Aesthetic Plastic Surgery

, Volume 43, Issue 4, pp 1000–1005 | Cite as

High Prevalence of Body Dysmorphic Disorder and Moderate to Severe Appearance-Related Obsessive–Compulsive Symptoms Among Rhinoplasty Candidates

  • Tatiana Dalpasquale Ramos
  • Maria José Azevedo de BritoEmail author
  • Vanessa Yuri Suzuki
  • Miguel Sabino Neto
  • Lydia Masako Ferreira
Original Article Rhinoplasty



Rhinoplasty is one of the most sought-after procedures in plastic surgery by individuals with body dysmorphic disorder (BDD). The identification of BDD symptoms is a challenge for plastic surgeons. The purpose of this study was to use a specific instrument for detection of BDD symptoms as a screening tool in rhinoplasty candidates and estimate the prevalence and severity of BDD symptoms in this population.


Eighty patients of both sexes seeking rhinoplasty were consecutively recruited at a plastic surgery outpatient clinic of a university hospital from February 2014 to March 2015. In a clinical interview, 50 of them showed an excessive preoccupation with physical appearance associated with clinically significant subjective distress and were, therefore, selected to participate in the study. All participants were assessed using the Brazilian-Portuguese versions of the Yale-Brown Obsessive Compulsive Scale modified for BDD (BDD-YBOCS) and the Body Dysmorphic Symptoms Scale (BDSS), which can be applied by plastic surgeons, who are laypersons in psychology/psychiatry.


Twenty-four (48%, 24/50) candidates had BDD symptoms, and 27 (54%, 27/50) showed moderate to severe appearance-related obsessive–compulsive symptoms. A strong correlation was found between the BDSS and BDD-YBOCS scores (r = 0.841, P < 0.001), and a strong agreement was observed between the BDSS cutoff point and body dysmorphic disorder symptom status (kappa = 0.822).


A high prevalence of BDD and moderate to severe appearance-related obsessive–compulsive symptoms was found among aesthetic rhinoplasty candidates. The BDSS may be used as a screening tool for BDD symptoms in plastic surgery patients.

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


Body dysmorphic disorders Body image Plastic surgery Rhinoplasty 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments. The study was approved by the Institutional Research Ethics Committee and performed in accordance with the Brazilian Ethical Review System on research involving human beings

Informed Consent

Written informed consent was obtained from all patients and parents or legal representatives after the procedures had been fully explained and prior to their inclusion in the study; anonymity was assured.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  • Tatiana Dalpasquale Ramos
    • 1
  • Maria José Azevedo de Brito
    • 2
    • 3
    Email author
  • Vanessa Yuri Suzuki
    • 1
  • Miguel Sabino Neto
    • 2
  • Lydia Masako Ferreira
    • 2
  1. 1.Graduate Program in Translational SurgeryFederal University of São Paulo (UNIFESP)São PauloBrazil
  2. 2.Division of Plastic Surgery, Department of SurgeryUNIFESPSão PauloBrazil
  3. 3.College of Health ScienceUniversity of Vale do Sapucaí (UNIVÁS)Pouso AlegreBrazil

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