When you have found the perfect plastic surgeon to perform the cosmetic surgery you have always craved, don’t take it personally if the surgeon gives you an exam before proceeding.

(More about finding an excellent plastic surgeon.)

Facial plastic and oculoplastic surgeons are often the victims of would-be patients who suffer a strange psychological disorder known as BDD, short for body dysmorphic disorder.

BDD causes people to be overly fixated on their appearance to the point that no cosmetic surgery is ever good enough.

Rejuvenation surgeons fear them like plague because BDD sufferers file lawsuits at the drop of a hat and file bitter complaints for no good reason.

          (See some face & neck lift before & after pictures.)

Why bring up the test?  A recent study of 597 cosmetic surgery patients found the BDD-afflicted can slip past face-to-face surgeon interviews, but were more often nailed by one of several paper tests.

Lead author Andrew W. Joseph, M.D., MPH is affiliated with the Division of Facial Plastic and Reconstructive Surgery at Johns Hopkins University School of Medicine in Baltimore, Maryland.

He and four colleagues screened 597 patients from several surgery centers for BDD and found that almost 10 percent had BDD.

But surgeons – after face-to-face meetings – only identified five percent of BDD patients.

          (Read more about BDD)

Nonetheless, the authors say formal BDD screening is not common in most cosmetic plastic surgery practices.

To help screen out BDD patients, a paper test known as the BDDQ was given to prospective patients. Nine surgeons at three surgery sites took part.

For instance, at one site, 342 patients were screened both by surgeons and via the paper BDDQ test. At another site 158 were studied while the third and final site looked at 97 similar patients.

          (See some permanent, non-surgical rhinoplasty pictures.)

Results? In a total of 597 would-be cosmetic surgery patients, 58 (9.7 percent of the study group) were found to be BDD positive.

But all surgeons in pre-surgery, face-to-face interviews spotted only 16 BDD sufferers.