April 21, 2026 • 23 mins
When does an insecurity cross the line into a mental health disorder?
It’s not as obvious as you think.
In this episode of Plastic Surgery Uncensored, Dr. Rady Rahban breaks down one of the most important distinctions in aesthetic medicine: the difference between normal self-improvement—and true body dysmorphia.
Because while insecurity is part of being human…
There’s a point where it stops being physical—and becomes psychological.
And if you miss that line, surgery doesn’t help.
It makes things worse.
Here’s what he unpacks:
• What body dysmorphia actually is—and why it’s often misunderstood
• The defining traits: obsession, distortion, and fixation on minor or nonexistent flaws
• Why hearing “this is ruining my life” is a major red flag
• The significance of multiple consults—and when it signals a deeper issue
• Why some patients can never be satisfied—no matter how technically successful the surgery is
• How social media, filters, and AI are accelerating distorted self-perception—especially in younger patients
He also addresses a reality most won’t say out loud:
In a field with increasing access and fewer barriers,
the responsibility to protect patients falls on the provider. Because not every patient should be operated on.
Dr. Rahban explains how he evaluates not just anatomy—but psychological readiness—and why sometimes the most ethical decision is to say no.
If you’ve ever questioned whether something is truly worth fixing—or wondered where the line actually is—this episode offers a clear, unfiltered framework to help you understand it.
✨ If you enjoyed this episode of Plastic Surgery Uncensored:
✔️ Subscribe on Apple Podcasts, Spotify, or wherever you listen.
✔️ Rate & Review—your feedback helps more people find us.
✔️ Follow Dr. Rady Rahban across all platforms for daily insights, behind-the-scenes, and patient education:
It’s not as obvious as you think.
In this episode of Plastic Surgery Uncensored, Dr. Rady Rahban breaks down one of the most important distinctions in aesthetic medicine: the difference between normal self-improvement—and true body dysmorphia.
Because while insecurity is part of being human…
There’s a point where it stops being physical—and becomes psychological.
And if you miss that line, surgery doesn’t help.
It makes things worse.
Here’s what he unpacks:
• What body dysmorphia actually is—and why it’s often misunderstood
• The defining traits: obsession, distortion, and fixation on minor or nonexistent flaws
• Why hearing “this is ruining my life” is a major red flag
• The significance of multiple consults—and when it signals a deeper issue
• Why some patients can never be satisfied—no matter how technically successful the surgery is
• How social media, filters, and AI are accelerating distorted self-perception—especially in younger patients
He also addresses a reality most won’t say out loud:
In a field with increasing access and fewer barriers,
the responsibility to protect patients falls on the provider. Because not every patient should be operated on.
Dr. Rahban explains how he evaluates not just anatomy—but psychological readiness—and why sometimes the most ethical decision is to say no.
If you’ve ever questioned whether something is truly worth fixing—or wondered where the line actually is—this episode offers a clear, unfiltered framework to help you understand it.
✨ If you enjoyed this episode of Plastic Surgery Uncensored:
✔️ Subscribe on Apple Podcasts, Spotify, or wherever you listen.
✔️ Rate & Review—your feedback helps more people find us.
✔️ Follow Dr. Rady Rahban across all platforms for daily insights, behind-the-scenes, and patient education:
- Instagram: @drradyrahban
- TikTok: @radyrahbanMD
- YouTube: @Rady Rahban
- Facebook: @Rady Rahban
Listen
Watch
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:06):
Welcome to another episode of Plastic Surgery and Centered. I'm
your host, as always, doctor Rider Raban, and I am
excited about today's episode because we're going to tackle and
talk about kind of a very important subject matter, which
is body dysmorphia and the distinction between it and the
regular normal desire to improve something. Because it's a sliding spectrum,
(00:29):
and the word is thrown around very loosely. It's a
real entity, a very concerning entity, an entity on the rise,
but we have to define it and make sure that
we don't mislabel people as having body dysmorphia when in
reality they don't, and then identifying those that have it
to make sure that we don't worsen their condition any rate.
(00:52):
They always say that plastic surgeons, in order to be incredibly,
incredibly successful and good, they need to be essentially psychologist,
which is actually very true. I have no formal training
in psychology, but I actually consider myself very very knowledgeable
in the under the underbelly of the human psychologic condition.
(01:14):
Because remember, at the end of the day, it is
insecurities that drive much of what we do. And while
that's absolutely okay, absolutely normal and absolutely treatable, there are instances,
as in the instance of body dysmorphia, where we cannot
correct them, we worsen their conditions, and we are actually
(01:36):
adding fuel to the fire. So let's dive right in
and let's talk about what's going on. Well, body dysmorphia
has been around forever. It's basically an unrealistic it's an
unrealistic preoccupation with a flaw. It has certain elements about
it that make it very distinct. Number one, the flaw
(01:57):
is usually very, very minor, almost I've had instances where
you can't even see it or it doesn't even exist.
It's compulsive, so in other words, it's repetitive. It's repetitive.
It's repetitive. It's part of an OCD component of psychologic issues.
There's constant comparison of well, look at this as compared
to that look at me. I should be that there's
(02:19):
there's my friend doesn't have it, look at so and
so angela jo only doesn't have it, et cetera. And lastly,
it's it's a psychologic issue. It's not a physical issue.
There is no physical issue there. It's a process in
the way we perceive our physicality. So it for sure
is an issue. It's always been around, but it's a
(02:39):
little bit on the rise. Why is it a little
bit on the rise, Well because of social media. And
what does social media have to do with body dysmorphia. Well,
what it does is now we have young people whose
minds and their and their psychology and their their sense
of self is incredibly malleable, vulnerable and naive, seeing hundreds,
(03:04):
if not thousands of images a day of people who
not look good, because that in and of itself causes insecurity,
but of people who don't even look like themselves. We
keep going back to the same issue over and over again,
which is this idea of comparing yourself to a filter,
a morph and ai perfect jaw, perfect skin, perfect pecs,
(03:27):
perfect nose, perfect brows, and now the idea of influencerism.
This never really was present during the developmental phases of
young adults in the past. So while body dysmorphia OCD,
all these things existed. Is definitely on the rise, and
now young adults can go and get plastic surgery, whereas
(03:49):
many years in the past that was never an issue.
So if you had body dysmorphia, you'd have to wait too,
your grown adult to really do anything about it. Now
you have sixteen year olds getting lip lifts and eighteen
year olds getting rhinoplasts and liposuction and all kinds of
things in a very very very very unscrupulous, dishonest landscape.
(04:10):
And as much as I love plastic surgery and I
love plastic surgeons and I love esthetic surgery, we are
the wild wild West. And there is absolutely, unarguably tons
of providers who will one hundred percent take advantage of
dysmorphic people and deliver the so called procedure that's being
(04:31):
requested and then sort of kick the can forward. Okay,
so let's go over the red flags. These are the
red flags. So there's two reasons why as a surgeon,
I want to identify body dysmorphia. Body dysmorphia. The reason
I want to identify this for two reasons. Number one, Selfishly,
(04:57):
I want to not get stuck in this web because
at the end of the day, because this is a
psychologic condition or a perception condition, it's an unwinnable puzzle.
In other words, there's nothing you can do surgically structurally
that will alleviate or eliminate the problem and make this
(05:20):
patient happy. That's the idea. Our goal is to make
patients happy, and we do so by doing something surgical, structural,
making something better, and therefore patients are happy. When a
patient is unh I call it insatiable, unable to be
made happy. It's a whin. It's an unwinnable or un
(05:44):
unwinnable game. So what are the red flags? Number one
is when a patient comes to me. And by the way,
I can tell you literally every week, every week I
can count the two to four patients that I see
that fall in this category. And back up for a second.
The second reason, of course, that we want to do this.
(06:04):
The second reason we want to do this, of course,
the selfish reason was I don't want to get stuck
with this patient and then be they're miserable and they
make us miserable. The second is we don't want to
worsen their condition, because every time someone operates, or every
time someone gives into this person's compulsion, they're worsening their condition.
And because surgery is irreversible, they can push them further
(06:27):
and further into a dark space and when reality, what
they need is psychiatric care, medications, and therapy. So every
week I see patients and every week. I know exactly,
like right now in my mind as I was thinking
about this episode, I can remember the two patients that
I saw last week that fall into this spectrum. Remember
(06:48):
it's a spectrum, and it's like a very it's a
very difficult spectrum. Obviously they sort of classic beaded. The
body dysmorphic disorder patients are easy, right, They're so easy
to identify. And obviously the healthy patient who's normal is
easy to identify. That's not the nuance. The nuances what
(07:11):
about the person who's in the middle, who sounds like
they're gonna be challenging but at the same time probably
will be okay. If I didn't operate on every person
that I was a little worried with, I probably do
a third of my cases. It's just the truth. So
what I do with every consult in addition to analyzing
(07:33):
their anatomy looking at who they are, is I'm constantly
taking data points of their psychologic readiness to figure out
if I want to get involved in this because I'm
like selling them a purse, I'm like cutting their hair,
I'm like doing their makeup, I'm like taking care of
their taxes. Once I operate on them, I marry them.
I am forever bound to that person. It is literally
(07:56):
like we had children together and I cannot escape them.
You better damn well bet that I'm going to do
everything in my power to try to flush out. Are
you just kind of a nitpicky person or are you
really a BDD person on the spectrum? So what are
the things that I look for? First thing I look
for is that the person has seen multiple consults. So
(08:18):
I always ask, so is this your first consult? And
when the patient's like, no, this is my ninth consult,
ninth consult, ninth consult for this wrinkle that's right next
to your nose. So the fact that they've seen nine
people is a red flag. Yes, seeing zero, seeing one
doctor is not ideal. A reasonable number of doctors two, three,
(08:43):
maybe four because your condition is very complicated. But once
you've seen nine doctors, there's a problem. There's a real,
real problem. That's a red flag. The second your issue,
the thing you're here for is so minor, so minute,
so inconsequential that there's no way on earth anyone would
(09:07):
be able to deliver it. So I have had patience
come to me and they're dead serious, They're very very
like sure of it. And they're like, hey, doc, do
you see you see how there's a little bit of
They don't even say the word little bit. You see
this major irregularity or asymmetry in my lip? You see
how the other side this and the other And I
swear to God, I stare and I go no, I
(09:29):
just don't see it. So right, there is a huge problem,
like I can't fix something I can't see right, I
don't see it. I can't fix it. Secondly, when the
margin of error is so small, I don't want to
be involved. Right if you people are always like listen,
I just want my nose made just just just a
(09:52):
little bit better. I want to have nothing to do
with that nose. Whereas if you have a horrible nose,
huge nose, I'll have everything to do with it every day. Well,
I understand that knows is ten times more difficult than mine. No, no, no, no,
that person has a million iterations of their nose. That
it will make them happy. You have like zero point
oh one percent probability that the thing that we'll do
is right. What if I overdo it, you'll be unhappy.
(10:14):
So I don't want to do anything that is so
minor or I can't tell the fact that they're hyper
focused on it and constantly keep pointing to it and
showing you, and is a problem they when they bring
in tons of photographs. I can tell immediately when I'm
doing a consult we have virtual consults, or when I
do in person consults and the patient brings a folder
with them, not because they're prepared, not because that they're
(10:37):
doing homework, because they bring a laptop and they start
showing me images and diagrams and profiles and arrows and
schematics and let me show you a power point. It's
not it's a red flag. I am an incredibly thorough person,
so trust me, I am all for it, and if
I needed something to get done, I would be prepared.
(10:58):
But I sure as hell won't bring fourteen diagrams and
images of like a slight contour of my nose. That's
a major concern. The words they use really matter, And
one of the most common red flag words is this
is ruining my life. What your droopy tip is ruining
(11:23):
your life? Yeah, doctor Remont, I can't even leave the house. Honestly,
It's like I'm having a hard time getting a job
when your esthetic issue is ruining your life. You have
a psychologic issue. Of course, noses make insecurities, It makes
you harder to date, Saggy breasts makes you not want
(11:46):
to maybe take your clothes off. I get all that,
there's a normal amount of that, But when you are
telling me that this problem, whatever medical problem you came
in for, is ruining your life, we know it's a
huge psychologic issue, not a physical problem. The last thing
is multiple revisions. Hey, doctor Bond, this is my fourth,
my sixth revision rhinoplasty. And then I look at the
(12:08):
nose and it's like I'm here because the last four doctors.
And then they start bad mouthing to doctors. We're terrible.
You know they're horrible. And I research you and then
love bombing you're the best. You're the only one that
can fix me. I know you're the right person for me.
I just pray you will take on my case. No, no, no, no,
(12:30):
I want to have nothing to do with your case
because there's no way on earth I'm going to be
able to help you and I'm going to be able
to get you to your destination. Okay, well, then, so
if all that is red flags, what are you actually
looking for? Because everyone's coming with an issue, everyone has
an insecurity, Everyone something bothers them. Remember it's a spectrum,
(12:54):
and what we're looking for is somebody that has a
very very specific concern, right specific concern, very realistic expectation,
and are emotionally stable. Hey doctor vroon, Hey, how's it going?
So tell me what's bothering you? Well, you know, I
got a big bump on my nose and my tip
is a little droopy and fat. I just kind of
(13:16):
want to make it a little bit better and cleaner,
and yeah, I think it'll be good. You do know
that it won't be perfectly straight. Yeah, yeah, of course.
If it's better, just a little better than this is
going to make me much happier. And what does your
life partner say? They don't think I need it. They
(13:36):
if they makes me happy, they're happy to do it.
So that is a patient I'm here for every single day.
What they're looking for. I can see what they're expecting
is within reason, and they're not coming here because they're
emotionally unstable. It's ruining their lives. Their life partner hates them,
and they're about to get a divorce and I have
to do this surgery. So those are very very very
(13:58):
important psychologic distinctions that are important. The biggest concern today
are the young adults. The reason I'm concerned about the
young adults is they have now access to things they
never had access to before, and they are the most
vulnerable part of our society because their brains are not
fully developed. And it's not a DIGGD young adult, it's
(14:22):
just the truth. The frontal lobe and all the development
and emotional stability and mistakes and all the errors that
we make. Everything usually happens prior to twenty five. Trust me,
there's a lot of stupid people after twenty five, but
a lot of your vulnerability as a sense of self
occurs earlier. So, as I mentioned, you got all these
young adults historically just physiologically developmentally, are still vulnerable. Then
(14:48):
you add some gasoline. That gasoline is all the social
media images of like hot women, hot men, chiseled men,
money cars, and then you you you add to that
to that dys morphia, you add the social media. It
(15:13):
was something else I was going to add to that,
and I'm trying to remember what I was just thinking,
and my brain just had an infar. You have young adults,
the social media teens, and what was the last thing? Oh,
I know now, yes, it just took a second. And
then before so you had this person who's vulnerable, right
(15:34):
then you add all these images makes them really insecure,
and then you light the match. What's the match surgery?
They go do something about it permanently. Before you were
you had body dysmorphia and you were putting on makeup
and you were Now you go, you literally go down
(15:56):
the street to a strip mall and doctor Kavorkian nurse
Jackie does something to you permanent or near permanent or whatever,
and you act on that dysmorphia. And the notion that
anyone gives a shit, or there's gonna be a watchdog
(16:17):
or some surgeon or someone's gonna have some ethical moral
grounds is zero. I'm sorry to tell you that. Yes,
of course there are good doctors and good nurses and
of course, but there are so many unscrupulous people that
you walk in, they're barely making ends meet. Some young
person comes in and says, oh, do you see this
(16:37):
that the other like, oh, of course, and then they
literally light the match, and then what happens poof this person,
this young adult who is already vulnerable and mostly unstable,
not in the right mind, does something surgical. In no
universe does that fix their problem, because their problem was
(17:00):
psychologic and it always makes things worse. Yeah, it makes
them better for a little while. Oh oh my god,
I feel better, and then starts the obsessions, press, the perseverations,
the picking, the OCD, and then whatever they did filler, rhinoplast,
the pinning, live destruction, blah blah blah just gets worse
(17:22):
and worse and worse, and then now they're so unhappy,
and then in many instances it leads to major things
like drug addiction, depression, suicide, et cetera. So the real
issue that we have is we have this epidemic going
on where social media, young adults, and cosmetic surgery all collide.
(17:45):
And the truth is that it really falls on the gatekeeper, right,
it falls on the gatekeeper. So who's the gatekeeper? It's us.
So the vulnerable people are psychologically born vulnerable. The images
fall on social media. But you know who's gonna who's
gonna who's gonna patrol the social media. Who's gonna be like, oh,
(18:08):
you can't put this image on it's filtered. Oh, like
that's what they should be doing. I think in other
countries they're starting to do that, like filtered images sho
gonna be allowed? But whatever, So who's the ultimate gatekeeper?
So the guy comes to me, He's like, hey, doctor,
I want to do my nose. Mm no, how about no?
So that's the gatekeeper. Ultimately, the gatekeeper is the person
(18:32):
who holds the keys to the kingdom. Right that they think.
And so the problem is that you can only you know,
there's only a handful of us that are still ethical
and willing to help the patient. So I try. So
what do I do? How do I walk them off
the ledge? If I feel that the person is reasonable
and can be talked to, I will actually take the
(18:55):
full duration of the console, bring the mirror, take some photos,
draw some pictures, and try to walk them off the ledge.
Explain to them why I don't see the asymmetry. Explain
to them that if I try to fix the asymmetry,
I'll create a new asymmetry. Explain to them that the
anatomy is such that if I cut here, then the
blood supply. I'll really do my very best to hope
(19:16):
that I can unlock some of this dysmorphia with academics, education,
and real reality. Believe it or not, I have been
successful many times because I am in a very unique position.
I am not a therapist, and I am not a
family member or a loved one. I am a doctor
(19:37):
who makes money from doing it. So when I am
telling them, and I'm telling them why they shouldn't do
it in a weird way, it's really powerful. It just
takes time, and you know, in a busy schedule, the
guy comes in or gal comes in immediately within ten minutes,
you're like, oh, this person's not all here, and it's
(19:58):
just easier to just be like, I can't help you
and then move on. But you have a very unique
window where you'll probably never get it and that person
will never be sitting in that seat again, So I
really try to help. I'm not gonna not make them
body dysmorphic, right, I can't change their underlying psychologic condition
in a twenty minute consult by the excuting in a
one hour consult. They need, they need therapy, and they
(20:21):
need medications. Despite everyone's ridiculous statements, I'm not gonna get
them in a one hour console. When they come in
to do a rhinoplasty, to go see a therapist. Hey,
you know, I don't think your nose needs it. And
by the way, maybe you might want to see a therapist. Yeah, okay,
that's gonna go Overwhell. That's never gonna go Overwhell. I'm
sorry to break it to you. They're not gonna be like, oh, thanks,
(20:43):
doctor Rebond, thanks for suggesting a psychologist and getting on
some OCD medications. But what I can do is, in
regard to that particular battle, that particular issue, I can
help slowly walk them back. But one thing I can
do for you're sure is not operate on them. I
(21:03):
can one hundred percent not make matters worse. So I
do that, and I say, listen, I'm so sorry. I
just don't think you can fix this, and I'm not
the right and I and I suggest you be careful. Now.
If they're really far gone and they're not going to
listen to anything I say, then of course I'm not
gonna sit there and educate them when they're just looking
at me like I'm crazy. But I certainly again won't
(21:26):
operate on them. And that's ultimately what I think is
our industry responsibility. I don't think you can change the
under genetics of some people who have BDD. I don't
think that's gonna happen. I don't think it's gonna be
eons before we get social media to take any responsibility,
and I don't think that'll ever happen. So at the
end of the day, the only place that we can
(21:46):
capture these people is at the gates of the providers.
Whether or not that's gonna happen to each provider on
their own, they're gonna have to sort of sit with
their own self and decide whether what their moral ethical
compasses and how they want to make a living. But
for me, it's pretty straightforward and pretty easy. I don't
want to make matters worse. And again, as I said,
(22:06):
from a selfish standpoint, I want to avoid these things
because it only we only get entangled in this very
very unwinnable, difficult situation. So anyways, that's my sort of
overall take on body dysmorphia. I do think the word
is thrown out left, right and center. Oh my god,
did you see you know your patient has body myosmorphia?
(22:28):
Why she got a no job and a breast augmentation?
And then pined your ears. She doesn't love herself. She's
definitely no. She had huge ears, she had no breast issue,
and she had a big nose, very finite issues. She's
totally normal, loves herself, super confident now, her family loves her,
and was very realistic. Her breast is still a l
(22:49):
asymmetric and one of her ears sticks out, and she's
happy as a clam. So we have to be very
careful as we use these labels, and obviously in the
instances where it's real. I think as a total we
have a responsibility any rate that's a rap. As always,
I hope you enjoy the show. I hope that you
find it helpful. I always ask two favors. I ask
(23:11):
favor number one. Please go write a nice review. It
makes a huge difference to the team. As a matter
of fact, just pause it right now. It takes two seconds.
You're gonna I'll go later, I'll do it. You're not
gonna do it later. Let's be honest. Just pause this,
go write the review, come back, hit click. It makes
everyone so happy. The second thing is if you can
share this with two people, you know, just two people forward, Hey,
check out this episode, because at the end of the day.
(23:33):
So many people only realize after they've done something foolish
that they wish they had done a little more homework,
and so we always try to get ahead of it together.
All right, guys, that's a rap. I will see you
guys next week. Have a wonderful week. Doctor Rabon on
plastic surgery on censored
Welcome to another episode of Plastic Surgery and Centered. I'm
your host, as always, doctor Rider Raban, and I am
excited about today's episode because we're going to tackle and
talk about kind of a very important subject matter, which
is body dysmorphia and the distinction between it and the
regular normal desire to improve something. Because it's a sliding spectrum,
(00:29):
and the word is thrown around very loosely. It's a
real entity, a very concerning entity, an entity on the rise,
but we have to define it and make sure that
we don't mislabel people as having body dysmorphia when in
reality they don't, and then identifying those that have it
to make sure that we don't worsen their condition any rate.
(00:52):
They always say that plastic surgeons, in order to be incredibly,
incredibly successful and good, they need to be essentially psychologist,
which is actually very true. I have no formal training
in psychology, but I actually consider myself very very knowledgeable
in the under the underbelly of the human psychologic condition.
(01:14):
Because remember, at the end of the day, it is
insecurities that drive much of what we do. And while
that's absolutely okay, absolutely normal and absolutely treatable, there are instances,
as in the instance of body dysmorphia, where we cannot
correct them, we worsen their conditions, and we are actually
(01:36):
adding fuel to the fire. So let's dive right in
and let's talk about what's going on. Well, body dysmorphia
has been around forever. It's basically an unrealistic it's an
unrealistic preoccupation with a flaw. It has certain elements about
it that make it very distinct. Number one, the flaw
(01:57):
is usually very, very minor, almost I've had instances where
you can't even see it or it doesn't even exist.
It's compulsive, so in other words, it's repetitive. It's repetitive.
It's repetitive. It's part of an OCD component of psychologic issues.
There's constant comparison of well, look at this as compared
to that look at me. I should be that there's
(02:19):
there's my friend doesn't have it, look at so and
so angela jo only doesn't have it, et cetera. And lastly,
it's it's a psychologic issue. It's not a physical issue.
There is no physical issue there. It's a process in
the way we perceive our physicality. So it for sure
is an issue. It's always been around, but it's a
(02:39):
little bit on the rise. Why is it a little
bit on the rise, Well because of social media. And
what does social media have to do with body dysmorphia. Well,
what it does is now we have young people whose
minds and their and their psychology and their their sense
of self is incredibly malleable, vulnerable and naive, seeing hundreds,
(03:04):
if not thousands of images a day of people who
not look good, because that in and of itself causes insecurity,
but of people who don't even look like themselves. We
keep going back to the same issue over and over again,
which is this idea of comparing yourself to a filter,
a morph and ai perfect jaw, perfect skin, perfect pecs,
(03:27):
perfect nose, perfect brows, and now the idea of influencerism.
This never really was present during the developmental phases of
young adults in the past. So while body dysmorphia OCD,
all these things existed. Is definitely on the rise, and
now young adults can go and get plastic surgery, whereas
(03:49):
many years in the past that was never an issue.
So if you had body dysmorphia, you'd have to wait too,
your grown adult to really do anything about it. Now
you have sixteen year olds getting lip lifts and eighteen
year olds getting rhinoplasts and liposuction and all kinds of
things in a very very very very unscrupulous, dishonest landscape.
(04:10):
And as much as I love plastic surgery and I
love plastic surgeons and I love esthetic surgery, we are
the wild wild West. And there is absolutely, unarguably tons
of providers who will one hundred percent take advantage of
dysmorphic people and deliver the so called procedure that's being
(04:31):
requested and then sort of kick the can forward. Okay,
so let's go over the red flags. These are the
red flags. So there's two reasons why as a surgeon,
I want to identify body dysmorphia. Body dysmorphia. The reason
I want to identify this for two reasons. Number one, Selfishly,
(04:57):
I want to not get stuck in this web because
at the end of the day, because this is a
psychologic condition or a perception condition, it's an unwinnable puzzle.
In other words, there's nothing you can do surgically structurally
that will alleviate or eliminate the problem and make this
(05:20):
patient happy. That's the idea. Our goal is to make
patients happy, and we do so by doing something surgical, structural,
making something better, and therefore patients are happy. When a
patient is unh I call it insatiable, unable to be
made happy. It's a whin. It's an unwinnable or un
(05:44):
unwinnable game. So what are the red flags? Number one
is when a patient comes to me. And by the way,
I can tell you literally every week, every week I
can count the two to four patients that I see
that fall in this category. And back up for a second.
The second reason, of course, that we want to do this.
(06:04):
The second reason we want to do this, of course,
the selfish reason was I don't want to get stuck
with this patient and then be they're miserable and they
make us miserable. The second is we don't want to
worsen their condition, because every time someone operates, or every
time someone gives into this person's compulsion, they're worsening their condition.
And because surgery is irreversible, they can push them further
(06:27):
and further into a dark space and when reality, what
they need is psychiatric care, medications, and therapy. So every
week I see patients and every week. I know exactly,
like right now in my mind as I was thinking
about this episode, I can remember the two patients that
I saw last week that fall into this spectrum. Remember
(06:48):
it's a spectrum, and it's like a very it's a
very difficult spectrum. Obviously they sort of classic beaded. The
body dysmorphic disorder patients are easy, right, They're so easy
to identify. And obviously the healthy patient who's normal is
easy to identify. That's not the nuance. The nuances what
(07:11):
about the person who's in the middle, who sounds like
they're gonna be challenging but at the same time probably
will be okay. If I didn't operate on every person
that I was a little worried with, I probably do
a third of my cases. It's just the truth. So
what I do with every consult in addition to analyzing
(07:33):
their anatomy looking at who they are, is I'm constantly
taking data points of their psychologic readiness to figure out
if I want to get involved in this because I'm
like selling them a purse, I'm like cutting their hair,
I'm like doing their makeup, I'm like taking care of
their taxes. Once I operate on them, I marry them.
I am forever bound to that person. It is literally
(07:56):
like we had children together and I cannot escape them.
You better damn well bet that I'm going to do
everything in my power to try to flush out. Are
you just kind of a nitpicky person or are you
really a BDD person on the spectrum? So what are
the things that I look for? First thing I look
for is that the person has seen multiple consults. So
(08:18):
I always ask, so is this your first consult? And
when the patient's like, no, this is my ninth consult,
ninth consult, ninth consult for this wrinkle that's right next
to your nose. So the fact that they've seen nine
people is a red flag. Yes, seeing zero, seeing one
doctor is not ideal. A reasonable number of doctors two, three,
(08:43):
maybe four because your condition is very complicated. But once
you've seen nine doctors, there's a problem. There's a real,
real problem. That's a red flag. The second your issue,
the thing you're here for is so minor, so minute,
so inconsequential that there's no way on earth anyone would
(09:07):
be able to deliver it. So I have had patience
come to me and they're dead serious, They're very very
like sure of it. And they're like, hey, doc, do
you see you see how there's a little bit of
They don't even say the word little bit. You see
this major irregularity or asymmetry in my lip? You see
how the other side this and the other And I
swear to God, I stare and I go no, I
(09:29):
just don't see it. So right, there is a huge problem,
like I can't fix something I can't see right, I
don't see it. I can't fix it. Secondly, when the
margin of error is so small, I don't want to
be involved. Right if you people are always like listen,
I just want my nose made just just just a
(09:52):
little bit better. I want to have nothing to do
with that nose. Whereas if you have a horrible nose,
huge nose, I'll have everything to do with it every day. Well,
I understand that knows is ten times more difficult than mine. No, no, no, no,
that person has a million iterations of their nose. That
it will make them happy. You have like zero point
oh one percent probability that the thing that we'll do
is right. What if I overdo it, you'll be unhappy.
(10:14):
So I don't want to do anything that is so
minor or I can't tell the fact that they're hyper
focused on it and constantly keep pointing to it and
showing you, and is a problem they when they bring
in tons of photographs. I can tell immediately when I'm
doing a consult we have virtual consults, or when I
do in person consults and the patient brings a folder
with them, not because they're prepared, not because that they're
(10:37):
doing homework, because they bring a laptop and they start
showing me images and diagrams and profiles and arrows and
schematics and let me show you a power point. It's
not it's a red flag. I am an incredibly thorough person,
so trust me, I am all for it, and if
I needed something to get done, I would be prepared.
(10:58):
But I sure as hell won't bring fourteen diagrams and
images of like a slight contour of my nose. That's
a major concern. The words they use really matter, And
one of the most common red flag words is this
is ruining my life. What your droopy tip is ruining
(11:23):
your life? Yeah, doctor Remont, I can't even leave the house. Honestly,
It's like I'm having a hard time getting a job
when your esthetic issue is ruining your life. You have
a psychologic issue. Of course, noses make insecurities, It makes
you harder to date, Saggy breasts makes you not want
(11:46):
to maybe take your clothes off. I get all that,
there's a normal amount of that, But when you are
telling me that this problem, whatever medical problem you came
in for, is ruining your life, we know it's a
huge psychologic issue, not a physical problem. The last thing
is multiple revisions. Hey, doctor Bond, this is my fourth,
my sixth revision rhinoplasty. And then I look at the
(12:08):
nose and it's like I'm here because the last four doctors.
And then they start bad mouthing to doctors. We're terrible.
You know they're horrible. And I research you and then
love bombing you're the best. You're the only one that
can fix me. I know you're the right person for me.
I just pray you will take on my case. No, no, no, no,
(12:30):
I want to have nothing to do with your case
because there's no way on earth I'm going to be
able to help you and I'm going to be able
to get you to your destination. Okay, well, then, so
if all that is red flags, what are you actually
looking for? Because everyone's coming with an issue, everyone has
an insecurity, Everyone something bothers them. Remember it's a spectrum,
(12:54):
and what we're looking for is somebody that has a
very very specific concern, right specific concern, very realistic expectation,
and are emotionally stable. Hey doctor vroon, Hey, how's it going?
So tell me what's bothering you? Well, you know, I
got a big bump on my nose and my tip
is a little droopy and fat. I just kind of
(13:16):
want to make it a little bit better and cleaner,
and yeah, I think it'll be good. You do know
that it won't be perfectly straight. Yeah, yeah, of course.
If it's better, just a little better than this is
going to make me much happier. And what does your
life partner say? They don't think I need it. They
(13:36):
if they makes me happy, they're happy to do it.
So that is a patient I'm here for every single day.
What they're looking for. I can see what they're expecting
is within reason, and they're not coming here because they're
emotionally unstable. It's ruining their lives. Their life partner hates them,
and they're about to get a divorce and I have
to do this surgery. So those are very very very
(13:58):
important psychologic distinctions that are important. The biggest concern today
are the young adults. The reason I'm concerned about the
young adults is they have now access to things they
never had access to before, and they are the most
vulnerable part of our society because their brains are not
fully developed. And it's not a DIGGD young adult, it's
(14:22):
just the truth. The frontal lobe and all the development
and emotional stability and mistakes and all the errors that
we make. Everything usually happens prior to twenty five. Trust me,
there's a lot of stupid people after twenty five, but
a lot of your vulnerability as a sense of self
occurs earlier. So, as I mentioned, you got all these
young adults historically just physiologically developmentally, are still vulnerable. Then
(14:48):
you add some gasoline. That gasoline is all the social
media images of like hot women, hot men, chiseled men,
money cars, and then you you you add to that
to that dys morphia, you add the social media. It
(15:13):
was something else I was going to add to that,
and I'm trying to remember what I was just thinking,
and my brain just had an infar. You have young adults,
the social media teens, and what was the last thing? Oh,
I know now, yes, it just took a second. And
then before so you had this person who's vulnerable, right
(15:34):
then you add all these images makes them really insecure,
and then you light the match. What's the match surgery?
They go do something about it permanently. Before you were
you had body dysmorphia and you were putting on makeup
and you were Now you go, you literally go down
(15:56):
the street to a strip mall and doctor Kavorkian nurse
Jackie does something to you permanent or near permanent or whatever,
and you act on that dysmorphia. And the notion that
anyone gives a shit, or there's gonna be a watchdog
(16:17):
or some surgeon or someone's gonna have some ethical moral
grounds is zero. I'm sorry to tell you that. Yes,
of course there are good doctors and good nurses and
of course, but there are so many unscrupulous people that
you walk in, they're barely making ends meet. Some young
person comes in and says, oh, do you see this
(16:37):
that the other like, oh, of course, and then they
literally light the match, and then what happens poof this person,
this young adult who is already vulnerable and mostly unstable,
not in the right mind, does something surgical. In no
universe does that fix their problem, because their problem was
(17:00):
psychologic and it always makes things worse. Yeah, it makes
them better for a little while. Oh oh my god,
I feel better, and then starts the obsessions, press, the perseverations,
the picking, the OCD, and then whatever they did filler, rhinoplast,
the pinning, live destruction, blah blah blah just gets worse
(17:22):
and worse and worse, and then now they're so unhappy,
and then in many instances it leads to major things
like drug addiction, depression, suicide, et cetera. So the real
issue that we have is we have this epidemic going
on where social media, young adults, and cosmetic surgery all collide.
(17:45):
And the truth is that it really falls on the gatekeeper, right,
it falls on the gatekeeper. So who's the gatekeeper? It's us.
So the vulnerable people are psychologically born vulnerable. The images
fall on social media. But you know who's gonna who's
gonna who's gonna patrol the social media. Who's gonna be like, oh,
(18:08):
you can't put this image on it's filtered. Oh, like
that's what they should be doing. I think in other
countries they're starting to do that, like filtered images sho
gonna be allowed? But whatever, So who's the ultimate gatekeeper?
So the guy comes to me, He's like, hey, doctor,
I want to do my nose. Mm no, how about no?
So that's the gatekeeper. Ultimately, the gatekeeper is the person
(18:32):
who holds the keys to the kingdom. Right that they think.
And so the problem is that you can only you know,
there's only a handful of us that are still ethical
and willing to help the patient. So I try. So
what do I do? How do I walk them off
the ledge? If I feel that the person is reasonable
and can be talked to, I will actually take the
(18:55):
full duration of the console, bring the mirror, take some photos,
draw some pictures, and try to walk them off the ledge.
Explain to them why I don't see the asymmetry. Explain
to them that if I try to fix the asymmetry,
I'll create a new asymmetry. Explain to them that the
anatomy is such that if I cut here, then the
blood supply. I'll really do my very best to hope
(19:16):
that I can unlock some of this dysmorphia with academics, education,
and real reality. Believe it or not, I have been
successful many times because I am in a very unique position.
I am not a therapist, and I am not a
family member or a loved one. I am a doctor
(19:37):
who makes money from doing it. So when I am
telling them, and I'm telling them why they shouldn't do
it in a weird way, it's really powerful. It just
takes time, and you know, in a busy schedule, the
guy comes in or gal comes in immediately within ten minutes,
you're like, oh, this person's not all here, and it's
(19:58):
just easier to just be like, I can't help you
and then move on. But you have a very unique
window where you'll probably never get it and that person
will never be sitting in that seat again, So I
really try to help. I'm not gonna not make them
body dysmorphic, right, I can't change their underlying psychologic condition
in a twenty minute consult by the excuting in a
one hour consult. They need, they need therapy, and they
(20:21):
need medications. Despite everyone's ridiculous statements, I'm not gonna get
them in a one hour console. When they come in
to do a rhinoplasty, to go see a therapist. Hey,
you know, I don't think your nose needs it. And
by the way, maybe you might want to see a therapist. Yeah, okay,
that's gonna go Overwhell. That's never gonna go Overwhell. I'm
sorry to break it to you. They're not gonna be like, oh, thanks,
(20:43):
doctor Rebond, thanks for suggesting a psychologist and getting on
some OCD medications. But what I can do is, in
regard to that particular battle, that particular issue, I can
help slowly walk them back. But one thing I can
do for you're sure is not operate on them. I
(21:03):
can one hundred percent not make matters worse. So I
do that, and I say, listen, I'm so sorry. I
just don't think you can fix this, and I'm not
the right and I and I suggest you be careful. Now.
If they're really far gone and they're not going to
listen to anything I say, then of course I'm not
gonna sit there and educate them when they're just looking
at me like I'm crazy. But I certainly again won't
(21:26):
operate on them. And that's ultimately what I think is
our industry responsibility. I don't think you can change the
under genetics of some people who have BDD. I don't
think that's gonna happen. I don't think it's gonna be
eons before we get social media to take any responsibility,
and I don't think that'll ever happen. So at the
end of the day, the only place that we can
(21:46):
capture these people is at the gates of the providers.
Whether or not that's gonna happen to each provider on
their own, they're gonna have to sort of sit with
their own self and decide whether what their moral ethical
compasses and how they want to make a living. But
for me, it's pretty straightforward and pretty easy. I don't
want to make matters worse. And again, as I said,
(22:06):
from a selfish standpoint, I want to avoid these things
because it only we only get entangled in this very
very unwinnable, difficult situation. So anyways, that's my sort of
overall take on body dysmorphia. I do think the word
is thrown out left, right and center. Oh my god,
did you see you know your patient has body myosmorphia?
(22:28):
Why she got a no job and a breast augmentation?
And then pined your ears. She doesn't love herself. She's
definitely no. She had huge ears, she had no breast issue,
and she had a big nose, very finite issues. She's
totally normal, loves herself, super confident now, her family loves her,
and was very realistic. Her breast is still a l
(22:49):
asymmetric and one of her ears sticks out, and she's
happy as a clam. So we have to be very
careful as we use these labels, and obviously in the
instances where it's real. I think as a total we
have a responsibility any rate that's a rap. As always,
I hope you enjoy the show. I hope that you
find it helpful. I always ask two favors. I ask
(23:11):
favor number one. Please go write a nice review. It
makes a huge difference to the team. As a matter
of fact, just pause it right now. It takes two seconds.
You're gonna I'll go later, I'll do it. You're not
gonna do it later. Let's be honest. Just pause this,
go write the review, come back, hit click. It makes
everyone so happy. The second thing is if you can
share this with two people, you know, just two people forward, Hey,
check out this episode, because at the end of the day.
(23:33):
So many people only realize after they've done something foolish
that they wish they had done a little more homework,
and so we always try to get ahead of it together.
All right, guys, that's a rap. I will see you
guys next week. Have a wonderful week. Doctor Rabon on
plastic surgery on censored
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
Betrayal Weekly
Betrayal Weekly is back for a new season. Every Thursday, Betrayal Weekly shares first-hand accounts of broken trust, shocking deceptions, and the trail of destruction they leave behind. Hosted by Andrea Gunning, this weekly ongoing series digs into real-life stories of betrayal and the aftermath. From stories of double lives to dark discoveries, these are cautionary tales and accounts of resilience against all odds. From the producers of the critically acclaimed Betrayal series, Betrayal Weekly drops new episodes every Thursday. If you would like to share your story, you can reach out to the Betrayal Team by emailing them at betrayalpod@gmail.com and follow us on Instagram at @betrayalpod and @glasspodcasts. Please join our Substack for additional exclusive content, curated book recommendations, and community discussions. Sign up FREE by clicking this link Beyond Betrayal Substack. Join our community dedicated to truth, resilience, and healing. Your voice matters! Be a part of our Betrayal journey on Substack.