Body Dysmorphic Disorder – Acne Scars

Body Dysmorphic Disorder & Acne Scars, At A Glance

  • Best ResultsUnlike to occur
  • Treatment RecoveryNA
  • Procedure TimeAvoid invasive procedures
  • Skin SpecialistIdeally psychiatrist/psychologist/nurse
  • Duration of ResultsVariable, depending on insight
  • AnaestheticNA
  • Back to WorkNA
  • Cost$$

Body Dysmorphic Disorder – Acne Scars

BDD or body dysmorphic disorder is a common condition affecting 2% of the population. Perception of acne scarring is one of the most common manifestations of BDD in dermatology. The absolute majority of sufferers have little or no insight regarding this condition. Most don’t even know they have it. Review this page as it may hopefully help you in making decisions about procedures.

FactsFacts on Body Dysmorphic Disorder

  • BDD patients often seek the help of dermatologists
  • BDD patients have a preoccupation of a perceived flaw, including acne scars
  • This flaw is often not objectively quantified, but subjectively distressing
  • This may have an impact on patient’s confidence, social behaviour, emotional & mental well being
  • Other skin conditions include redness, enlarged pores & aging concerns
  • It is important to quantify what is objective pathology versus subjective perception
  • For objectively demonstrable & significant acne scars, I employ surgery, powerful lasers, & deep peels
  • For subjectively severe perceptions in the absence of objective pathology the algorithm is very different
  • BDD patients are best treated with milder treatments & the help of psychologists & psychiatrists

What is body dysmorphic disorder or BDD?

This common disorder manifests as an abnormal preoccupation with perceived defects or flaws in their appearance.  BDD is very different from actual pathology whereby objective assessment can demonstrate abnormalities of physical appearance, such as scars, blemishes, pores, redness, age related changes (The problem is that BDD patients do not have this insight).

BDD patients tend to overthink their appearance and perceive their condition to be many multitude of times worse than what others perceive. Severe BDD causes debilitating stress, social isolation, anxiety & depression.  A procedural approach (lasers, peels, surgery, injectables) is rarely the sole answer for this condition. Ideally it should be managed by a team of doctors & psychologists.

How does body dysmorphic disorder & acne scars present?

Essentially an individual’s perceived scarring is subjective impactful, though objective assessment shows mild scarring. I find this type of scarring the hardest to treat (by far).

BDD, by definition, is a patient’s perceived flaws that exist in accordance with their own biased judgement and are usually so insignificant to others and are often too minor or undetectable that they go unnoticed. Although, unfortunately for the individual experiencing BDD, no amount of reassurance from others can convince them of this.

If you have BBD, I am not the correct dermatologist to treat your scarring. This has nothing to do with the fact that I won’t offer you solutions. My most likely avenue is to prescribe you a course of low risk, suitable treatments by my nursing team. Treatments include sensible laser resurfacing, suitable peels / TCA Paint.

I will not subject you to the risks of surgery, deep peels & lasers in the context of your scars & what my work entails. For objectively mild scars, the correct solution is a low risk, minimally invasive procedure, supplemented with psychotherapy by trained psychologists & psychiatrists.


What tests are there to determine if acne scarring is objectively severe compared to subjectively severe?

It is difficult to make objective assessments if you have BDD to begin with, as your analysis is subjective. It is much like asking a blind person to see the writing on the board. If one lacks objective insight the only way of assessment is to obtain opinions from family, friends & honest health care professionals.

Your family GP can give you some insight. Seeking the option from family & friends is invaluable. Listen to them. Understanding that you have BDD is the first step in healing (both physical & emotional).

This is how to self-test. The first thing to understand is that healthy scar assessment is based upon the confidence at normal conversational distances under normal lighting. It is not about finding the exact angle of light that highlights your scars. Conversational distances, as defined clinically using the Goodman Baron Grade is at 50 cm. I do think this is way too close. Ideally it should be at 60 to 70 cm. If scarring is not a predominant feature (again measured objectively), then chances are you will not have pathological scarring (different from having no scars).

51 1

In normal lighting, take a series of photos from different angles. Distance the camera at 70 cm. Have an objective assessor review your scars & grade them accordingly. If you have mild scars (or no scars) but they have a massive impact on your emotional well-being, you may suffer from BDD. A trained psychologist can provide that diagnosis.

What is the difference between objectively severe scars versus subjectively severe?

Objectively severe scars can be seen by a normal individual at a significant distance. As a guide, the majority of my scar revision patients (as opposed to say a nurse led scar revision list) will have scars visible at 2-3 meters, often up to 6+ meters. The algorithm for managing severe scarring is very different from managing mild scarring. For severe scars I employ surgical, lasers, & very deep peels. For subjectively severe scars, often the entry point for my subcision creates a scar bigger than the scar perceived.

box car scars
Objectively severe scars are seen at distances of many meters.

Subjectively severe scars are best corrected with small diameter lasers, non-invasive techniques, & precise focal peels. These procedures are carried out by my nurses. In some cases, I may employ dermal fillers to correct shadow deficits. Medicare does not give any rebate for the management of mild scars (objective assessment).

Davin’s Viewpoint on Body Dysmorphic Disorder

This is a very common condition. The problem is that the absolute majority of patients do not know they have it. I find it a challenging condition to treat, as I do not have the skill sets to manage this condition. Ideally it should be managed with family & friends as the foundation of support, as well as a psychologist & psychiatrist. Unfortunately, the vast majority of patients do not see past their short sightedness & will continue to have a cycle of anxiety, depression, loss of confidence & obsessive compulsive disorders.

In the context of what I do, acne scarring BDD is frequently encountered. My success rate for treating this condition is very low, as I cannot convince patients to seek psychological assistance. My skill sets & mode of practice is not conducive to treating this type of scarring.

Red flags for this disorder include the phrases ‘in certain lights I can see… ‘or ‘my family & friends can not see what I see…’

I base my revision of scars & aesthetics on improving the confidence of people to realise what others may perceive. Ideally, this is the end-point of treatment.

For patients with BDD, it is not that we will not address your concerns (if they are actually there at all), it is important to understand that the ideal solution is not just a medical procedure. Having a healthy outlook is super important, & hence why psychologists can help. In the majority of times, my nurses will provide a reasonable, cost effective solution with minimal risks.

Join the conversation

Join Dr Davin Lim on Instagram to stay up to date


Enquire now!

Get In Touch

Quick Contact

Dr Lim has unparalleled experience in dermatology. Fill in the form below and he will get back to you with your query
This field is for validation purposes and should be left unchanged.