title: Avoiding Psychological Pitfalls in Aesthetic Medical Procedures.
abstract: OBJECTIVE
  To assess the prevalence of body dysmorphic disorder (BDD) in an aesthetic surgery setting in the region of Southwest China, and to ascertain the differences in terms of body images between patients in the aesthetic setting and general Chinese population. This study tracked patient satisfaction with their body image changes while undergoing aesthetic medical procedures to identify whether the condition of patients who were presenting with BDD symptoms or their psychological symptoms could be improved by enhancing their appearance. Additionally, this study explored whether there was improvement in quality of life (QoL) and self-esteem after aesthetic medical procedures.
  
  
  METHODS
  A total of 106 female patients who were undergoing aesthetic medical procedures for the first time (plastic surgery, n = 26; minimally invasive aesthetic treatment, n = 42; and aesthetic dermatological treatment, n = 38) were classified as having body dysmorphic disorder symptoms or not having body dysmorphic disorder symptoms, based on the body dysmorphic disorder examination (BDDE), which was administered preoperatively. These patients were followed up for 1 month after the aesthetic procedures. The multidimensional body self-relations questionnaire-appearance scales (MBSRQ-AS) and rosenberg self-esteem scale (RSE-S) were used to assess patients' preoccupation with appearance and self-esteem pre-procedure and 1 month post-procedure. Additionally, 100 female healthy control participants were recruited as a comparative group into this study and they were also assessed using BDDE, MBSRQ-AS, and RSE-S.
  
  
  RESULTS
  A total of 14.2 % of 106 aesthetic patients and 1 % of 100 healthy controls were diagnosed with BDD to varying extents. BDDE scores were 72.83 (SD ± 30.7) and 68.18 (SD ± 31.82), respectively, before and after the procedure for the aesthetic patient group and 43.44 (SD ± 15.65) for the healthy control group (F = 34.28; p < 0.001). There was a significant difference between the groups in subscales of MBSRQ-AS, i.e. appearance evaluation (F = 31.31; p < 0.001), appearance orientation (F = 31.65; p < 0.001), body areas satisfaction (F = 27.40; p < 0.001), and RSE-S scores (F = 20.81; p < 0.001). There was no significant difference, however, in subscales of MBSRQ-AS, i.e. overweight preoccupation (F = 1.685; p = 0.187), self-classified weight (F = 0.908; p = 0.404) between groups. All the subscales of MBSRQ-AS showed significant differences between the aesthetic patients (pre-procedure) and female adult norms from Dr. Cash's result given in Table 4 (p < 0.001). The study also showed that there were no significant differences in the scores of BDDE, MBSRQ-AS, and RSE-S of those fifteen aesthetic patients diagnosed with BDD after aesthetic procedures lasting one month.
  
  
  CONCLUSIONS
  There was a high prevalence rate (14.2 %) of body dysmorphic disorder in aesthetic procedure seekers, and it seemed that those patients suffering from BDD were more likely to be dissatisfied with the results of the aesthetic medical procedures. However, general aesthetic patients showed improvement in most assessments which indicated that aesthetic medical procedures could not only enhance patient appearance, but also patient low self-esteem and QoL. Self-satisfaction could also be promoted. A screening procedure for BDD including suitable screening questionnaires might be considered for routine use in aesthetic clinical settings to minimize dissatisfaction and complaints.
  
  
  METHODS
  This journal requires that the 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. www.springer.com/00266 .
authors.affiliation: Department of Plastic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.
authors.forename: Qiuyu
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Department of Plastic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.
authors.forename: Chuan
authors.initials: C
authors.lastname: Cao
authors.affiliation: Department of Plastic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Guo
authors.affiliation: Department of Plastic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.
authors.forename: Xiaoge
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Plastic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.
authors.forename: Lele
authors.initials: L
authors.lastname: Lu
authors.affiliation: Department of Plastic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.
authors.forename: Wenping
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Plastic Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China. pro.lishirong@hotmail.com.
authors.forename: Shirong
authors.initials: S
authors.lastname: Li
mesh_terms: D000328:Adult; D057215:Body Dysmorphic Disorders / Q000175:diagnosis / Q000523:psychology* / Q000601:surgery*; D001828:Body Image / Q000523:psychology*; D002681:China; D003430:Cross-Sectional Studies; D062109:Dermatologic Surgical Procedures / Q000379:methods / Q000523:psychology; D004954:Esthetics; D005260:Female; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000523:psychology; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011379:Prognosis; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods / Q000523:psychology; D013518:Surgery, Plastic / Q000379:methods* / Q000523:psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
keywords: Aesthetic dermatologic procedures; Aesthetic medical procedures; Body dysmorphic disorder; Body image; Minimally invasive aesthetic procedures; Plastic surgery