Study Says: Too Many Plastic Surgeons Overlooking Signs of Mental Illness Before Surgery

A nip here, a tuck there, a fuller lip, a smaller nose—there are so many options for refining your features through cosmetic surgery. According to new research published by JAMA Facial Plastic Surgery, nearly one in 10 patients seeking facial plastic surgery suffers from body dysmorphic disorder (BBD), but plastic surgeons aren’t always able to spot the signs. Researchers found that less than half of the patients diagnosed with body image issues and mentally illness were screened positive for the disorder by doctors during their evaluations.

During the study, a team at Johns Hopkins University’s division of facial plastic and reconstructive surgery screened almost 600 patients who sought facial plastic surgery at three medical sites during an 11-month period. Using a specialized questionnaire, the team determined whether the patients suffered from body dysmorphic disorder—a condition that is characterized by an imagined defect in one’s physicality that sometimes leads to extreme or excessive cosmetic surgery

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Almost 10 percent of the study's participants screened positive for BBD, but only 4 percent of patients were suspected of having the psychiatric disorder by their plastic surgeons. “We all knew patients with BDD were in our practice, but we didn’t know the prevalence of it,” said associate professor of otolaryngology/head and neck surgery and study author Dr. Lisa Earnest Ishii, in an interview with CBS News.

In addition to its findings, the study also highlights that there is no formal screening process in place, nor is there documentation on how many patients with mental illness pass the screening process and are able to follow through with their plastic surgery wishes. Dover, OH, facial plastic surgeon David Hartman, MD, says he, for one, is hyperaware of red flags during the initial consultation. “Although some patients can be crafty at disguising their disorder, especially if they have been around the block with other surgeons, 90 percent of mental illness can be detected in the first few minutes of the initial interview. I try to determine if a patient has ever been happy with a prior procedure or treatment.”

For a good plastic surgeon, discussing desired results isn’t solely about getting to know his patients' aesthetic goals, but also to identify if something doesn’t seem right during the screening process. “I want to make sure our patients have a realistic expectation: improvement, not perfection. When we are in doubt as to the suitability of a given patient for a cosmetic procedure, we refer them to our chosen psychologist for a formal evaluation and report," says Dr. Hartman.