The body dysmorphic disorder patient: to perform rhinoplasty or not?

By virtue of being a (primarily) aesthetic rather than a functional procedure, rhinoplasty is unique among rhinological operations. As such, it raises moral, philosophical and social issues that no other procedure does. The preoperative assessment of a rhinoplasty patient includes a number of considerations that are unique in this type of surgery; during the outpatient consultation, the patient's motivation for surgery, stability and overall psychological evaluation, with a special emphasis on body dysmorphic disorder, have to be taken into consideration. Body dysmorphic disorder is a relatively common obsessive-compulsive spectrum disorder defined by a constant and impairing preoccupation with imagined or slight defects in appearance. Body dysmorphic disorder is associated with poor quality of life, extremely high rates of suicide and--following cosmetic surgery--high rates of dissatisfaction, occasionally manifesting as aggressiveness. A combination of psychological and medical management is the treatment of choice and this review aims to address the frequently controversial rhinoplasty indications for these patients.