title: Self-mutilation by a patient with borderline personality disorder.
abstract: We present an unusual insatiable aesthetic/plastic surgery patient with borderline personality disorder (BPD) who removed her upper eyelids by herself after we rejected her request for revision blepharoplasty. This impulsive self-injury was attributed to anxiety from what the patient considered to be abandonment by the surgeon. Even after the eyelid defects were successfully treated, the patient requested several other revisions, including tattoo removal. Compared with other mental disorders, including body dysmorphic disorder, preoccupation with appearance in BPD is less profound and shifts from one body part to another. In an aesthetic and plastic surgery practice, a different psychiatric approach should be used for individuals with BPD, and the proper timing for a psychiatric referral should be established.
  
  
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authors.affiliation: Division of Aesthetic Surgery, Department of Plastic Surgery, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8866, Japan, dmorioka@gmail.com.
authors.forename: Daichi
authors.initials: D
authors.lastname: Morioka
authors.forename: Fumio
authors.initials: F
authors.lastname: Ohkubo
authors.forename: Yasuyoshi
authors.initials: Y
authors.lastname: Amikura
mesh_terms: D000328:Adult; D019882:Blepharoplasty / Q000523:psychology; D001883:Borderline Personality Disorder / Q000453:epidemiology*; D005143:Eyelids / Q000293:injuries* / Q000601:surgery*; D005260:Female; D006801:Humans; D007175:Impulsive Behavior; D010817:Physician-Patient Relations; D016079:Refusal to Treat; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000523:psychology*; D016038:Skin Transplantation