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.