Psychiatric Evaluation in Rhinoplasty and our pioneering work: Munish Shandilya, Ireland.

Most surgeons offering surgical Rhinoplasty on a regular basis would have considered the need for a preoperative Psychiatric Evaluation. Some surgeons believe that they can detect the warning signals and it is needed only when they are unsure of safe candidacy in a patient while some others believe that validated screening tools are adequate to avoid operating on patients where the injudicious offer of surgery may be harmful to the patient. We are at a stage where more data and frequent discussions will indicate the balanced approach to optimise formal evaluation based on guidelines.

We have a unique database of having completed Psychiatric Evaluation as a Mandatory requirement prior to offering Cosmetic Rhinoplasty. This is a prospective study that exposed a 4% failure of the Surgeon recognizing mild Body Dysmorphic Disorder (BDD) despite all the attention of this very group. It is well-recognized that interviews, screening, and Surgeons honed gut-feelings are not enough to detect marginal BDD in all cases.

As our experience with the Mild BDD group has increased, our early experience indicates that more detailed counseling, the involvement of patients own support circle and presence of good Insight allows safe and satisfactory surgical outcomes in this group. The long-term results will be important in this group to conclude that intervention in selected cases of mild BDD is safe.

We are proud of having shared our unique and substantial experience in this area in the conferences in Cannes, France (EAFPS), Rio, Brazil, London, UK (EAFPS) and have upcoming invitations from Regensburg, Germany (EAFPS) and Dallas, USA (AAFPRS)

Mandatory Psychiatric Evaluation in a person aspiring for a Cosmetic Rhinoplasty is worth considering and the fact that 17 speakers will be talking about Preoperative evaluation, during the Annual Meeting of the European Academy of Facial Plastic Surgery (EAFPS), shows how important it is to ensure Happier outcomes.