If surgeons screen rhinoplasty patients for body dysmorphia before surgery, when is that screening supposed to happen?
I came across this video where Dr. Richard Reish is asked:
“How do you address if a patient did not like their results?”
His answer caught my attention because the question is about a patient being unhappy with their surgical result, but his response turns to screening patients beforehand, including “identifying issues such as body dysmorphia,” and not offering those patients surgery.
This raised a question for me because I was personally present throughout the preoperative process in a case involving Dr. Reish.
There were two separate telehealth appointments before the rhinoplasty, and I was present for both. I was also there on the day of surgery. I did not witness any screening for body dysmorphia during either telehealth appointment.
The medical records produced also do not document a body dysmorphia screening, BDD questionnaire, psychological evaluation, or similar assessment during those preoperative telehealth appointments.
The first documented in-person preoperative examination occurred in the preoperative holding area on the day of surgery, at which point the surgery had already been scheduled and paid for.
So this leaves me with two questions:
If screening for body dysmorphia is supposed to determine whether someone should be offered cosmetic surgery, when and how should that screening actually take place?
And if a patient was considered an appropriate candidate, accepted for surgery, paid for the procedure and was operated on, why does body dysmorphia enter the discussion when the patient later says they are unhappy with the surgical result?
That distinction is what I find troubling about this video.
The two telehealth encounters and the day-of-surgery examination I’m describing are supported by the produced medical records.