The Body Dysmorphic Disorder Questionnaire - Aesthetic Surgery: are we screening the troublesome patients?

This study aims to clarify the current concept of performing rhinoplasty in patients with possible body dysmorphic disorder (BDD). The primary outcome was to investigate the validity and evolution over time of the Body Dysmorphic Disorder Questionnaire - Aesthetic Surgery (BDDQ-AS) before and after surgery. Methods Together with the BDDQ-AS, also the NOSE scale, FACE-Q nose and nostrils, and Utrecht questionnaire were used for convergent validation. In this prospective study, 187 patients completed these PROMs at 4 time points: at the preoperative consultation and postoperatively at 3, 6 and 12 months. Results 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 aesthetics of their noses with worse scores on UQ, FACE-Q nose and VAS. 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. Age and previous nasal trauma were statistically significant covariates associated with positive BDDQ-AS screening. Conclusion Due to the overwhelming decrease in positive BDDQ-AS outcome after surgery, a positive screening result on the BDDQ-AS should not be interpreted as a formal contra-indication for surgery. Collaboration with psychologists or psychiatrists remains crucial to diagnose BDD conclusively.