Rhinoplasty is a difficult surgery.
To me there is just one aim : My patient should be happier after the surgery and for that objective I spend a lot of my time with my patients both before and after the surgery.
Psychological aspects and their influence on outcomes is a well known fact. What can a surgeon do to minimise these ?
Have you heard of Body Dysmorphic Disorder (BDD) ?
Do you know that BDD is quite common amongst persons seeking Cosmetic Rhinoplasty ?
Those with moderate to severe BDD perform poorly and have low satisfaction rates and surgery is considered contraindicated in this group. These are generally speaking easily diagnosed by your surgeon and surgery here can be a poor option.
Some of those with mild and sub-clinical BDD may benefit from surgery. This group is difficult to diagnose and it is difficult to ascertain its severity.
Current Protocols for safe assessment of our Cosmetic Rhinoplasty patients include assessment by your surgeon and a formal Psychiatric Evaluation.
This is by no means a reflection on a particular persons personality.
Despite vast experience, your surgeon has missed persons with mild BDD even after spending approximately two hours during interviews. This was also the experience of 285 American Plastic Surgeons who regularly missed the diagnosis of BDD according to one study.
In the absence of any clear guidelines, your surgeon prefers the route of a formal psychiatric evaluation on all patients seeking a cosmetic rhinoplasty. He has given several invited lectures on this very important topic to International audience of Rhinoplasty Surgeons in Cannes, Rio De Janeiro & London.
Your surgeon sends referrals for Psychiatric Evaluation to one Adult and one Paediatric Psychiatrist to maintain uniformity and to take advantage of their ever-building experience in this small area. If a patient insists on an evaluation by a different Psychiatrist it can be accepted if your surgeon feels it is in your best interest.
You will be reassured to know that only persons considered good and safe candidates for Rhinoplasty by your surgeon are referred for PE. This is to identify subclinical mild form of BDD who are carefully advised again and so far all these patients (they are less than 1% of patients screened by Mr Shandilya) could be offered surgery with satisfactory results.
So, if you are referred for a Psychiatric Evaluation … I am already happy with your safe candidature … you are being asked to spend money for a further consultation … to ensure that you are not one of the less than 1% who may need further discussion.
Unfortunately there is a possibility that I may have to decline surgery after your PE but this is rare and has not happened yet.
Mr Munish Shandilya formally declares that these decisions are his own and taken in the best interest of his patients. He has no financial interest in these referrals.
