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Background: Many patients with body dysmorphic disorder (BDD) seek out cosmetic surgery to alleviate their symptoms of distress related to a perceived defect in their appearance; however, the prevalence and risk factors for BDD among patients with cosmetic concerns have not been well characterized. Methods: We screened adult patients presenting to the clinic from June 2021 through September 2022 for BDD using the BDD Questionnaire-Aesthetic Surgery (BDDQ-AS) who were seen in consultation for rhinoplasty, aging face, and injectables. Results: Among 488 patients, the prevalence of screening positive for BDD was 41.0%. The prevalence of a positive BDD screen was highest among patients who were younger ( p  = 0.02), and those who had a positive self-reported psychiatric history ( p  = 0.02). Among rhinoplasty patients, those with aesthetic/cosmetic motivations, and those seeking revision rhinoplasty had higher rates of positive BDD screen. Higher scores on the Standardized Cosmesis and Health Nasal Outcomes Survey-Nasal Obstruction Score (SCHNOS-O) ( p  = 0.01) and Standardized Cosmesis and Health Nasal Outcomes Survey-Nasal Obstruction Score-Nasal Cosmesis Score (SCHNOS-C) ( p  < 0.0001) were predictive of a positive BDD screen, while question 5 of the SCHNOS was highly predictive of positive BDD screening ( p  < 0.0001). Conclusions: Our study characterizes relationships between positive BDD screening and age, gender, self-reported psychiatric history, and motivations for consultation, among patients seen for cosmetic surgery evaluation in a facial plastic and reconstructive surgery setting.

Objective: To investigate the effectiveness of diced cartilage graft for dorsal augmentation in rhinoplasty. Methods: In a retrospective study, patients who underwent rhinoplasty with dorsal augmentation using diced cartilage graft from June 2017 to December 2021 were identified. Patients with complete preoperative and at least one postoperative Standardized Cosmesis and Health Nasal Outcomes Survey-Cosmesis (SCHNOS-C) and visual analogue scale (VAS) scores were included in the study. Postoperative periods were classified into ≤6 and >6 months. Mean preoperative outcome scores were compared with postoperative scores utilizing a Paired t -test, and postoperative scores were compared utilizing a Wilcoxon rank-sum test. Results: A total of 71 patients with a median age of 36 years, range (18-74) fit inclusion criteria. Majority were female patients 49 (69%). The postoperative period ranged from 17 days to 3.5 years. The mean follow-up period (standard deviation) for ≤6 and >6 months was 2.8 (1.5) and 14.2 (6.3) months, respectively. A decrease in mean SCHNOS-C, SCHNOS item 8, and an increase in VAS scores ( p  < 0.0001) were seen at both postoperative time periods compared with preoperative levels. Conclusion: This study demonstrates that dorsal augmentation with diced cartilage graft is an effective technique in correcting dorsal aesthetic deformities.

Background: In revision rhinoplasty, lateral crural repositioning/reconstruction is considered a complex maneuver. The aim of this study is to measure patient outcomes after lateral crural repositioning/reconstruction in revision rhinoplasty. Methods: In this retrospective case series, patients who underwent revision rhinoplasty with lateral crural repositioning/reconstruction for functional, cosmetic, or combined purposes were reviewed. Preoperative Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) scores, functional and cosmetic visual analog scales (VAS-functional [F] and VAS-cosmetic [C]), and lateral wall insufficiency (LWI) grades were compared with their respective postoperative scores. Results: Forty-two patients were identified who underwent lateral crural repositioning. The mean postoperative follow-up for ≤6 months (PO1) and >6 months (PO2) was 3.1 (standard deviation [SD] 1.7) and 11.5 (SD 5.3) months, respectively. At both postoperative periods, significant improvement ( p  < 0.05) in patient-reported outcomes was observed in mean SCHNOS-Obstruction, SCHNOS-Cosmesis, VAS-F, and VAS-C scores. The postoperative changes in LWI scores (Δ) were significant on both sides at zone 1 at PO1 ( p  < 0.05) and PO2 ( p  < 0.05), and at PO2 on the left side ( p  < 0.05) only, for zone 2. Conclusion: Lateral crural repositioning with reconstruction is an effective maneuver in revision rhinoplasty in a subset of patients and specifically helps to improve nasal tip aesthetics while preserving function.