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Preoperative Symptoms of Body Dysmorphic Disorder Determine Postoperative Satisfaction and Quality of Life in Aesthetic Rhinoplasty

Picavet, Valerie A. M.D.; Gabriëls, Loes M.D.; Grietens, Jente; Jorissen, Mark M.D., Ph.D.; Prokopakis, Emmanuel P. M.D., Ph.D.; Hellings, Peter W. M.D., Ph.D.

Plastic and Reconstructive Surgery: April 2013 - Volume 131 - Issue 4 - p 861–868
doi: 10.1097/PRS.0b013e3182818f02
Cosmetic: Original Articles

Background: In patients seeking aesthetic rhinoplasty, a high prevalence of body dysmorphic disorder symptoms has recently been reported. However, the impact of these symptoms on the outcomes after rhinoplasty remains elusive. This large-scale study determines the influence of preoperative body dysmorphic disorder symptoms on patients' postoperative satisfaction and quality of life, using validated questionnaires.

Methods: A 1-year prospective study of 166 adult patients undergoing cosmetic rhinoplasty in a tertiary referral center was performed. Severity of body dysmorphic disorder symptoms was assessed by the modified Yale-Brown Obsessive Compulsive Scale. Postoperative satisfaction was evaluated using a visual analog scale for patients' appraisal of nasal shape and the Rhinoplasty Outcome Evaluation. Generic quality of life was quantified by the Sheehan Disability Scale, whereas the appearance-related disruption of everyday life was measured by the Derriford Appearance Scale-59.

Results: Preoperative body dysmorphic disorder symptom scores inversely correlated with postoperative satisfaction at 3 months (visual analog scale nasal shape: rho = −0.43, p < 0.001; Rhinoplasty Outcome Evaluation: rho = −0.48, p < 0.001) and 12 months (rho = −0.40, p < 0.001; and rho = −0.41, p < 0.001, respectively) after surgery. In addition, body dysmorphic disorder symptom scores positively correlated with Sheehan Disability Scale scores and Derriford Appearance Scale-59 scores at 3 months (rho = 0.43, p < 0.001 and rho = 0.48, p < 0.001, respectively) and 12 months (rho = 0.32, p < 0.001, and rho = 0.48, p < 0.001, respectively) postoperatively.

Conclusion: This study provides the first evidence of the negative impact of preoperative body dysmorphic disorder symptoms on subjective outcomes after rhinoplasty, hence unveiling a crucial factor in patient dissatisfaction after aesthetic rhinoplasty.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk: I.

Leuven, Belgium; Ulm, Germany; and Crete, Greece

From the Departments of Otorhinolaryngology, Head and Neck Surgery, and Psychiatry, University Hospitals Leuven; the Department of Otorhinolaryngology, Ulm University; the Department of Neurosciences, KU Leuven; and the Department of Otorhinolaryngology, University of Crete School of Medicine.

Received for publication August 28, 2012; accepted October 24, 2012.

Presented at Nose and Face World, in Rome, Italy, May 9 through 12, 2012.

Disclosure:The authors have no financial interest to declare in relation to the content of this article. No outside funding was received.

Prof. Dr. Peter W. Hellings, M.D., Ph.D.; Ear, Nose, and Throat Department, University Hospitals Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, B-3000 Leuven, Belgium, peter.helling@med.kuleuven.be

©2013American Society of Plastic Surgeons