The unspoken side of medical aesthetics
What is the association between undiagnosed body dysmorphia, anxiety and medical aesthetics?
So much has changed in medical aesthetics since I first began in this speciality a decade ago, especially as it related to my signature Full Face Aesthetics (FFA) approach.
While there is less of accusing practitioners of “botching” patients if a patient is unhappy, it is also my observation that we have more and more patients who struggle with medical aesthetics.
Medical aesthetics, like cosmetic surgery, is an entirely optional aspect of medicine that, done well, is not cheap.
Because it is a want, not a need, it is also not covered by insurance, so the expenses are on patients.
Due to the explosion of photoshop, filters and now AI it is becoming harder in clinic to educate patients on what realistic medical aesthetics can achieve. Much of my time is taken up educating them on what it CANNOT achieve, based on “glass skin”, “no pores”, “no shadows” on social media.
With my signature Full Face Aesthetics approach, I have also found that 2025 has exposed some challenges that I’ve not dealt with in prior years.
What kind of challenges?
Patients who seem perfect on paper and at the initial consultation, who go on to develop excessive anxiety about normal and expected side effects during the healing phase, such that it becomes crippling.
There is no way to rush the process, it will take however long it will take, and worrying about it tends to cause more anxiety and occasionally, has led to my suggesting we stop as it would not be in the patient’s best interests to continue.
That it is such a rarely discussed issue among the speciality worries me equally as we are all meant to be screening for health anxiety and body dysmorphic disorder.
In reality, despite my decade in mental health training, this is a really important but nuanced topic in medical aesthetics and especially my FFA.
The Mighty Pursuit recently posted on Instagram about the pursuit of beauty, and quoted Nikki Glaser who said People treat you better when you’re hotter. It’s just a fact. It’s a sad fact of life.
Here’s the problem with this though, which is what I am seeing more and more of in 2025, often to distressing and disheartening levels:
Source: Might Pursuit on IG
Here are my thoughts on the association:
1. Undiagnosed Body Dysmorphic Disorder (BDD) or BDD traits
BDD is a mental health condition where someone is excessively preoccupied with perceived flaws in their appearance, often unnoticeable to others. Some common examples I hear weekly in clinic:
- “You can’t see it here but in my bathroom light, there is a shadow”
- “You can see it in this selfie I have here.”
- "You can see it in certain angles in photos, look!”
- “You can’t see it but I can feel it.”
- “I want to get rid of my pores. How can I do that?”
In aesthetics, this can present as patients repeatedly seeking treatments for issues that clinicians cannot objectively identify.
- I say to you, “If I cannot see it, I cannot treat it.”
- I also say “If it is a lighting in a room, or an angle, it would be cheaper to change the lighting or the angle of the photos.”
- I also say “What you have is already healthy and beautiful, and normal. I think if we did anything, it would improve your concern by 10-20%. Is the cost worth that degree of improvement to you?”
- I also say “It’s only been x days or weeks since your last treatment, let’s wait a bit longer before doing more.”
Because it’s undiagnosed in many, it can go unnoticed and lead to over-treatment or inappropriate treatment requests.
- This may look like patients who have been to multiple clinics and injectors with no clear history of what was done, timeline and other details.
- It may look like patients who are overfilled because their practitioners were not communicating among themselves.
- It may also look like patients who seek far more reassurance than is healthy, who are impatient for results, which cannot be rushed when it comes to human physiology.
2. Anxiety
Anxiety often overlaps with BDD—patients may experience heightened worry, intrusive thoughts, and dissatisfaction after treatments.
- This may also look like believing the new medication or drug is the cause of new symptoms that may occur around the time of the treatment or medication and therefore blaming it.
- It may also look like patients who seek far more reassurance than is healthy, who are impatient for results, which cannot be rushed when it comes to human physiology.
Pre-existing anxiety can be worsened if the patient undergoes procedures that don’t resolve their perceived issue, reinforcing a cycle of distress and dissatisfaction.
3. Medical Aesthetics
Patients with undiagnosed BDD and anxiety are more likely to:
- Have unrealistic expectations of outcomes, even if they say they are realistic at the initial consultation. This is often not intentional but through a process known as perception drift, whereby when patients achive the achievable 80%+ improvement, their mind goes to “what else can we do to get to 100%”? Having a trusted, single doctor/ clinic may mean that we watch out for this and discuss it when I see it in you.
- Request repeated or extreme interventions. This is where trust in the therapeutic relationship means that I can say no, and you are willing to work with the process, instead of simply going elsewhere to get the treatment.
- Experience dissatisfaction even after technically successful procedures.
- Struggle with trust in the clinician, potentially damaging the therapeutic relationship.
For your doctor, this increases risk of:
- Ethical dilemmas (treat vs. decline); having challenging conversations especially if the patient treats medical aesthetics and prescription medications as retail sales.
- Complaints, legal issues, or reputational harm.
- Emotional strain from not being able to meet patient expectations.
4. The Core Association
So as noted above in the Mighty Pursuit post and podcast, there is an overlap between BDD (where we would not treat once identified or suspected), anxiety and medical aesthetics especially my FFA.
- BDD → Distorted self-perception
- Anxiety → Heightened worry & dissatisfaction
- Medical Aesthetics → Can unintentionally reinforce the cycle if the underlying condition isn’t addressed and trust in the doctor/ clinician lacking.
So what do we do at Skin Essentials?
There is no perfect approach when it comes to dealing with humans because we are complex and multifacted.
As such, I do my best with the following:
- Screen for BDD and anxiety during consultations (e.g., with careful history-taking); my medical aesthetics consultations now have 45 minutes allocated for patients and my FFA is by application only, with a consultation that goes upto 90 minutes if suitable. It still does not screen for 100% of prospects with potential issues and vulnerabilities because sometimes people themselves may be unaware.
- I look for red flags: frequent requests outside of consultations, a history of multiple providers, hyperfocus on flaws or correcting normal anatomy, or emotional volatility.
- Refer to mental health professionals when appropriate—sometimes the best treatment is not a treatment, but support and guidance.
In summary: Undiagnosed BDD +/- anxiety can make medical aesthetics and especially FFA, unsafe, ineffective, and psychologically harmful if not identified early.
We spend a lot of time in clinic with our patients addressing this and having honest conversations that may feel uncomfortable in the moment. If it is my clinical opinion that you may be unsuitable, it is a duty of care for me to decline treatment, or as soon as it becomes apparent, in your best interests.
At all points, the goal is to work with you in a way that feels ultimately, joyous on the path to helping you look the way you feel inside, not to add to your anxiety and stress day to day.