A new perspective

As the Joint Council for Cosmetic Practitioners agrees to introduce measures to protect those who may be vulnerable as result of mental health problems, Harry Singh explores what this means for dentists practising facial aesthetic treatments

Mind, the mental health charity, defines body dysmorphic disorder (BDD) on their website (www.mind.org.uk) as ‘an anxiety disorder related to body image’.

Individuals with BDD may seek out cosmetic treatments to correct what they perceive as flaws, hoping they will then be satisfied with their appearance.

According to Tech Times, BDD affects roughly one in 50 people, so this is quite a prevalent mental health issue, and given that cosmetic treatments performed in the UK between 2002 and 2018 increased by 300% (Higgins and Wysong, 2018), it is quite likely dentists offering non-invasive facial aesthetic treatments will come across BDD sufferers at some point in their career.

BDD as a contraindication

Reputable facial aesthetic practitioners understand that BDD is a contraindication to cosmetic procedures, not least because it makes obtaining true consent impossible and any treatment can make the patient’s mental health issues worse. While not compulsory, screening for BDD is, nonetheless, an essential element of delivering the best possible care to patients and every clinician should be doing it.

It was, therefore, no surprise when, early in 2019, Superdrug announced it was to start checking patients wanting facial aesthetic treatment for BDD. Raising awareness of this mental health problem is key to stopping unwitting consumers handing their money over to cosmetic cowboys, very often leaving the patient worse off both physically and mentally.

Superdrug’s stance, as well as that of the Joint Council for Cosmetic Practitioners, is to be applauded, not only for making that decision, but also for effectively circulating the news.

Identifying BDD

In a world where social media use is rife and where we know images can be manipulated to look much better than the reality, many people have unrealistic expectations. People see celebrities with a perfect body and face, and want it for themselves.

To offset this, every first appointment should involve a detailed consultation and assessment of the patient’s situation. Allow a cooling-off period – never treat on the same day. Overplay the downtime and possible complications.

It is also important to show the results of realistic cases, to counterbalance unachievable, manipulated images on social media.

Weeding out patients with BDD is in their best interest, and will save you stress and time, removing the almost inevitable complaint that will come your way if you treat a BDD sufferer.

If you don’t think a patient needs the treatment they want or you cannot improve their concerns, do not treat them. Just say no and, if appropriate, refer them to a colleague for a second opinion.


Higgins S, Wysong A (2018) Cosmetic surgery and body dysmorphic disorder – an update. International Journal of Women’s Dermatology 4: 43-48

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