Rhinoplasty patients may have mirror disease

August 23, 2011

About one in three people seeking rhinoplasty — commonly called a nose job — have signs of body dysmorphic disorder.
About one in three people seeking rhinoplasty — commonly called a nose job — have signs of body dysmorphic disorder.

Call it a beak, bill, schnoz, smeller, snout, sniffer, snoot. We’ve all got one.

But, now, a new study suggests that many people who complain about the size or shape of their noses show signs of body dysmorphic disorder (BDD), spending their days preoccupied with slight or imagined defects in their appearance. Because of their inability to pass a mirror without checking out the hated feature, you can say these folks have “mirror disease.”

A study of 266 patients evaluated by plastic surgeons for rhinoplasty (nose job) procedures in Belgium, over a 16-month period, were given a questionnaire to assess symptoms of BDD. According to the New York Times, July 27, 2011, study results showed that “among those seeking rhinoplasty for medical reasons — to correct a breathing problem, for example — only 2 percent of patients exhibited symptoms of the disorder. But among patients seeking to change their noses for cosmetic reasons, 43 percent showed signs of the disorder, expressing an unreasonable preoccupation and distress about their bodies despite having noses that were relatively normal.”

This study shows a surprisingly high rate of BDD among nose-job patients. Previous studies have shown that about 10 percent of all patients seeking plastic surgery have BDD.

But not everybody who thinks they have a big nose has BDD. What you have to look at is whether or not this preoccupation interferes with love and work. Does this patient struggle to maintain social relationships? Does this patient have difficulty getting to work and remaining employed?

According to David B. Sarwer, associate professor of psychology at the Center for Human Appearance at the Perelman School of Medicine at the University of Pennsylvania, patients with BDD are “…chronically thinking about their nose, checking in the mirror or a reflective surface, or they avoid situations where people can see their profile.”

A Seattle plastic surgeon advises doctors not to operate on these patients because chances are they will not be satisfied with the results. He finds these patients easy to spot, “Often patients who have this can’t stop looking at themselves. When I’ve encountered cases like this, I’ve found it difficult to make eye contact. They tend to stand in the mirror in the examination room and look at themselves throughout the exam.”


The mission of the American Society for Aesthetic Plastic Surgery (ASAPS) includes medical education, public education and patient advocacy. Plastic Surgery News Briefs are summaries of current stories found through various news and magazine outlets that relate to or mention plastic surgery and cosmetic procedures. The views expressed in these news articles do not necessarily reflect the opinions of ASAPS, but are merely published as an educational service to our members and the general public. For additional information on these subjects and other plastic surgery related topics, please go to www.surgery.org

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