Identifying the body-dysmorphic patient in aesthetic surgery.

Body dysmorphophobia (BDD) is a psychiatric illness experienced by up to 20% of patients requesting cosmetic surgery. Because of its diverse presentations, BDD should be searched out and recognized by the plastic surgeon. Otherwise, the unwary operator will invariably have to deal with a profoundly dissatisfied patient. Patients with BDD hate their bodies and may seek out cosmetic surgery as a solution. However, they invariably are not satisfied despite the objective result. Many eventually fall into the cosmetic surgical victim category of "overoperation." These patients need psychological counseling and referral to psychiatrists with a special interest in body image. Recognition and deferral of surgery for BDD patients is advised because findings have shown the propensity of these patients to litigate, threaten, and even harm or kill their surgeon.