Crerand subsequently reported in greater detail on the same cohort of patients [11]. The authors specifically investigated the possibility of outcome differences between surgical, minimally invasive (MI), and “other” procedures. There were too few MI procedures to perform a three-way comparison; the authors therefore performed two separate statistical analyses, one in which surgical and MI procedures were pooled (surgical/MI) and compared to “other” procedures, and a second in which surgical procedures were compared to MI and “other” (MI/other) procedures. Despite the somewhat arbitrary distinction between MI and “other” procedures, the authors found a statistically significant difference between the surgical/MI group and the “other” group in improvement in preoccupation with the treated body part (25.3 % versus 15.6 %, p = 0.04). There was no significant difference in perceived improvement in appearance of the treated body part (33.3 % versus 24.8 %, p = 0.11) or in improvement of overall BDD symptoms (2.3 % versus 4.0 %, p = 0.75). In the surgical versus MI/other comparison, surgical interventions were more likely to result in improvement in preoccupation with the treated body part (27.9 % for surgical versus 15.9 % for MI/other, p = 0.023) and trended toward greater improvement in perceived appearance of the treated body part (36.1 % versus 24.9 %, p = 0.069). There was no difference in overall BDD symptom severity (1.6 % versus 4.0 %, p = 0.368). While the authors found some differences in outcome depending on the type of procedure that was performed, the outcomes were nonetheless poor across all types of procedures.

Veale et al. [8] described patients who had been referred to them by consultant psychiatrists, dermatologists, and cosmetic surgeons, or who had self-referred. Of those who were assessed over a period of 9 months and who met criteria for BDD, 48 % had seen either a cosmetic surgeon or dermatologist at least once, and 26 % had undergone one or more operations on their perceived defect. About 81 % rated themselves as dissatisfied with the outcome of the consultation or operation.

Veale [12] subsequently reported on 25 patients with BDD who at the time of psychiatric assessment had reported that they had previously had cosmetic surgery. The patients had undergone a total of 46 operations. Several patients reported performing their own cosmetic surgery because they had been turned down by a physician or because they could not afford it. Satisfaction after a first cosmetic procedure was an average of 3.9 on a scale of 0–10, and this decreased to 2.8 after a second and third procedure. Three patients claimed that they were not preoccupied by their appearance prior to surgery, and their symptoms of BDD developed only after a procedure that they believed to have been performed poorly.

Even when patients have been satisfied with the results of cosmetic procedures, preoccupation can transfer to a different body part. In Veale’s [12] study, four of the six patients who rated themselves satisfied went on to have additional procedures or were dissatisfied with another area of their body. In a separate study, Tignol et al. [13] noted that five of seven patients who had undergone cosmetic surgery were preoccupied with a new body site at 5-year follow-up.

Suicide attempts have also been reported in association with BDD, although there is little to suggest that these were consequences of or even temporally related to cosmetic treatment of perceived deformity. Cotterill and Cunliffe reviewed a series of 16 patients who committed suicide at some time after presenting with dermatological problems to their dermatologic clinic. Of these, three had been diagnosed with BDD at initial presentation [14]. In Veale et al.’s [8] cohort of 50 patients, 24 % reported prior suicide attempts. One patient who had been referred with suspected BDD committed suicide prior to evaluation and was therefore not included in the cohort. Phillips et al. [15] reported an annual suicidal ideation rate among patients with BDD of 57.8 % and a mean annual suicide attempt rate of 2.6 %.