Rhinoplasty Outcomes in Patients With Symptoms of Body Dysmorphia

Abstract

Background

Patients with symptoms of body dysmorphia often seek consultation for aesthetic rhinoplasty. While body dysmorphic disorder is a formal psychiatric diagnosis, recent evidence indicates that patients with symptoms of this condition who seek rhinoplasty may experience increased satisfaction with their appearance following surgery.

Objectives

To determine the psychological impact of rhinoplasty in patients screened preoperatively and postoperatively with a body dysmorphia screening questionnaire.

Methods

Retrospective chart review was performed of patients who underwent aesthetic and/or functional rhinoplasty by a single surgeon from June 2021 to April 2023. Adult patients with a complete preoperative and postoperative Body Dysmorphic Disorder–Aesthetic Surgery questionnaire (BDDQ-AS), Standardized Cosmesis and Health Nasal Outcomes Survey–Obstruction and Cosmesis (SCHNOS), and visual analog scale (VAS) were included. Patient characteristics and outcomes were analyzed, stratifying by BDDQ-AS screen.

Results

One-hundred fifteen patients (88% female) met criteria for inclusion. There was an 83% resolution rate of BDDQ-AS positive screening following rhinoplasty. Positive BDDQ-AS screening status preoperatively and postoperatively correlated with worse aesthetic satisfaction (all P < .002). No patient-reported outcome measures were indicative of which patients with a BDDQ-AS positive screen preoperatively would experience “resolution” postoperatively.

Conclusions

Body dysmorphia screening resolution following surgical intervention correlated with improved patient aesthetic satisfaction, pointing to a potential positive psychological impact of undergoing rhinoplasty.

Level of Evidence: 3

See the Commentary on this article here.

In rhinoplasty, appropriate patient selection is key for achieving postoperative patient satisfaction. Among comorbid psychiatric conditions, body dysmorphic disorder (BDD) is a specific condition believed to be a relative contraindication to aesthetic surgery.^1,2-6 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.”⁷ The historical teaching is that BDD is not treatable with cosmetic surgery, because the core issue is a psychiatric diagnosis.

In the population of patients seeking cosmetic rhinoplasty, evidence in the literature suggests a relatively higher prevalence of BDD (variably reported from 7% to 50%) compared to the general population, which is estimated at 2%.^3,8-12 This difference may indicate that patients with BDD are more likely to seek rhinoplasty and other cosmetic procedures.^12-14 However, the difference may also arise from the distinction between having symptoms of body dysmorphia vs a formal diagnosis of body dysmorphic disorder. As physicians increasingly use objective screening tools to detect patients exhibiting symptoms of body dysmorphia, more patients with subclinical concerns may be detected. In a majority of outcome studies on this topic, patients are labeled as having BDD based on validated surveys or interview rather than formal psychiatric evaluation and diagnosis. Regardless of formal diagnostic status or symptoms alone, most previous research reports poor outcomes in patients with body dysmorphia symptoms following aesthetic surgery.^3-5,15,16 Therefore, symptoms alone are cause for careful screening and further investigation to understand this patient population, although it might not indicate exclusionary status for these patients. Recent research by Rabaioli et al (2022) with validated surveys demonstrated improvement in several quality of life outcomes and postoperative body dysmorphic symptoms in patients following functional or aesthetic rhinoplasty.¹⁷ More objective evidence is needed to understand if patients with symptoms of body dysmorphia are appropriate candidates for cosmetic rhinoplasty.

Rhinoplasty surgeons increasingly rely on validated patient-reported outcome measures (PROMs) to screen patients and analyze outcomes in a more objective fashion. Rhinoplasty-specific dual-function PROMs such as the Standardized Cosmesis and Health Nasal Survey (SCHNOS) are designed to quantify both nasal obstructive symptoms and severity of nasal aesthetic concerns.¹⁸ The Body Dysmorphic Disorder Questionnaire–Aesthetic Surgery (BDDQ-AS) is a validated body dysmorphia screening tool created specifically for aesthetic rhinoplasty.¹¹ Spataro et al demonstrated that worse cosmetic satisfaction rates as measured by SCHNOS-cosmesis (SCHNOS-C) scores correlated with higher risk of a positive BDDQ-AS screen.¹⁹ Okland et al found that individuals who reported worse self-esteem as related to nasal appearance preoperatively were more likely to report worse postoperative satisfaction and to seek revision rhinoplasty.^18,20 The wider employment of these validated tools may help to further identify patients with symptoms of body dysmorphia, as well as to more precisely understand the relationship between excessive body image concerns and outcomes following aesthetic surgery.

In this study, we examined the probable psychological impact of surgery in rhinoplasty patients when screened preoperatively and postoperatively for symptoms of body dysmorphia utilizing the BDDQ-AS questionnaire. We further explored if a negative or positive BDDQ-AS screening result preoperatively affected postoperative obstructive and aesthetic rhinoplasty outcomes, according to the SCHNOS obstruction (SCHNOS-O) and cosmesis (SCHNOS-C) scores and visual analog scale for nasal obstruction (VAS-F) and aesthetic satisfaction (VAS-C) scores. We also explored if there was any relation between preoperative PROMs and postoperative BDDQ-AS screening results that could predict which patients with a positive preoperative body dysmorphia screening result would benefit from surgery.

METHODS

Study Participants

In this retrospective study, patients who underwent rhinoplasty by the senior author (S.P.M.) between June 2021 and April 2023 for functional, aesthetic, or combined nasal complaints were reviewed. Patients were included in the study if they were age 18 years or older and had a complete preoperative and at least 1 postoperative BDDQ-AS, SCHNOS, or VAS questionnaire completed during a follow-up visit more than 28 days after surgery. Patients who did not meet the inclusion criteria were excluded. Only postoperative BDDQ-AS screening results, SCHNOS-O and SCHNOS-C scores, and VAS-F and VAS-C scores available from the longest follow-up after surgery were considered for the study. This study was approved by the Stanford University Institutional Review Board.

Patient Reported Outcome Measures (PROMs)

Body Dysmorphic Disorder Questionnaire–Aesthetic Surgery (BDDQ-AS)

The BDDQ-AS is a validated 7-question self-administered diagnostic instrument with a high sensitivity and specificity developed to screen for body dysmorphia in aesthetic rhinoplasty patients.¹⁰ A patient screens positive on the BDDQ-AS if they report concern (Q1 = yes) and preoccupation with their appearance (Q2 = yes) and also report that their appearance causes distress and/or negative changes to their daily life (Q3 or 4 or 5 or 6 ≥ 3, or Q7 = yes).¹¹ An example of the BDDQ-AS diagnostic questionnaire can be found in the article published by Lekakis et al.¹⁰

Standardized Cosmesis and Health Nasal Outcomes (SCHNOS)

The SCHNOS is a validated 10-question self-administered PROM that involves 2 separate scores: SCHNOS-O for nasal obstruction, and SCHNOS-C for nasal cosmesis. The maximum score for each domain is 100, with higher scores representing higher degrees of impairment.¹⁸ Question #5 (hereafter referred to as SCHNOS-5) specifically relates to self-esteem as related to nasal appearance. An example of the SCHNOS PROM can be found in the article published by Moubayed et al.¹⁸

Visual Analog Scale for Nasal Function (VAS-F) and Aesthetic Satisfaction (VAS-C)

The VAS-F and VAS-C are 0 to 10 scales focused on nasal obstruction and satisfaction with nasal cosmesis, respectively. The VAS-F quantifies nasal obstruction severity on a patient-rated scale from 0 to 10, with 0 representing “no” nasal obstruction and 10 “severe” nasal obstruction. The VAS-C quantifies patient satisfaction with nasal appearance, with 0 representing “no” satisfaction and 10 “extreme” satisfaction. Examples of the VAS-F and VAS-C scales can be found in the article published by Moubayed et al.¹⁸

Statistical Analysis

Descriptive statistics were carried out for patient characteristics, rhinoplasty type, and nasal complaints. Continuous variables were reported as means and standard deviation (SD). Categorical variables were reported as frequencies and percentages for the entire cohort and stratified by preoperative BDDQ-AS screening status (Table 1).

The following analyses were carried out:

1. Preoperative BDDQ-AS screening status of patients was compared to postoperative BDDQ-AS status by rhinoplasty type utilizing Pearson's chi-squared test, or Fisher’s exact test if n < 5 (Table 1).

2. Mean SCHNOS-O, SCHNOS-C, SCHNOS-5, VAS-F, and VAS-C scores (preoperative vs postoperative) for all patients were compared utilizing a paired t test (Table 2).

3. Preoperative and postoperative mean SCHNOS-O, SCHNOS-C, SCHNOS-5, VAS-F, and VAS-C scores in patients were stratified by preoperative and postoperative BDDQ-AS screening status, and the following comparisons were done:

   • Mean preoperative scores for SCHNOS-O, SCHNOS-C, SCHNOS-5, VAS-F, and VAS-C were compared between BDDQ-AS positive and BDDQ-AS negative patients utilizing a 2-sample t test (Table 3).

   • Mean postoperative scores for SCHNOS-O, SCHNOS-C, SCHNOS-5, VAS-F, and VAS-C were compared between BDDQ-AS positive and BDDQ-AS negative patients utilizing a 2-sample t test (Table 3).

4. The total cohort was then further stratified into 4 distinct subgroups: Those who screened BDDQ-AS positive both preoperatively and postoperatively (BDDQ-AS +/+); those who screened BDDQ-AS negative both preoperatively and postoperatively (BDDQ-AS −/−); those who screened BDDQ-AS positive preoperatively but screened BDDQ-AS negative postoperatively (BDDQ-AS ±); and those who screened BDDQ-AS negative preoperatively but screened BDDQ-AS positive postoperatively (BDDQ-AS −/+). A between-subgroup comparison of preoperative and postoperative SCHNOS-O, SCHNOS-C, SCHNOS-5, VAS-F, and VAS-C scores, and the respective change (Δ) in scores, was performed with a 2-sample t test (Table 4).

For all analyses, a 2-tailed P value of <.05 was considered significant. Stata 14 (Stata Corp., College Station, TX) was utilized for all statistical analyses.

RESULTS

One-hundred fifteen patients met inclusion criteria for this retrospective study. The mean age was 36.0 (11.9) years (range 18-72 years) with 101 (88%) female. Seventy-three patients (63.5%) underwent rhinoplasty for cosmetic reasons only, 28 (24%) for combined cosmetic and functional reasons, and 14 (13%) for functional reasons only. Eighty patients (69.6%) underwent primary rhinoplasty, and 35 (30%) revision rhinoplasty (Table 1). The mean postoperative follow-up time point in the study was 122.9 (89.4) days (range 29-390 days).

Among 35 (30%) patients who screened positive for body dysmorphia per BDDQ-AS preoperatively, 24 (68%) patients presented for cosmetic reasons only, 9 (26%) patients for cosmetic and functional reasons, and 2 (6%) for functional reasons only. There were no significant demographic differences found between the preoperative BDDQ-AS positive and negative groups with regard to sex of the patient, indication for surgery (cosmetic, functional, or both), previous or comorbid psychiatric history, or primary vs revision rhinoplasty (Table 1).

Improvement in Postoperative Patient-Reported Outcome Measures With Rhinoplasty

For all patients included in this study, there were significant (all P < .0001, paired t test) postoperative improvements based on preoperative score (SD) vs postoperative score (SD) (Table 2) in:

1. Nasal obstructive symptoms as measured by SCHNOS-O, 38.78 (31.63) vs 22.26 (23.55); and VAS-F, 3.97 (3.1) vs 2.03 (2.24).

2. Aesthetic nasal complaints as measured by SCHNOS-C, 54.14 (26.54) vs 11.88 (18.47), and SCHNOS-5, 2.18 (1.66) vs 0.52 (1.11); and increased aesthetic nasal satisfaction by VAS-C 3.48 (2.29) vs 8.33 (2.28).

Patients Who Screened Positive for Body Dysmorphia Had Worse Aesthetic Nasal Outcome Measures Both Preoperatively and Postoperatively

Preoperatively, BDDQ-AS positive (n = 35) vs negative (n = 80) patients had significantly higher aesthetic nasal PROM scores: SCHNOS-C 72.95 (23.27) vs 45.92 (23.62) (P < .0001, 2-sample t test); SCHNOS-5 3.6 (1.33) vs 1.56 (1.39) (P < .0001, 2-sample t test); and lower aesthetic satisfaction scores: VAS-C 2.5 (2.39) vs 3.9 (2.11) (P = .002, 2-sample t test). However, no such differences were identified between BDDQ-AS positive and negative patients for obstructive symptoms: SCHNOS-O 42.57 (32.29) vs 37.13 (31.40) (P = .40, 2-sample t test); or VAS-F 4.29 (3.02) vs 3.83 (3.15) (P = .47, 2-sample t test) (Table 3).

Postoperatively, BDDQ-AS positive patients (n = 9) also had significantly higher aesthetic nasal PROM scores than the postoperative BDDQ-AS negative patients (n = 106): SCHNOS-C 41.11 (16.58) vs 9.4 (16.43) (P < .0001, 2-sample t test); SCHNOS-5 3.0 (1.58) vs 0.31 (0.76) (P < .0001, 2-sample t test); and lower aesthetic satisfaction scores: VAS-C 3.9 (2.76) vs 8.7 (1.80) (P < .0001, 2-sample t test). Postoperative differences in obstructive symptoms were also observed between these groups, as measured by SCHNOS-O 42.2 (26.82) vs 20.6 (22.60) (P = .008, 2-sample t test); but not VAS-F 3.11 (1.76) vs 1.94 (2.26) (P = .13, 2-sample t test) (Table 3).

A Majority of Patients With a Positive Body Dysmorphia Screen Preoperatively Screened Negative Following Rhinoplasty

Preoperatively, 35 (30%) patients had a BDDQ-AS positive screen and 80 (69%) a negative screen; whereas postoperatively, 9 (8%) patients screened positive and 106 (92%) screened negative. Therefore, there was an initial postoperative resolution rate of 74% among rhinoplasty patients who screened positive preoperatively (Table 3).

On further stratification by postoperative BDDQ-AS screening status the following groups of patients were isolated and defined from the cohort (as described in Methods section): BDDQ-AS +/+ (n = 6), BDDQ-AS −/− (n = 77), and BDDQ-AS ± (n = 29). Among the 80 patients who screened BDDQ-AS negative preoperatively, 77 (96%) remained BDDQ-AS negative postoperatively while 3 (4%) among this group screened BDDQ-AS positive postoperatively. Among the 35 patients who screened BDDQ-AS positive preoperatively, 29 (83%) screened BDDQ-AS negative (±) and 6 (17%) continued to screen BDDQ-AS positive postoperatively (+/+). Therefore the true resolution rate was 83% in our study, based on preoperative and postoperative BDDQ-AS screening (Table 4). All BDDQ-AS +/+ patients (n = 6) were female. Four were patients who presented for cosmetic reasons, and 2 presented for both cosmetic and functional reasons. Among the 3 BDDQ-AS −/+ patients, 2 were female, 2 underwent primary rhinoplasty, and all 3 had some cosmetic concerns. Due to the low number of patients in this group, it was not included in the subgroup analyses.

BDDQ-AS Subgroup Analyses

Preoperative but not Postoperative Cosmetic Patient–Reported Outcomes Differed Between BDDQ-AS Preoperative Positive/Postoperative Negative and BDDQ-AS Preoperative Negative/Postoperative Negative Individuals

Comparing preoperative PROMs, patients in the BDDQ-AS ± group had significantly worse aesthetic nasal complaints than the BDDQ-AS −/− group: SCHNOS-C 71.61 (24.59) vs 45.67 (23.97) (P < .0001, 2-sample t test); SCHNOS-5 3.52 (1.4) vs 1.53 (1.4) (P < .0001, 2-sample t test); and lower aesthetic satisfaction scores: VAS-C 2.59 (2.5) vs 3.92 (2.09) (P = .006, 2-sample t test). There were no significant differences in their preoperative nasal obstruction symptom scores as measured by SCHNOS-O, 41.04 (34.28) vs 35.97 (31.3) (P = .47, 2-sample t test); or VAS-F, 4.24 (3.25) vs 3.69 (3.11) (P = .42, 2-sample t test). There were no differences between mean postoperative SCHNOS-O, SCHNOS-C, SCHNOS-5, VAS-F, or VAS-C scores between BDDQ-AS ± and −/− groups. There was a greater degree of change (Δ) in aesthetic PROMs in the BDDQ-AS ± compared to −/− individuals on SCHNOS-C, Δ (−62.64 (28.19) vs −36.10 (28.73); P < .0001, 2-sample t test); Δ SCHNOS-5 (−3.17 vs −1.23; P < .0001, 2-sample t test); and Δ VAS-C (6.07 vs 4.81; P = .04, 2-sample t test) (Table 4).

Postoperative but not Preoperative Cosmetic Patient–Reported Outcomes Differed Between the BDDQ-AS Preoperative Positive/Postoperative Negative and BDDQ-AS Preoperative Positive/Postoperative Positive Individuals

Comparing preoperative PROMs between the BDDQ-AS ± and +/+ subgroups, there were no differences between mean scores: SCHNOS-O 41.03 (34.28) vs 50.00 (20.49) (P = .54); SCHNOS-C 71.61 (24.59) vs 79.44 (15.41) (P = .46); SCHNOS-5 3.52 (1.40) vs 4.00 (0.89) (P = .43); VAS-F 4.24 (3.25) vs 4.5 (1.64) (P = .85); or VAS-C 2.59 (2.50) vs 2.0 (1.90) (P = .59).

Comparing postoperative PROMs, the BDDQ-AS preoperative positive/postoperative negative group had significantly lower aesthetic nasal complaints. SCHNOS-C 8.97 (17.3) vs 35 (15.7) (P = .002, 2-sample t test); SCHNOS-5 0.34 (0.86) vs 2.5 (1.39) (P < .0001, 2-sample t test); and significantly higher aesthetic satisfaction scores: VAS-C 8.66 (1.74) vs 5.33 (2.87) (P = .0002, 2-sample t test). Postoperative differences in obstructive symptoms were also observed between these groups: SCHNOS-O 14.83 (18.35) vs 42.5 (32.37) (P = .006, 2-sample t test); and VAS-F 1.34 (1.67) vs 3.16 (1.94) (P = .02, 2-sample t test).

When comparing change (Δ) in PROMs between these subgroups, a significant difference was observed for Δ SCHNOS-5 (−3.17 (1.49) vs −1.5 (2.18); P = .03, 2-sample t test) only (Table 4).

DISCUSSION

In this study, we examined body dysmorphia screening status preoperatively and postoperatively in rhinoplasty patients, and studied patient-reported outcomes in this population with the SCHNOS questionnaire, as well as patients' functional and aesthetic satisfaction before and after surgery. To our knowledge, this is one of the earliest studies to demonstrate improvement in body dysmorphia symptoms following surgical intervention, as measured by a negative BDDQ-AS screen postoperatively after a positive preoperative screen, and corresponding improvement in aesthetic PROMs (SCHNOS-C and VAS-C), in a subset of patients following rhinoplasty. Patients with diagnosed body dysmorphic disorder (BDD) are widely considered poor candidates for aesthetic surgery. Despite this, many patients with symptoms of body dysmorphia present for cosmetic surgical evaluation.^12-14 Increasing use of screening tools has led to identification of patients who have symptoms, but no formal diagnosis of BDD. The majority of previous research suggests that patients with symptoms of body dysmorphia alone have poor outcomes following cosmetic surgery.^3-5,15,16 We found that patients who screened positive for body dysmorphia symptoms on BDDQ-AS preoperatively or postoperatively demonstrated worse aesthetic patient-reported outcome measures than negative-screening patients. However, patients who screened BDDQ-AS positive preoperatively, on average, experienced resolution in body dysmorphia symptoms following rhinoplasty, and had corresponding reductions in aesthetic concerns and increases in aesthetic satisfaction. Our findings suggest that a subset of patients who report symptoms of body dysmorphia may be more suitable candidates for aesthetic rhinoplasty than previous evidence with similar criteria for identifying patients in this population suggests. We again emphasize that a report of body dysmorphia symptoms does not equate to a diagnosis of body dysmorphic disorder. The results do not endorse surgical intervention on patients with diagnosed body dysmorphic disorder.

Importantly, those with resolution of body dysmorphia symptoms (BDDQ-AS preoperatively positive and postoperatively negative, preop+/postop−) had high rates of aesthetic satisfaction after surgery, with PROMs that were nearly identical to postoperative cosmetic PROMs from the BDDQ-AS preoperatively negative and postoperatively negative (preop−/postop−) group. The BDDQ-AS preop+/postop− patients also demonstrated significantly greater improvement on cosmetic PROMs than the BDDQ-AS preop−/postop− screening population; the caveat here is that a better baseline of aesthetic satisfaction limits room for improvement. Regardless, such a high degree of positive change in aesthetic satisfaction among the BDDQ-AS preop+/postop− population was an unexpected finding with important implications for patient selection in rhinoplasty.

Among those who were BDDQ-AS positive preoperatively, there were no differences in preoperative patient-reported outcomes between those who experienced resolution (BDDQ-AS preop+/postop−) and those who were positive before and after rhinoplasty (BDDQ-AS preop+/postop+). We found no preoperative PROM that could indicate which patients among the preoperative BDDQ-AS positive-screening cohort might benefit from rhinoplasty, or which might not. Despite this, even those who screened positive on BDDQ-AS after surgery (BDDQ-AS preop+/postop+) reported some improvement in cosmetic satisfaction. Future work will aim to determine factors associated with a positive response to aesthetic surgical intervention.

There were several limitations to our study. Patients were from a single institution, and all were under the care of 1 experienced rhinoplasty surgeon (S.P.M.). The majority were female. The surgeon was not blinded to the screening results, which may have impacted patient selection for surgery. Due to low sample size, it was not possible to analyze patients’ BDDQ-AS status and PROMs based on type of nasal complaint. As mentioned above, although the BDDQ-AS is a validated screening tool in rhinoplasty, a positive screen does not constitute a formal diagnosis of body dysmorphic disorder, which is made by a psychiatrist. We understand that BDD is a clinical diagnosis and that the BDDQ-AS is not a diagnostic tool per se. However, we also understand that it is very unlikely for practitioners to perform full BDD diagnostic testing (including psychiatric consultation) on every patient. Furthermore, previous studies have shown that we cannot simply rely on a “sixth sense” to determine which patients may have BDD.^21,22 We advocate for utilization of convenient screening questionnaires and PROMs, such as the BDDQ-AS and the SCHNOS. We decided to utilize the BDDQ-AS as a proxy for those at greater risk for having BDD, that is, those who screened positive for BDD-like symptoms.

Lack of an adequate cohort size limited dividing follow-up periods into short and long term and carrying out a true postoperative result comparison, especially because the final aesthetic outcome may not be achieved until 1 year after rhinoplasty. Future work could seek to address these limitations by increasing the number of sites, surgeons, and male patients, as well as increasing the duration of follow up. It would be interesting, although challenging, to have patients who screen positive for body dysmorphia on BDDQ-AS in an aesthetic rhinoplasty clinic evaluated by a psychiatrist to determine if formal diagnosis of body dysmorphic disorder is present, and if any additional features could help to predict which patients may or may not benefit from surgery.

Taken together, our findings suggest that patients presenting for rhinoplasty who screen positive for body dysmorphia should not be strictly considered poor candidates for surgery. Indeed, as a screening questionnaire, the BDDQ-AS does not formally diagnose such patients (as noted). Our findings suggest that, as with all PROMs and validated questionnaires, each result must be taken as a data point to assist the clinician's judgement, rather than as a strict criterion for decision-making. In the senior author (S.P.M.)'s practice, a qualitative assessment of all available data determines suitable candidacy for surgery. This includes attention to the BDDQ screening tool, a history of previously diagnosed comorbid psychiatric illness (eg, anxiety, depression) and current or previous psychiatric medications, and a general assessment of the patient's demeanor during consultation. Patients who are committed to surgery and whose overall clinical picture suggests psychiatric clearance is indicated are explicitly asked for written clearance for surgery from a psychiatrist or appropriate caregiver (eg, therapist) before a preoperative appointment.

A subset of patients who screen positive for body dysmorphia preoperatively and negative after rhinoplasty may have comparable improvement in their postoperative nasal aesthetic outcome and satisfaction to those who never screened positive for excessive body image concerns. Our results extend previous findings by Rabaioli et al that patients with body dysmorphia see improvement in quality of life metrics following functional and aesthetic rhinoplasty.¹⁷ These data also more generally strengthen the argument for employing more objective measures to study patient characteristics and outcomes in aesthetic surgery.

CONCLUSIONS

Most rhinoplasty patients who screened positive for symptoms of body dysmorphia preoperatively screened negative after surgery and reported as much aesthetic benefit from surgery as those who preoperatively screened negative. No patient-reported outcome measures were indicative of which patients with a positive screen preoperatively would experience resolution postoperatively. Body dysmorphia screening resolution following surgical intervention correlated with improved aesthetic outcomes and patient satisfaction, pointing to a potential psychological impact of undergoing rhinoplasty in this patient population. Screening questionnaires must be taken as 1 of many data points in the clinician's decision-making process.

Disclosures

The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.

Funding

The authors received no financial support for the research, authorship, and publication of this article.

REFERENCES

Author notes