The Mirror of Culture: A Systematic Review and Meta-Analysis of the Prevalence of Body Dysmorphic Disorder in Asian Rhinoplasty Seekers

Body dysmorphic disorder (BDD) is a condition to be assessed preoperatively prior to cosmetic rhinoplasty, as it may influence patient outcomes and satisfaction. The prevalence of BDD in Asians is not well-studied, and the literature consists predominantly of smaller case series. This systematic review and meta-analysis estimated BDD prevalence in Asian rhinoplasty candidates and examined the impact of diagnostic methods and regional factors. Following Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, five databases were searched up to March 2025. Two reviewers independently screened studies. Meta-analysis using a random-effects model was conducted; study quality and publication bias were assessed. Fifteen studies (n = 1,977) were included. The pooled BDD prevalence was 30.0% (95% CI: 26.8–35.7), with higher rates using the Body Dysmorphic Disorder Questionnaire (36%) versus DSM-V criteria (18%). Substantial heterogeneity was observed and addressed. BDD may affect nearly one in three Asian rhinoplasty candidates, underscoring the need for standardized diagnostic protocols and culturally sensitive preoperative assessment to improve patient outcomes and safety.