Prevalence and Characteristics Associated with Positive Body Dysmorphic Disorder Screening Among Patients Presenting for Cosmetic Facial Plastic Surgery

Patient-Reported Outcome Measures in Nasal Valve Repair and Nasal Obstruction

Although no gold-standard test exists for measuring the success of surgery in functional rhinoplasty, the patient's own subjective experience of their nasal airway obstruction and its impact on quality of life is paramount in outcomes assessment. Patient-reported outcome measures (PROMs) are questionnaires designed to evaluate both disease-specific nasal functional and esthetic domains and global health-related quality of life domains. Ideal PROMs are derived from patient input, psychometrically validated, reliable, and responsive. Assessment at both preoperative and postoperative visits allows for quantitative analysis of surgical outcomes and helps promote communication between the patient and surgeon.

Assessing the Effectiveness of a Short Form Screening Tool (COPs) for Body Dysmorphic Disorder in Cosmetic Surgery Patients: A Study of Pre- and Post-Operative Outcomes

Recent regulatory changes in Australian cosmetic surgery necessitate preoperative screening for body dysmorphic disorder (BDD). This study, which focuses on patient outcomes, evaluates the COPs tool's efficacy and examines its implications on patients undergoing cosmetic procedures. A total of 189 patients were included: 78 underwent Medicare-classified "cosmetic" surgeries, and 111 underwent "medically necessary" procedures. Patients completed the COPs assessment pre- and post-operatively, with a score >40 indicating BDD susceptibility. Results show no significant pre- to post-operative change in COPs scores across different surgical procedures (body, breast, facial, and mixed) in both "cosmetic" (p = 0.2-0.4) and "itemised" groups (p = 0.15-0.33). However, overall, there was a marked reduction in COPs scores post-operatively (p < 0.001), indicating improved self-perception. Specifically, 91% of patients initially BDD-prone showed scores < 40 post-operatively. Conversely, 3.8% of initially low-scoring patients developed BDD-prone scores post-operatively. Comparison between cosmetic and itemised groups revealed higher preoperative COPs scores in the itemised group (p = 0.006), though post-operative scores did not differ significantly (p = 0.33). Incidences of post-operative BDD-prone scores or scores < 40 did not differ between groups (p = 0.61). Complication rates and the need for revision surgery were similar between groups. These findings suggest two plausible interpretations: First, preoperative screening with the COPs tool may positively influence self-perception related to BDD among cosmetic surgery patients, potentially serving as a therapeutic adjunct for those at risk. Second, while screening tools are beneficial, they may have limitations in predicting post-operative outcomes related to BDD development. Further research should explore these dynamics to refine screening practices and optimise patient outcomes in cosmetic surgery contexts. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Increased Prevalence of Psychiatric Conditions in Panniculectomy Patients With Prior Bariatric Surgery: A Nationwide Epic Cosmos Study

Introduction Patients with established body dysmorphic disorder (BDD) diagnoses are highly likely to be dissatisfied with plastic surgery and may have increased complication rates. Identifying at-risk patients prior to surgery is crucial to achieving patient satisfaction and minimizing adverse effects. This study seeks to assess the prevalence of BDD and associated psychiatric disorders in patients who have undergone panniculectomy and to evaluate potential associations between psychiatric comorbidity and prior bariatric surgery. Materials and methods Data used in this study came from Epic Cosmos (Epic Systems Corporation, Verona, WI, USA), a community collaboration of health systems representing over 233,000,000 patient records from over 1,325 hospitals and 28,900 clinics. All patients at least 18 years of age with an encounter between January 11, 2014, and January 10, 2024 (n=232,933,561) were included, and records were grouped based on procedural history using documented current procedural terminology codes. Prevalence of psychiatric diagnoses was measured using documented International Classification of Diseases (ICD) 10 codes, and 99% confidence intervals were recorded. Odds ratios (OR) were calculated for group comparison, and p<0.01 was used to determine significance. Results Patients who have undergone panniculectomy (n=62,671) demonstrated significantly increased prevalence of BDD (0.182% vs. 0.011%; OR=16.3, p<0.001), anxiety (43.2% vs. 13.5%; OR=4.9 p<0.001), and depression (35% vs. 9.7%; OR=5.0, p<0.001) compared to those who have not undergone the procedure (n=232,870,890). Of the 62,671 patients with a recorded panniculectomy, those who had also undergone bariatric surgery (n=7,313) showed a significantly increased prevalence of BDD (0.397% vs. 0.154%; OR=2.6, p<0.001), anxiety (64.1% vs. 40.5%; OR=2.6, p<0.001), and depression (57% vs. 32.1%; OR=2.8, p<0.001) than those without prior bariatric surgery (n=55,358). Conclusion Patients undergoing panniculectomy are at high risk for BDD and other psychiatric comorbidities that justify formal screening prior to scheduling surgery. Surgeons should maintain a low threshold in seeking psychiatric evaluation for any concerning patients presenting for panniculectomy evaluation, especially in those with a bariatric surgery history, to ensure holistic benefit for their patients. Additionally, psychiatric professionals who understand the stress of elective plastic surgery should be utilized when available.

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 objective was to investigate the validity and evolution over time of the Body Dysmorphic Disorder Questionnaire-Aesthetic Surgery (BDDQ-AS) before and after surgery. Together with the BDDQ-AS, also the Nasal Obstruction Symptom Evaluation scale, FACE-Q nose and nostrils, and Utrecht questionnaire (UQ) were used for convergent validation. In this prospective study, 187 patients completed these patient-reported outcome measures at four time points: at the preoperative consultation and postoperatively at 3, 6 and 12 months. 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 esthetics of their noses with worse scores on UQ, FACE-Q nose, and visual analog scale. 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. Younger age and absence of nasal trauma were statistically significant covariates associated with positive BDDQ-AS screening. Due to the overwhelming decrease in positive BDDQ-AS outcomes after surgery, a positive screening result on the BDDQ-AS should not be interpreted as a formal contraindication for surgery. Collaboration with psychologists or psychiatrists remains crucial to diagnose BDD conclusively.

Body Dysmorphic Disorder in Aesthetic and Reconstructive Plastic Surgery-A Systematic Review and Meta-Analysis

(1) Background: Body dysmorphic disorder (BDD) presents significant challenges in aesthetic and reconstructive plastic surgery, impacting patient outcomes and well-being. Understanding its prevalence and associated factors is crucial for effective patient care. (2) Methods: A systematic review of national and international databases on body dysmorphic disorder, plastic surgery, cosmetic surgery, reconstructive surgery, and prevalence yielded 999 studies between 1878 and April 2024. Inclusion criteria focused on studies reporting prevalence while excluding those with small sample sizes (<20 participants), unclear diagnostic criteria for BDD, and non-English accessibility. (3) Results: A meta-analysis using a random effects model was conducted on 65 studies involving 17,107 patients to estimate the prevalence of BDD. The overall estimated prevalence of BDD was 18.6%; 10,776 (62.9%) were females, with a mean age of 35.5 ± 11.7 years. Subgroup meta-analysis found significant variability in effect sizes across countries and types of specialty, of which Brazil showed the highest proportion and dermatology exhibited the smallest. Meta-regression analysis found no significant relationship between the year of publication and prevalence rates. (4) Conclusions: Our findings update the current literature on BDD prevalence in aesthetic and reconstructive plastic surgery. We emphasize the importance of proactive screening and multidisciplinary care approaches to address the complex challenges posed by patients with BDD. Further research is needed to explore evolving trends in BDD prevalence and factors influencing its expression across different cultural contexts.