In today’s image-conscious world, the beauty industry is booming, with aesthetic procedures becoming increasingly mainstream. However, behind the rise in cosmetic treatments lies an important ethical responsibility for doctors: identifying and addressing the psychological well-being of their patients. This is especially critical when it comes to individuals who may suffer from body dysmorphic disorder (BDD)—a mental health condition where a person becomes obsessively preoccupied with perceived flaws in their appearance.
For aesthetic experts, striking the balance between helping patients achieve greater confidence and avoiding the reinforcement of harmful thought patterns is not just challenging—it is essential. How do top aesthetic doctors ensure their practices align with patient well-being? What ethical frameworks guide their decisions in complex cases like BDD?
In this blog post, we explore the role of medical ethics in aesthetic practice and how leading professionals handle cases of body dysmorphia with care and integrity. Drawing from the knowledge and experience of Lydia Badia, a renowned facial aesthetic surgeon, we will also address some of the most pressing questions patients and practitioners often ask. From recognising red flags to determining when a procedure is inappropriate, Lydia shares her expert insights on prioritising mental health in the pursuit of beauty.
How do you recognise when a client’s request for treatment stems from body dysmorphia, depression, or another underlying mental health issue rather than a genuine aesthetic concern?
The patient typically expresses anxiety, shame or depression and believes that surgery will ‘fix’ their life. There is a high emotional reaction with distress, preoccupation and sometimes avoidance of work, or any social interactions.
Certain patterns in patients seeking cosmetic surgery are deeply tied to trauma, especially from childhood. Adverse childhood events such as physical, emotional, or sexual abuse, neglect and dysfunctional family dynamics can impair a person’s body image and self-esteem. These patients find it difficult to form or maintain relationships. The use of words like ‘botched’, ‘ruined,’ ‘disfigured’ is usually a sign of displaced anger if they have already had surgery.
Attachment difficulties and mistrust of professionals make rapport delicate.
What language or approach do you use to decline treatment while preserving the client’s dignity, especially in a world where UHNWs (Ultra-High-Net-Worth Individuals) are used to always getting a “yes”?
The goal when declining surgical treatment is to protect the patient. Mental health care and support to address the underlying emotional issues and stabilise the body dysmorphia should take place in a similar way that a patient with diabetes needs good control before embarking on surgery. The underlying emotional issues should be addressed otherwise they will remain dissatisfied because the surgery will not resolve the internal trauma.
Do you collaborate with mental health professionals, and if so, how do you introduce that support without alienating or upsetting the client?
We normalize psychological support and start by saying that sometimes past experiences, especially in childhood, can affect how we see ourselves today. Has that been part of your experience?
We acknowledge the distress and are empathetic, shifting the focus from surgery to wellbeing. Exploring the emotional side of how you feel about your body can be more helpful than surgery ever could. We can refer to a mental health professional who specialises in body image.
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