Aesthetic/Cosmetic Surgery and Psychiatry

In this chapter, we discuss psychiatric considerations relevant to the cosmetic surgery patient. Cosmetic (aesthetic) surgery is the discipline of medicine focused on enhancing appearance through medical and surgical techniques. It is practiced by doctors from a variety of medical fields, including plastic surgery, and aims to correct undesirable features of the body by reconstruction. All cosmetic procedures are elective because all the visible organs are functionally intact; therefore, selection process relies on subjective complaints, and patient satisfaction is the main outcome measure. Body dysmorphic disorder has a 7–8% prevalence among US cosmetic surgery patients, making it the most common psychiatric disorder among cosmetic surgery patients, yet it remains under-recognized. Importantly, though, it is closely associated with poor outcomes. Higher prevalence of substance use, particularly tobacco and alcohol use, has been identified in cosmetic surgery candidates. Suicidality in particular is associated with the diagnosis of body dysmorphic disorder and among breast augmentation patients. Finally, we review the challenges of psychosocial screening unique to this surgical population.