Eur J Plast Surg (2002) 25:309 DOI 10.1007/s00238-002-0410-8 INVITED COMMENTAR Y L. Clodius “The importance of recognizing body dysmorphic disorder in cosmetic surgery patients: do our patients need a preoperative psychiatric evaluation?” by V. Vindigni et al. Published online: 13 September 2002 © Springer-Verlag 2002 For the plastic surgeon body dysmorphic disorder (BDD) expertise in plastic surgery cannot be obtained by visit- is not a rare, but also not a welcome, problem. Vindigni ing weekend courses on, for example, cosmetic surgery. et al.  are to be congratulated for addressing and for Surgery for a human is more than surgical technique. In statistically analyzing this difficult matter. an earlier contribution of mine to this journal  I de- My father was a psychiatrist, and I became well ac- scribed a 17-year-old female with lymphedematous full- quainted with some of his patients. Occasionally I asked thickness skin grafts to her left midface. I fully discussed him about the 5-year results in his schizophrenia pa- the various possibilities of somatic therapy, but failed to tients. “Don’t ask the wrong question,” was his reply, en- discuss with her the emotional implications. Following couraging me to chose a profession which, I thought to her visit, she committed suicide. be, purely technical. Also, the contribution by Vindigni If you must decide whether to send your patient to a et al. demonstrates how wrong I was. The specialist in psychiatrist, or if there a discrepancy between his soma- plastic surgery must be more than an expert technician, tic problem and his emotional interpretation, Josef’s  more than a skilled manual craftsman. Each of our pa- differentiation might help: the norm-esthetic patient (no tients is a world of his own. The therapist must realize problem), the hypoesthetic patient (he cares a little), and that achieving a beautiful result, for example, by rhino- the hyperesthetic patient. We must diagnose and discuss plasty, does not necessarily satisfy, or help, the individu- the difficulties of his problems, and whether we can al sitting in front of him. By understanding the patient’s help. Josef’s fourth category was the paresthetic patient: emotions we grasp that the size or severity of bodily al- he projects his psychiatric problems onto his body, and terations or defects does not parallel the patient’s expec- needs corresponding therapy. tations. Buying a time piece, a watch, seems to be a pure ra- The authors also raise a question with legal implica- tional matter. Yet, the director of an important watch- tions: Is it necessary for every patient seeking cosmetic manufacturing company has observed that in buying a surgery also to be seen by a psychiatrist? To choose the watch, the watch itself accounts for only 10% of the best for the patient, optimal training by competent teach- buyer’s considerations – the other 90% are emotions. ers is a must in the education needed to become a plastic and reconstructive surgeon. One of the chiefs in my training used to take me along to his office, and to see References his patients (if they agreed) together. After that patient 1. Vindigni V, Pavan C, Semenzin M, Granà S, Gambaro FM, had left, indications, possible management including sur- Marini M, Bassetto F, Mazzoleni F (2002) The importance of geries, and finances were discussed. I am convinced that recognizing body dysmorphic disorder in cosmetic surgery pa- tients: do our patients need a preoperative psychiatric evalua- tion? Eur J Plast Surg (http://dx.doi.org/10.1007/s00238-002- This commentary refers to the article at 0408-3) http://dx.doi.org/10.1007/s00238-002-0408-2 2. Clodius L (2002) Lymphedema – common sense. Eur J Plast Surg 25:66 L. Clodius ( ) 3. Josef JJ (1931) Nasenplastik und sonstige Gesichtsplastik. CF. Kabitzsch, Leipzig Seefeldstrasse 4, 8008 Zurich, Switzerland
European Journal of Plastic Surgery – Springer Journals
Published: Dec 13, 2002
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