Caring for Patients With Body Dysmorphic Disorder Seeking to Undergo Plastic Surgery and/or Aesthetic Interventions.

In the field of medical aesthetics and plastic surgery, it is not uncommon to interact with clients who never seem to be satisfied, regardless of the success of an intervention. Medical professionals may attribute this to the patient having an overly critical nature; however, this continual dissatisfaction could also be the result of a mental health disorder known as body dysmorphic disorder (BDD) that is significantly underdiagnosed and prevalent within the plastic surgery and aesthetic patient population. According to the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5; American Psychiatric Association, 2013), BDD is defined as, "a preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others" (Substance Abuse and Mental Health Services Administration, 2016, Table 23). Having the ability to identify the signs of BDD, utilize appropriate communication skills with individuals who may have BDD, and understand the implications of providing additional aesthetic treatments for patients who present with BDD allows aesthetic practitioners to prioritize and promote patient safety, well-being, and satisfaction.

The Impact of Health Literacy on Trust in Online Plastic Surgery Content: A Nationwide Analysis.

INTRODUCTION: On most online platforms, just about anyone can disseminate plastic surgery (PS) content regardless of their educational or professional background. This study examines the general public's perceptions of the accuracy of online PS content and the factors that contribute to the discernment of credible information. METHODS: The Amazon Mechanical Turk crowdsourcing platform was used to survey adults in the United States. The survey assessed respondent demographics, health literacy (HL), and perceptions of online PS content accuracy. T-tests, Chi-square tests, and post hoc analyses with Bonferroni corrections assessed differences between HL groups. Multivariate linear regressions assessed associations between sociodemographic variables and perceptions of online content. RESULTS: In total, 428 (92.0%) of 465 complete responses were analyzed. The median age of respondents was 32 y (interquartile range: 29-40). Online sources were predominantly perceived to have a high degree of accuracy, with mean scores of various platforms ranging from 3.8 to 4.5 (1 = not accurate at all; 5 = extremely accurate). The low HL group perceived social media sites and review sites to be more accurate than the high HL respondents, particularly for Reddit (P = 0.004), Pinterest (P = 0.040), and Snapchat (P = 0.002). CONCLUSIONS: There is a concerning relationship between low HL and the perceptions of the accuracy of online PS sources. This study underscores the need for education campaigns, the development of trustworthy online resources, and initiatives to improve HL. By fostering a more informed public, individuals seeking PS can make better informed decisions.

Sociocultural pressures and engagement with cosmetic products and procedures in adult women.

Previous studies have shown that cosmetic procedures and products that perpetuate Western hegemonic beauty standards among women have become increasingly popular, and pressures from sociocultural agents to utilize them are significant. However, little work has documented the relationship between perceived sociocultural pressures and use of cosmetic procedures and products among a larger age range of adult women. A community sample of 308 women aged 18-66, mean (SD) age of 35.7 (9.7), reported on the cosmetic procedures they had considered or used, as well as perceived pressures from the media, peers, romantic partners, and health and beauty professionals. Findings revealed that, among those investigated, the most frequently utilized products and procedures were supplements and hair removal. However, a significant minority reported considering more invasive procedures, including cosmetic surgery. Media was the predominant source of pressure, while partners were the least frequently endorsed. While pressure from professionals and peers had small-to-moderate associations with utilization of cosmetic products and procedures, pressure from partners had the largest association with their use. This work frames important future directions for examining the impact of sociocultural pressures on women's willingness to utilize cosmetic products and procedures that are sometimes underregulated and risky for physical and mental health.

Health professionals' and beauty therapists' perspectives on female genital cosmetic surgery: an interview study.

BACKGROUND: Female genital cosmetic surgery (FGCS) changes the structure and appearance of healthy external genitalia. We aimed to identify discourses that help explain and rationalise FGCS and to derive from them possibilities for informing clinical education. METHODS: We interviewed 16 health professionals and 5 non-health professionals who deal with women's bodies using a study-specific semi-structured interview guide. We analysed transcripts using a three-step iterative process: identifying themes relevant to indications for FGCS, identifying the discourses within which they were positioned, and categorising and theorising discourses. RESULTS: We identified discourses that we categorised within four themes: Diversity and the Normal Vulva (diversity was both acknowledged and rejected); Indications for FGCS (Functional, Psychological, Appearance); Ethical Perspectives; and Reasons Women Seek FGCS (Pubic Depilation, Media Representation, Pornography, Advertising Regulations, Social Pressure, Genital Unfamiliarity). CONCLUSIONS: Vulvar aesthetics constitute a social construct to which medical practice and opinion contribute and by which they are influenced; education and reform need to occur on all fronts. Resources that not only establish genital diversity but also challenge limited vulvar aesthetics could be developed in consultation with women, healthcare practitioners, mental health specialists, and others with knowledge of social constructs of women's bodies.

Australian women's motivations for, and experiences of, cosmetic surgery: A qualitative investigation.

Little qualitative literature has examined women's motivations for undergoing cosmetic surgery or their experiences throughout the surgery process (e.g., consultation, aftercare, and recovery). To fill this gap, we interviewed 15 Australian women (Mage = 37.67) who had undergone cosmetic surgery. We conducted a reflexive thematic analysis from which we generated five overarching themes. Broadly, participants described the 'cosmetic surgery lifestyle' as being normalised in contemporary Australian society. In terms of their own cosmetic surgery experiences, several expressed suffering from severe depression immediately post-surgery. Most participants also discussed how interactions with other people influenced their cosmetic surgery journeys. For instance, several described having problematic and/or distressing interactions with cosmetic surgeons, while others spoke to the lack of emotional support they received from romantic partners. Finally, almost all participants described how cosmetic surgery was a decision they made 'for themselves' (i.e., completely independent of external influence), yet, paradoxically, described how negative comments made by others drove them to cosmetic surgery. These findings contribute to existing feminist accounts of cosmetic surgery and highlight ethical concerns regarding how cosmetic surgery is practiced in Australia.

Psychosocial issues and body dysmorphic disorder in aesthetics: Review and debate.

Body dysmorphic disorder (BDD) is a serious and debilitating psychiatric condition that disproportionately presents in dermatologic and cosmetic surgery patients. BDD is currently underrecognized in cosmetic medical settings and is thought to be underdiagnosed by behavioral health professionals. The significant comorbidities associated with this disorder, as well as potential harm done to both patient and physician, raise ethical and medicolegal concerns regarding its treatment. Although cosmetic interventions have historically been discouraged in BDD, recent studies have provided controversial evidence of benefit in certain cohorts. The rise of "snapchat dysmorphia" and the proposed explanatory phenomenon of perception drift have generated further debate around the de novo development or unmasking of BDD. We critically review and summarize existing debates around the treatment of BDD in cosmetic medicine. We provide guidance for screening, clinical interviewing, and the provision of psychoeducation in cases of suspected BDD.

Perception of cosmetic surgery and associated side effects: A content analysis study of South Korean female college students.

ABSTRACT: This study explores the perception of female college students in South Korea regarding cosmetic surgery and its side effects.Face-to-face interviews were conducted with 28 female college students over a period of 4 months, starting in October 2019. All participants were female college students who had not undergone cosmetic surgery. The collected data were analyzed qualitatively, using conventional content analysis.Four categories and 13 subcategories were extracted from 112 meaningful codes reflecting perceptions related to cosmetic surgery and its associated side effects. The 4 categories that emerged in the study were: "reaction to the side effects of cosmetic surgery", "reasons for cosmetic surgery", "prospects of the participant's own cosmetic surgery", and "prerequisites for decision-making regarding cosmetic surgery".The results of this study could be used as reference material by surgeons to ensure safer cosmetic surgeries. A sufficient consideration period and patient education prior to selective cosmetic surgery would minimize patient complaints and expand the base of safe cosmetic surgery.

Body dysmorphic disorder (BDD) in the orthodontic and orthognathic setting: A systematic review.

General prevalence of Body Dysmorphic Disorder (BDD), a psychiatric disorder in which patients focus on an imagined body defect not visible to others, varies between 0.7 and 2.5%. Up to 86% present with complaints in the area of teeth or face. Patients with BDD pursue an aesthetic rather than functional recovery, making BDD a possible contraindication to treatment. The aim of this systematic review was to review prevalence of BDD within the orthodontic and/or orthognathic population, to describe diagnostic tools for early detection of patients with BDD and to assess the outcome after treatment. A systematic search was conducted up to November 2020 using PubMed, Embase, Web of Science Core Collection and Cochrane Library. Following the screening of 1423 articles, 5 prospective studies were included. Prevalence of BDD within the orthodontic and orthognathic population varied from 5.2% to 13% (average of 6.2%). Literature showed a trend of higher BDD prevalence within younger, female and single patient population, although results are not conclusive. Questionnaires can be useful for preliminary detection of BDD. General anamnesis with questioning medical or psychiatric history, medication and personal expectations remains very important. Red flags could be previous consultations for the same problem or presence of psychiatric comorbidities. Prospective studies are necessary to map satisfaction of these patients and need for re-interventions after treatment.

Body Dysmorphic and Narcissistic Personality Disorder in Cosmetic Rhinoplasty Candidates.

BACKGROUND: Body dysmorphic disorder (BDD) and other psychological problems are more common in cosmetic surgery applicants. OBJECTIVE: The aim of this study was to investigate the frequency of the symptoms of BDD and narcissistic personality disorder in rhinoplasty candidates. MATERIALS AND METHODS: This descriptive cross-sectional study was performed on rhinoplasty applicants. All subjects were evaluated by BDD and narcissistic personality questionnaires (NPI-16). RESULTS: A total of 380 patients were studied. Our findings showed that the prevalence of mild, moderate, and severe BDD symptoms was 31.6%, 43.4% and 25%, respectively. The mean BDD scores were not significantly different in variables such as gender, age, marital status, history of cosmetic surgery, education, place of residence, and income. 29.5% of the subjects had symptoms of narcissism. There was no significant relationship between the symptoms of narcissism and variables such as gender, age, marital status, history of cosmetic surgery, place of residence, and income. Higher education was associated with higher rates of narcissistic personality disorder (p-value = 0.021). CONCLUSIONS: According to the results of the study, there was no statistically significant relationship between BDD score and demographic parameters. Also, association between narcissistic personality disorder and demographic characteristics was not significant except for education. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Body image and acceptance of cosmetic surgery in China and the Netherlands: A qualitative study on cultural differences and similarities.

There is an established relationship between acceptance of cosmetic surgery and psychological factors, including body image. However, qualitative research among diverse cultural groups is needed to provide a more fine-grained understanding of the influences on women's attitudes towards cosmetic surgery. In this study, 20 Chinese and 20 Dutch women aged 18-50 years (MChinese = 34.20; MDutch = 34.70) participated in one-on-one semi-structured interviews. Data were analyzed using reflexive thematic analysis. We identified three themes that captured the factors that women perceived to foster favorable attitudes towards cosmetic surgery: (a) sociocultural pressures (e.g., normalization of cosmetic surgery, appearance-focused peers); (b) intrapersonal characteristics (e.g., beauty-ideal internalization, social comparison); and (c) benefits of beauty (e.g., attracting men, socioeconomic benefits). Conversely, two themes captured the factors perceived to reduce favorable attitudes towards cosmetic surgery: (a) intrapersonal characteristics (e.g., unconditional body acceptance, self-confidence); and (b) external considerations (e.g., health risks, financial costs). Overall, Chinese and Dutch participants shared many similarities in their opinions about what might affect cosmetic surgery consideration. The most striking cross-cultural differences concerned perceived socioeconomic benefits of beauty (mainly Chinese women) and women's conceptualization of body appreciation. This study may enable a more comprehensive understanding about the factors influencing Chinese and Dutch women's attitudes towards cosmetic surgery, and the nuances in these relationships across these cultures.

Analysis of social media use by European plastic surgery societies: A missing link for #PlasticSurgery.

PURPOSE: The field of Plastic Surgery is prominent on social media around the world. Board certified plastic surgeons and societies of plastic surgery play a role in providing accurate, evidence-based information to the public, patients, and colleagues. The aim of this study was to explore the use of social media by European Plastic Surgery Societies. METHODS AND MATERIALS: A retrospective analysis of the presence and activity of European Plastic Surgery Societies on Facebook, Twitter and Instagram was conducted between December 12th 2018 and December 12th 2019. The results have been compared to the American Society of Plastic Surgeons. RESULTS: Twenty, eleven and nine European societies yielded an active account on Facebook, Twitter and Instagram respectively. Only seven European societies had an account on all three platforms and were therefore considered polypresent. The amount of followers of those seven societies was significantly higher than of the others (p-value = 0.02). Their activity yielded significantly more posts on Facebook (p-value = 0.02). The American Society of Plastic Surgeons had more followers on all three platforms than all European societies combined. CONCLUSION: Social media are still rather unexploited by European Plastic Surgery Societies. A tendency towards increased visibility can be observed, yet a higher penetration is required to further educate and engage through social media. The quantitative data provided serve as reasonable foundation for further studies and a guide for growth of #PlasticSurgery.

Under the knife: Unfavorable perceptions of women who seek plastic surgery.

Plastic surgery is growing in popularity. Despite this, there has been little exploration to date regarding the psychosocial consequences of seeking plastic surgery. Our study investigated how women seeking plastic surgery are perceived by others. We presented a random sample of 985 adults (men = 54%, Mage = 35.84 years, SDage = 10.59) recruited via Amazon's Mechanical Turk with a series of experimental stimuli consisting of a photographed woman (attractive versus unattractive) and a vignette describing an activity she plans to engage in (plastic surgery versus control activity). Participants rated stimuli on perceived warmth, competence, morality, and humanness. We ran linear mixed-effect models to assess all study hypotheses. There was a negative plastic surgery effect; that is, women seeking plastic surgery were perceived less favorably than those planning to complete control activities across all outcome variables (warmth, competence, morality, and humanness). These relationships were moderated by physical attractiveness; while attractive women planning to undergo plastic surgery were perceived less favorably than attractive women planning to engage in control activities, perceptions of unattractive individuals remained unchanged by plastic surgery status. We theorized that empathy toward unattractive women seeking plastic surgery mitigated the negative plastic surgery effect for these women. In sum, our results suggest that perceptions of attractive women are worsened when these women decide to seek cosmetic surgery. Perceptions of warmth and competence have implications for an individual's self-esteem and interpersonal relationships, while perceptions of morality and humanness can impact an individual's ability to fulfil their psychological needs. As such, we concluded that attractive women seeking plastic surgery are potentially subject to experience negative psychosocial outcomes. Future research ought to examine whether perceptions and outcomes differ for women seeking reconstructive plastic surgery (versus cosmetic plastic surgery) and whether they differ across different types of surgeries (i.e. face versus body).

What's in a Name? Implicit Bias Affects Patient Perception of Surgeon Skill.

BACKGROUND: Implicit bias is the unconscious associations and beliefs held toward specific demographic groups. Instagram is commonly used by plastic surgeons to market their practice. This study investigates whether a surgeon's name on a social media platform influences perception of their competence and their likelihood of gaining a new patient. METHODS: A mock Instagram post was created using before-and-after photographs of a breast augmentation patient. Eight different ethnicities were selected, and common female and male names were selected based on U.S. Census data for each ethnicity. Surveys using the Instagram post were distributed asking responders to evaluate the competency of the surgeon and how likely they are to become a patient of that plastic surgeon. The surgeon's name was the only variable in the survey. RESULTS: A total of 2965 survey responses were analyzed. The majority of responders were Caucasian (57 percent); 55 percent were men and 45 percent were women. Overall, competence and recruitment likelihood scores between surgeons of different ethnicities were not significantly different. Caucasian and Latinx responders both assigned higher competence and recruitment likelihood scores to their own respective ethnicities. CONCLUSIONS: Implicit bias plays a role in whether or not a patient is likely to seek care from a surgeon with an ethnically identifiable name. The two most common cosmetic surgery demographic groups, Caucasians and Latinxs, were also the only two ethnic groups to display in-group favoritism. Public education should be directed toward surgeon qualifications and experience in an effort to reduce implicit bias on patient decision-making.

A Report of Gender Bias and Sexual Harassment in Current Plastic Surgery Training: A National Survey.

BACKGROUND: Gender bias and sexual misconduct continue to pervade medicine. The authors hypothesize that gender bias and sexual misconduct disproportionately and negatively affect female plastic surgery trainees. METHODS: A national survey of plastic surgery trainees (2018 to 2019) was conducted using previously validated sexual harassment surveys adapted for relevance to plastic surgery. Respondents were queried about experiences with workplace gender bias and harassment; personal and professional impact; and reporting practices. Analyses included chi-square, logistic regression, and analysis of variance. Significance was accepted for values of p < 0.05. RESULTS: There were 236 responses (115 female respondents; 20.1 percent response rate). Most respondents were Caucasian (Asian/Pacific Islander, n = 34) residents (n = 123). The feeling of hindrance to career advancement was greater for women, by 10-fold (p < 0.001), and increased with age (p = 0.046). Women felt uncomfortable challenging attitudes regarding gender inequality (p < 0.001), regardless of training levels (p = 0.670) or race (p = 0.300). Gender bias diminished female trainees' career goals/ambition (p < 0.001). Women were more likely to experience sexual harassment, in the form of jokes (p = 0.003) and comments about their body or sexuality (p = 0.014). Respondents reported the majority of perpetrators of harassment to be attending physicians (30 percent) and other trainees (37 percent). Most common reasons to not report incidents included "futility" (29 percent) and "fear" (20 percent). Women experienced at least three symptoms of depression/anxiety, significantly higher than men (p = 0.001). CONCLUSIONS: Gender bias and sexual misconduct negatively affect female trainees' attitudes toward their career. Two-thirds of cases of sexual harassment originate from other physicians. Minority trainees are less prepared to address transgressions and more likely to experience sexual coercion. Trainees perceive a culture nonconducive to reporting. These findings can guide changes and discussions surrounding workplace culture in plastic surgery training.