COSMETIC High Prevalence of Body Dysmorphic Disorder Symptoms in Patients Seeking Rhinoplasty Valerie A. Picavet, M.D. Emmanuel P. Prokopakis, M.D., Ph.D. Lutgardis Gabriëls, M.D., Ph.D. Mark Jorissen, M.D., Ph.D. Peter W. Hellings, M.D., Ph.D. Leuven, Belgium; and Heraklion, Greece Background: Nasal aesthetic deformities may be associated with significant body image dissatisfaction. The only diagnostic category in the current list of psy- chiatric disorders that directly addresses these concerns is body dysmorphic disorder. This large-scale study determined the prevalence of body dysmorphic disorder and its symptoms in patients seeking rhinoplasty and evaluated the clinical profile of these patients. Methods: Two hundred twenty-six patients were given questionnaires including demographic characteristics, visual analogue scales for nasal shape, the Yale- Brown Obsessive Compulsive Scale modified for body dysmorphic disorder to assess severity of symptoms, a generic quality-of-life questionnaire, and the Derriford Appearance Scale 59, to assess appearance-related disruption of ev- eryday living. Independent observers scored the nasal shape. Results: Thirty-three percent of patients showed at least moderate symptoms of body dysmorphic disorder. Aesthetic goals (p  0.001), revision rhino- plasty (p = 0.003), and psychiatric history (p = 0.031) were associated with more severe symptoms. There was no correlation between the objective and subjective scoring of the nasal shape. Yale-Brown scale modified for body dys- morphic disorder scores correlated inversely with the subjective nasal scoring (n = 210, p  0.001), without relation to the objective deformity of the nose. Body dysmorphic disorder symptoms significantly reduced the generic quality of life (n = 160, p  0.001) and led to significant appearance-related disruption of everyday living (n = 161, p  0.001). Conclusions: The prevalence of moderate to severe body dysmorphic disorder symptoms in an aesthetic rhinoplasty population is high. Patients undergoing revision rhinoplasty and with psychiatric history are particularly at risk. Body dysmorphic disorder symptoms significantly reduce the quality of life and cause significant appearance-related disruption of everyday living. (Plast. Reconstr. Surg. 128: 509, 2011.) CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III. R hinoplasty takes a unique position in the field of facial aesthetic surgery. The mor- phology of the nose and its central position in the face seem to be crucial not only for facial harmony, but also for normal psychological function. 1 The nasal shape is frequently one of the factors that disturb, consciously or unconsciously, our personality development and body image. 2 The latter is believed to motivate the pursuit of cosmetic surgery. 3–5 The only diagnostic category in the current list of psychiatric disorders, the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition), that directly addresses body im- age concerns is body dysmorphic disorder. There- fore, this well-established psychiatric disorder seems to be of particular relevance in appearance- enhancing medical treatments. 4 According to its From the Department of Otorhinolaryngology and the Psy- chiatric Department, University Hospitals Leuven, and the Department of Otorhinolaryngology, University Hospital Heraklion. Received for publication November 12, 2010; accepted Feb- ruary 3, 2011. Presented at the 33rd Annual Conference of the European Academy of Facial Plastic Surgery, in Antalya, Turkey, Sep- tember 1 through 5, 2010; and the 23rd Conference of the European Rhinologic Society, in Geneva, Switzerland, June 20 through 24, 2010. Copyright ©2011 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0b013e31821b631f Disclosure: The authors have no financial interest to declare in relation to the content of this article. No outside funding was received. www.PRSJournal.com 509