Simulation for a patient with suspected dysmorphia: care
Almost every patient has something about their face they dislike. In some, that dissatisfaction takes on a different dimension: it lasts hours a day, focuses on details no one else can see and does not improve with a procedure. When body dysmorphic disorder is suspected, a simulation can make the condition worse instead of helping.
This page does not teach diagnosis. It helps you notice signs, decide whether the image should be shown and talk without offending. The topic is delicate, and the final decision belongs to the qualified professional, in line with the rules of their professional board in Brazil.
Why can the simulation worsen fixation?
Because it offers the obsession a new surface. A patient fixated on one detail sees, in the image, another detail to adjust. With each change, the "ideal standard" moves further away, and the feeling of inadequacy stays.
Other mechanisms show up often:
- Repeated comparison. The patient flips between Before and After dozens of times and finds tiny differences.
- Demanding the result. The image becomes the standard the procedure "has to" deliver.
- A source of checking. The photo starts being used as a ritual to relieve anxiety, which returns soon after.
- The effect of filters. People who already use social media filters have an unrealistic reference for skin, symmetry and proportion. See filter dysmorphia.
None of this means the simulation is "dangerous" in itself. It means that, for certain profiles, it needs a pause.
Which signs deserve attention?
No single sign settles the picture, but together they help:
| Sign | What it may indicate |
|---|---|
| Focus on a minimal flaw you cannot see | Distorted perception of one's own face |
| Daily time spent looking at mirrors, photos or the phone | Checking ritual |
| Previous procedures without lasting relief | Cycle of dissatisfaction |
| Requests for small changes with every image | Pursuit of an unreachable ideal |
| Avoiding going out, working or socializing because of the detail | Significant distress |
| Intense comparison with a specific person or filter | Unrealistic reference |
Document what was reported, in neutral language, in the medical history. Ask openly: "how much time a day does this detail take up in your thoughts?" The answer often clarifies more than the mirror does.
What to do in the moment: show or not show?
If the suspicion is mild and the patient is simply insecure, the simulation can go ahead carefully, in a single presentation and with a clear limit. If the suspicion is strong, the most prudent course is not to show the image for now.
You can explain it like this:
If the patient insists on seeing it, one option is to show the plain photo (without simulation) and talk about what they see. The After image is saved for after the complementary assessment. That is not a refusal, it is a sequence.
How do you refer without offending?
A referral is a gesture of care, and how you present it decides whether it will be accepted:
- Start with what you see that is positive. Show that the patient was heard.
- Speak in the first person. "I would feel more comfortable if you also spoke with a mental health professional before we decide."
- Keep the door open. "Whenever you like, we can talk about the plan again."
- Do not make the relationship conditional. A referral is not a punishment.
Avoid handing over a professional's contact as if it were a penalty; offer it as a complement to care. And document in the patient record what was discussed.
What if the patient gets angry or cries?
It is possible. Feeling "turned away" can cause sadness or irritation. Do not argue. Breathe, validate the feeling and restate your position of care. For these moments, see patient cries in the consultation and aggressive patient in the consultation. If the person is at risk, the priority is safety and an immediate referral, not the orofacial harmonization (HOF) consultation.
Saying no is also a gesture of care
Saying no to a request is not always losing the patient: often it is what preserves the relationship. The full conversation is in saying no to a patient with dysmorphia and in patient with suspected dysmorphia. The principle is patient autonomy with professional responsibility: the patient decides about their body, and you decide what you agree to perform and under what conditions.
What to document?
- The patient's account in their own words, without labels.
- Signs observed and the amount of time they report worrying.
- The decision made: show, postpone, refer or decline.
- The guidance given and the patient's response.
- Date and responsible professional.
The record protects you and guides the next visit, even if another professional takes over the case. Data handling follows the LGPD (Brazil's data protection law), with extra care: mental health data is sensitive and should not circulate outside the patient record.
Frequently asked questions
What is body dysmorphia?
It is a condition in which a person is excessively preoccupied with a small or imagined flaw in their appearance, with significant distress. The diagnosis is clinical and belongs to mental health professionals.
Can I show the simulation to someone with suspected dysmorphia?
In general, it is better to avoid it until the situation is clarified. The image can fuel the fixation and new demands.
How do I refer the patient without offending them?
Talk about your care, not their problem. Say you would like a complementary assessment before deciding on any procedure and that this is part of a good plan.
Is refusing the procedure mandatory in these cases?
It is up to the professional to assess, in line with the rules of their professional board in Brazil. What matters most is not treating just because the patient asks, and documenting the decision and the reason.
Harmy images are illustrative simulations generated by AI from the patient's photo to support the conversation between practitioner and patient. They are not a promise of results. Indication, technique, product and volume are solely the decision of the licensed practitioner. This content is for information only and does not replace a clinical assessment.