To evaluate the effect of cosmetic surgery and the stability of body dysmorphic disorder (BDD) diagnosis in patients with a minimal defect in appearance, with and without BDD, 5 years after their request for plastic surgery.

Thirty patients requesting cosmetic surgery with minimal defect in appearance, of whom 12 had BDD and 18 did not, were re-evaluated 5 years later by telephone interview regarding their cosmetic surgery interventions, satisfaction with the intervention, BDD diagnosis, handicap, and psychiatric comorbidity.

Of the 30 patients, we were able to re-evaluate 24 subjects (80%), 10 with BDD and 14 non-BDD. Seven BDD subjects had undergone cosmetic surgery vs 8 non-BDD. Patient satisfaction with the intervention was high in both groups. Nevertheless at follow-up, 6 of the 7 operated BDD patients still had a BDD diagnosis and exhibited higher levels of handicap and psychiatric comorbidity compared to their non-BDD counterparts. Moreover, 3 non-BDD patients had developed a BDD at follow-up.

This prospective study confirms that cosmetic surgery is not efficient on BDD despite declared patient satisfaction. Cosmetic surgery had no significant effects on BDD diagnosis, handicap or psychiatric comorbidity in BDD patients at 5-year follow-up. Furthermore, BDD appeared at follow-up in some initially non-BDD diagnosed subjects. Patients' declared satisfaction with surgery may contribute to explain why some plastic surgeons may not fully adhere to the contraindication of cosmetic surgery in BDD.