Major warning to surgeons ‘operating on BDD patients’

A disturbing presentation by a European facial plastic surgeon at the recent global aesthetics conference in Miami has warned ‘80% of surgeons know in hindsight they’ve operated on patients with Body Dysmorphic Disorder’ – and cautioned his peers about potentially catastrophic consequences.

This year’s annual statistics report from the American Society of Plastic Surgeons noted there were more than 17.7 million surgical and minimally invasive cosmetic procedures performed in the USA in 2018, ‘a number that has risen steadily over the past five years’.

But ‘it’s not all good news,’ warned the latest assessment by Dermatology Times. ‘Along with this increase is
the likelihood that more patients with psychological disorders are also walking through the practice door’.

It followed a disturbing presentation titled ‘Body Dysmorphic Disorder in Cosmetic Surgery: A Practical Review’ by Dr Capi Wever, a facial plastic surgeon practicing in the Netherlands, at the recent Global Aesthetics conference in Miami.

Dr Wever’s address outlined the prevalence of body dysmorphic disorder (BDD) in the profession and how to best manage it.

He particularly emphasised a major issue arising across the profession around the globe, declaring bluntly:
‘I think many surgeons are not aware about the details and how to diagnose and treat people that have BDD.’

BDD is defined as a psychiatric disorder ‘characterised by preoccupation with an imagined defect in physical appearance or
a distorted perception of one’s
body image,’ according to a study published in the International Journal of Women’s Dermatology.

While the general population has a 2% prevalence of BDD, that increases to more than 10% in aesthetic medicine.

And Dr Wever believes 80% of surgeons ‘know in hindsight they’ve operated on patients with BDD’
– which ‘underscores the need to identify signs of the disorder’.

When assessing whether a patient is exhibiting symptoms of BDD, Dr Wever advised: ‘You should look for people that have a minor aesthetic concern, but attribute a whole lot of emotional value to it.

‘BDD has obsessive components. Ask ‘how often do you look at yourself in the mirror?’

‘Mirror gazing and grooming for more than two or three hours a day are typical hallmarks.’

Dr Wever supported his assertions with reference to a 2017 study titled ‘Cosmetic Professionals’ Awareness of Body Dysmorphic Disorder’ published in the journal Plastic and Reconstructive Surgery.

It surveyed 173 members of Dutch professional associations for aesthetic plastic surgery, dermatology and cosmetic medicine and reported ‘two-thirds considered BDD as a contraindication’.

Dr Wever warned treatment for these patients ‘is not to operate, but instead recommend psychological treatment’.

He summed up: ‘If you suspect it and catch them ahead of time, don’t o er them surgery.’

Most importantly, Dr Wever emphasised that if those patients ‘are not identified before surgery, there is a risk of dangerous consequences’.

He explained: ‘A lot of people with BDD do something called ‘splitting’. They categorise the world as the bad parts and the good parts.

‘Surgery can actually trigger them moving from a positive self-image to a negative self-image, which can lead to self-damage.’
And in addition to an ‘internal split that can occur with a patient, external splitting directed towards the medical team’ can also happen.
In those cases, Dr Wever warned, ‘you can go from being the good guy to the bad guy just by operating on them – and they can start harming you.’

This can manifest itself in ‘lawsuits, threats of physical harm and even murder’. Since 1991, three plastic surgeons have been murdered by dissatisfied patients with BDD, according to a study published in Aesthetic Plastic Surgery.

Hence Dr Wever explained BDD is a topic that ‘everyone in the aesthetic industry should be aware of and educated about, so patients can receive the correct treatment’.

He summed up: ‘The standard treatment for these people is definitely not to operate. You will not make them happy.’

Sources: Dermatology Times,, International Journal of Women’s Dermatology, Plastic and Reconstructive Surgery and Aesthetic Plastic Surgery. AMP