BDD – Rhinoplasty of the Mind

Dr. Gregory Fisher, FACS, is the expert on body image. Among his numerous publications and articles, he focuses on the correlation of rhinoplasty and decrease of the symptoms of body dysmorphic disorder (BDD). BDD is the result of misperceived proportion among various parts of the body. This can occur with hands and the torso, feet or – the nose.

“The most frequent requests for ‘adjustment’,” says Dr. Fisher, “concern the face. The face is the most obvious, always visible, part of the body, which communicates our feelings and sensations. People with larger noses may appear unnecessarily ‘pushy’ or self-assertive.” This perception is then reflected in their own conduct and they may become what (they thing) corresponds to their appearance.

Many people with BDD have “unrealistic expectations,” says Dr. Fisher. They will never be satisfied and the most perfect result will fall short of the “ideal” they want to achieve. Unfortunately, this “ideal” is just as unreal in the person’s mind as it is in reality. Dr. Fisher suggests pre-operative computer imaging or portrait imposition may assist prior to surgery, in order to realize where to go and what to avoid.

However, Dr. Gregory T. Fisher, M.D., F.A.C.S. is also an expert in psychology and psychiatry. He can help such patients in other ways… “If only the patient will listen,” says Dr. Fisher, “I cannot perform miracles, but my team and I, we come very very close to it.”

A recent study published in Plastic and Reconstructive Surgery® (http://tinyurl.com/c2gqube), the journal of the American Society of Plastic Surgeons® (ASPS), parallels Dr. Fisher’s observations. The study concludes that rhinoplasty patients with BDD may be more likely to be disappointed with their results. People with BDD perceive one or more of their features as a defect. According to the ASPS (http://tinyurl.com/clc3bc8), BDD is “the only psychiatric diagnosis that directly considers body image concerns.”

“As a physician,” says Dr. Fisher, “I must consider primarily the patient’s long-term health. – As a plastic surgeon,” emphasizes Dr. Fisher, “I must always weigh their psychology and mental health. People who approach me for plastic surgery here in Los Angeles will obviously have some aesthetic concerns, but they need to understand what aesthetic medicine can and cannot fix.”

“Moreover,” adds Dr. Fisher, “one cannot consider a bodypart-at-a-time so to speak. For instance rhinoplasty is as much about the rest of the face as it is about the nose. I can change the shape of your nose to best balance with the chin and cheekbones, but balance is an uneasy concept for anyone with BDD, because BDD is all about balance and the inability to balance.”

One thought on “BDD – Rhinoplasty of the Mind

  1. I really love this. It’s stganre to me in some ways that the idea of positive body image gets lost in the notion of what healing from an ED means At least, it has for me. I’ve been in recovery and been abstinent or whatever for the past 9 years and yet I’m *just now* starting to work on the distorted notions I have about how I look. This seems bizarre; after all, even the most superficial understanding of EDs defines (sometimes SOLELY) as about appearance (and food rituals.) But I think for many of us, perhaps because we’ve been able to maintain our weight and follow a meal plan, perhaps because we accept (as a society) that everyone hates how they look the notion of working on how we perceive our bodies gets lost. I’ve been taught to focus on what my body can DO, on who I AM, etc and all of that has been helpful, but it’s done nothing to heal the shame I feel about my appearance. To do that, I have to work on changing my view of how my body LOOKS, and I really appreciate you addressing that here. To paraphrase a good friend of mine, Don’t recover because you’ve accepted a false sense of ugliness. Recover because you’ve recognized how gorgeous you truly are.

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