Body Dysmorphic Disorder in Aesthetic Medicine: An Update and Critical Review

Background: Body dysmorphic disorder (BDD) is highly relevant to aesthetic medicine because affected patients frequently seek dermatologic, nonsurgical, and surgical appearance-altering procedures while attributing their distress to a perceived physical defect rather than to underlying psychopathology. Modern aesthetic practice has become increasingly complex as clinicians must now address not only diagnosis and procedural suitability, but also social-media-driven appearance dissatisfaction, repeated procedure seeking, digital self-image distortion, screening mandates, practitioner bias, and medicolegal risk. Methods: A comprehensive review of studies published from 2024 to 2026 was performed. Fifty articles addressing BDD in aesthetic medicine, cosmetic surgery, dermatology, facial aesthetics, dental and orthodontic aesthetics, screening, psychosocial determinants, and management frameworks were analyzed in detail. Each publication was classified according to the Oxford Centre for Evidence-Based Medicine 2009 Levels of Evidence. Results: The recent literature confirms that BDD and clinically significant dysmorphic symptoms remain common in cosmetic populations, although prevalence estimates vary substantially by setting, screening tool, and diagnostic threshold. Social media exposure, image filtering, low insight, psychiatric comorbidity, maladaptive expectations, and prior cosmetic treatment history repeatedly emerged as relevant correlates. Systematic reviews and large observational studies support routine psychological screening and multidisciplinary referral pathways, whereas narrative and conceptual papers emphasize ethical refusal, longitudinal safeguarding, and the need to move beyond a simple binary model of “BDD versus no BDD.” Several studies also indicate that cosmetic intervention rarely resolves core psychopathology and may instead perpetuate dissatisfaction, repeated treatment seeking, or dispute. Conclusions: Current evidence favors structured, psychologically informed patient selection over appearance-based decision making alone. BDD in aesthetic medicine should be approached as a patient-safety issue, an ethical issue, and a treatment-outcome issue. Routine screening, careful expectation management, and early mental health referral remain the most defensible clinical strategies. Future work should prioritize standardized diagnostic pathways, prospective outcome studies, and better differentiation between syndromal BDD, subthreshold body image concern, and culturally mediated appearance dissatisfaction.