title: Preoperative symptoms of body dysmorphic disorder determine postoperative satisfaction and quality of life in aesthetic rhinoplasty.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Picavet
authors.forename: Loes
authors.initials: L
authors.lastname: Gabriëls
authors.forename: Jente
authors.initials: J
authors.lastname: Grietens
authors.forename: Mark
authors.initials: M
authors.lastname: Jorissen
authors.forename: Emmanuel P
authors.initials: EP
authors.lastname: Prokopakis
authors.forename: Peter W
authors.initials: PW
authors.lastname: Hellings
mesh_terms: D000328:Adult; D057215:Body Dysmorphic Disorders / Q000175:diagnosis* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012225:Rhinoplasty; D011795:Surveys and Questionnaires