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Patient selection in cosmetic surgery is a difficult and arduous task that is unique to the specialty. Because the patient is electing to have surgery, surgeons have the luxury of refusing to participate in the patient’s care if he or she is not an appropriate candidate for cosmetic surgery. Although some patients may not realize, the surgeon ultimately selects the patient and not vice versa. Plastic surgeons have often tried to categorize patient characteristics preoperatively that could help predict behavior postoperatively, which is a difficult if not impossible task. Perhaps some day a battery of behavior examinations will accurately define a patient’s personality so that surgeons can more objectively and definitively determine which patients will be pleased with the results of cosmetic surgery and which patients have unrealistic expectations. For now, however, good communication is the best method.

The patient’s dissatisfaction with his or her physical appearance may range from a healthy self-concern to a preoccupation with one’s appearance that impairs daily functioning. Body dysmorphic disorder is defined as a preoccupation with an imagined or slight defect in appearance that leads to markedly excessive concern. This disorder was initially called dysmorphophobia when it first appeared in the European medical literature in 1886. In other early descriptions, body dysmorphic disorder was termed “l’obsession de la honte du corps” (obsession with shame of the body) or dysmorphophobic syndrome. Body dysmorphic disorder is the only diagnostic category directly addressing body image concerns in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The preoccupation must cause significant distress or impairment in social, occupational, or other areas of functioning. Although any area of the body may be the focus, the most common areas seem to be the skin, face, and nose. Men may become preoccupied with their genitals, height, hair, and body build, whereas women typically report concerns with their weight, hips, legs, and breasts. Body dysmorphic disorder appears to affect men and women with equal frequency. Patients with body dysmorphic disorder may report preoccupation with five to seven body parts over the course of the disease. Following are some questions to ask the patient in the preoperative visit:

  • Do you worry about the appearance of your face or body?

  • If so, what is your concern? How bad do you think your face or body part appears?

  • How much time do you spend worrying about the appearance of your face or body part?

  • Have you done anything to hide the problem or rid yourself of the problem?

  • Does this concern with your appearance affect any aspect of your life (eg, school, job, or social life)?


The cosmetic surgery consultation often begins with a telephone call or e-mail. This contact leaves a lasting impression on both the patient and surgeon. Proper telephone etiquette is important for both parties involved. The office receptionist is often the ...

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