Obsession with Perfection: The issue of body dysmorphia and cosmetic treatments

teeth mirror check

Ever since humans gained an awareness of their self-image, we have possessed a desire to appear aesthetically pleasing. This desire has remained constant over the centuries, despite political and cultural changes. What has changed however are the methods we have adopted to enhance our appearance, through the evolution of medicine and science we are provided with more options in achieving more dramatic aesthetic changes.

With the increased life expectancy coupled with improved standard of living, more people have the means and access to engage in advanced methods of appearance enhancement, such as cosmetic dental and medical procedures.

So long as the goal to improve one’s appearance remain realistic, these physical changes will usually also lead to positive changes in one’s life and well-being.

But when this desire becomes an all consuming and destructive obsession, quite often it is a very different type of treatment a patient may require, rather than the cosmetic procedures they may think they need. There are psychological conditions where a person may see or imagine defects in their appearance, which in reality are not real, or should not be of any real concern.

Getting down to the tooth of the issue

Wanting your teeth to be a few shades whiter, or perhaps a little bit straighter might be reasonable goals for most patients receiving treatment from their dentist, but when the desire for cosmetic treatment is driven by adverse psychological issues, going ahead and performing such treatment might not always be in the patient’s best interests.

The condition of seeing or imagining imperfections in one’s appearance to the point that it negatively impacts on a person’s quality of life is called ‘body dysmorphia’. It is a psychological disorder, as defined in the Diagnostic and Statistical Manual of Mental Disorders:

Body Dysmorphic Disorder (BDD) – A preoccupation with an imagined or slight defect in appearance. This preoccupation causes significant distress or impairment in social, occupational or other areas of functioning in the person’s life. Another disorder, such as whole image dissatisfaction (as in anorexia nervosa), cannot explain this preoccupation (DSM –IV)

Because of the nature of the condition, quite often dentists, orthodontists, maxillofacial surgeons, and plastic surgeons will be the first port of call for these people, who are seeking cosmetic treatments rather than psychologists or counselling. Practitioners need to be aware of the warning signs of body dysmorphia, to assist in avoiding and preventing patients from seeking and obtaining unnecessary treatments, either within their practice or elsewhere.

The decision to go ahead and perform unnecessary treatments may result from a lack of vigilance by a practitioner, not knowing what to look for in the patient, or worse, professionals who are driven more by serving their own economic goals than the best interests of the patient. Don’t think it doesn’t happen, one need only look at some disastrous outcomes of unnecessary plastic surgery or cosmetic treatments, where the doctor really should have said ‘enough is enough’ and instead referred the patient to a psychologist.

 The dangers of unnecessary treatments

Aside from considerable financial damage, the physical costs of continued unnecessary treatment can be serious. Undergoing any elective procedure carries risks, the more a person exposes themselves to treatment after treatment, the greater the risk of complication, ongoing dissatisfaction can lead to a vicious cycle. In the context of dentistry, with unnecessary or excessive whitening, over-bleaching result in damage to the enamel, severe burns and extreme sensitivity.

Signs and symptoms

Whilst it is encouraged that a patient seek the opinion of more that one professional before committing to any treatment, a potential warning sign exposing a patient’s motivation for cosmetic treatment can be “doctor shopping.” If a practitioner knows or suspects that a patient has seen several doctors already about a procedure, this can be a good warning that they have been ‘knocked back’ for unnecessary treatment elsewhere.

In assessing whether a patient might be influenced by a body dysmporphic disorder, practitioners need to look for signs of:

  • Depression;
  • Anxiety;
  • Medication history;
  • Family, personal and work problems;
  • Self perceived problems that are not evident, or not proportional to the distress expressed;
  • The person is not quite sure of what he/she is trying to achieve;
  • Seeking multiple other cosmetic consultations or professional opinions, or ‘doctor shopping’;
  • Having cosmetic procedures done in the past;
  • Not happy with the outcome of past procedures;
  • History of litigation;
  • Seeing surgery as a solution to all their problems;
  • Patient’s general presentation and body language:
    • Restlessness
    • Avoidance of eye contact

In the course of seeing patients, aesthetic dentists do come across individuals who see faults in themselves that others do not, whether it be a alleged problem with their teeth, face, or their appearance in general. It is vital when consulting a patient that the practitioner be on the lookout for the warning signs of body dysmorphia, and direct the patient to an appropriate professional to address the issue before any further consideration of cosmetic treatments.


This article is based on the research notes and submissions of Dr Yvonne King for the completion of her Master’s studies in Aesthetic Dentistry. The information is general and should not be relied on solely in making any decisions about treatment.

Please contact us if you would like to learn more about the services available at the Cosmetic and Laser Dentistry Centre.

If anything in this article has raised concerns for you personally regarding body dysmorphia or your health in general, please get in touch with your healthcare professional.

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