Surgeons nip and tuck — but cosmetic procedures won’t shatter body-image delusions

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People who fret over slight or imagined physical defects may seek out cosmetic procedures to fix them. But those ‘fixes’ can rarely cure a case of body dysmorphic disorder (BDD), according to a study released today in the Annals of Plastic Surgery.

Previous research, according to the study, shows that some 7%-8% of U.S. cosmetic-surgery patients suffer from BDD — a pathological preoccupation with bodily “defects” that is bad enough to interfere with the patient’s daily life. Among the 200 BDD patients surveyed in today’s Annals┬ástudy, 62 men and women sought out cosmetic surgery (e.g., a nose job) or a minimally invasive treatment (e.g., a collagen injection), and 42 of those patients actually received them. (Cost was the most frequent barrier to treatment.) Following two thirds of those received procedures, however, patients claimed that they felt absolutely no better about their treated body part. And almost none of the patients — even those who did like their procedures — had lasting improvement in overall body image. A scant 2% of the patients showed fewer BDD symptoms. The remaining 98% were just as worried as ever about their bodies.

The study authors say that people may express satisfaction with an individual procedure without feeling any better overall, possibly because early improvements in well-being can fade over time, post-surgery. They also write:

Another possible explanation for improvement in preoccupation with the treated body area specifically, but not overall BDD symptoms, is that after surgery [or after a minimally invasive procedure], some patients “switched” their preoccupation to another body area. We did not examine this in our study, but we often observe this clinically; as one patient said, “After my nose job, my nose looked a little better, but my stomach took over for my nose.”

The study authors recommend that cosmetic surgeons be more careful about whom they treat — using a quick questionnaire, for example, to screen for delusional ideas about body image, since these patients are unlikely to be helped by a procedure that does not address their underlying psychological problem. And while it’s easy to rag on plastic surgeons as people who were only ever in it for the money anyway (this is, remember, also the profession that will reconstruct your face if you’re ever a burn victim, so don’t judge too harshly), there are signs that doctors do turn away patients whom they recognize to be overly troubled. Men with BDD, for example, were just as likely to seek surgery as women with BDD. But men were more often turned away — perhaps, the study authors write, because doctors were more skeptical that male patients were mentally sound.