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Journal time: Body Dysmorphic Disorder Association with Abdominoplasty

Posted: June 1, 2016 > Body > Journal Time > tummy tuck > Blog Home

woman-sofaMarch 2016 issue of the Aesthetic Journal had an article “Prevalence of Body Dysmorphic Disorder Symptoms and Body Weight Concerns in Patients Seeking Abdominoplasty.”  This was a study out of Brazil, so things may be a little different than the Bay Area.  But I think it is important to look at the changes we have with pregnancies and aging and figure out what is normal? In this age of perfectionism and airbrushed photos, do we have impossible expectations? I see women for abdominoplasty all the time. Most do not have dysmorphic disorder. Those who are unhappy are entitled to be unhappy with their bellies- hanging skin, extensive stretch marks, muscles blown out by pregnancies, looking 5 months pregnant on a daily basis. Many have dieted and exercised to no avail. These are not issues fixable without surgery.  But I also see women with great bellies, who I like to tell “If I had your belly, I would be running naked down El Camino.” These are women with great abdomens- flat, no fat, minimal loose skin.

So when does your dissatisfaction become a disorder? First, let’s identify what is body dysmorphic disorder.

What is Body Dysmorphic Disorder?

There are 6 domains to assess preoccupation and negative self evaluation

  • Appearance
  • Self consciousness and embarrassment
  • Excessive importance given to appearance in self evaluation
  • Avoidance of activities (social and public situations or physical contact with other people)
  • Body camouflaging (camouflage strategies with clothing, accessories, makeup and body posture to hide the perceived defect)
  • Body checking (self inspection, reassurance seeking, comparing self with others)

They rate these items on a 0 – 6 scale, looking at the incidence in the past 4 weeks. Scoring is done on the frequency (number of days) or intensity (mild to severe). So the score ranges from 0 (happy with yourself!) to 168.  If your score is >66, you have a high degree of dissatisfaction and associated with the diagnosis of BDD.

When I read this list, I think what woman doesn’t think these things? Self conscious about that muffin top hanging over the jeans?… Playing with the skin looseness when doing a sit up?… Layering shirts to keep the belly in and spanx to keep it looking flat?… Checking out others at the gym who had kids- why do they look better? …. not wanting to go to the work pool party because you don’t want to be in a swim suit in front of your colleagues?  These feelings are normal.

Please know the keys to this disorder.

  • Preoccupied, obsessive thinking.  Repetitive behaviors such as mirror checking.
  • Negative Self Evaluation
  • **Differ from what an objective third party would think.  A key here is “a preoccupation with defects in physical appearance which are slight or not observable to others.”
  • Impair your living- their social relationships and employment

Seeing a Plastic Surgeon

If you have an area which really bugs you, it’s just a good thing to see a plastic surgeon. I am here to educate you on what is going on, not sell you on doing something. For most of my patients there is relief knowing what the issues are. It answers many questions floating in their head–How bad is it? Do all women look this way after kids? Is it fixable? Do I need to do sit ups? Diet? What would a tummy tuck do? Or do I need to accept it?



Ninety patient were evaluated by those with BDD symptoms and those without. They did a clinical assessment and took a body dysmorphic disorder exam.


  • 57% had Body Dysmorphic symptoms.
  • There were significant associateions between the BDD symptoms and the degree of body dissatisfaction, level of preoccupation with their physical appearance, and avoidance behaviors.
  • The more severe the symptoms of BDD the higher the level of concern with body weight and shape.

In the evaluation of this journal article, the reviewer had good points. Of all surgeries, abdominoplasty tends to have real objective issues, many of which cannot be fixed without surgery. “These are more than slight.  In this respect … these women may have more similarities to women who present for breast reduction for extremely large breasts than women who present for rhinoplasty to correct a relatively small dorsal hump.”



Please keep in mind: subjects covered in this blog and certain tips and advice are not substitutes for professional medical advice. This blog is for general informational purposes only. If you are considering plastic surgery, reconstructive surgery, or cosmetic enhancement, you should always consult with a board-certified plastic surgeon and/or your general practitioner in-person for professional medical advice.

If you think you may have a medical emergency, call your doctor or (in the United States) 911 immediately. Always seek the advice of your doctor before starting or changing treatment.

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