When Surgery Cannot Correct the Perceived Defect: Screening, Decision-Making, and Outcomes of Body Dysmorphic Disorder in Aesthetic Plastic Surgery

Body dysmorphic disorder (BDD) can bring a patient to an aesthetic surgeon seeking anatomical correction of a problem whose principal treatment requires mental health care.This critical narrative review examines prevalence, screening, surgical outcomes, consent, and referral in aesthetic plastic surgery.A documented PubMed update was undertaken on 30 October 2026, supplemented by reference tracing, full-text retrieval, and professional guidance.Primary studies were interpreted only when their methods and results could be examined in full text; secondary syntheses were identified separately.The evidence requires three distinctions: appearance dissatisfaction versus BDD, screening positivity versus a confirmed diagnosis, and satisfaction with an operated feature versus improvement in the disorder.Prevalence estimates vary substantially with recruitment and assessment method.Screening instruments differ in content, reference standards, and validation populations; none independently determines surgical suitability.Psychiatric BDD cohorts report little sustained global improvement after cosmetic procedures.Selected rhinoplasty cohorts describe postoperative symptom or functional improvement, but some exclude previously diagnosed BDD, use screening thresholds rather than diagnostic interviews, and have substantial attrition.These findings do not establish aesthetic surgery as treatment for BDD or validate a subgroup of patients with active BDD for surgery.Clinical assessment should integrate the anatomical indication with preoccupation, repetitive behaviors, impairment, insight, comorbidity, expectations, and safety.Suspected or diagnosed BDD warrants assessment by a mental health professional with relevant expertise before elective aesthetic intervention.Deferral should include an explained referral pathway and access to evidence-based treatment.The proposed clinical framework is a reasoning aid, not a validated prediction rule.