A recent article published in the Journal of Plastic and Reconstructive Surgery discusses a study that linked body dysmorphic disorder (BDD) to 1/3rd of patients seeking rhinoplasty (nose job). Body dysmorphic disorder is a mental condition where the person becomes fixated on a flaw in their appearance (whether real or perceived). This goes beyond just being dissatisfied with one’s appearance, and leads to severe body image problems, which I turn can lead to unhealthy behaviors such as plastic surgery addiction, bulimia or anorexia. Naturally, some degree of body dissatisfaction is necessary for anyone to seek cosmetic surgery, such as a person wanting to remove a bump on the nose or slenderize a bulbous nose tip. Any ethical and reputable plastic surgeon uses various techniques in taking a history and physical aimed to reveal patients who may have BDD or other body image problems. The concern is that BDD patients undergo rhinoplasty and are either dissatisfied, thereby remaining fixated on “imaginary ugliness”, or move on to another body area to be distraught over. The article in the Journal of Plastic and Reconstructive Surgery does not say or imply that 1/3rd of patients who seek a nose job are crazy. It brings to light that a significant portion of patients seeking rhinoplasty fall somewhere on the continuum from low to high in terms of having body dysmorphic disorder. The American Society of Plastic Surgeons embraces a standard that would rather turn patient away from having a procedure than to feed an unhealthy mental condition. The aim of the professionals at the Eisemann Plastic Surgery Center in Houston is to balance the desires of the patient with what is medically best for the patient.