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Many nose job seekers suffer from a mental health condition

Dominika Osmolska Psy.D.'s picture

Many, if not most, people complain, at one time or another, about the size and shape of their nose. A considerable minority go on to have their noses restructured surgically, commonly called nose-jobs in popular parlance, and rhinoplasty in medical jargon. A significant percentage of those individuals, it turns out, may have a mental health condition called body dysmorphic disorder.

Many rhinoplasty procedures are done to correct breathing problems or serious anomalies with the anatomy of the nose. Many others are for purely cosmetic reasons. Now a study out of Belgium, published in the August issue of the journal Plastic and Reconstructive Surgery, suggests that close to 43% of patients seeking rhinoplasty for cosmetic reasons alone showed signs of body dysmorphic disorder, versus only 2% for those who sought the procedure for ostensibly medical reasons. Over all, 1 out of 3, or 33 percent of patients in the study showed symptoms of the disorder.

The findings are based on a study of 266 patients evaluated by plastic surgeons in Belgium over a 16-month period. The patients made appointments to discuss a rhinoplasty procedure and were given a questionnaire to assess their symptoms of body dysmorphic disorder. The study shows a surprisingly high rate of body dysmorphic disorder among nose-job patients, compared to previous studies, which have shown that about 10 percent of patients seeking plastic surgery suffer from the condition.

It is important to keep in mind that not all patients seeking a nose job for cosmetic reasons suffer from the disorder. Some people may be genuinely distressed by a very badly misshapen or disproportionate nose. “We know body image dissatisfaction falls on a continuum, and there has to be some degree of dissatisfaction that leads us to see a plastic surgeon in the first place,” said David B. Sarwer, associate professor of psychology at the Center for Human Appearance at the Perelman School of Medicine at the University of Pennsylvania.

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It is when the preoccupation with the appearance of one’s nose interferes with daily functioning and social and family interactions that is an indicator of real trouble. If someone has problems getting to work, showing up for social events or becoming a shut-in because of the perceived ugliness of their nose, they are probably suffering from the disorder.

Body dysmorphic disorder can be quite disabling and shows similarities in symptoms to OCD, or obsessive-compulsive disorder. It is characterized by obsessive thoughts about the perceived defect, compulsive behaviors related to the perceived defect, such as mirror and make-up checking, delusional thoughts about the perceived defect, and even suicidal thoughts.

BDD is also frequently associated with episodes of major depression and anxiety, as well as some personality disorders, such as avoidant personality disorder and dependent personality disorder. These disorders revolve around issues of anxiety around being rejected. Both BDD sufferers and those with avoidant personalities are exceedingly self-conscious in social situation and constantly on the look-out for signs of rejection.

Dr. Phillip Haeck, a Seattle plastic surgeon and president of the American Society of Plastic Surgeons, said the organization advises doctors not to proceed with surgery for patients who exhibit signs of the disorder.

“The biggest mistake is to offer to operate on them, because the chances that they will be satisfied afterward, no matter how good the shape of the nose may be, are very low,” said Dr. Haeck.

Such patients can become frequent plastic-surgery shoppers, spending hundreds of thousands of dollars on various corrective procedures which ultimately never result in the perfected person they hope to be.



People should be content with the size of their nose. If someone has a big nose that's ok and people should not be prejudiced because of the size of a nose.