Body Dysmorphic Disorder in Aesthetic Practice: Ethics, Risks, and Recognition

Aesthetic medicine often sits at the crossroads of beauty, identity, and self-worth. While treatments can enhance confidence, they also pose ethical challenges—especially when concerns cross the threshold into Body Dysmorphic Disorder (BDD).

What is Body Dysmorphic Disorder (BDD)?

Body Dysmorphic Disorder is a mental health condition where a person becomes excessively preoccupied with perceived defects in their appearance. These “flaws” are often minimal or even invisible to others, yet the distress they cause can be overwhelming. Patients may spend hours checking their reflection, comparing themselves to others, or seeking reassurance about specific features.

In aesthetic clinics, this frequently leads to repeated requests for cosmetic procedures in the hope of achieving a sense of satisfaction that always seems just out of reach. This characteristic dissatisfaction, despite technically successful treatments, should raise concern for any responsible practitioner.

Why BDD Poses Risks in Aesthetic Clinics

While aesthetic medicine can enhance confidence for many patients, it is not a cure for deep-seated psychological issues. Treating a patient with undiagnosed BDD poses risks not only to the patient but also to the practitioner. Such patients may become frustrated with even excellent results, pursue unnecessary repeat treatments, or in some cases, initiate complaints or legal action when their unrealistic expectations are not met.

Aesthetic improvements that are intended to make someone feel “better” can backfire when the underlying issue isn’t appearance but perception. Even when the physical changes align with what was promised, patients with BDD may not feel any happier…or worse, they may find a new flaw to fixate on, perpetuating a cycle of dissatisfaction.

Spotting and Managing BDD in Consultations

In everyday consultations, identifying BDD requires sensitivity and attentiveness. Often, it’s not what the patient says, but how they say it—their tone, urgency, emotional intensity, or unrealistic goals—that provides the strongest clues.

For example, a patient who returns multiple times for minor corrections to an objectively balanced feature, despite reassurance and successful outcomes, may be exhibiting signs of BDD.

Aesthetic clinicians should aim to evaluate a patient’s “psychological readiness” during consultation, not just their suitability for the procedure. This means listening carefully to their motivations, watching for signs of obsession, and being attuned to any mismatch between their concerns and what you observe clinically.

In cases where BDD is suspected, it is often in the patient’s best interest to decline treatment and instead refer them to a mental health professional. The temptation to “help” by agreeing to a small treatment can be strong, particularly if the patient is persistent or visibly distressed. However, doing so may reinforce the belief that a procedure will resolve their discomfort, when in reality, it may only deepen the disorder. Saying no can feel uncomfortable, but in these cases, it is the most compassionate and professional response.

Conclusion: Ethics Over Aesthetics

The work of aesthetic medicine can be transformative, but it should never be exploitative. When we place ethics before aesthetics, we safeguard the integrity of the profession and, more importantly, the health of our patients. By recognising psychological red flags, declining inappropriate treatments, and referring when necessary, clinicians not only uphold their duty of care but also reinforce the core values of ethical aesthetic practice.