, and psychiatric diagnoses. CONCLUSION Preoperative Satisfaction with Breasts scores are an important independent predictor of postoperative satisfaction after PMBR. Just as vital sign and work-up are carefully documented before surgery, preoperative scores should be collected to pre-emptively gauge patients' satisfaction and optimize postoperative outcomes.
Collapse
Affiliation(s)
- Minji Kim
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Evan Matros
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lillian A Boe
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carrie S Stern
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Babak J Mehrara
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert J Allen
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
4
|
Declau F, Pingnet L, Smolders Y, Fransen E, Verkest V. The Body Dysmorphic Disorder Questionnaire-Aesthetic Surgery: Are We Screening the Troublesome Patients? Facial Plast Surg 2024; 40:571-580. [PMID: 38198825 DOI: 10.1055/a-2241-9934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
This study aims to clarify the current concept of performing rhinoplasty in patients with possible body dysmorphic disorder (BDD). The primary objective was to investigate the validity and evolution over time of the Body Dysmorphic Disorder Questionnaire-Aesthetic Surgery (BDDQ-AS) before and after surgery. Together with the BDDQ-AS, also the Nasal Obstruction Symptom Evaluation scale, FACE-Q nose and nostrils, and Utrecht questionnaire (UQ) were used for convergent validation. In this prospective study, 187 patients completed these patient-reported outcome measures at four time points: at the preoperative consultation and postoperatively at 3, 6 and 12 months. The preoperative BDDQ-AS positivity rate was as high as 55.1%. Postoperatively, there was a highly significant decrease in the odds of scoring positive on the BDDQ-AS. At the preoperative consultation, positively screened patients were less satisfied with the esthetics of their noses with worse scores on UQ, FACE-Q nose, and visual analog scale. The preoperative differences in outcome measure ratings disappeared postoperatively, except for the FACE-Q nostrils, which surprisingly showed better values in BDDQ-AS positive patients. Younger age and absence of nasal trauma were statistically significant covariates associated with positive BDDQ-AS screening. Due to the overwhelming decrease in positive BDDQ-AS outcomes after surgery, a positive screening result on the BDDQ-AS should not be interpreted as a formal contraindication for surgery. Collaboration with psychologists or psychiatrists remains crucial to diagnose BDD conclusively.
Collapse
Affiliation(s)
- Frank Declau
- Department of ENT, Head and Neck Surgery, GZA-ziekenhuizen, Campus Sint-Vincentius, Antwerp, Belgium
- Department of ENT, Head and Neck Surgery, Antwerp University School of Medicine and Health Sciences, Antwerp, Belgium
| | - Laura Pingnet
- Department of ENT, Head and Neck Surgery, Antwerp University School of Medicine and Health Sciences, Antwerp, Belgium
| | - Yannick Smolders
- Department of ENT, Head and Neck Surgery, Antwerp University School of Medicine and Health Sciences, Antwerp, Belgium
| | - Erik Fransen
- Centre of Medical Genetics, University of Antwerp, and Antwerp University Hospital, Edegem, Belgium
| | - Valérie Verkest
- Department of ENT, Head and Neck Surgery, GZA-ziekenhuizen, Campus Sint-Vincentius, Antwerp, Belgium
- Department of ENT, Head and Neck Surgery, Antwerp University School of Medicine and Health Sciences, Antwerp, Belgium
| |
Collapse
|
5
|
Hohenberger R, Baumann I, Riedel F, Plinkert PK, Bulut OC. Impact of Psychiatric Symptoms on Nasal Perception in Septorhinoplasty Patients. Facial Plast Surg 2024; 40:560-564. [PMID: 38196074 DOI: 10.1055/a-2240-8943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
Psychological assessment plays a crucial role in the preoperative phase of septorhinoplasty (SRPL), exerting potential influence on both pre- and postoperative aspects of quality of life (QoL). In this prospective study, SRPL patients were systematically screened using two validated questionnaires for body dysmorphic disorder (BDD) and one each for anxiety, depression, and somatic symptom disorder (SSD). Nasal perception was evaluated utilizing two disease-specific, self-report instruments: The Rhinoplasty Outcomes Evaluation (ROE) and the Functional Rhinoplasty Outcome Inventory-17 (FROI-17). A total of 95 patients were enrolled. Positive screening rates were 40.4 and 28.3% for BDD, 37.3% for elevated anxiety, 16.4% for depression, and 22.4% for SSD. Mean scores on the ROE and FROI indicated lower QoL in all positive screening groups. Statistically significant differences were observed for anxiety (FROI total score: 47.1 ± 14.6 to 37.8 ± 16.2; p = 0.021) and BDD (ROE: 43.7 ± 15.7 to 32.5 ± 15.5; p = 0.003 and FROI total score: 47.4 ± 15.3 to 37.8 ± 17.1; p = 0.014). The Hospital Anxiety and Depression Scale exhibited a significant correlation with the preoperative FROI score (r = 0.34, p = 0.005). Patients with positive screenings for depression, anxiety, BDD, and SSD demonstrated compromised QoL during preoperative assessments compared with their negative counterparts, reflecting diminished nasal perception in both esthetic and functional dimensions. Surgeons must be cognizant of these psychological aspects during preoperative evaluations.
Collapse
Affiliation(s)
- Ralph Hohenberger
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Ingo Baumann
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Peter K Plinkert
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | | |
Collapse
|
6
|
Motoki THC, Silva EN, Isoldi FC, Ferreira LM. Self-image, self-esteem, anxiety, and functional capacity in patients undergoing open-structure rhinoplasty. J Plast Reconstr Aesthet Surg 2024; 99:88-95. [PMID: 39357139 DOI: 10.1016/j.bjps.2024.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 06/27/2024] [Accepted: 09/01/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND Rhinoplasty may improve negative psychological aspects, such as mild to moderate body dysmorphic disorder; however, the repercussions on the self-image and quality of life of patients after the procedure are unknown. OBJECTIVE To evaluate self-image, self-esteem, anxiety, and functional capacity of patients undergoing open-structure rhinoplasty. METHODS A primary, analytical, clinical, longitudinal, and prospective study was conducted, which included 30 female patients, aged between 18 and 50 years with elongated nose and nasal hump, who underwent open and structured rhinoplasty. All procedures were performed by a team from the Rhinology DCP/Unifesp. The Rosenberg Self-Esteem Scale - EPM, BDSS, BDD-YBOCS, SF-36, SRQ-20, and STAI (T/E) questionnaires were administered before the surgery and at 6, 12, and 18 months after surgery. RESULTS The results showed statistically significant differences in the Rosenberg scale - EPM (p = 0.017), BDSS (p < 0.001), BDD (p = 0.006), SF-36 (p = 0.041), SRQ-20 (p = 0.012), and STAI-T (p = 0.001) scores in general analyses. Additionally, the statistically significant changes persisted in various stratified postoperative periods. In the qualitative analysis, there was only statistical significance for the classification of the BDSS score, where the "Absent" (absence of body dysmorphism) index increased from 70.0% in the preoperative state to 96.7% in 18 months postoperatively. The "Present" (presence of body dysmorphism) index fell from 30.0% to 3.3% in the same period (p = 0.001). CONCLUSION Open-structure rhinoplasty improved the patients' self-image, self-esteem, anxiety, and mental health.
Collapse
Affiliation(s)
- Thamy Harumi Cardoso Motoki
- Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Eduardo Nascimento Silva
- Division of Plastic Surgery, Department of Surgery, Universidade Estadual de Ponta Grossa, Paraná, PR, Brazil
| | - Felipe Contoli Isoldi
- Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Lydia Masako Ferreira
- Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
7
|
Cazzato V, Ellis C, Makris S. 'Magic cosmetic fillers': Appearance-enhancement effects on self-face recognition. PLoS One 2024; 19:e0305580. [PMID: 38870257 PMCID: PMC11175468 DOI: 10.1371/journal.pone.0305580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/31/2024] [Indexed: 06/15/2024] Open
Abstract
People naturally exhibit a self-serving bias which can be observed in their tendency to judge their own physical attractiveness more favourably than that of others. Despite this positive self-perception, minimally invasive cosmetic injectable procedures for facial rejuvenation and enhancement are becoming increasingly common. It remains unclear, however, whether recognizing an altered version of one's own face, enhanced cosmetically, correlates with a positive view of cosmetic surgery and excessive preoccupations about physical characteristics perceived as defects (body dysmorphic concerns). In this study, 30 healthy female participants, aged 18-24 years (Mage = 21.1 years, SD = 1.6), engaged in a face recognition task during which their faces were digitally morphed with that of gender-matched unfamiliar women who had undergone cosmetic enhancements, specifically lip and cheek fillers. The duration of exposure to these modified faces varied with short (500 msec) and long (2000 msec) viewing periods. Participants were asked to identify whether the digital morphs represented themselves or the other woman. Self-reports regarding acceptance of cosmetic surgery and dysmorphic concerns were collected. Participants PSE indicated a tendency towards self-bias under short presentation times, shifting towards the other as presentation times lengthened. Interestingly, this effect was associated with greater acceptance of cosmetic surgery and higher body dysmorphic concerns. This study underscores the importance of understanding how perceptions of others' physical appearances can influence self-recognition and attitudes towards cosmetic surgery, which may have both positive and potentially harmful implications.
Collapse
Affiliation(s)
- Valentina Cazzato
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
- Department of Cognitive Sciences, Psychology, Education and Cultural Studies, University of Messina, Messina, Messina, Italy
| | - Charlotte Ellis
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Stergios Makris
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
- Arts and Wellbeing Research Centre, Edge Hill University, Ormskirk, United Kingdom
| |
Collapse
|
8
|
AlAwadh I, Bogari A, Azhar T, AlTaylouni N, AlSughier N, AlKarzae M, AlQuniabut I, AlDosari B. Prevalence of Body Dysmorphic Disorder Among Rhinoplasty Candidates: A Systematic Review. EAR, NOSE & THROAT JOURNAL 2024; 103:377-383. [PMID: 34789021 DOI: 10.1177/01455613211056543] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Body dysmorphic disorder (BDD) represents a bridge between the fields of psychiatry and cosmetic surgery. It is a psychiatric disorder involving altered body image and has been associated with cosmetic surgery. Many studies have investigated BDD following rhinoplasty. However, their findings were inconsistent, which prompted us to conduct this systematic review to obtain strong evidence about the prevalence of BDD among rhinoplasty candidates. METHODS We searched the literature using electronic databases such as PubMed, Scopus, Web of Science, and others using keywords relevant to the study outcomes. We also manually examined the references of the included studies and relevant reviews to look for articles that might have been missed during the electronic search. RESULTS Nine articles met the inclusion criteria. We identified 7 other relevant articles; since they had been included in a review conducted in 2016, they were not included in the final list of articles. However, they were included in the discussion, and their findings have been compared with ours. The included articles resulted in a total sample of 712 rhinoplasty candidates. The estimated prevalence rates of BDD in these articles ranged from 22% to 52%, which was considered high by all the authors of the included studies. CONCLUSION The prevalence of BDD among rhinoplasty candidates is high, and adequate management and interventions are needed to reduce it.
Collapse
Affiliation(s)
- Ibrahim AlAwadh
- Otolaryngology and Head and Neck, Facial Plastic, Ministry of Health & King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Bogari
- Otolaryngology and Head and Neck Resident, Ministry of Health, Riyadh, Saudi Arabia
| | - Turki Azhar
- College of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Nada AlTaylouni
- College of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Naif AlSughier
- Department of Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia
| | - Mohammed AlKarzae
- Otolaryngology and Head and Neck-Facial Plastic, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Ibrahim AlQuniabut
- Department of Surgery, Unaizah College of Medicine and Medical Sciences, Qassim University, Kingdom of Saudi Arabia
| | - Badi AlDosari
- Otolaryngology and Head and Neck-Facial Plastic, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
9
|
Bafaqeeh SA, Bayar Muluk N, Öztürk Z, Oğuz O, Altiner Hİ, Cingi C. Comparison of 1 Year Nasal Tip Projection Results of Triple Cartilage Combining Suture (Flexible Tongue-in-Groove) and Classical Tongue-in-Groove Techniques. EAR, NOSE & THROAT JOURNAL 2024:1455613241255997. [PMID: 38783595 DOI: 10.1177/01455613241255997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Objectives: In the present study, we compared patient satisfaction with classical tongue-in-groove (TIG) technique and triple cartilage combining suture (TCCS; flexible tongue-in-groove) techniques applied to the nasal tip in rhinoplasty. Methods: In this retrospective study, 80 patients who underwent rhinoplasty operations with TIG or TCCS techniques applied to the tip region were included. There were 40 patients in both groups. All patients in groups 1 and 2 were evaluated by the criteria written below at preoperative, postoperative first month, and postoperative first year: (1) Rhinoplasty Outcomes Evaluation Questionnaire (ROE), (2) tip projection (cm), (3) nasal dorsum length (cm), (4) tip projection ratio (Goode), (5) nasofrontal angle, and (6) nasolabial angle. Results: The patients were followed up at 84.32 ± 19.38 months in the TIG group and 87.47 ± 18.01 months in the TCCS group. Our results showed that preoperative, postoperative first-month, and first-year tip projection (P = .013, P = .022, and P = .020, respectively), and nasal dorsum length values (P = .009, P = .020, and P = .020, respectively) of the TCCS group were significantly lower than those in the TIG group. There was a positive correlation between the postoperative first month and postoperative first year ROE scores. Lower preoperative tip projection ratio (Goode) values and higher nasolabial angle values were related to higher ROE scores showing patient satisfaction. Conclusion: For the patient satisfaction after tip rhinoplasty, lower projection ratio (Goode) and higher nasolabial angle values were related to ROE scores. Although there are no significant results, lower tip projection results in the TCCS group may be related to more patient satisfaction due to natural appearance.
Collapse
Affiliation(s)
- Sameer Ali Bafaqeeh
- College of Medicine, Otolaryngology Department, King Saud University, Riyadh, Saudi Arabia
| | - Nuray Bayar Muluk
- Faculty of Medicine, Department of Otorhinolaryngology, Kirikkale University, Kirikkale, Turkey
| | - Zeynel Öztürk
- Faculty of Medicine, Department of Otorhinolaryngology, Istanbul Nişantaşı University; and Baypark Hospital, Otolaryngology Clinics, Istanbul, Turkey
| | - Oğuzhan Oğuz
- Health Services Vocational School, Department of Audiology, Istanbul Nişantaşı University, Istanbul, Turkey
- Dr. Oğuzhan Oğuz Wellnose Clinic, Istanbul, Turkey
| | - Halil İbrahim Altiner
- Department of Otorhinolaryngology, Bilecik Training and Research Hospital, Bilecik, Türkiye
| | - Cemal Cingi
- Medical Faculty, Department of Otorhinolaryngology, Eskisehir Osmangazi University, Eskisehir, Turkey
| |
Collapse
|
10
|
Hohenberger R, Endres P, Salzmann I, Plinkert PK, Wallner F, Baumann I, Alt J, Riedel F, Lippert BM, Bulut OC. Quality of Life and Screening on Body Dysmorphic Disorder, Depression, Anxiety in Septorhinoplasty. Laryngoscope 2024; 134:2187-2193. [PMID: 38050954 DOI: 10.1002/lary.31212] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/10/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVES Septorhinoplasty (SRPL) can improve quality of life (QoL) in functional and aesthetical aspects of the nose. A key factor compromising postoperative satisfaction is symptoms of body dysmorphic disorder (BDD), defined by excessive concerns and distress over slight or imagined physical defects. Although a high prevalence of BDD in SRPL patients is evident, the effect of positive screening on BDD and other psychiatric disorders is understudied. It was hypothesized that patients screening positive for BDD, depression or anxiety do not show increased postoperative QoL. METHODS A multicenter, prospective study including 259 patients. For psychiatric evaluation, the BDD concern questionnaire-aesthetic version and the Hospital Anxiety and Depression Scale were used; for disease-specific QoL the Rhinoplasty Outcomes Evaluation (ROE) and the Functional Rhinoplasty Outcome Inventory (FROI-17). RESULTS In preoperative evaluation, 32.5% had a positive screening for BDD, 42.2% for increased anxiety, and 32.9% for depression. Mean QoL improved in the whole cohort (FROI total score: 54.4 ± 21.8 to 32.8 ± 23.7 and ROE: 32.3 ± 15.6 to 69.8 ± 23.1, both p < 0.001). Patients screening positive for BDD, depression or anxiety did show an increased postoperative QoL, but to a significantly lower degree and with lower pre- and postoperative QoL levels. CONCLUSIONS SRPL patients show a high prevalence of BDD symptoms, elevated anxiety, and depression. These subgroups show lower QoL levels and an impaired QoL increase after surgery. Rhinoplasty surgeons must be aware of the disorders and their symptoms, discuss potential concerns with the patients, and potentially refer them to a specialist. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2187-2193, 2024.
Collapse
Affiliation(s)
- Ralph Hohenberger
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Philipp Endres
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Irina Salzmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter K Plinkert
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Frank Wallner
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Ingo Baumann
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Janes Alt
- Department of Otorhinolaryngology, Head and Neck Surgery, SLK Kliniken, Heilbronn, Germany
| | | | - Burkard M Lippert
- Department of Otorhinolaryngology, Head and Neck Surgery, SLK Kliniken, Heilbronn, Germany
| | - Olcay Cem Bulut
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, SLK Kliniken, Heilbronn, Germany
- HNO-Zentrum Rhein-Neckar, Mannheim, Germany
| |
Collapse
|
11
|
Moosaie F, Javankiani S, Mansournia MA, Rahavi S, Najeeb ZJ, Mohammadi S, Saedi B. Comparison of Aesthetic and Functional Rhinoplasty Outcomes Between Patients with Body Dysmorphic Disorder and Normal Individuals. Aesthetic Plast Surg 2024:10.1007/s00266-024-03961-y. [PMID: 38575764 DOI: 10.1007/s00266-024-03961-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/16/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Rhinoplasty is among the top five most popular cosmetic surgical procedures worldwide. Among rhinoplasty candidates, the most common mental health disorder is body dysmorphic disorder. (BDD). The present study aimed to assess the prevalence of BDD among rhinoplasty candidates, its association with the patient's self-assessment of aesthetic outcome and nasal functional, post-rhinoplasty compared to applicants with negative screening for BDD. METHODS The following study is a cross-sectional, comparative study. Out of the 209 rhinoplasty candidates screened by the BDDQ questionnaire, 39 were positive for BDD. From the remaining 170 patients who screened negative for BDD, 39 participants were randomly selected as the control group for the comparative analysis. Rhinoplasty outcome evaluation (ROE) and standardized cosmesis and health nasal outcomes survey-cosmetic (SCHNOS-C) questionnaires were used for assessment of patient satisfaction with the cosmetic outcome of rhinoplasty. Nasal obstruction symptom evaluation (NOSE) and standardized cosmesis and health nasal outcomes survey-obstruction (SCHNOS-O) were used for the assessment of satisfaction with functional outcomes between groups of patients screened positive and negative for BDD. RESULTS The prevalence of BDD was 18.66% among rhinoplasty candidates. The average age of patients screened positive for BDD was 31.41. The mean ROE score was significantly lower (i.e. lower satisfaction) in patients screened positive for BDD (15.69 versus 19.08, P = 0.001), regardless of confounding variables, such as age, sex, and marital status. SCHNOS-C score was higher (i.e. less satisfaction) among patients with BDD (47.01 versus 34.96, P = 0.021) and was significantly associated with higher odds of severe aesthetic concern post-rhinoplasty (OR (95%CI) = 5.000 (1.135-22.022), P = 0.033). Patients screened positive for BDD had significantly higher NOSE scores (i.e. less satisfaction with functional outcome) compared to participants negative for BDD (49.74 versus 37.82, P = 0.012). SCHNOS-O score had no significant association with BDD (P = 0.053). Furthermore, there was no significant association between BDD and NOSE or SCHNOS-O score after adjustment for the confounders. CONCLUSION Patients screened positive for BDD were significantly less satisfied with the cosmetic outcome of the rhinoplasty compared to those screened negative for BDD. Assessment of BDD among rhinoplasty candidates before surgery, could potentially be beneficial for both patients and surgeons. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Fatemeh Moosaie
- Otolaryngology Department, Tehran University of Medical Sciences, Tehran, Iran
- International Surgical Research Association (ISRA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Psychosomatic medicine research center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Dr. Qarib St, Keshavarz Blvd, Tehran, 1419733141, Iran
| | - Sepide Javankiani
- Otolaryngology Department, Tehran University of Medical Sciences, Tehran, Iran
- International Surgical Research Association (ISRA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Rahavi
- Otolaryngology Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Zainab Julia Najeeb
- International Surgical Research Association (ISRA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Sara Mohammadi
- Otolaryngology Department, Tehran University of Medical Sciences, Tehran, Iran
- International Surgical Research Association (ISRA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Babak Saedi
- Otolaryngology Department, Tehran University of Medical Sciences, Tehran, Iran.
- Psychosomatic medicine research center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Dr. Qarib St, Keshavarz Blvd, Tehran, 1419733141, Iran.
| |
Collapse
|
12
|
Yu Z, Zhang Z, Wang X, Song D, Yan Q, Sun Y, Xiong X, Meng X, Li W, Yi Z. Psychological evaluation of Asian female patients with rhinoplasty. J Plast Reconstr Aesthet Surg 2024; 88:112-118. [PMID: 37972441 DOI: 10.1016/j.bjps.2023.10.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Patients requiring plastic surgery exhibit more abnormal psychological trends (e.g., body dysmorphic disorder [BDD], depression, and anxiety) than those requiring other surgeries. However, there are only a few domestic studies on the psychological aspects of the population requiring plastic surgery. Therefore, we analyzed the psychological characteristics and psychological impact of rhinoplasty in female patients. METHODS In this study, patients were classified into 2 groups: 151 males and 60 females. The self-rating scale of body image (SSBI), self-rating anxiety scale, self-rating depression scale, and postoperative satisfaction questionnaire were used to examine the patients before and after surgery. The results were analyzed using t-test, analysis of variance, chi-square test, paired rank sum test, and Pearson correlation analysis. RESULTS The total prevalence of BDD in female patients who underwent rhinoplasty was 7.3%. The prevalence of anxiety disorders was 31.8% and that of depression was 45.0%. Female patients with BDD were more likely to exhibit depression (55.5%) and anxiety (36.4%). The SSBI score was related to marital status (p = 0.001) and history of rhinoplasty (p = 0.000). Moreover, there was a significant negative correlation between preoperative BDD score and postoperative satisfaction (r = -0.392, p = 0.002) as well as between the previous history of rhinoplasty and postoperative satisfaction (r = -0.603, p = 0.000). CONCLUSION Pathological psychologies such as anxiety, depression, and BDD are common in patients scheduled to undergo rhinoplasty, and BDD is more likely to be associated with depression. Rhinoplasty has little psychological impact on patients, i.e., it neither causes improvement nor deterioration. Female patients who have undergone rhinoplasty should be considered to a have high risk of BDD. Although the outcomes of surgery are generally quite positive, patients diagnosed with BDD are more likely to be dissatisfied.
Collapse
Affiliation(s)
- Zidi Yu
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ziwei Zhang
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiancheng Wang
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Dandan Song
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Quanding Yan
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yang Sun
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiang Xiong
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xianxi Meng
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wenbo Li
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhongjie Yi
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| |
Collapse
|
13
|
Stevens SM, Markatia ZA, Ameli K, Bayaraa E, Lee WW. Prevalence of Body Dysmorphic Disorder in Orbital Plastic Surgery and Its Relationship with the Use of Social Media. Aesthetic Plast Surg 2023; 47:2447-2452. [PMID: 37464215 DOI: 10.1007/s00266-023-03483-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/21/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND The prevalence of body dysmorphic disorder (BDD) in the general population ranges from 0.7 to 2.4%; however, higher rates are seen among aesthetic patients. Given the recent rise in popularity of cosmetic surgery, particularly in the post-COVID pandemic setting, the authors hypothesize the prevalence has increased. The purpose of the study is to examine the prevalence of BDD in patients presenting to an oculoplastic surgery clinic at an academic center and determine correlation with social media use. METHODS This is a survey of patients presenting to the oculoplastic surgery clinic. Participants completed the Dysmorphic Concern Questionnaire (DCQ), in addition to survey questions about social media use. Main outcomes included a positive screen and social media use. RESULTS A total of 175 patients that presented to the oculoplastic and reconstructive surgery clinic were surveyed. All patients, including cosmetic, functional, and non-surgical, were offered participation in the survey. 9.13% of all patients screened positive for BDD. Patients that screened positive were more commonly female (71.43%). The distribution of patients with BDD was even between Hispanics (52.38%) and non-Hispanics, and 85.71% of patients with BDD were Caucasian. Of patients that screened positive, 71.43% use social media. CONCLUSIONS The prevalence of BDD may have increased in the past seven years and is seen most in females and Caucasians. There is a positive correlation with social media, which has increased in popularity since the COVID-19 pandemic. It is important to maintain a high clinical suspicion for BDD and consider screening if there is concern. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Shanlee M Stevens
- Department of Ophthalmology, Bascom Palmer Eye Institute, 900 NW 17th Street, Miami, FL, 33136, USA
| | - Zahra A Markatia
- Department of Ophthalmology, Bascom Palmer Eye Institute, 900 NW 17th Street, Miami, FL, 33136, USA
| | - Kambiz Ameli
- Department of Ophthalmology, Bascom Palmer Eye Institute, 900 NW 17th Street, Miami, FL, 33136, USA
| | - Enkhmandakh Bayaraa
- Department of Ophthalmology, Bascom Palmer Eye Institute, 900 NW 17th Street, Miami, FL, 33136, USA
| | - Wendy W Lee
- Department of Ophthalmology, Bascom Palmer Eye Institute, 900 NW 17th Street, Miami, FL, 33136, USA.
| |
Collapse
|
14
|
Wei EX, Kimura KS, Abdelhamid AS, Abany AE, Losorelli S, Green A, Kandathil CK, Most SP. Prevalence and Characteristics Associated with Positive Body Dysmorphic Disorder Screening Among Patients Presenting for Cosmetic Facial Plastic Surgery. Facial Plast Surg Aesthet Med 2023. [PMID: 37930999 DOI: 10.1089/fpsam.2023.0212] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
Background: Many patients with body dysmorphic disorder (BDD) seek out cosmetic surgery to alleviate their symptoms of distress related to a perceived defect in their appearance; however, the prevalence and risk factors for BDD among patients with cosmetic concerns have not been well characterized. Methods: We screened adult patients presenting to the clinic from June 2021 through September 2022 for BDD using the BDD Questionnaire-Aesthetic Surgery (BDDQ-AS) who were seen in consultation for rhinoplasty, aging face, and injectables. Results: Among 488 patients, the prevalence of screening positive for BDD was 41.0%. The prevalence of a positive BDD screen was highest among patients who were younger (p = 0.02), and those who had a positive self-reported psychiatric history (p = 0.02). Among rhinoplasty patients, those with aesthetic/cosmetic motivations, and those seeking revision rhinoplasty had higher rates of positive BDD screen. Higher scores on the Standardized Cosmesis and Health Nasal Outcomes Survey-Nasal Obstruction Score (SCHNOS-O) (p = 0.01) and Standardized Cosmesis and Health Nasal Outcomes Survey-Nasal Obstruction Score-Nasal Cosmesis Score (SCHNOS-C) (p < 0.0001) were predictive of a positive BDD screen, while question 5 of the SCHNOS was highly predictive of positive BDD screening (p < 0.0001). Conclusions: Our study characterizes relationships between positive BDD screening and age, gender, self-reported psychiatric history, and motivations for consultation, among patients seen for cosmetic surgery evaluation in a facial plastic and reconstructive surgery setting.
Collapse
Affiliation(s)
- Eric X Wei
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Health Care, Palo Alto, California, USA
| | - Kyle S Kimura
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Health Care, Palo Alto, California, USA
| | - Ahmed S Abdelhamid
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Health Care, Palo Alto, California, USA
| | - Ahmed El Abany
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Health Care, Palo Alto, California, USA
| | - Steven Losorelli
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Health Care, Palo Alto, California, USA
| | - Allen Green
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Health Care, Palo Alto, California, USA
| | - Cherian K Kandathil
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Health Care, Palo Alto, California, USA
| | - Sam P Most
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Health Care, Palo Alto, California, USA
| |
Collapse
|
15
|
Nabavizadeh SS, Naseri R, Sadeghi E, Afshari A, Dehdari Ebrahimi N, Sadeghi A. Prevalence of body dysmorphic disorder in rhinoplasty candidates: A systematic review and meta-analysis. Health Sci Rep 2023; 6:e1495. [PMID: 37599660 PMCID: PMC10435832 DOI: 10.1002/hsr2.1495] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/18/2023] [Accepted: 08/02/2023] [Indexed: 08/22/2023] Open
Abstract
Background Body dysmorphic disorder (BDD) is a prevalent mental disorder, particularly in those seeking plastic surgery, leading to unnecessary surgeries and postsurgical dissatisfaction. Among the plastic surgeries, rhinoplasty is the most commonly sought, yet the data on prevalence of BDD among the candidates of rhinoplasty is limited. Therefore, this systematic review and meta-analysis aimed to estimate the prevalence of BDD in rhinoplasty candidates. Methods The online libraries of Web of Science, PubMed, Cochrane Library, ProQuest, Research Square, Scopus, and Google Scholar were searched up to August 2022. Statistical analyses were performed using STATA software (v. 16). The heterogeneity was determined using the I 2 statistic, and an overall estimated analysis was conducted. Subgroup analyses were performed on study year, age, gender, World Health Organization regional classification, sociodemographic index, country, sample size, and employed diagnostic tool. A meta-regression analysis was performed to identify potential sources of heterogeneity. Results Out of 12,999 studies assessed, 18, with a combined sample size of 2132 individuals, met our criteria and were included in the study. The pooled prevalence of BDD was 32.7% (95% CI: 23.6-41.7; I 2 = 96.45%). Subgroup analyses revealed the studies that were conducted in the European region (42.8%), with a sample size of ≥100 (40.2%), utilized the BDD modification of the Y-BOCS (BDD-YBOCS) diagnostic method (47.3%), and with a quality score of ≥6 (34.2%) demonstrated higher prevalence of BDD. The meta-regression analysis identified a higher prevalence in the BDD-YBOCS diagnostic method than in the BDD questionnaire (β: 0.23; 95% CI: 0.04-0.43; p = 0.022). Conclusions The prevalence of BDD is high in those seeking rhinoplasty. Clinicians should be aware of BDD symptoms to prevent unnecessary surgery and dissatisfaction. Public awareness through the media and access to affordable medical services should also be provided.
Collapse
Affiliation(s)
- Sara S. Nabavizadeh
- Student Research Committee, School of MedicineShiraz University of Medical SciencesShirazIran
- Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
| | - Reyhaneh Naseri
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
- School of MedicineShiraz University of Medical SciencesShirazIran
| | - Erfan Sadeghi
- Research Consultation Center (RCC)Shiraz University of Medical SciencesShirazIran
| | - Aylar Afshari
- Student Research Committee, School of MedicineShiraz University of Medical SciencesShirazIran
| | | | - Alireza Sadeghi
- Transplant Research CenterShiraz University of Medical SciencesShirazIran
| |
Collapse
|
16
|
Hotton M, Cropper J, Rundle J, Crawford R. The role of the clinical psychologist within a cleft service. Br Dent J 2023; 234:887-891. [PMID: 37349436 DOI: 10.1038/s41415-023-5952-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 06/24/2023]
Abstract
Clinical psychologists are core members of UK cleft services. This paper outlines the variety of ways in which clinical psychologists work across the lifespan to promote the psychological wellbeing of those born with a cleft and their families. In the context of dental or orthodontic treatment, this involves a combination of early intervention and advice, psychological assessment or specialist psychological therapy for individuals experiencing dental anxiety or anxiety regarding the appearance of their teeth. This paper therefore aims to highlight the varying roles which clinical psychologists play in the provision of cleft-related dental care, often alongside multidisciplinary colleagues.
Collapse
Affiliation(s)
| | - Jenny Cropper
- Clinical Psychologist, Spires Cleft Centre, Oxford, UK
| | - Jen Rundle
- Clinical Psychologist, Evelina London Cleft Service, UK
| | - Rebecca Crawford
- Clinical Psychologist, National Cleft Surgical Service for Scotland, UK
| |
Collapse
|
17
|
Seekis V, Kennedy R. The impact of #beauty and #self-compassion tiktok videos on young women's appearance shame and anxiety, self-compassion, mood, and comparison processes. Body Image 2023; 45:117-125. [PMID: 36870186 DOI: 10.1016/j.bodyim.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 03/06/2023]
Abstract
This study examined the impact of exposure to beauty, self-compassion, and travel (control) TikTok videos on young women's face-related appearance shame and anxiety, self-compassion, mood, upward appearance comparisons and thoughts. Undergraduate women (N = 115) were randomly assigned to view one of three compilation TikTok videos on either beauty tips, self-compassion strategies, or travel destinations. Upward appearance comparisons and thoughts were assessed at post-test only given the items related to video exposure; all other measures were assessed at pre- and post-test. Controlling for pre-test measures, results showed that face-related appearance shame and anxiety, and negative mood were higher, whereas self-compassion was lower in the beauty group relative to the travel control and self-compassion groups. Self-compassion was higher in the self-compassion group relative to the travel control. Women in the beauty group reported more upward appearance comparisons and appearance thoughts relative to women in the travel control and self-compassion groups. The self-compassion group reported more appearance thoughts relative to the travel control. Findings contribute to prior research by showing that brief exposure to beauty TikToks may have a negative effect on how young women feel about their appearance, but also how self-compassion videos may help young women feel more compassionate toward themselves.
Collapse
Affiliation(s)
- Veya Seekis
- School of Applied Psychology, Griffith University, Australia.
| | | |
Collapse
|
18
|
Pereira IN, Chattopadhyay R, Fitzpatrick S, Nguyen S, Hassan H. Evidence-based review: Screening body dysmorphic disorder in aesthetic clinical settings. J Cosmet Dermatol 2023. [PMID: 36847707 DOI: 10.1111/jocd.15685] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/26/2022] [Accepted: 02/02/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is a psychiatric disturbance with high incidence in aesthetic clinical settings. Early recognition may avoid unnecessary elective procedures with ethical and medicolegal consequences. AIMS To identify validated BDD screening tools and critically appraise current literature regarding its implementation and efficacy in aesthetic medicine and surgery scenarios, with the purpose of transposing the findings to the broad clinical settings in the field. METHODS Data was collected using advanced search from PubMed (MEDLINE). Having satisfied the search parameters, 12 studies referring BDD definition according to Diagnostic and Statistical Manual of Mental Disorder (DSM-5) criteria and including a BDD screening tool in clinical aesthetic settings were selected. RESULTS While BDD screening enables the recognition of at-risk individuals, further work is required to uncover the best screening tool for general aesthetic clinical practice. Level III evidence favored BDD Questionnaire (BDDQ)/BDDQ-Dermatology Version (DV), and The Dysmorphic Concern Questionnaire (DCQ) among the limited available validated screening instruments to be used outside the psychiatric environment. Based on level II self-classification, one study selected BDDQ-Aesthetic Surgery (AS) version for rhinoplasty patients. The validation process of both BDDQ-AS and Cosmetic Procedure Screening Questionnaire (COPS) had limitations. For BDD screening potential in avoiding postoperative complications, the limited studies found evaluating the outcomes following aesthetic treatments using validated BDD screening measures showed a trend toward less satisfaction with aesthetic treatment outcome among positive screening population against non-BDD counterparts. CONCLUSION Further research is necessary to establish more effective methods to identify BDD and evaluate the impact of positive findings on aesthetic intervention outcomes. Future studies may elucidate which BDD characteristics best predict a favorable outcome and provide high-quality evidence for standardized protocols in research and clinical practice.
Collapse
Affiliation(s)
| | - Rashmi Chattopadhyay
- Barts & The London School of Medicine & Dentistry, Centre for Cutaneous Research, Blizard Institute of Cell and Molecular Science, Queen Mary University, London, UK
| | - Sean Fitzpatrick
- Barts & The London School of Medicine & Dentistry, Centre for Cutaneous Research, Blizard Institute of Cell and Molecular Science, Queen Mary University, London, UK
| | - Sheila Nguyen
- Barts & The London School of Medicine & Dentistry, Centre for Cutaneous Research, Blizard Institute of Cell and Molecular Science, Queen Mary University, London, UK
| | - Haidar Hassan
- Barts & The London School of Medicine & Dentistry, Centre for Cutaneous Research, Blizard Institute of Cell and Molecular Science, Queen Mary University, London, UK
| |
Collapse
|
19
|
Discrepancy of the subjective perception of the nasal appearance between independent individuals and patients undergoing functional rhinoplasty (fRPL). Eur Arch Otorhinolaryngol 2023; 280:191-197. [PMID: 35763081 PMCID: PMC9813204 DOI: 10.1007/s00405-022-07504-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/09/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE Satisfaction with the nasal appearance is a crucial outcome parameter in functional rhinoplasty (fRPL). The visual analogue scale is a suitable instrument not only for the preoperative patient assessment, but also as a patient-reported outcome measure in fRPL. In this study, we analyzed whether a high discrepancy in the preoperative subjective perception of the nasal appearance between patients and other individuals predicts a lower level of satisfaction with the postoperative result and hence a worse outcome of fRPL. METHODS Standardized facial pictures of patients (n = 80) who underwent fRPL were taken preoperatively, 3 and 12 months postoperatively. In addition, patients were asked to complete the German version of the Utrecht Outcome Assessment Questionnaire in Aesthetic Rhinoplasty (D-OAR). The standardized facial pictures of the patients were presented to surgeons as well as to examiners without a medical background, and they were asked to evaluate the patients' nasal appearance using the visual analogue scale. RESULTS The external evaluation of patient's nasal appearance was 1.7 points higher in median than the patient's subjective perception (range -5.7-7.00). A large discrepancy between self- and external estimation significantly correlates with higher D-OAR values (r = 0.539, p < 0.001). Patients with high scores in the D-OAR trick questions, indicating a body dysmorphic disorder, show a significant larger discrepancy between the external- and the self-assessment (2.8 ± 0.5 vs. 1.4 ± 0.3, mean ± SEM, p = 0.017). CONCLUSIONS Large discrepancies between the self and external assessment of the nasal appearance are associated with a high-perceived influence of the appearance of the nose on the quality of life in patients undergoing functional rhinoplasty. That might be an indicator for unrealistic expectations concerning the postoperative outcome. Knowledge about this factor helps to identify the need for intensive discussion about possibilities and limitations of the planned procedure to avoid postoperative dissatisfaction.
Collapse
|
20
|
Mascarenhas JG, de Deus MM, Kosugi EM, de C. Guimarães V. Prevalence of Body Dysmorphic Disorder and Dysmorphic Symptoms in Rhinoplasty Candidates: a Systematic Review and Meta-Analysis. TRENDS IN PSYCHOLOGY 2022. [DOI: 10.1007/s43076-022-00237-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
21
|
Lekakis G, Constantian M, Most SP, Picavet V, Hellings PW. Novel Selection Tools in Rhinoplasty Patients. Facial Plast Surg 2022; 38:447-454. [PMID: 36100246 DOI: 10.1055/s-0042-1748314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
With no consensus document or guideline to help us compute the psychological make-up of rhinoplasty candidates and in the light of new perspectives of some key opinion leaders in the field of patient selection, the goals of this article are to offer a glimpse of the current literature together with the knowledge gaps, introduce some new tools for the preoperative consultation, help us identify who among our patients is at greatest risk for a poor outcome, and explain how childhood trauma can be linked to body shame and postoperative dissatisfaction.
Collapse
Affiliation(s)
- Garyfalia Lekakis
- Department of Otorhinolaryngology Head and Neck Surgery, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium.,Department of Otorhinolaryngology Head and Neck Surgery, Hopital Moliere Longchamp, Brussel, Brussel, Belgium
| | - Mark Constantian
- Department of Surgery, University of Wisconsin-Madison Center for Health Systems Research and Analysis, Hollis, New Hampshire.,Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia
| | - Sam P Most
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California
| | - Valerie Picavet
- Department of ENT, ENT Practice Moser Gehrking Sauter and Partner, Augsburg, Germany
| | - Peter William Hellings
- Department of Otorhinolaryngology Head and Neck Surgery, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| |
Collapse
|
22
|
Seekis V, Barker G. Does #beauty have a dark side? Testing mediating pathways between engagement with beauty content on social media and cosmetic surgery consideration. Body Image 2022; 42:268-275. [PMID: 35841700 DOI: 10.1016/j.bodyim.2022.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 10/17/2022]
Abstract
Beauty content on social media has grown exponentially, however research has yet to investigate its association with appearance concerns. This study drew on components of the tripartite influence model to test the associations between young women's engagement with beauty content on social media and cosmetic surgery consideration. A sample of 399 undergraduate women aged 17-25years (Mage = 19.36) completed measures of beauty social media engagement, upward appearance comparison, general attractiveness internalization, dysmorphic appearance concerns, and consideration of cosmetic surgery. Path analysis was used to test direct and indirect associations. In line with the tripartite influence model, results supported a serial mediation model that comprised significant paths from beauty social media engagement through in turn, upward appearance comparison, general attractiveness internalization, and dysmorphic appearance concerns, to cosmetic surgery consideration. However, neither general attractiveness internalization nor dysmorphic appearance concerns mediated the link between beauty social media engagement and consideration of cosmetic surgery. Findings provide new insights into the links between engagement with the growing beauty social media trend and cosmetic surgery consideration.
Collapse
Affiliation(s)
- Veya Seekis
- School of Applied Psychology, Griffith University, Australia.
| | - Grace Barker
- School of Applied Psychology, Griffith University, Australia.
| |
Collapse
|
23
|
Pikoos TD, Rossell SL, Tzimas N, Buzwell S. Is the needle as risky as the knife? The prevalence and risks of body dysmorphic disorder in women undertaking minor cosmetic procedures. Aust N Z J Psychiatry 2021; 55:1191-1201. [PMID: 33636988 DOI: 10.1177/0004867421998753] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Body dysmorphic disorder is commonly considered a contraindication for major cosmetic surgery, but whether body dysmorphic disorder relates to poorer outcomes from minor cosmetic treatment remains unknown. This study aimed to explore the prevalence of body dysmorphic disorder in clients seeking non-surgical cosmetic procedures and to examine whether body dysmorphic disorder clients are vulnerable in minor cosmetic settings. Vulnerability was explored in terms of psychological distress, unrealistic expectations and motivations for treatment outcome, and reduced satisfaction with past cosmetic procedures. METHOD A cross-sectional online survey was completed by 154 women seeking minor cosmetic procedures which included the Body Dysmorphic Disorder Questionnaire - Dermatology Version to screen for body dysmorphic disorder, and measures of cosmetic treatment motivation, expectations and satisfaction. RESULTS Roughly 25% of women in the current sample screened positive for a potential body dysmorphic disorder diagnosis. Participants with suspected body dysmorphic disorder demonstrated higher levels of psychological distress and more unrealistic expectations and motivations for cosmetic treatment, such as improving social or romantic relationships. However, body dysmorphic disorder participants reported similar levels of satisfaction with past minor cosmetic treatments to the non-body dysmorphic disorder group. CONCLUSION While the relationship between body dysmorphic disorder and treatment outcome warrants further investigation in prospective research tracking satisfaction and adverse reactions over time, this preliminary evidence suggests clients with suspected body dysmorphic disorder display several vulnerabilities in non-surgical cosmetic settings. Given the rapidly increasing accessibility of minor cosmetic procedures, further research is needed to determine their safety for clients with body dysmorphic disorder. Detection of body dysmorphic disorder in non-surgical cosmetic settings could facilitate earlier psychological intervention, promoting superior long-term outcomes.
Collapse
Affiliation(s)
- Toni D Pikoos
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.,Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Nicky Tzimas
- Cosmetic Professional Development Institute of Australia, Melbourne, VIC, Australia
| | - Simone Buzwell
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| |
Collapse
|
24
|
Spataro EA, Olds CE, Kandathil CK, Most SP. Comparison of Reconstructive Plastic Surgery Rates and 30-Day Postoperative Complications Between Patients With and Without Psychiatric Diagnoses. Aesthet Surg J 2021; 41:NP684-NP694. [PMID: 33220052 DOI: 10.1093/asj/sjaa313] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Psychiatric comorbidity is associated with greater 30-day postoperative complication rates in various surgical specialties, but is not well characterized for reconstructive plastic surgery. OBJECTIVES The aim of this study was to compare reconstructive plastic surgery rates and 30-day postoperative complications between patients with and without psychiatric diagnoses. METHODS This was a retrospective cohort study comparing patients with and without psychiatric diagnoses. Data for January 1, 2007 to December 31, 2015 were collected from the IBM MarketScan Commercial and Medicare Supplemental Databases. Rates of reconstructive plastic surgery, demographic data, covariant diagnoses, and 30-day postoperative complications were collected. Differences between the 2 groups were assessed by multivariable logistic regression. RESULTS Among 1,019,128 patients (505,715 with psychiatric diagnoses and 513,423 without psychiatric diagnoses) assessed, reconstructive plastic surgery rates were between 4.8% and 7.0% in those with psychiatric diagnoses, compared with 1.6% in patients without psychiatric diagnoses. The greatest odds of undergoing reconstructive plastic surgery were in patients with body dysmorphic disorder (BDD) (adjusted odds ratio [aOR], 3.16; 95% confidence interval [CI], 1.76-5.67) and anxiety disorder (aOR, 3.08; 95% CI, 2.97-3.17). When assessing 1,234,206 patients (613,400 with psychiatric diagnoses and 620,806 without psychiatric diagnoses), all of whom underwent reconstructive plastic surgery, 2-fold greater odds of any 30-day postoperative complication was associated with psychiatric diagnoses (aOR, 2.01; 95% CI, 1.28-3.11), as well as greater odds of specific complications (surgical site infection, bleeding, and hospital admission). Eating disorder diagnosis was associated with the greatest odds of a complication (aOR, 4.17; 95% CI, 3.59-4.86), followed by nasal surgery (aOR, 3.65; 95% CI, 2.74-4.89), and BDD (aOR, 3.16; 95% CI, 1.76-5.67). CONCLUSIONS Diagnosis of a psychiatric condition is associated with greater rates of reconstructive plastic surgery, and 2-fold greater odds of 30-day postoperative complications. LEVEL OF EVIDENCE: 4
Collapse
Affiliation(s)
- Emily A Spataro
- Division of Facial Plastic Surgery, Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Cristen E Olds
- Division of Facial Plastic Surgery, Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Cherian K Kandathil
- Division of Facial Plastic Surgery, Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Sam P Most
- Division of Facial Plastic Surgery, Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
25
|
Spataro EA, Kandathil CK, Saltychev M, Olds CE, Most SP. Correlation of the Standardized Cosmesis and Health Nasal Outcomes Survey With Psychiatric Screening Tools. Aesthet Surg J 2020; 40:1373-1380. [PMID: 31917417 DOI: 10.1093/asj/sjaa004] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Identifying mental health disorders, including body dysmorphic disorder (BDD), is important prior to rhinoplasty surgery; however, these disorders are underdiagnosed, and screening tools are underutilized in clinical settings. OBJECTIVES The authors sought to evaluate the correlation of a rhinoplasty outcomes tool (Standardized Cosmesis and Health Nasal Outcomes Survey [SCHNOS]) with psychiatric screening tools. METHODS Patients presenting for rhinoplasty consultation were prospectively enrolled and administered mental health instruments to assess depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and BDD (BDD Questionnaire-Aesthetic Surgery [BDDQ-AS]) as well as the SCHNOS rhinoplasty outcomes scale. Convergent validity of SCHNOS scores with these mental health instruments was assessed as well as calculation of an optimal SCHNOS-C score to screen for BDD. RESULTS A total 76 patients were enrolled in the study. The average SCHNOS-O score (standard deviation) was 46.1 (34.0) and the average SCHNOS-C score was 61.1 (27.0). Five (7%) patients screened positive for depression, and 24 (32%) patients screened positive for mild, 5 (7%) for moderate, and 4 (5%) for severe anxiety. Twenty-four (32%) patients screened positive for BDD by BDDQ-AS scores. SCHNOS-O and SCHNOS-C did not correlate with Patient Health Questionnaire-9 or Generalized Anxiety Disorder-7 scores; SCHNOS-C did correlate with BDDQ-AS. A score of 73 or greater on SCHNOS-C maximized the sensitivity and specificity of also screening positive for BDD with BDDQ-AS. This score correlated with a sensitivity of 62.5%, specificity of 80.8%, and number needed to diagnose of 2.3, meaning for every 2 patients with a score of ≥73 on SCHNOS-C, 1 will have a positive BDDQ-AS score. CONCLUSIONS SCHNOS-C correlates with BDDQ-AS and may help screen rhinoplasty patients at higher risk for BDD. LEVEL OF EVIDENCE: 2
Collapse
Affiliation(s)
- Emily A Spataro
- Division of Facial Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO
| | - Cherian K Kandathil
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
| | - Mikhail Saltychev
- Department of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Cristen E Olds
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
| | - Sam P Most
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
| |
Collapse
|
26
|
Dilger AE, Sykes JM. Unhappy Patients Can Turn into Angry Patients: How to Deal with Both. Facial Plast Surg Clin North Am 2020; 28:461-468. [PMID: 33010864 DOI: 10.1016/j.fsc.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patient satisfaction is the ultimate measure of success in cosmetic facial plastic surgery. A successful outcome depends on patient selection, technical performance, and postoperative care. Patient perception can be influenced by physician-patient interactions. Surgical training focuses on diagnosis-identifying variations in physical condition and treatment. Although these skills are essential to a well-trained and successful facial plastic surgeon, the importance of proper patient selection, management of expectations, and empathetic communication in cosmetic surgery are often overlooked in education and cannot be understated. This article outlines the contributing factors to difficult physician-patient relationships and strategies for mitigating these situations.
Collapse
Affiliation(s)
- Amanda E Dilger
- Facial Plastic and Reconstructive Surgery, Beverly Hills, CA, USA; Roseville Facial Plastic Surgery, Roseville, CA, USA
| | - Jonathan M Sykes
- Facial Plastic Surgery, UC Davis Medical Center, Sacramento, CA, USA; Facial Plastic Surgery, Roxbury Institute, Beverly Hills, CA, USA.
| |
Collapse
|
27
|
Rabaioli L, Oppermann PDO, Pilati NP, Klein CFG, Bernardi BL, Migliavacca R, Lavinsky-Wolff M. Evaluation of postoperative satisfaction with rhinoseptoplasty in patients with symptoms of body dysmorphic disorder. Braz J Otorhinolaryngol 2020; 88:539-545. [PMID: 32978118 PMCID: PMC9422649 DOI: 10.1016/j.bjorl.2020.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/07/2020] [Accepted: 07/23/2020] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION The prevalence of body dysmorphic disorder among candidates for plastic surgery may vary from 6% to 54%. Some studies report discrete benefits with the surgical results, while others show symptomatic exacerbation. Some authors even affirm that body dysmorphic disorder would be a surgical contraindication, against others who suggest satisfactory results. OBJECTIVE To describe the prevalence of body dysmorphic disorder in rhinoseptoplasty candidates and to compare outcomes among patients with and without body dysmorphic disorder symptoms. METHODS Cohort study. Individuals ≥ 16 years, candidates for aesthetic and/or functional rhinoseptoplasty were recruited at a university hospital in Brazil. The prevalence of body dysmorphic disorder was assessed through the Body Dysmorphic Disorder Examination (BDDE) and the patients divided into groups: no symptoms of body dysmorphic disorder, mild-moderate and severe symptoms. The specific quality of life outcomes, Nasal Obstruction Symptom Evaluation (NOSE) and Rhinoplasty Outcome Evaluation (ROE) were evaluated before and after 90 and 180 days of the procedure. RESULTS 131 individuals were included, 59.5% female. The prevalence of preoperative symptoms of body dysmorphic disorder was 38%. There was a reduction in the symptoms of body dysmorphic disorder in the preoperative body dysmorphic disorder examination versus 3 and 6 months in all groups (78.94 ± 2.46 vs. 33.63 ± 6.41 and 35.51 ± 5.92, respectively, p < 0.002). Among patients with severe body dysmorphic disorder symptoms, rhinoplasty outcome evaluation ranged from 21.24 ± 3.88 to 58.59 ± 5.83 at 3 months and 52.02 ± 5.41 at 6 months postoperatively (p < 0.001); while NOSE from 71 ± 8.47 to 36.11 ± 12.10 at 6 months postoperatively (p < 0.01). CONCLUSION The prevalence of body dysmorphic disorder symptoms in our sample was high. Rhinoseptoplasty was associated with an improvement in quality of life outcomes related to nasal function and aesthetic outcome in all groups, irrespective of the presence and intensity of body dysmorphic disorder symptoms. Rhinoseptoplasty in body dysmorphic disorder symptomatic patients was also associated with a reduction in postoperative body dysmorphic disorder symptoms, even in severe cases.
Collapse
Affiliation(s)
- Luísi Rabaioli
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Medicina, Ciências Cirúrgicas, Porto Alegre, RS, Brazil; Hospital de Clínicas Porto Alegre (HCPA), Departamento de Otorrinolaringologia, Porto Alegre, RS, Brazil.
| | | | - Natália Paseto Pilati
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Porto Alegre, RS, Brazil
| | - Cássia Feijó Gomes Klein
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Porto Alegre, RS, Brazil
| | - Bárbara Luiza Bernardi
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Porto Alegre, RS, Brazil
| | - Raphaella Migliavacca
- Hospital de Clínicas Porto Alegre (HCPA), Departamento de Otorrinolaringologia, Porto Alegre, RS, Brazil
| | - Michelle Lavinsky-Wolff
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Medicina, Ciências Cirúrgicas, Porto Alegre, RS, Brazil; Hospital de Clínicas Porto Alegre (HCPA), Departamento de Otorrinolaringologia, Porto Alegre, RS, Brazil
| |
Collapse
|
28
|
Abstract
Body dysmorphic disorder and borderline personality disorder are common in esthetic practices and occur in up to 15% of patients. Operating on these patients may not only lead to dissatisfaction but may also worsen their premorbid condition and can induce negative behavior toward the practice. Preventing surgery and referring patients for cognitive therapy is essential. An adequate understanding of these conditions and the available screening tools is indispensable for all esthetic practitioners. Unrealistic emotional attribution to a facial shape, multiple procedures, a near-normal nose at the outset, childhood trauma, multiple comorbid mental conditions, and social dysfunction are red-flags to consider.
Collapse
|
29
|
A systematic review on the Derriford Appearance Scale (DAS) questionnaire in surgical research. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-020-01660-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
30
|
Di Rosa L, Cerulli G, De Pasquale A. Psychological Analysis of Non-surgical Rhinoplasty. Aesthetic Plast Surg 2020; 44:131-138. [PMID: 31768580 DOI: 10.1007/s00266-019-01538-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 10/31/2019] [Indexed: 11/29/2022]
Abstract
The aim of this study is to analyze the psychological outcomes for patients undergoing non-surgical correction of nasal defects using injections of cross-linked hyaluronic acid. We assessed changes in the subjective perception of nasal appearance after non-surgical rhinoplasty using the Rhinoplasty Outcomes Evaluation (ROE) questionnaire, which is validated and widely used in the literature. One hundred adult subjects without prior history of surgical or non-surgical rhinoplasty underwent non-surgical recontouring using the hyaluronic acid filler from December 2016 to December 2018. The points of inoculation have been standardized by the authors and are divided according to the aesthetic subunits of the nose. A final 74 patients (65 females and 9 males) completed a one-year follow-up and were included in the present study. The ROE questionnaire consists of six questions and assesses the way patients perceive the appearance of their nose and the way they think the people around them view the appearance of their nose. The results of each question were analyzed for each patient, comparing the preoperative results over a 12-month time-frame. Candidates for rhinoplasty, either medical or surgical, are among the most difficult to treat and, interestingly, there is substantial literature showing that among these patients, there is a higher rate of psychiatric disorders. Many of these patients seek aesthetic surgery and are often dissatisfied with the outcome of their surgery. The authors suggest that the use of ROE is not only a valid method of assessing patient satisfaction, but it could also be used as a tool to highlight some of the psychological characteristics of patients long before performing any treatment and could help identify potentially problematic patients.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Collapse
|
31
|
Sarwer DB. Body image, cosmetic surgery, and minimally invasive treatments. Body Image 2019; 31:302-308. [PMID: 30704847 DOI: 10.1016/j.bodyim.2019.01.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 12/20/2022]
Abstract
Over the past 60 years, a growing body of research has investigated the psychological aspects of cosmetic surgery and related minimally-invasive treatments. While the earliest studies were influenced by psychoanalytic thinking, much of the work over the past several decades has been influenced by Thomas Cash's cognitive-behavioral theory of body image and has focused on the appearance concerns of patients who seek these procedures. The majority of individuals interested in the procedures report heightened dissatisfaction typically focused on the feature being considered for treatment. Studies from around the world also have suggested that between 5-15% of patients who present for cosmetic procedures meet diagnostic criteria for body dysmorphic disorder (BDD). While individuals with BDD typically do not report a reduction in their BDD symptoms following a cosmetic procedure, the great majority of patients without the disorder do report improvement in body image. The paper reviews this literature and also discusses the role of body image in three newer areas of plastic surgery-body contouring after massive weight loss, genital procedures (either for cosmetic purposes or as part of gender reassignment), and vascularized composite allotransplantation, including face and hand transplantation.
Collapse
Affiliation(s)
- David B Sarwer
- College of Public Health, Temple University, United States.
| |
Collapse
|
32
|
Strazdins E, Nie YF, Ramli R, Palesy T, Christensen JM, Alvarado R, Marcells GN, Harvey RJ. Association Between Mental Health Status and Patient Satisfaction With the Functional Outcomes of Rhinoplasty. JAMA FACIAL PLAST SU 2019; 20:284-291. [PMID: 29450446 DOI: 10.1001/jamafacial.2018.0001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Mental health can have an impact on patient satisfaction with rhinoplasty. However, the association between mental health and patient satisfaction with functional outcomes of rhinoplasty is poorly understood. Objective To determine whether preoperative mental health is associated with satisfaction with functional outcomes of rhinoplasty. Design, Setting, and Participants This case-control study assessed baseline nasal function and postsurgical functional outcomes for 88 consecutive patients undergoing rhinoplasty with both cosmetic and functional goals at 2 tertiary rhinologic centers in Sydney, Australia. Exposures Poor mental well-being was defined preoperatively by the Optum SF-36v2 Health Survey mental component summary. Main Outcomes and Measures Nasal function was assessed with patient-reported outcome measures, including visual analog scales, the Nasal Obstruction Symptom Evaluation Scale (NOSE), the 22-item Sinonasal Outcome Test (SNOT-22), and Likert scales. Objective outcomes included nasal peak inspiratory flow, nasal airway resistance, and minimum cross-sectional area. All outcomes were assessed preoperatively and 6 months postoperatively. The 36-item Optum SF-36v2 Health Survey mental component summary was used to assess mental well-being, with a score of less than 40 indicating poor mental well-being and a score 40 or higher indicating normal well-being. Results Mean (SD) patient age was 37.6 (12.9) years and 53 of 88 (60.2%) were women. The mental component summary defined impaired well-being in n = 24 (cases) and normal well-being in n = 64 (controls). There were improvements in the total study population across most nasal function outcomes and in both groups. After rhinoplasty, benefit was seen for both groups in visual analog scale (left side mean [SD] change, 18 [30]; P < .001 and right side mean [SD] change, 24 [30]; P < .001); NOSE (mean [SD] change, 1.35 [1.21]; P < .001); and SNOT-22 (mean [SD] change, 0.81 [0.88]; P < .001) scores. Nasal peak inspiratory flow improved for both groups (mean [SD] change, 32 [45] L/min; P < .001), while nasal airway resistance and minimum cross-sectional area remained similar (change in nasal airway resistance, 0.086 Pa/cm3/s; 95% CI, -0.007 Pa/cm3/s to 0.179 Pa/cm3/s and change in minimum cross-sectional area, -0.04 cm2; 95% CI, -0.21 cm2 to 0.13 cm2). Patients with poor mental health had similar improvements in nasal function compared with controls. Conclusions and Relevance Rhinoplasty imparts similar benefits to nasal function assessed by patient-reported outcome measures and objective airflow measures regardless of preoperative mental health status. Level of Evidence 3.
Collapse
Affiliation(s)
- Erika Strazdins
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Yu Feng Nie
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Raziqah Ramli
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Tom Palesy
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Jenna M Christensen
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Raquel Alvarado
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | | | - Richard J Harvey
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| |
Collapse
|
33
|
High Prevalence of Body Dysmorphic Disorder and Moderate to Severe Appearance-Related Obsessive-Compulsive Symptoms Among Rhinoplasty Candidates. Aesthetic Plast Surg 2019; 43:1000-1005. [PMID: 30607575 DOI: 10.1007/s00266-018-1300-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 12/16/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Rhinoplasty is one of the most sought-after procedures in plastic surgery by individuals with body dysmorphic disorder (BDD). The identification of BDD symptoms is a challenge for plastic surgeons. The purpose of this study was to use a specific instrument for detection of BDD symptoms as a screening tool in rhinoplasty candidates and estimate the prevalence and severity of BDD symptoms in this population. METHODS Eighty patients of both sexes seeking rhinoplasty were consecutively recruited at a plastic surgery outpatient clinic of a university hospital from February 2014 to March 2015. In a clinical interview, 50 of them showed an excessive preoccupation with physical appearance associated with clinically significant subjective distress and were, therefore, selected to participate in the study. All participants were assessed using the Brazilian-Portuguese versions of the Yale-Brown Obsessive Compulsive Scale modified for BDD (BDD-YBOCS) and the Body Dysmorphic Symptoms Scale (BDSS), which can be applied by plastic surgeons, who are laypersons in psychology/psychiatry. RESULTS Twenty-four (48%, 24/50) candidates had BDD symptoms, and 27 (54%, 27/50) showed moderate to severe appearance-related obsessive-compulsive symptoms. A strong correlation was found between the BDSS and BDD-YBOCS scores (r = 0.841, P < 0.001), and a strong agreement was observed between the BDSS cutoff point and body dysmorphic disorder symptom status (kappa = 0.822). CONCLUSIONS A high prevalence of BDD and moderate to severe appearance-related obsessive-compulsive symptoms was found among aesthetic rhinoplasty candidates. The BDSS may be used as a screening tool for BDD symptoms in plastic surgery patients. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
|
34
|
Systematic Review of Quality-of-Life Measurement After Aesthetic Rhinoplasty. Aesthetic Plast Surg 2018; 42:1635-1647. [PMID: 30019242 DOI: 10.1007/s00266-018-1199-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/07/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The assessment of outcomes in aesthetic rhinoplasty is highly relevant because patient satisfaction and improved health-related quality of life (QoL) are the predominant factors in determining success. The patient-reported outcome measures (PROMs) employed in rhinoplasty research studies are remarkably diverse, thus yielding difficulties with data analysis. The aim of this article is to provide a comprehensive review of the literature to reveal the relevance of the QoL assessment for rhinosurgeons. METHODS A systematic literature search with the terms "Rhinoplasty" and "Quality of Life" was conducted using PubMed/MEDLINE, Google Scholar and Cochrane databases. Primarily, all publications related to QoL following aesthetic rhinoplasty between 2002 and 2017 were identified. As a secondary selection, we focused on articles with a prospective study design, a significant cohort size (at least 50 patients) and a follow-up period of at least 6 months after aesthetic rhinoplasty. RESULTS A total of 62 PROM studies assessing QoL following aesthetic rhinoplasties were obtained. We ascertained an increasing publication rate of QoL articles over the last 15 years. Only 17 studies satisfied comprehensive inclusion criteria of a high qualitative study selection. The Rhinoplasty Outcome Evaluation was the most frequently used QoL questionnaire of the secondary selection (70.6%). The total number of 16 various questionnaires exhibit high heterogeneity. CONCLUSION Our data strengthen the increasing importance of the assessment of QoL after rhinoplasty. Despite a lack of reliable publications with considerable heterogeneity and large variability in outcomes, functional-aesthetic rhinoplasty leads to a significant improvement of patient's health-related QoL. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
|
35
|
Oladokun D, Baumgart A, Baumann I, Bulut OC. Quality of Life Gain After Septorhinoplasty: An Analysis of Health Utility and Cost Utility Values Associated with Septorhinoplasty. Aesthetic Plast Surg 2018; 42:1618-1624. [PMID: 30251221 DOI: 10.1007/s00266-018-1226-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/23/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Septorhinoplasty is a common procedure performed in rhinology and facial plastic surgery. Despite this, the health benefits associated with the procedure remain controversial. In this study, a health utility assessment of patients undergoing septorhinoplasty was performed. Health gains associated with the procedure, and the cost at which they were acquired, were also determined. METHODS Sixty-seven patients undergoing septorhinoplasty at a German tertiary-level hospital were included in the study. Study participants completed the Short Form 36 (SF-36) and satisfaction questionnaires before and 12 months after septorhinoplasty. The Short Form six-dimensional (SF-6D) instrument was used to acquire quality-adjusted life year (QALY) values from SF-36 responses, thus allowing estimation of pre- and post-operative health utilities. Health utility gains after septorhinoplasty were determined and combined with cost data to estimate cost per QALY gained. RESULTS Patients undergoing septorhinoplasty reported mean pre-operative health utility values of 0.70 pre-operatively and 0.74 post-operatively resulting in health gains of 0.04 QALYs. Patients satisfied with their procedures had significant health utility gains, while dissatisfied patients did not experience any significant gains. The cost of septorhinoplasty to statutory health insurance was €3487.69. When compared to the baseline, the incremental utility ratio for septorhinoplasty was €94,797.30 per QALY gained. CONCLUSIONS This study successfully estimated the health utilities and gains associated with septorhinoplasty. The findings indicate that the procedure has associated health gains but at a high cost-utility ratio. These values provide a reference point for further much-needed economic evaluations. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Dare Oladokun
- Department of Otorhinolaryngology, Leeds General Infirmary, Leeds, UK
| | - Andre Baumgart
- Mannheim Institute of Public Health, Universität Medizin Mannheim, Mannheim, Germany
| | - Ingo Baumann
- Department of Otorhinolaryngology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Olcay Cem Bulut
- Department of Otorhinolaryngology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| |
Collapse
|
36
|
Schieber K, Kollei I, de Zwaan M, Martin A. The Dysmorphic Concern Questionnaire in the German General Population: Psychometric Properties and Normative Data. Aesthetic Plast Surg 2018; 42:1412-1420. [PMID: 29946895 DOI: 10.1007/s00266-018-1183-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The Dysmorphic Concern Questionnaire (DCQ) is a widely used screening instrument assessing dysmorphic concerns ranging from a mild to an excessive level. It is often used in the setting of plastic and aesthetic surgery. The present study aimed at examining the psychometric properties of the DCQ in a random general population sample. METHODS A representative sample of the German general population (N = 2053, aged between 18 and 65 years, 54% females) completed the DCQ as well as questionnaires on depression and appearance concerns. RESULTS The DCQ showed a good internal consistency with Cronbach's α = 0.81. Its one-factor model structure was confirmed. Normative data were stratified according to gender and age. Women reported more dysmorphic concerns than men, but also within females the DCQ scores differed between age classes. Overall, 4.0% of the sample reported excessive dysmorphic concerns based on a previously defined cutoff sum score ≥ 11. CONCLUSION The DCQ is a valid and reliable screening tool to identify individuals with excessive dysmorphic concerns. Excessive concerns may indicate also the presence of body dysmorphic disorder, but for verifying a final diagnosis the use of a structured clinical interview is necessary. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
|
37
|
Higgins S, Wysong A. Cosmetic Surgery and Body Dysmorphic Disorder - An Update. Int J Womens Dermatol 2017; 4:43-48. [PMID: 29872676 DOI: 10.1016/j.ijwd.2017.09.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 09/21/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022] Open
Abstract
With the increasing volume and popularity of cosmetic procedures and surgeries, physicians in related specialties are increasingly likely to encounter patients with body dysmorphic disorder. Given the ethical, safety, and legal considerations involved in aesthetic procedures in these patients, accurate identification and appropriate selection for procedures is crucial.
Collapse
Affiliation(s)
- S Higgins
- Department of Dermatology, Keck Medicine of University of Southern California, Los Angeles, CA
| | - A Wysong
- Department of Dermatology, Keck Medicine of University of Southern California, Los Angeles, CA
| |
Collapse
|
38
|
Strazdins E, Nie YF, Ramli R, Palesy T, Christensen JM, Marcells GN, Harvey RJ. Association of Mental Health Status With Perception of Nasal Function. JAMA FACIAL PLAST SU 2017; 19:369-377. [PMID: 28727888 DOI: 10.1001/jamafacial.2017.0459] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Mental health issues are thought to be overrepresented among patients undergoing rhinoplasty and may be associated with patient presentation prior to surgery. Objective To assess the association of poor mental health with perception of nasal function. Design, Setting, and Participants A cross-sectional study of patients presenting for airway assessment was performed from December 1, 2011, to October 31, 2015, at 2 tertiary rhinoplasty centers in Sydney, Australia. Mental health was independently defined preoperatively by the Mental Component Summary of the 36-item Short Form Health Survey version 2 (a score of <40 indicated poor mental well-being), the Rosenberg Self-Esteem Scale (a score of <15 indicated low self-esteem), and the Dysmorphic Concerns Questionnaire (a score of >11 indicated above-average dysmorphic concerns). Main Outcomes and Measures Nasal function was assessed with patient-reported outcome measures, including the Nasal Obstruction Symptom Evaluation Scale, the 22-item Sinonasal Outcome Test, a visual analog scale to rate ease of breathing on the left and right sides, and Likert scales to assess overall function and nasal obstruction. Nasal airflow was assessed by nasal peak inspiratory flow, nasal airway resistance, and minimum cross-sectional area. Results Among 495 patients in the study (302 women and 193 men; mean [SD] age, 36.5 [13.6] years), compared with patients with good mental health, those with poor mental health had poorer scores in all patient-reported outcome measures, including the visual analog scale for the left side (mean [SD], 51 [25] vs 42 [25]; P = .001), visual analog scale for the right side (mean [SD], 54 [24] vs 45 [26]; P < .001), Nasal Obstruction Symptom Evaluation Scale (mean [SD], 2.64 [0.95] vs 1.96 [1.04]; P < .001), 22-item Sinonasal Outcome Test (mean [SD], 2.14 [0.84] vs 1.33 [0.83]; P < .001), nasal obstruction (58 of 145 [40.2%] vs 83 of 350 [23.7%] with severe or worse obstruction; P < .001), and nasal function (72 of 145 [49.7%] vs 111 of 350 [31.8%] with poor or worse function; P < .001). Subclinical differences in nasal peak inspiratory flow could be demonstrated, but all other nasal airflow measures were similar. Low self-esteem produced a similar pattern, but dysmorphia did not. Conclusions and Relevance Poor mental health status is associated with a poorer self-perception of nasal function compared with those who are mentally healthy with clinically similar nasal airflow. Clinicians should be aware that patients with poor mental health reporting obstructed airflow may in part be representing an extension of their negative emotions rather than true obstruction and may require further assessment prior to surgery. Level of Evidence NA.
Collapse
Affiliation(s)
- Erika Strazdins
- St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Yu Feng Nie
- St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Raziqah Ramli
- Department of Medicine, University of New South Wales, Zetland, New South Wales, Australia
| | - Tom Palesy
- Faculty of Medicine, University of New South Wales, Darlinghurst, New South Wales, Australia
| | - Jenna M Christensen
- St Vincent's Centre for Applied Medical Research, University of New South Wales, Darlinghurst, New South Wales, Australia
| | | | - Richard John Harvey
- Rhinology and Skull Base Surgery, St Vincent's Centre for Applied Medical Research, University of New South Wales, Darlinghurst, Sydney, New South Wales, Australia.,Rhinology and Skull Base Surgery, Macquarie University, New South Wales, Australia
| |
Collapse
|
39
|
Kotzampasakis D, Mantalos P, Kotzampasakis S, Danias N, Nikolopoulos T. Assessment of Aesthetic Results of 100 Patients Who Underwent Rhinoplasty-Rhinoplasty Outcome Evaluation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1404. [PMID: 29062632 PMCID: PMC5640329 DOI: 10.1097/gox.0000000000001404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/16/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND To assess the long-term aesthetic results of rhinoplasty and predict the final outcome. METHODS The sample was composed of 100 patients (34 men and 66 women) between 23 and 57 years old (mean, 34.8) operated on exclusively for aesthetic reasons. The time elapsed from the operation ranged from 3 to 13 years with a mean of 6.8 years. The study used Rhinoplasty Outcome Evaluation questionnaire, a simple, reliable, validated, and widely used inventory. RESULTS The vast majority of patients (93%) were satisfied postoperatively with scores > 50% (67 patients had scores > 80%). Only 7 patients had scores less than 50%. The mean score was 82.4 ± 1.7% with a median of 87%. In addition, it seems that the results of the operation remain high through time with a small decline along age groups and years elapsed. Women were found more satisfied than men (P = 0.03). CONCLUSIONS The study concludes that the results of aesthetic rhinoplasty, if performed by skilled and experienced surgeons, are very satisfying and stable throughout time.
Collapse
Affiliation(s)
- Dimitrios Kotzampasakis
- From the ORL Department, “Konstantopouleio” Gen Hospital N.Ionia, Athens, Greece; “IASO” Private Gen Hospital, Athens, Greece; “Iatriko Kentro Psychikou,” Athens, Greece; 4th Gen Surgery Department, “Attikon” Gen University Hospital, University of Athens, Greece; and 2nd ORL Department, “Attikon” Gen University Hospital, University of Athens, Greece
| | - Panagiotis Mantalos
- From the ORL Department, “Konstantopouleio” Gen Hospital N.Ionia, Athens, Greece; “IASO” Private Gen Hospital, Athens, Greece; “Iatriko Kentro Psychikou,” Athens, Greece; 4th Gen Surgery Department, “Attikon” Gen University Hospital, University of Athens, Greece; and 2nd ORL Department, “Attikon” Gen University Hospital, University of Athens, Greece
| | - Stylianos Kotzampasakis
- From the ORL Department, “Konstantopouleio” Gen Hospital N.Ionia, Athens, Greece; “IASO” Private Gen Hospital, Athens, Greece; “Iatriko Kentro Psychikou,” Athens, Greece; 4th Gen Surgery Department, “Attikon” Gen University Hospital, University of Athens, Greece; and 2nd ORL Department, “Attikon” Gen University Hospital, University of Athens, Greece
| | - Nikolaos Danias
- From the ORL Department, “Konstantopouleio” Gen Hospital N.Ionia, Athens, Greece; “IASO” Private Gen Hospital, Athens, Greece; “Iatriko Kentro Psychikou,” Athens, Greece; 4th Gen Surgery Department, “Attikon” Gen University Hospital, University of Athens, Greece; and 2nd ORL Department, “Attikon” Gen University Hospital, University of Athens, Greece
| | - Thomas Nikolopoulos
- From the ORL Department, “Konstantopouleio” Gen Hospital N.Ionia, Athens, Greece; “IASO” Private Gen Hospital, Athens, Greece; “Iatriko Kentro Psychikou,” Athens, Greece; 4th Gen Surgery Department, “Attikon” Gen University Hospital, University of Athens, Greece; and 2nd ORL Department, “Attikon” Gen University Hospital, University of Athens, Greece
| |
Collapse
|
40
|
Sweis IE, Spitz J, Barry DR, Cohen M. A Review of Body Dysmorphic Disorder in Aesthetic Surgery Patients and the Legal Implications. Aesthetic Plast Surg 2017; 41:949-954. [PMID: 28204935 DOI: 10.1007/s00266-017-0819-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/03/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is an often under-recognized yet severe psychiatric illness. There is limited guidance for plastic surgeons in the USA in how to recognize and manage patients with BDD and protect themselves from potential litigation and harm. Therefore, in collaboration with legal counsel, we remind our profession of the serious nature of patients with BDD, provide warning signs for recognizing BDD, and critically evaluate the validity of informed consent and the legal ramifications of operating on such patients in the USA. METHODS A literature review was performed to clearly define the psychopathology of BDD and identify cases of patients with BDD who underwent cosmetic surgery resulting in potential threats to the surgeon. An additional search of the legal literature was performed in collaboration with legal counsel to identify key cases of patients with BDD attempting litigation following cosmetic surgery procedures. RESULTS The diagnostic criteria and psychopathology of BDD are presented. Warning signs are highlighted to alert the plastic surgeon to patients at high risk for BDD. Strategies for legal protection include a pre-procedure checklist for patients that are suspected of having a BDD diagnosis. CONCLUSION Body dysmorphic disorder is prevalent in the cosmetic surgery population. Patients with BDD often have a poor outcome following aesthetic surgery, which can result in a dangerous or even deadly situation for the surgeon. We aim to remind aesthetic plastic surgeons of the psychopathology, severity, and specific risks associated with operating on patients with BDD while suggesting specific protective strategies. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Iliana E Sweis
- Division of Plastic, Reconstructive, and Cosmetic Surgery, Department of Surgery, University of Illinois Hospital and Health Science System at Chicago, 820 S. Wood Street, Suite 515 Clinical Science North Building (M/C 958), Chicago, IL, 60612, USA
| | - Jamie Spitz
- Division of Plastic, Reconstructive, and Cosmetic Surgery, Department of Surgery, University of Illinois Hospital and Health Science System at Chicago, 820 S. Wood Street, Suite 515 Clinical Science North Building (M/C 958), Chicago, IL, 60612, USA.
| | | | - Mimis Cohen
- Division of Plastic, Reconstructive, and Cosmetic Surgery, Department of Surgery, University of Illinois Hospital and Health Science System at Chicago, 820 S. Wood Street, Suite 515 Clinical Science North Building (M/C 958), Chicago, IL, 60612, USA
| |
Collapse
|
41
|
Ishii LE, Tollefson TT, Basura GJ, Rosenfeld RM, Abramson PJ, Chaiet SR, Davis KS, Doghramji K, Farrior EH, Finestone SA, Ishman SL, Murphy RX, Park JG, Setzen M, Strike DJ, Walsh SA, Warner JP, Nnacheta LC. Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty. Otolaryngol Head Neck Surg 2017; 156:S1-S30. [PMID: 28145823 DOI: 10.1177/0194599816683153] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective Rhinoplasty, a surgical procedure that alters the shape or appearance of the nose while preserving or enhancing the nasal airway, ranks among the most commonly performed cosmetic procedures in the United States, with >200,000 procedures reported in 2014. While it is difficult to calculate the exact economic burden incurred by rhinoplasty patients following surgery with or without complications, the average rhinoplasty procedure typically exceeds $4000. The costs incurred due to complications, infections, or revision surgery may include the cost of long-term antibiotics, hospitalization, or lost revenue from hours/days of missed work. The resultant psychological impact of rhinoplasty can also be significant. Furthermore, the health care burden from psychological pressures of nasal deformities/aesthetic shortcomings, surgical infections, surgical pain, side effects from antibiotics, and nasal packing materials must also be considered for these patients. Prior to this guideline, limited literature existed on standard care considerations for pre- and postsurgical management and for standard surgical practice to ensure optimal outcomes for patients undergoing rhinoplasty. The impetus for this guideline is to utilize current evidence-based medicine practices and data to build unanimity regarding the peri- and postoperative strategies to maximize patient safety and to optimize surgical results for patients. Purpose The primary purpose of this guideline is to provide evidence-based recommendations for clinicians who either perform rhinoplasty or are involved in the care of a rhinoplasty candidate, as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The target audience is any clinician or individual, in any setting, involved in the management of these patients. The target patient population is all patients aged ≥15 years. The guideline is intended to focus on knowledge gaps, practice variations, and clinical concerns associated with this surgical procedure; it is not intended to be a comprehensive reference for improving nasal form and function after rhinoplasty. Recommendations in this guideline concerning education and counseling to the patient are also intended to include the caregiver if the patient is <18 years of age. Action Statements The Guideline Development Group made the following recommendations: (1) Clinicians should ask all patients seeking rhinoplasty about their motivations for surgery and their expectations for outcomes, should provide feedback on whether those expectations are a realistic goal of surgery, and should document this discussion in the medical record. (2) Clinicians should assess rhinoplasty candidates for comorbid conditions that could modify or contraindicate surgery, including obstructive sleep apnea, body dysmorphic disorder, bleeding disorders, or chronic use of topical vasoconstrictive intranasal drugs. (3) The surgeon, or the surgeon's designee, should evaluate the rhinoplasty candidate for nasal airway obstruction during the preoperative assessment. (4) The surgeon, or the surgeon's designee, should educate rhinoplasty candidates regarding what to expect after surgery, how surgery might affect the ability to breathe through the nose, potential complications of surgery, and the possible need for future nasal surgery. (5) The clinician, or the clinician's designee, should counsel rhinoplasty candidates with documented obstructive sleep apnea about the impact of surgery on nasal airway obstruction and how obstructive sleep apnea might affect perioperative management. (6) The surgeon, or the surgeon's designee, should educate rhinoplasty patients before surgery about strategies to manage discomfort after surgery. (7) Clinicians should document patients' satisfaction with their nasal appearance and with their nasal function at a minimum of 12 months after rhinoplasty. The Guideline Development Group made recommendations against certain actions: (1) When a surgeon, or the surgeon's designee, chooses to administer perioperative antibiotics for rhinoplasty, he or she should not routinely prescribe antibiotic therapy for a duration >24 hours after surgery. (2) Surgeons should not routinely place packing in the nasal cavity of rhinoplasty patients (with or without septoplasty) at the conclusion of surgery. The panel group made the following statement an option: (1) The surgeon, or the surgeon's designee, may administer perioperative systemic steroids to the rhinoplasty patient.
Collapse
Affiliation(s)
- Lisa E Ishii
- 1 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Travis T Tollefson
- 2 University of California Davis Medical Center, Sacramento, California, USA
| | - Gregory J Basura
- 3 University of Michigan Medical Center, Taubman Center, Ann Arbor, Michigan, USA
| | | | | | - Scott R Chaiet
- 6 The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kara S Davis
- 7 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Karl Doghramji
- 8 Jefferson Sleep Disorder Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Edward H Farrior
- 9 Farrior Facial Plastic and Cosmetic Surgery, Tampa, Florida, USA
| | | | - Stacey L Ishman
- 11 Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Robert X Murphy
- 12 Lehigh Valley Health Network, Bethlehem, Pennsylvania, USA
| | - John G Park
- 13 Mayo Clinic Center for Sleep Medicine, Rochester, Minnesota, USA
| | - Michael Setzen
- 14 New York University School of Medicine, New York, New York, USA
| | - Deborah J Strike
- 15 Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Sandra A Walsh
- 10 Consumers United for Evidence-Based Healthcare, Fredericton, Canada
| | - Jeremy P Warner
- 16 Division Plastic and Reconstructive Surgery, Northshore University Health System, Northbrook, Illinois, USA
| | - Lorraine C Nnacheta
- 17 Department of Research and Quality, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| |
Collapse
|
42
|
Ishii LE, Tollefson TT, Basura GJ, Rosenfeld RM, Abramson PJ, Chaiet SR, Davis KS, Doghramji K, Farrior EH, Finestone SA, Ishman SL, Murphy RX, Park JG, Setzen M, Strike DJ, Walsh SA, Warner JP, Nnacheta LC. Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty Executive Summary. Otolaryngol Head Neck Surg 2017; 156:205-219. [DOI: 10.1177/0194599816683156] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Lisa E. Ishii
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Gregory J. Basura
- University of Michigan Medical Center, Taubman Center, Ann Arbor, Michigan, USA
| | | | | | - Scott R. Chaiet
- The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kara S. Davis
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Karl Doghramji
- Jefferson Sleep Disorder Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Stacey L. Ishman
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - John G. Park
- Mayo Clinic Center for Sleep Medicine, Rochester, Minnesota, USA
| | - Michael Setzen
- New York University School of Medicine, New York, New York, USA
| | - Deborah J. Strike
- Department of Otolaryngology–Head and Neck Surgery, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Sandra A. Walsh
- Consumers United for Evidence-Based Healthcare, Fredericton, Canada
| | - Jeremy P. Warner
- Division Plastic and Reconstructive Surgery, Northshore University Health System, Northbrook, Illinois, USA
| | - Lorraine C. Nnacheta
- Department of Research and Quality, American Academy of Otolaryngology—Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| |
Collapse
|
43
|
Bowyer L, Krebs G, Mataix-Cols D, Veale D, Monzani B. A critical review of cosmetic treatment outcomes in body dysmorphic disorder. Body Image 2016; 19:1-8. [PMID: 27517118 DOI: 10.1016/j.bodyim.2016.07.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 07/14/2016] [Indexed: 11/18/2022]
Abstract
A high proportion of individuals with body dysmorphic disorder (BDD) undergo cosmetic treatments in an attempt to 'fix' perceived defect/s in their physical appearance. Despite the frequency with which such procedures are sought, few studies have prospectively examined the outcomes of cosmetic procedures in individuals with BDD. This article aims to critically review the literature and discuss the current debate that exists on outcomes of cosmetic treatment for individuals with BDD. An emerging literature suggests the majority of individuals with BDD have poor outcomes after cosmetic interventions; however, based on the current literature, it cannot be fully ruled out that certain individuals with mild BDD and localised appearance concerns may benefit from these interventions. Gaps in the current literature are highlighted, alongside recommendations for future research. Carefully conducted longitudinal studies with well-characterised patient populations are needed.
Collapse
Affiliation(s)
- Laura Bowyer
- National and Specialist OCD, BDD and Related Disorders Clinic, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK.
| | - Georgina Krebs
- National and Specialist OCD, BDD and Related Disorders Clinic, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK; King's College London, Social, Genetic and Development Centre, Institute of Psychiatry, Psychology and Neurosciences, London SE5 8AF, UK
| | - David Mataix-Cols
- Child and Adolescent Psychiatry Research Centre, Karolinska Institutet, Stockholm, Sweden
| | - David Veale
- Centre for Anxiety Disorders, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK; King's College London, Institute of Psychiatry, Psychology & Neurosciences, London SE5 8AF, UK
| | - Benedetta Monzani
- King's College London, Institute of Psychiatry, Psychology & Neurosciences, London SE5 8AF, UK
| |
Collapse
|
44
|
Ramos TD, de Brito MJA, Piccolo MS, Rosella MFNDSM, Sabino M, Ferreira LM. Body Dysmorphic Symptoms Scale for patients seeking esthetic surgery: cross-cultural validation study. SAO PAULO MED J 2016; 134:480-490. [PMID: 28076636 PMCID: PMC11448731 DOI: 10.1590/1516-3180.2016.0068160416] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 03/16/2016] [Accepted: 04/16/2016] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE: Rhinoplasty is one of the most sought-after esthetic operations among individuals with body dysmorphic disorder. The aim of this study was to cross-culturally adapt and validate the Body Dysmorphic Symptoms Scale. DESIGN AND SETTING: Cross-cultural validation study conducted in a plastic surgery outpatient clinic of a public university hospital. METHODS: Between February 2014 and March 2015, 80 consecutive patients of both sexes seeking rhinoplasty were selected. Thirty of them participated in the phase of cultural adaptation of the instrument. Reproducibility was tested on 20 patients and construct validity was assessed on 50 patients, with correlation against the Yale-Brown Obsessive Compulsive Scale for Body Dysmorphic Disorder. RESULTS: The Brazilian version of the instrument showed Cronbach's alpha of 0.805 and excellent inter-rater reproducibility (intraclass correlation coefficient, ICC = 0.873; P < 0.001) and intra-rater reproducibility (ICC = 0.939; P < 0.001). Significant differences in total scores were found between patients with and without symptoms (P < 0.001). A strong correlation (r = 0.841; P < 0.001) was observed between the Yale-Brown Obsessive Compulsive Scale for Body Dysmorphic Disorder and the Body Dysmorphic Symptoms Scale. The area under the receiver operating characteristic curve was 0.981, thus showing good accuracy for discriminating between presence and absence of symptoms of body dysmorphic disorder. Forty-six percent of the patients had body dysmorphic symptoms and 54% had moderate to severe appearance-related obsessive-compulsive symptoms. CONCLUSIONS: The Brazilian version of the Body Dysmorphic Symptoms Scale is a reproducible instrument that presents face, content and construct validity.
Collapse
Affiliation(s)
- Tatiana Dalpasquale Ramos
- BSc. Master’s Student, Postgraduate Program on Translational Surgery, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
| | - Maria José Azevedo de Brito
- PhD. Affiliate Professor, College of Health Science, Universidade do Vale do Sapucaí (UNIVÁS), Minas Gerais; Postdoctoral Researcher, Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
| | - Mônica Sarto Piccolo
- MD, PhD. Adjunct Professor, Postgraduate Program on Translational Surgery, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
| | | | - Miguel Sabino
- MD, PhD. Associate Professor, Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
| | - Lydia Masako Ferreira
- MD, PhD. Full Professor, Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil.
| |
Collapse
|
45
|
Sarwer DB, Polonsky HM. Body Image and Body Contouring Procedures. Aesthet Surg J 2016; 36:1039-47. [PMID: 27634782 DOI: 10.1093/asj/sjw127] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2016] [Indexed: 11/13/2022] Open
Abstract
Dissatisfaction with physical appearance and body image is a common psychological phenomena in Western society. Body image dissatisfaction is frequently reported by those who have excess body weight, but also is seen in those of normal body weight. For both groups of individuals, this dissatisfaction impacts self-esteem and quality of life. Furthermore, it is believed to be the motivational catalyst to a range of appearance-enhancing behaviors, including weight loss efforts and physical activity. Body image dissatisfaction is also believed to play a role in the decision to seek the wide range of body contouring procedures offered by aesthetic physicians. Individuals who seek these procedures typically report increased body image dissatisfaction, focus on the feature they wish to alter with treatment, and often experience improvement in body image following treatment. At the same time, extreme body image dissatisfaction is a symptom of a number of recognized psychiatric disorders. These include anorexia nervosa, bulimia nervosa, and body dysmorphic disorder (BDD), all of which can contraindicate aesthetic treatment. This special topic review paper provides an overview of the relationship between body image dissatisfaction and aesthetic procedures designed to improve body contouring. The review specifically focuses on the relationship of body image and body weight, as well as the presentation of body image psychopathology that would contraindicate aesthetic surgery. The overall goal of the paper is to highlight the clinical implications of the existing research and provide suggestions for future research on the psychological aspects of body contouring procedures.
Collapse
Affiliation(s)
- David B Sarwer
- From the Center for Obesity Research and Education, Temple University College of Public Health, Philadelphia, PA
| | - Heather M Polonsky
- From the Center for Obesity Research and Education, Temple University College of Public Health, Philadelphia, PA
| |
Collapse
|
46
|
Body dysmorphic disorder in different settings: A systematic review and estimated weighted prevalence. Body Image 2016; 18:168-86. [PMID: 27498379 DOI: 10.1016/j.bodyim.2016.07.003] [Citation(s) in RCA: 185] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 06/30/2016] [Accepted: 07/18/2016] [Indexed: 11/24/2022]
Abstract
Our aim was to systematically review the prevalence of body dysmorphic disorder (BDD) in a variety of settings. Weighted prevalence estimate and 95% confidence intervals in each study were calculated. The weighted prevalence of BDD in adults in the community was estimated to be 1.9%; in adolescents 2.2%; in student populations 3.3%; in adult psychiatric inpatients 7.4%; in adolescent psychiatric inpatients 7.4%; in adult psychiatric outpatients 5.8%; in general cosmetic surgery 13.2%; in rhinoplasty surgery 20.1%; in orthognathic surgery 11.2%; in orthodontics/cosmetic dentistry settings 5.2%; in dermatology outpatients 11.3%; in cosmetic dermatology outpatients 9.2%; and in acne dermatology clinics 11.1%. Women outnumbered men in the majority of settings but not in cosmetic or dermatological settings. BDD is common in some psychiatric and cosmetic settings but is poorly identified.
Collapse
|
47
|
Morselli PG, Micai A, Boriani F. Eumorphic Plastic Surgery: Expectation Versus Satisfaction in Body Dysmorphic Disorder. Aesthetic Plast Surg 2016; 40:592-601. [PMID: 27251751 DOI: 10.1007/s00266-016-0655-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 04/25/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Eumorphic Plastic Surgery aims at improving the severe psychosocial pain caused by a deformity. Dysmorphopathology is an increasingly relevant problem facing the plastic surgeon. OBJECTIVE The aim of this study is to describe the perioperative questionnaires created by the senior author and to present a cohort of plastic surgery patients suffering from dysmorphopathies. These patients were prospectively followed and evaluated with the proposed questionnaires through their surgical pathway to explore the degree of satisfaction or disappointment compared to expectations. METHODS All candidates for plastic surgery procedures between April 2011 and June 2013 were included in the study. Preoperatively, all patients completed the Patient Expectation Questionnaire (E-pgm). Twelve months postoperatively, they completed the Patient Satisfaction Questionnaire (S-pgm). The E-pgm and S-pgm were compared to evaluate the consistency between the patient's preoperative expectations and postoperative evaluations. RESULTS A total of 158 patients were included in the study. Out of them, 79 % experienced an improvement or no variation between preoperative expectations and postoperative satisfaction. With regard to the motivation for undergoing surgery, 91 % showed that the surgical procedure met the motivation. An overall positive perioperative change in life was experienced by 93 % of patients. CONCLUSIONS The E-pgm questionnaire proved to be a valid and reliable tool for the selection of suitable candidates for surgery and for identification of dysmorphophobic patients. Enhancing the doctor-patient relationship and communication can reduce ambiguity and avoid troublesome misunderstandings, litigation and other legal implications. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Paolo Giovanni Morselli
- Department of Plastic Surgery, S Orsola-Malpighi Hospital, University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy.
| | - Alessandro Micai
- Department of Plastic Surgery, S Orsola-Malpighi Hospital, University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy
| | | |
Collapse
|
48
|
Body Dysmorphic Disorder in Patients Seeking Abdominoplasty, Rhinoplasty, and Rhytidectomy. Plast Reconstr Surg 2016; 137:462-471. [PMID: 26818280 DOI: 10.1097/01.prs.0000475753.33215.8f] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Body dysmorphic disorder may negatively affect self-perception of body shape and lead patients to seek cosmetic surgery. This study estimates the level of body dissatisfaction and prevalence of body dysmorphic disorder symptoms in candidates for three plastic surgical procedures. METHODS Three hundred patients of both sexes divided into three groups (abdominoplasty, n = 90; rhinoplasty, n =151; and rhytidectomy, n =59) were classified as having (n =51, n =79, and n =25, respectively) or not having (n =39, n =72, and n =34, respectively) body dysmorphic disorder symptoms, based on the Body Dysmorphic Disorder Examination, which was administered preoperatively. RESULTS Prevalence rates of body dysmorphic disorder symptoms in the abdominoplasty, rhinoplasty, and rhytidectomy groups were 57, 52, and 42 percent, respectively. Significant between-group differences were observed regarding age (p < 0.001), body mass index (p = 0.001), and onset of body dysmorphic disorder symptoms (p < 0.001). Within-group differences in body dysmorphic disorder severity were observed in the abdominoplasty (p < 0.001), rhinoplasty (p < 0.001), and rhytidectomy (p = 0.005) groups. Body dysmorphic disorder severity was significantly associated with degree of body dissatisfaction (mean Body Dysmorphic Disorder Examination total scores; p < 0.001), avoidance behaviors (p< 0.001), sexual abuse (p = 0.026), suicidal ideation (p < 0.001), and suicide attempt (p = 0.012). CONCLUSIONS Abdominoplasty candidates showed the highest prevalence; rhytidectomy candidates exhibited the highest percentage of severe cases, and rhinoplasty candidates had the lowest percentage of severe cases.
Collapse
|
49
|
Lekakis G, Picavet VA, Gabriëls L, Grietens J, Hellings PW. Body Dysmorphic Disorder in aesthetic rhinoplasty: Validating a new screening tool. Laryngoscope 2016; 126:1739-45. [PMID: 27223322 DOI: 10.1002/lary.25963] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 01/25/2016] [Accepted: 02/11/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To validate a new screening tool for body dysmorphic disorder (BDD) in patients seeking aesthetic rhinoplasty. STUDY DESIGN We performed a prospective instrument validation study in an academic rhinology clinic. METHODS The Body Dysmorphic Disorder Questionnaire-Aesthetic Surgery (BDDQ-AS) is a seven-item short questionnaire validated in 116 patients undergoing aesthetic rhinoplasty. Screening was positive if the patient acknowledged on the BDDQ-AS that he/she was concerned about their appearance (question 1 = yes) AND preoccupied with these concerns (question 2 = yes) AND that these concerns caused at least moderate distress or impairment in different domains of daily life (question 3 or 4 or 5 or 6 ≥ 3 or question 7 = yes). Construct validity was assessed by comparing the BDDQ-AS to the Sheehan Disability Scale and the Derriford Appearance Scale-59. To determine concurrent validity, the BDDQ-AS was compared to the Yale-Brown Obsessive Compulsive Scale Modified for BDD. Finally, the predictive value of the BDDQ-AS on satisfaction 12 months after rhinoplasty was evaluated using a visual analogue scale and the Rhinoplasty Outcome Evaluation. RESULTS Reliability of the BDDQ-AS was adequate, with Cronbach alpha = .83 for rhinoplasty patients and .84 for controls. Sensitivity was 89.6% and specificity 81.4%. BDDQ-AS-positive patients (n = 55) were more impaired in daily life and experienced more appearance-related distress and dysfunction compared to BDDQ-AS-negative patients. Moreover, they had more severe BDD symptoms. Finally, BDDQ-AS-positive patients were less satisfied after surgery compared to BDDQ-AS-negative patients. CONCLUSIONS We hereby validated a new screening tool for BDD in an aesthetic rhinoplasty population. LEVEL OF EVIDENCE 3b. Laryngoscope, 126:1739-1745, 2016.
Collapse
Affiliation(s)
- Garyfalia Lekakis
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Valerie A Picavet
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Loes Gabriëls
- Department of Psychiatry, University Hospitals Leuven, and Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Jente Grietens
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Peter W Hellings
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
50
|
Brito MJAD, Nahas FX, Cordás TA, Gama MG, Sucupira ER, Ramos TD, Felix GDAA, Ferreira LM. Prevalence of Body Dysmorphic Disorder Symptoms and Body Weight Concerns in Patients Seeking Abdominoplasty. Aesthet Surg J 2016; 36:324-32. [PMID: 26851144 DOI: 10.1093/asj/sjv213] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is one of the most common psychiatric conditions found in patients seeking cosmetic surgery, and body contouring surgery is most frequently sought by patients with BDD. OBJECTIVES To estimate the prevalence and severity of BDD symptoms in patients seeking abdominoplasty. METHODS Ninety patients of both sexes were preoperatively divided into two groups: patients with BDD symptoms (n = 51) and those without BDD symptoms (n = 39) based both on the Body Dysmorphic Disorder Examination (BDDE) and clinical assessment. Patients in the BDD group were classified as having mild to moderate or severe symptoms, according to the BDDE. Body weight and shape concerns were assessed using the Body Shape Questionnaire (BSQ). RESULTS The prevalence of BDD symptoms was 57%. There were significant associations between BDD symptoms and degree of body dissatisfaction, level of preoccupation with physical appearance, and avoidance behaviors. Mild to moderate and severe symptoms of BDD were present in 41% and 59% of patients, respectively, in the BDD group. It was found that the more severe the symptoms of BDD, the higher the level of concern with body weight and shape (P < .001). Patients having distorted self-perception of body shape, or distorted comparative perception of body image were respectively 3.67 or 5.93 times more likely to show more severe symptoms of BDD than those with a more accurate perception. CONCLUSIONS Candidates for abdominoplasty had a high prevalence of BDD symptoms, and body weight and shape concerns were associated with increased symptom severity.
Collapse
Affiliation(s)
- Maria José Azevedo de Brito
- Dr De Brito is an Affiliate Professor, College of Health Science, Universidade do Vale do Sapucaí, Minas Gerais; and A Postdoctoral Researcher, Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil. Dr Nahas is an Affiliate Professor and Dr Ferreira is a Full Professor, Division of Plastic Surgery, Department of Surgery, UNIFESP, São Paulo, Brazil. Dr Cordás is a Joint Professor, Department of Psychiatry, Universidade de São Paulo (USP), São Paulo, Brazil. Dr Gama is an Associate Professor, Institute of Social Sciences, Universidade do Minho, Guimaraes, Portugal. Dr Sucupira is a plastic surgeon in private practice in Rio de Janeiro, Brazil. Ms Ramos is a Graduate Student in the Graduate Program in Translational Surgery, UNIFESP, São Paulo, Brazil. Dr Felix is a Medical Resident, Paulista School of Medicine, UNIFESP, São Paulo, Brazil
| | - Fábio Xerfan Nahas
- Dr De Brito is an Affiliate Professor, College of Health Science, Universidade do Vale do Sapucaí, Minas Gerais; and A Postdoctoral Researcher, Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil. Dr Nahas is an Affiliate Professor and Dr Ferreira is a Full Professor, Division of Plastic Surgery, Department of Surgery, UNIFESP, São Paulo, Brazil. Dr Cordás is a Joint Professor, Department of Psychiatry, Universidade de São Paulo (USP), São Paulo, Brazil. Dr Gama is an Associate Professor, Institute of Social Sciences, Universidade do Minho, Guimaraes, Portugal. Dr Sucupira is a plastic surgeon in private practice in Rio de Janeiro, Brazil. Ms Ramos is a Graduate Student in the Graduate Program in Translational Surgery, UNIFESP, São Paulo, Brazil. Dr Felix is a Medical Resident, Paulista School of Medicine, UNIFESP, São Paulo, Brazil
| | - Táki Athanássios Cordás
- Dr De Brito is an Affiliate Professor, College of Health Science, Universidade do Vale do Sapucaí, Minas Gerais; and A Postdoctoral Researcher, Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil. Dr Nahas is an Affiliate Professor and Dr Ferreira is a Full Professor, Division of Plastic Surgery, Department of Surgery, UNIFESP, São Paulo, Brazil. Dr Cordás is a Joint Professor, Department of Psychiatry, Universidade de São Paulo (USP), São Paulo, Brazil. Dr Gama is an Associate Professor, Institute of Social Sciences, Universidade do Minho, Guimaraes, Portugal. Dr Sucupira is a plastic surgeon in private practice in Rio de Janeiro, Brazil. Ms Ramos is a Graduate Student in the Graduate Program in Translational Surgery, UNIFESP, São Paulo, Brazil. Dr Felix is a Medical Resident, Paulista School of Medicine, UNIFESP, São Paulo, Brazil
| | - Maria Gabriela Gama
- Dr De Brito is an Affiliate Professor, College of Health Science, Universidade do Vale do Sapucaí, Minas Gerais; and A Postdoctoral Researcher, Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil. Dr Nahas is an Affiliate Professor and Dr Ferreira is a Full Professor, Division of Plastic Surgery, Department of Surgery, UNIFESP, São Paulo, Brazil. Dr Cordás is a Joint Professor, Department of Psychiatry, Universidade de São Paulo (USP), São Paulo, Brazil. Dr Gama is an Associate Professor, Institute of Social Sciences, Universidade do Minho, Guimaraes, Portugal. Dr Sucupira is a plastic surgeon in private practice in Rio de Janeiro, Brazil. Ms Ramos is a Graduate Student in the Graduate Program in Translational Surgery, UNIFESP, São Paulo, Brazil. Dr Felix is a Medical Resident, Paulista School of Medicine, UNIFESP, São Paulo, Brazil
| | - Eduardo Rodrigues Sucupira
- Dr De Brito is an Affiliate Professor, College of Health Science, Universidade do Vale do Sapucaí, Minas Gerais; and A Postdoctoral Researcher, Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil. Dr Nahas is an Affiliate Professor and Dr Ferreira is a Full Professor, Division of Plastic Surgery, Department of Surgery, UNIFESP, São Paulo, Brazil. Dr Cordás is a Joint Professor, Department of Psychiatry, Universidade de São Paulo (USP), São Paulo, Brazil. Dr Gama is an Associate Professor, Institute of Social Sciences, Universidade do Minho, Guimaraes, Portugal. Dr Sucupira is a plastic surgeon in private practice in Rio de Janeiro, Brazil. Ms Ramos is a Graduate Student in the Graduate Program in Translational Surgery, UNIFESP, São Paulo, Brazil. Dr Felix is a Medical Resident, Paulista School of Medicine, UNIFESP, São Paulo, Brazil
| | - Tatiana Dalpasquale Ramos
- Dr De Brito is an Affiliate Professor, College of Health Science, Universidade do Vale do Sapucaí, Minas Gerais; and A Postdoctoral Researcher, Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil. Dr Nahas is an Affiliate Professor and Dr Ferreira is a Full Professor, Division of Plastic Surgery, Department of Surgery, UNIFESP, São Paulo, Brazil. Dr Cordás is a Joint Professor, Department of Psychiatry, Universidade de São Paulo (USP), São Paulo, Brazil. Dr Gama is an Associate Professor, Institute of Social Sciences, Universidade do Minho, Guimaraes, Portugal. Dr Sucupira is a plastic surgeon in private practice in Rio de Janeiro, Brazil. Ms Ramos is a Graduate Student in the Graduate Program in Translational Surgery, UNIFESP, São Paulo, Brazil. Dr Felix is a Medical Resident, Paulista School of Medicine, UNIFESP, São Paulo, Brazil
| | - Gabriel de Almeida Arruda Felix
- Dr De Brito is an Affiliate Professor, College of Health Science, Universidade do Vale do Sapucaí, Minas Gerais; and A Postdoctoral Researcher, Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil. Dr Nahas is an Affiliate Professor and Dr Ferreira is a Full Professor, Division of Plastic Surgery, Department of Surgery, UNIFESP, São Paulo, Brazil. Dr Cordás is a Joint Professor, Department of Psychiatry, Universidade de São Paulo (USP), São Paulo, Brazil. Dr Gama is an Associate Professor, Institute of Social Sciences, Universidade do Minho, Guimaraes, Portugal. Dr Sucupira is a plastic surgeon in private practice in Rio de Janeiro, Brazil. Ms Ramos is a Graduate Student in the Graduate Program in Translational Surgery, UNIFESP, São Paulo, Brazil. Dr Felix is a Medical Resident, Paulista School of Medicine, UNIFESP, São Paulo, Brazil
| | - Lydia Masako Ferreira
- Dr De Brito is an Affiliate Professor, College of Health Science, Universidade do Vale do Sapucaí, Minas Gerais; and A Postdoctoral Researcher, Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil. Dr Nahas is an Affiliate Professor and Dr Ferreira is a Full Professor, Division of Plastic Surgery, Department of Surgery, UNIFESP, São Paulo, Brazil. Dr Cordás is a Joint Professor, Department of Psychiatry, Universidade de São Paulo (USP), São Paulo, Brazil. Dr Gama is an Associate Professor, Institute of Social Sciences, Universidade do Minho, Guimaraes, Portugal. Dr Sucupira is a plastic surgeon in private practice in Rio de Janeiro, Brazil. Ms Ramos is a Graduate Student in the Graduate Program in Translational Surgery, UNIFESP, São Paulo, Brazil. Dr Felix is a Medical Resident, Paulista School of Medicine, UNIFESP, São Paulo, Brazil
| |
Collapse
|