Should I have cosmetic surgery if I might have BDD?
If you are considering a procedure for a feature you cannot stop thinking about, it is worth pausing first. Here is the view I would give anyone who asked me.
You have been thinking about it for a long time. Maybe you have had a consultation already, or several. The reasoning feels sound: the feature is the problem, so fix the feature, and the hours you lose to it will come back. Other people get procedures and feel better. Why not you?
Here is the honest view I would give anyone who sat down with me and asked this question, and then the decision is yours.
The question to ask first
Before anything about the procedure, there is a question about the preoccupation. How much time does this feature take up in your day? Not the time you spend on it in front of a mirror, but the time it takes up in your head. Do you check it, cover it, compare it, avoid situations because of it? Have other people said they cannot see the problem, and have you assumed they were being kind?
If the honest answer is that this feature has been running your day for months or years, and that people who love you cannot see what you see, then what you are dealing with may not be a feature. It may be body dysmorphic disorder, and BDD changes the calculation entirely.
What tends to happen
I want to be careful here, because I am a therapist rather than a surgeon, and I am not going to tell you what any procedure will or will not do to your face or body. What I can tell you, from working with the condition, is that cosmetic procedures rarely bring the relief people with BDD expect, and that the preoccupation often moves to another feature.
The engine underneath BDD is a pattern of doubt, checking and short-lived relief that will attach itself to something, and the feature is only where it currently sits. Remove the feature it is currently attached to, and there is a period of relief, sometimes weeks, and then the attention moves. People come to me having had two or three procedures, each of which was going to be the last one.
There is also the money. Some people spend what they do not have, and the debt becomes another thing to carry alongside the preoccupation that did not lift.
Why the relief does not last
The relief after a procedure works the same way the relief after checking a mirror works. For a moment the question feels answered. Then the certainty fades, because certainty about appearance is not something a procedure can provide any more than a mirror can, and the doubt returns. Only now the surgeon becomes part of the checking: did they do it right, does it look natural, should it have been done differently.
This is the same mechanism I work with in OCD, and it is why BDD is classified alongside it. The compulsion promises resolution and delivers a brief pause before the next round.
What I would suggest instead of a rule
Talk it through first. Not with the aim of talking you out of anything, but with the aim of finding out what is actually driving the decision. If the preoccupation is BDD, then there is a treatment for it, CBT adapted specifically for the condition, and it addresses the engine rather than the feature. Most people find that once the preoccupation has gone back to a normal size, the question of surgery looks completely different, in one direction or the other.
If, after that work, you still want the procedure, that is your decision and I will respect it. What I want to avoid is someone making a permanent, expensive decision while the condition is the one doing the deciding.
What the work involves
We map your cycle: the trigger, the image of yourself that appears in your mind, the meaning you attach to it, and everything you do to feel safer. We shift attention out of the internal picture and back into the world, which is where the evidence actually lives. And we gradually drop the checking, camouflaging, comparing and reassurance-seeking, at a pace you set, so you can find out what happens without them.
I will not tell you the feature does not matter to you, and I will not promise a cure. What I can say is that the length of time you have lived with this turns out to matter much less than whether the cycle gets broken.
If you are weighing a procedure and any of this sounds like your situation, the BDD page explains how I treat it, and I would rather you had the conversation before the appointment than after.