Frequently asked
questions

No. Cosmetic Surgery Psychiatry accepts direct referrals from cosmetic surgeons, dermatologists, aesthetic practitioners, and other healthcare professionals. You can email us, use the online referral form, or call. A GP letter is not required at any stage of the process.

Yes — and we actively encourage this. Email assess@cosmeticsurgerypsychiatry.co.uk and we will arrange a brief call at a time that suits you. You don’t need to share identifying patient information at this stage. Many practitioners find a 10-minute conversation either resolves their uncertainty or confirms that a formal referral is the right step.

Document the offer clearly in the patient’s notes, along with their refusal and your reasoning for recommending assessment. Then defer the procedure. You cannot be compelled to operate without appropriate clinical safeguards, and a patient’s refusal of assessment is a legitimate and defensible reason to decline.

GMC guidance supports the right of practitioners to decline procedures they consider clinically inappropriate. If you document the offer, the refusal, and your clinical concerns thoroughly, you are in a strong position regardless of the patient’s subsequent response.

No. Most patients referred to Cosmetic Surgery Psychiatry are cleared for surgery — the assessment confirms that no psychiatric contraindication is present, and you proceed with confidence and documentation. Think of it as the psychiatric equivalent of a pre-operative medical review: it is a safeguard, not a veto.

Where a contraindication is identified, the report explains why, what treatment is needed first, and when it would be appropriate to reassess. This is not a refusal — it is a clinical pathway.

The minimum we need is: your name and practice, the patient’s initials, age and sex, the procedure planned, and a brief description of your concerns. Screening scores (BDDQ, PHQ-9) are helpful but not required. Full details are collected via the secure referral form or by email.

Yes. If you anticipate regular referrals, we can discuss a practice arrangement with agreed fee structures, turnaround guarantees, and a named contact. Email us at assess@cosmeticsurgerypsychiatry.co.uk to discuss.

Our reports are consultant-level psychiatric assessments that meet all standard medico-legal requirements. We recommend checking with your specific insurer, but in our experience reports from GMC-registered Consultant Psychiatrists are accepted without issue by major medical defence organisations.

The report reflects the psychiatrist’s independent clinical opinion. If you believe significant clinical information was not available to the assessor, or if circumstances have materially changed, contact us to discuss. We do not revise recommendations in response to pressure, but we do respond to new clinical information.

Your surgeon wants to make sure that surgery is the right step for you at this time, and that it is likely to give you the outcome you are hoping for. Certain psychological presentations — most commonly a condition called Body Dysmorphic Disorder — mean that surgery often doesn’t provide the relief patients expect, and may even make things worse. The assessment is a clinical safeguard, not a judgement.

You will meet with a Consultant Psychiatrist for approximately 60–90 minutes. The appointment is a conversation — not a test. The psychiatrist will ask about your general mental health, your feelings about your appearance, how your concern affects your daily life, and what you hope surgery will achieve. Some short questionnaires will also be completed.

The session is confidential and conducted with sensitivity. If you have any concerns about what the assessment involves, please ask when you book — we are happy to explain anything in advance.

No. The assessment is a clinical evaluation, not a pass/fail test. The psychiatrist is trying to understand your mental health and whether surgery is likely to help you. If a concern is identified, the report will include recommendations for the most helpful next steps — it is not a permanent refusal of treatment.

The written report is sent to your referring surgeon. It will include clinical findings and a recommendation on whether surgery is appropriate. The assessment is conducted to a high standard of clinical confidentiality — we share what is clinically relevant, not a transcript of your conversation.

If you have concerns about specific disclosures, please raise these at the start of your appointment and the psychiatrist will clarify what will and won’t be included.

If the report concludes that surgery is not recommended at this time, it will also include a clear explanation of why and what would need to happen first — typically a course of psychological treatment such as CBT, which is highly effective for conditions like BDD. This is not a permanent outcome: with the right treatment, many patients are later cleared for surgery.

We can advise on the most appropriate onward pathway and will not leave you without clear guidance about next steps.

Yes. Video consultations are available for patients anywhere in the UK. The assessment is conducted via a secure, encrypted platform and is clinically equivalent to an in-person appointment. Details are provided when you book.

Fees depend on the type of assessment — BDD Screening Assessments start from £450, and Full Pre-operative Assessments from £650. In some cases, your surgeon or their practice may cover the cost as part of your pre-operative pathway. Please confirm this with your referring clinician. Payment is due at the time of booking.

For routine assessments, appointments are typically available within 1–2 weeks of referral. For urgent cases (Rapid Pathway), we aim to offer an appointment within 48–72 hours. We acknowledge all referrals within one working day.

Standard reports are completed within 5–7 working days of the assessment. Rapid pathway reports are provided within 3 working days, with a verbal summary to the referring clinician on the day of assessment.

Reports are provided as a PDF document addressed to the referring clinician. They are typically 3–5 pages, structured in a consistent format (history, mental state, screening scores, diagnosis, risk assessment, recommendation), and suitable for inclusion in the patient’s medical record.

Yes. Reports are written to a standard appropriate for medico-legal purposes — factual, clearly reasoned, and signed by a GMC-registered Consultant Psychiatrist. If expert witness support is required, please contact us to discuss separately.

In certain circumstances, assessments can be conducted at your clinical premises. Contact us to discuss — this is typically arranged for practice groups with regular referral volumes or where a patient has limited mobility.

Yes. The BDD contraindication applies to all cosmetic interventions, including Botox, fillers, skin treatments, and other non-surgical procedures. The threshold for referral is lower for reversible, minor procedures — but patients with confirmed or suspected BDD should not undergo any appearance-changing treatment without psychiatric assessment. Patients seeking repeated injectables with escalating dissatisfaction are among the highest-risk groups seen in aesthetic practice.

Body Dysmorphic Disorder (BDD) is a psychiatric condition characterised by preoccupation with one or more perceived defects in appearance that are not visible to others, or appear only slight. The preoccupation is accompanied by repetitive behaviours (mirror checking, skin picking, reassurance-seeking) and causes significant distress and functional impairment.

BDD affects approximately 7–15% of cosmetic surgery patients. Surgery does not help BDD — studies consistently show that 81–100% of BDD patients report no improvement after cosmetic procedures. The underlying disorder is neurobiological: BDD involves abnormal visual processing of appearance-related information, which is not corrected by physical change.

Effective treatments include specialist CBT for BDD and SSRI antidepressants at higher doses than used for depression.

The eight most significant red flags are: (1) multiple procedures with persistent or escalating dissatisfaction; (2) requesting correction of features you cannot identify on examination; (3) describing appearance in extreme language disproportionate to clinical findings; (4) arriving with large numbers of photographs from social media or celebrities; (5) significant functional impairment related to the appearance concern; (6) marked anxiety or distress during physical examination; (7) a history of complaints against previous surgeons; (8) extreme dissatisfaction expressed immediately post-operatively before healing is complete.

Yes. The BDDQ (Body Dysmorphic Disorder Questionnaire) is a validated 4-item self-report screening tool with 100% sensitivity and 89% specificity in cosmetic surgery populations. It takes under 2 minutes to complete and is available free at bddcentral.com. We recommend including it in every new patient questionnaire pack.

A positive BDDQ screen should trigger referral to Cosmetic Surgery Psychiatry before any procedure is performed. The BDDQ is a screen, not a diagnosis — formal psychiatric assessment is required to confirm or exclude BDD.

No. Many patients with psychiatric diagnoses are entirely appropriate candidates for cosmetic surgery. The key question is always whether the specific condition, at its current severity, is likely to impair the patient’s ability to benefit from surgery or give informed consent.

Patients with well-controlled, stable depression may be cleared without condition. Patients with remitted BDD may be cleared with close monitoring. Patients with active BDD, active suicidal ideation, or psychosis are contraindicated — but these are temporary clinical states, not permanent ones. With appropriate treatment, many patients who initially cannot proceed are later able to do so.

The key distinctions are: (1) Visibility — in BDD, the perceived defect is invisible or minimal to others; (2) Proportionality — the distress is markedly disproportionate to any objective finding; (3) Time — BDD patients spend an average of 3–8 hours per day preoccupied with the feature; (4) Impairment — BDD causes significant functional impairment (avoiding work, social withdrawal, housebound); (5) Pattern — BDD tends to involve symptom migration (concern moves from one feature to another over time).

Normal candidates for cosmetic surgery may dislike a feature and want it improved. They can see the feature clearly, their distress is proportionate, they function normally, and they have realistic expectations. BDD patients cannot.

Your surgeon wants to make sure that surgery is the right step for you at this time, and that it is likely to give you the outcome you are hoping for. Certain psychological presentations — most commonly a condition called Body Dysmorphic Disorder — mean that surgery often doesn't provide the relief patients expect, and may even make things worse. The assessment is a clinical safeguard, not a judgement.

You will meet with a Consultant Psychiatrist for approximately 60–90 minutes. The appointment is a conversation — not a test. The psychiatrist will ask about your general mental health, your feelings about your appearance, how your concern affects your daily life, and what you hope surgery will achieve. Some short questionnaires will also be completed.

The session is confidential and conducted with sensitivity. If you have any concerns about what the assessment involves, please ask when you book — we are happy to explain anything in advance.

No. The assessment is a clinical evaluation, not a pass/fail test. The psychiatrist is trying to understand your mental health and whether surgery is likely to help you. If a concern is identified, the report will include recommendations for the most helpful next steps — it is not a permanent refusal of treatment.

The written report is sent to your referring surgeon. It will include clinical findings and a recommendation on whether surgery is appropriate. The assessment is conducted to a high standard of clinical confidentiality — we share what is clinically relevant, not a transcript of your conversation.

If you have concerns about specific disclosures, please raise these at the start of your appointment and the psychiatrist will clarify what will and won't be included.

If the report concludes that surgery is not recommended at this time, it will also include a clear explanation of why and what would need to happen first — typically a course of psychological treatment such as CBT, which is highly effective for conditions like BDD. This is not a permanent outcome: with the right treatment, many patients are later cleared for surgery.

We can advise on the most appropriate onward pathway and will not leave you without clear guidance about next steps.

Yes. Video consultations are available for patients anywhere in the UK. The assessment is conducted via a secure, encrypted platform and is clinically equivalent to an in-person appointment. Details are provided when you book.

Fees depend on the type of assessment — BDD Screening Assessments start from £450, and Full Pre-operative Assessments from £650. In some cases, your surgeon or their practice may cover the cost as part of your pre-operative pathway. Please confirm this with your referring clinician. Payment is due at the time of booking.

For routine assessments, appointments are typically available within 1–2 weeks of referral. For urgent cases (Rapid Pathway), we aim to offer an appointment within 48–72 hours. We acknowledge all referrals within one working day.

Standard reports are completed within 5–7 working days of the assessment. Rapid pathway reports are provided within 3 working days, with a verbal summary to the referring clinician on the day of assessment.

Reports are provided as a PDF document addressed to the referring clinician. They are typically 3–5 pages, structured in a consistent format (history, mental state, screening scores, diagnosis, risk assessment, recommendation), and suitable for inclusion in the patient's medical record.

Yes. Reports are written to a standard appropriate for medico-legal purposes — factual, clearly reasoned, and signed by a GMC-registered Consultant Psychiatrist. If expert witness support is required, please contact us to discuss separately.

In certain circumstances, assessments can be conducted at your clinical premises. Contact us to discuss — this is typically arranged for practice groups with regular referral volumes or where a patient has limited mobility.

Yes. The BDD contraindication applies to all cosmetic interventions, including Botox, fillers, skin treatments, and other non-surgical procedures. The threshold for referral is lower for reversible, minor procedures — but patients with confirmed or suspected BDD should not undergo any appearance-changing treatment without psychiatric assessment. Patients seeking repeated injectables with escalating dissatisfaction are among the highest-risk groups seen in aesthetic practice.

Body Dysmorphic Disorder (BDD) is a psychiatric condition characterised by preoccupation with one or more perceived defects in appearance that are not visible to others, or appear only slight. The preoccupation is accompanied by repetitive behaviours (mirror checking, skin picking, reassurance-seeking) and causes significant distress and functional impairment.

BDD affects approximately 7–15% of cosmetic surgery patients. Surgery does not help BDD — studies consistently show that 81–100% of BDD patients report no improvement after cosmetic procedures. The underlying disorder is neurobiological: BDD involves abnormal visual processing of appearance-related information, which is not corrected by physical change.

Effective treatments include specialist CBT for BDD and SSRI antidepressants at higher doses than used for depression.

The eight most significant red flags are: (1) multiple procedures with persistent or escalating dissatisfaction; (2) requesting correction of features you cannot identify on examination; (3) describing appearance in extreme language disproportionate to clinical findings; (4) arriving with large numbers of photographs from social media or celebrities; (5) significant functional impairment related to the appearance concern; (6) marked anxiety or distress during physical examination; (7) a history of complaints against previous surgeons; (8) extreme dissatisfaction expressed immediately post-operatively before healing is complete.

Yes. The BDDQ (Body Dysmorphic Disorder Questionnaire) is a validated 4-item self-report screening tool with 100% sensitivity and 89% specificity in cosmetic surgery populations. It takes under 2 minutes to complete and is available free at bddcentral.com. We recommend including it in every new patient questionnaire pack.

A positive BDDQ screen should trigger referral to Cosmetic Surgery Psychiatry before any procedure is performed. The BDDQ is a screen, not a diagnosis — formal psychiatric assessment is required to confirm or exclude BDD.

No. Many patients with psychiatric diagnoses are entirely appropriate candidates for cosmetic surgery. The key question is always whether the specific condition, at its current severity, is likely to impair the patient's ability to benefit from surgery or give informed consent.

Patients with well-controlled, stable depression may be cleared without condition. Patients with remitted BDD may be cleared with close monitoring. Patients with active BDD, active suicidal ideation, or psychosis are contraindicated — but these are temporary clinical states, not permanent ones. With appropriate treatment, many patients who initially cannot proceed are later able to do so.

The key distinctions are: (1) Visibility — in BDD, the perceived defect is invisible or minimal to others; (2) Proportionality — the distress is markedly disproportionate to any objective finding; (3) Time — BDD patients spend an average of 3–8 hours per day preoccupied with the feature; (4) Impairment — BDD causes significant functional impairment (avoiding work, social withdrawal, housebound); (5) Pattern — BDD tends to involve symptom migration (concern moves from one feature to another over time).

Normal candidates for cosmetic surgery may dislike a feature and want it improved. They can see the feature clearly, their distress is proportionate, they function normally, and they have realistic expectations. BDD patients cannot.