Prevalence of Body Dysmorphic Disorder and Dysmorphic Symptoms in Rhinoplasty Candidates: a Systematic Review and Meta-Analysis

Risk for body dysmorphic disorder (BDD) is higher in the population that seeks rhinoplasty. However, its prevalence varies widely, which makes screening prior to procedures less of a priority. The authors performed a systematic review and meta-analysis of BDD and dysmorphic symptoms in rhinoplasty patients. The PubMed, Cochrane, and SciELO electronic databases were searched in April 2021, along with the reference list of relevant articles, with no limitations as to year or language of publication. Cross-sectional and longitudinal studies were included that addressed rhinoplasty patients from otorhinolaryngology or plastic surgery clinics who underwent screening or were diagnosed with BDD via a validated instrument. Overall BDD prevalence was pooled as well as its prevalence by predefined study-level characteristics (geographic location, specialty sought, reason for rhinoplasty, only primary rhinoplasty seekers, and diagnostic method). Twelve studies involving 1318 candidates for rhinoplasty yielded a 34% prevalence of BDD (27.2–42.1%, with 95% confidence interval). In the subgroups, the prevalence of BDD was 23% among primary rhinoplasty candidates, 48% for patients who sought out plastic surgeons, 33% for patients who sought out otorhinolaryngologists, and 43% for Brazilian patients. The prevalence of BDD found in rhinoplasty candidates was markedly high in all analyzed settings, which highlights the importance of routine screening in a systematic way in rhinoplasty clinics worldwide.