Does Your Doctor Have BDD?
Aesthetic practitioners are seven times more likely to have symptoms of body dysmorphic disorder, a new study finds.
It’s the elephant in the room—and it’s holding a syringe.
While overfilled faces are hardly headline news, what has become a talking point of late, at least in certain circles, is the disturbing ubiquity of bloated cheeks, outsize lips, and cartoonish chins among aesthetic professionals, many of whom preach about “undetectable injectables” from Patreon accounts and conference podiums.
During aesthetic meetings, I have often been shocked by the prevalence of overfilled practitioners.
It’s a horror movie when I go to IMCAS and see colleagues from all over the world. I don’t understand how people can still trust us to deliver “natural and elegant” results.
At international conferences, every second doctor looks over-processed!
Sadly, our industry still uses a number of practitioners who are grossly overfilled as KOLs [key opinion leaders aka paid spokespeople] and ambassadors.
I lifted these comments from a post shared by Steven Harris, an aesthetics doctor, researcher, and educator in London. With a strong social media presence, he uses his platform to debunk unproven treatments and fight against “alienization” in aesthetics. Dr. Harris, who has a masters in cognitive behavioral therapy, recently co-authored a study on body dysmorphic disorder (BDD) in aesthetic practitioners, bringing awareness to what some deem to be a burgeoning crisis in the field of aesthetic medicine.
In the paper, Dr. Harris and his fellow researchers explain that BDD is characterized by an obsessive preoccupation with perceived physical flaws, leading to significant emotional distress. But “BDD is not just an issue where someone flippantly thinks that their nose is too big or their eyes are too close together,” notes Vanessa J. Cutler, MD, a clinical assistant professor of psychiatry at NYU Grossman School of Medicine. “It’s a complex neuropsychological disorder where there are differences in the ways in which the brain processes visual inputs,” including fine details and facial expressions.
Understandably, “BDD is often considered a contraindication for aesthetic procedures,” Dr. Cutler tells me, as patients with the condition tend to experience a heightened sensitivity to pain and an overall dissatisfaction with cosmetic outcomes. More concerning still, people with BDD “are at very high risk for suicidal thoughts,” she adds, and repeated unhappy outcomes could exacerbate this risk.
In Dr. Harris’s study, the experimental group included aesthetic physicians and surgeons; lawyers comprised the control group. Using standardized questionnaires and scales to measure depression and anxiety and to assess possible symptoms of BDD in study subjects, the researchers determined that the aesthetic practitioners were approximately seven times more likely than the lawyers to have signs of BDD. (You can read the full paper here for more on methodology and nuances.)
Given that BDD alters visual processing, how might an aesthetic doctor with BDD interpret the canvas of a patient’s face, Dr. Cutler wonders, and how might that interpretation influence treatments and outcomes? What’s more, she asks, “could the interactions between a patient with BDD and a practitioner with BDD play a foundational role in the normalization of overfilled faces and other extreme results?”
The results of Dr. Harris’s study “emphasize the need for targeted mental health support, comprehensive training programs, and clear guidelines to protect both practitioners and patients,” the authors say. “Promoting mental health awareness and resilience within the aesthetic community is essential for improving professional practices and fostering healthier perceptions of beauty and self-esteem.”
Soon after Dr. Harris posted his team’s findings—“approximately 8.2% of aesthetic practitioners exhibit symptoms consistent with possible BDD, which was significantly higher than [the rate] found in our control group at 2% and the estimated 2.4% prevalence in the general population”—comments poured in, many echoing those I highlighted above.
In response, Dr. Harris was careful to point out that BDD isn’t necessarily associated with overfilling; nor is it something that can readily be “seen” on a face. In his opinion, “most exaggerated [filler] results aren’t due to BDD but to perception drift, which … is social media-driven distortion of what looks ‘normal,’” he explains to a follower. With recurring treatments, people inch further away from their natural-born baseline, and their perception of “normal” unconsciously shifts. Their faces slowly morph, but since the changes are incremental, they generally don’t notice it happening. Left unchecked, perception drift can lead to overfilling.
In 2023, Dr. Harris co-authored a fascinating study on overfilled lips, attempting to understand what drives female patients to fill their lips to the point of distortion. Perception drift played a strong role.
Dr. Harris’s BDD post also shined a light on the troubling trend of injectors pushing or violating the boundaries of textbook anatomy and then owning the resultant distortion as an aesthetic choice—call it caricature chic—as if outlandish features were a desirable look rather than an alarming aberration.
Since injectors are often influencers—they create, contribute to, and uphold beauty standards—the aesthetic they adopt and promote can affect more than their own face. Those who buck refinement and eschew restraint may risk normalizing, in a widespread way, an uncanny appearance—skewed proportions and bizarre effects that don’t exist in nature and cannot be achieved without cosmetic interventions.
What baffles me about this phenomenon is the notoriety of certain overfilled doctors. They are often the ones partnering with big skincare brands, speaking on behalf of pharmaceutical companies, and giving interviews (and injections) to beauty editors. I honestly don’t know what to make of it. Are we suffering from a collective case of filler blindness? Do we equate extreme outcomes with glamour and status? Has the contagion of filler fatigue warped our sense of taste along with our features?
While you’re mulling possible explanations, please enjoy this Q&A with the insightful Dr. Harris, who discusses the implications of his study findings, the dangers posed by injectors with BDD and perception drift, and how to find a doctor with an eye for natural beauty.
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