Understanding and identifying BDD in cosmetic dermatology is crucial for ensuring ethical, effective, and patient-centered care. Aesthetic medicine should not only focus on physical transformations but also on the psychological well-being of patients.
By integrating screening processes, fostering honest communication, and collaborating with mental health professionals, aesthetic practitioners can protect both their patients and their practice from the negative implications of treating BDD-affected individuals.
Raising awareness and prioritizing mental health in cosmetic interventions will ultimately lead to better patient outcomes, improved professional integrity, and a more responsible approach to aesthetic medicine.
What Is BDD?
Body Dysmorphic Disorder (BDD), also known as dysmorphophobia, is a psychological condition characterized by an obsessive preoccupation with perceived flaws in one’s appearance. They cause significant distress and impairment in daily life. BDD patients frequently seek cosmetic procedures—both surgical and non-surgical—as a means of "correcting" these perceived imperfections.
However, their expectations are often unrealistic, leading to dissatisfaction even after multiple interventions. The nature of BDD makes it particularly concerning in the field of cosmetic dermatology, where patients may insist on unnecessary or excessive treatments that fail to address their underlying psychological condition.
There are few questionnaires available for BDD. Please find an example here 'Do I have BDD?'
The Incidence of BDD in Aesthetic and Medical Practice
BDD is more common than often assumed. However, in cosmetic dermatology and plastic surgery settings, the prevalence is even higher, with studies estimating that between 5% and 15% of patients seeking aesthetic treatments may suffer from this disorder.
The demand for aesthetic procedures continues to rise, increasing the likelihood that practitioners will encounter BDD patients. This underscores the critical need for screening and ethical decision-making to ensure that procedures are performed on appropriate candidates rather than individuals struggling with underlying psychological distress.
Diagnostic Features of BDD in the Context of Aesthetic Procedures
Practitioners should be aware of key diagnostic features to identify potential BDD cases, particularly in those seeking repeated or extreme cosmetic enhancements. These include:
Excessive concern about a specific physical feature that others perceive as normal or only slightly different.
Frequent mirror-checking or, conversely, complete avoidance of mirrors.
Repetitive behaviors such as excessive grooming, skin picking, or comparing one’s appearance to others.
Constantly seeking reassurance from practitioners, family, or friends regarding perceived defects.
Significant distress or impairment in social, occupational, or personal areas due to appearance concerns.
A history of multiple, unsatisfactory cosmetic procedures, often with different practitioners.
Consequences of Overlooking BDD in Cosmetic and Medical Practice
If a practitioner fails to recognize BDD and proceeds with the requested procedure, several adverse outcomes may arise:
Dissatisfaction with Results: BDD patients are rarely satisfied with aesthetic treatments and often seek additional corrections, leading to an endless cycle of interventions.
Emotional Distress and Worsening Mental Health: Post-procedure dissatisfaction can exacerbate anxiety, depression.
Negative Impact on the Practitioner’s Reputation: Unhappy patients may file complaints, leave negative reviews, or seek legal action against practitioners, even if the procedure was performed correctly.
Increased Ethical and Professional Responsibility: Performing unnecessary or repeated procedures on a BDD patient can raise serious ethical concerns within the medical community, as it may contribute to their psychological distress rather than alleviating it.
Heightened Risk of Complications: Patients with BDD may insist on excessive or overly aggressive treatments, increasing the likelihood of complications such as scarring, pigmentation issues, or prolonged healing times.
Recommended Approaches for Managing Patients with BDD in Aesthetic Dermatology
Given the complexities associated with BDD, practitioners should adopt a strategic and ethical approach:
Early Screening and Psychological Assessment: Using validated screening tools like the Body Dysmorphic Disorder Questionnaire (BDDQ) can help identify at-risk patients before performing any procedures.
Patient Education and Communication: Providing empathetic explanations about realistic expectations and the psychological nature of their concerns can help redirect the patient’s focus.
Referral to Mental Health Professionals: Encouraging patients to seek cognitive-behavioral therapy (CBT) or psychiatric evaluation can provide long-term benefits beyond cosmetic alterations.
Avoiding Unnecessary or Excessive Procedures: Ethical responsibility should take precedence over financial incentives. If a practitioner suspects BDD, declining the procedure and prioritizing the patient's mental well-being is the best course of action.
Collaborating with Multidisciplinary Teams: Working alongside psychologists, psychiatrists, and other medical professionals ensures that patients with BDD receive the comprehensive care they need rather than repeated aesthetic treatments that may worsen their condition.
On June 20th, at AIME Paris 2025, within the ANTI-AGING / COSMETOLOGY / ECO-AGING MEDICINE / HAIR conference room, I will be co-hosting a session alongside Diala Haykal, with the support of ELSD, titled: "Pioneering Energy-Based Devices (EBD) for Advanced Aesthetic Care."
Together with two other leading international experts Dr. Pablo Boixeda and Dr. Jelena Jeftic, we will provide valuable insights on:
Breakthrough Treatments for Rosacea Care
Revolutionary Laser Innovations in Skin Resurfacing
Next-Generation Laser Solutions for Hair Reduction
The Role of AI in Transforming Aesthetic Treatments
We look forward to welcoming you to this transformative session—let’s shape the future of aesthetics together!
