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Below are two case studies where patients have screened positive for body dysmorphic disorder before a cosmetic procedure, and on one occasion, after having completed a rhinoplasty . They show that difficult conversations can have good outcomes, and that collaboration between all parties is key.
These stories come from Dr Toni Pikoos and Dr Ben Buchanan’s experience working with the cosmetic patients and are shared with the their permission. The names of the practitioners and patients have been changed.
Amelia, a fit and attractive 28 year old spent countless hours in front of the mirror, inspecting and critiquing her appearance. She was particularly obsessed with the size and shape of her breasts, which she felt were too small and uneven. Despite assurances from friends and loved ones that she was beautiful just the way she was, Amelia found herself yearning for a breast augmentation. She hoped that altering her physical appearance would bring her the peace and self-acceptance she yearned for.
She researched, saved money, and finally, she scheduled a consultation with Dr. Simmons, a renowned plastic surgeon known for his work in breast augmentations. However, Dr. Simmons was not only a highly skilled surgeon but also a compassionate and ethical doctor who cared about the overall wellbeing of his patients. He understood that surgery wasn’t always the solution, especially for those dealing with deep-seated body image issues.
During Amelia’s consultation, Dr. Simmons administered a screening questionnaire designed to detect signs of Body Dysmorphic Disorder (BDD). The results showed a high likelihood that Amelia was indeed suffering from BDD. Rather than scheduling the surgery immediately, Dr. Simmons gently advised Amelia to consider psychological counseling before making a decision about the surgery.
Amelia left the clinic that day feeling more confused than ever, but deep down, she also felt a profound sense of relief. This revelation meant that her perceived ugliness and dissatisfaction with her appearance were not necessarily the reality but rather a product of her disorder. For the first time, she had a chance to address the root cause of her distress.
She followed Dr. Simmons’s advice and started therapy. She discovered that her perception of her body was distorted and began to understand that her harsh criticism of her appearance was unfounded. Amelia spent the next few years working with psychologist confronting her internalised negativity and slowly learning to accept and love herself.
Throughout this journey, Amelia never completely abandoned the idea of breast augmentation. However, her perspective shifted drastically. She no longer viewed the surgery as a desperate attempt to correct a perceived flaw but rather as a personal choice that could enhance her confidence. She began to appreciate her body, not for how it looked, but for how it housed her spirit and served her throughout her life.
After years of introspection and self-love, Amelia decided to revisit the idea of breast augmentation. This time, she wasn’t seeking surgery out of self-loathing or desperation, but from a place of self-assurance and empowerment.
She returned to Dr. Simmons, explaining her transformation and her desire to proceed with the surgery. Dr. Simmons, impressed by her emotional growth and new perspective, agreed to perform the surgery.
After the operation, Amelia found herself looking in the mirror with a fresh set of eyes. Yes, her breasts were larger, but that wasn’t what truly mattered to her anymore. What mattered was the woman who stared back at her – a woman who had faced her demons, learned to love herself, and made a personal decision that wasn’t influenced by perceived inadequacies, but by self-love and acceptance.
Amelia’s journey was not an easy one, but it was necessary. It reminded her that the most significant changes come from within and that external alterations, while sometimes desired, should never be the sole source of self-worth or happiness. She had learned to love herself, in every sense, and in doing so, found the peace she had been seeking all along.
Jess had always been known for her full, luscious lips. She was a regular client at the local aesthetics clinic, where Nurse Simone, an experienced nurse injector, had been administering her lip fillers for years. Despite the praises she received about her lips, Jess was never quite satisfied with their size or shape. She constantly sought more volume, scrutinizing every minor asymmetry and imperfection.
One day, during a routine appointment, Nurse Simone paused, her syringe hovering mid-air. She looked at Jess, her brow furrowed with concern. “Jess,” she began, “I think we need to talk.”
Nurse Simone had seen a lot of clients over the years, many who regularly sought cosmetic enhancements. But Jess was different. The anxiety she displayed over her lips, the relentless pursuit for perfection, had alarmed her.
Nurse Simone had been trained to recognize the signs of Body Dysmorphic Disorder (BDD), a mental health condition where individuals obsess over perceived flaws in their appearance. This disorder could lead to excessive and unhealthy cosmetic interventions.
“I think we should put a pause on the fillers,” Nurse Simone suggested. “There’s something called Body Dysmorphic Disorder, and I’m wondering if this might be impacting your perception of your lips.”
Jess looked shocked, even hurt. But Nurse Simone was gentle and firm. She administered a BDD screening questionnaire, explaining each question carefully. As Jess answered, it became clear that she was indeed likely suffering from BDD.
Instead of sending Jess away, Nurse Simone offered her resources for mental health professionals and encouraged her to take a step back from the lip fillers for a while to address her emotional wellbeing.
Initially, Jess felt a torrent of emotions—anger, shame, and disbelief. But as the reality of her situation sunk in, she began to feel an unexpected emotion: relief. She was not ugly, as she had long believed. Her intense self-criticism and perceived flaws were distortions caused by her BDD.
Embracing this revelation, Jess sought therapy and began to address her body dysmorphia head-on. She attended regular sessions with a psychologist and spent the next six months focused on improving her mental health.
Six months later, Jess returned to Nurse Simone clinic, not just for lip fillers, but also to express her gratitude. She thanked Nurse Simon for her bravery and kindness in confronting her about her disorder. She credited Nurse Simone for setting her on the path to self-acceptance and recovery.
Nurse Simone was overjoyed. It was not every day that she could truly make a difference in someone’s life beyond their physical appearance. She was just doing her job, but it felt good to know that she had helped Jess in a much more profound way.
She hugged Jess tightly, saying, “I’m proud of you, Jess. You’re more beautiful now than ever, and it’s not about your lips. It’s about the strength and self-love that I see in your eyes.”
From then on, Nurse Simone used Jess’s story as a beacon of hope and a reminder of the essential role she played as a nurse injector. Not just in enhancing physical appearances, but in promoting overall mental and emotional wellbeing. In doing so, she felt she was serving her patients, like Jess, in the best way possible.
Rosemary had always been unhappy with her nose. From her adolescent years, she had wished for a narrower bridge and a more defined tip. When she finally had the resources, she sought out a reputable plastic surgeon, Dr. Morgan, who performed her first rhinoplasty.
Despite Dr. Morgan’s assurance that the operation was a success, Rosemary was unsatisfied with the result. She found fault with the minutest details, leading to constant frustration and dissatisfaction. Her annoyance with Dr. Morgan grew, and at one point, she even threatened to take legal action, believing her nose to be ruined rather than improved.
Some years late Rosemary was still determined to fix what she perceived as a “botched surgery”, so she sought out a second surgeon, Dr. Hammond. A well-respected figure in the field, he took note of Rosemary’s intense dissatisfaction with her previous surgery and her apparent obsession with perfection. Yet, he agreed to perform the surgery, hoping to bring her some peace.
Following the second surgery, Rosemary woke up in the recovery room eager to see her new nose. Dr. Hammond had done an excellent job, correcting some of the minor issues from the first surgery and giving her the defined tip she had requested. Yet, as she looked at herself in the mirror, all she could see were flaws. The bridge could be narrower, the tip more upturned; the list of ‘imperfections’ seemed endless.
Seeing her disappointment, Dr. Hammond felt a sinking feeling. He had observed Rosemary’s intense preoccupation with her appearance and her inability to find satisfaction, even after two successful surgeries. These were signs he had come to recognise as indicative of Body Dysmorphic Disorder (BDD).
He decided to discuss his concerns with Rosemary, approaching the conversation with empathy and respect. “Rosemary,” he said gently, “I believe you might be dealing with something called Body Dysmorphic Disorder. It’s a condition where a person can’t stop thinking about perceived defects or flaws in their appearance, which are often minor or not observable to others.”
Though taken aback at first, Rosemary slowly began to understand Dr. Hammond’s perspective. She agreed to a referral to a psychologist who specialised in perfectionism and unrelenting standards.
Dr. Hammond and the psychologist had a history of collaboration. They understood that their roles, while different, both aimed at the same goal—helping their patients lead happier, healthier lives. They worked in tandem, with the psychologist providing therapy to address Rosemary’s BDD and perfectionism, while Dr. Hammond provided the necessary medical support.
Though Rosemary never found complete satisfaction with her nose, her perspective began to change. Therapy helped her understand that her constant quest for perfection was not only unattainable but also a manifestation of her BDD.
She came to appreciate Dr. Hammond’s delicate handling of her case. His recognition of her struggles and referral to the psychologist set her on a path of self-discovery and healing. She sent him a heartfelt email one day, thanking him for his insight and kindness, and for seeing what others had missed.
And so, Rosemary embarked on a journey to address the root cause of her dissatisfaction, learning to temper her standards and find acceptance within herself. Her story served as a stark reminder to both Dr. Hammond about the deep interconnection between physical and mental health, and the role they each played in treating it.
Dr. Hammond saw the first surgeon who Rosemary was so dissatisfied with at a conference. They got talking, and Dr. Hammond learnt that she’d found the Rosemary’s case so distressing that she’d taken time of her surgery practice, only returning once she, too, had learnt to let go of her perfectionism. It turns out patients aren’t the only people who are unfairly hard on themselves.
