Introduction:

This assessment was conducted at the request of Dr. Thompson to evaluate Ms. Taylor’s psychological readiness for rhinoplasty. Ms. Taylor was informed that assessment findings would be shared with the referring surgeon, who retains ultimate decision-making authority regarding procedure suitability. Confidentiality limits were explained and consent was obtained.

Current Presentation:

Ms. Taylor reports that she has been considering rhinoplasty for approximately five years but only recently sought consultation following improved financial stability. She describes longstanding dissatisfaction with the appearance of her nose, characterising it as “too prominent” and “making my face look unbalanced.” She has previously attempted to manage these concerns through makeup techniques and specific photograph angles. Ms. Taylor hopes for a “more refined nasal tip and reduced bump” and anticipates feeling “more confident in social situations” and “less self-conscious during professional interactions.” She is paying for the procedure herself through personal savings. Her motivation appears primarily internal rather than driven by external pressure. She demonstrates realistic expectations about potential outcomes and articulates a clear understanding of recovery time, possible complications, and the permanence of changes.

The Appearance Anxiety Inventory score of 29 indicated symptoms in the moderate range, consistent with significant body image anxiety and/or Body Dysmorphic Disorder. In particular, Ms. Taylor is experiencing elevated Threat Monitoring (vigilant about potential appearance-related judgments) and Camouflaging (using strategies to hide perceived flaws). The impact on functioning is significant, with reported daily avoidance of certain photographs, mirrors in public spaces, and frequent hesitation during work presentations due to self-consciousness about profile visibility.

Past Cosmetic Procedures:

Ms. Taylor reports no previous cosmetic procedures.

Body Image:

Ms. Taylor reports general dissatisfaction focused on her nose, which she describes as “the one feature that has always bothered me since puberty.” She recalls first becoming self-conscious about her nose at age 14 following a comment from a peer. Her mirror use involves frequent checking and comparison from different angles, particularly examining her profile. She consistently avoids front-facing photographs and certain lighting situations that emphasise her nose profile, often positioning herself strategically in group photos. Her appearance-related distress is primarily focused on this specific feature, though she reports some generalised self-consciousness in professional settings where she feels her appearance is being evaluated.

Current Life Situation:

Ms. Taylor lives independently in her own apartment. She works as a marketing manager for a national company. She has arranged four weeks of combined annual and long service leave for recovery, with the capacity to work remotely thereafter if needed.

Family History:

Ms. Taylor reports close relationships with her parents and younger sister. She describes a stable, supportive childhood without significant trauma. There is no known family history of mental health conditions. Her mother initially expressed concern about the procedure but has become supportive after learning more about it. No family members have undergone cosmetic procedures.

Social History:

Ms. Taylor is currently single after ending a three-year relationship six months ago (unrelated to appearance concerns). She has a stable social network with three close friends who are supportive of her decision. Two friends will assist with post-operative care and transport. One close friend had breast augmentation two years ago with a positive outcome. Ms. Taylor acknowledges some societal pressure in her profession to maintain a polished appearance, but her decision appears predominantly personal. She reports moderate confidence in social settings with notable self-consciousness during first impressions and when meeting new people professionally.

Developmental & Medical History:

No significant developmental or medical concerns were reported. Sleep and appetite are within normal ranges. Ms. Taylor currently takes an oral contraceptive (Levlen ED) for menstruation management and occasional paracetamol for headaches.

Psychiatric History:

Ms. Taylor has no formal psychiatric diagnoses. She attended six sessions of counselling three years ago for work-related stress with reported benefit. She is not currently receiving psychological treatment. Her substance use is limited to occasional social alcohol consumption (1-2 standard drinks weekly).

Past Medical History:

Ms. Taylor underwent a tonsillectomy at age 7. She reports no other significant medical history or hospitalisations.

Risk Assessment:

Ms. Taylor denies any current or historical suicidal ideation, plans, or attempts. Multiple protective factors were identified including stable employment, housing, finances, and social support.

Mental Status Examination:

• Appearance: Ms. Taylor presented as a well-groomed woman in professional attire with appropriate hygiene and grooming.
• Behaviour: She engaged cooperatively throughout the assessment with appropriate posture and eye contact, though occasionally turned slightly to present her “better angle.”
• Speech: Her speech was of normal rate, volume, and articulation with logical flow.
• Mood: Ms. Taylor described her mood as “a bit nervous but generally positive.”
• Affect: Her affect was congruent with stated mood, with full range and appropriate reactivity, though mild anxiety was noted when discussing appearance concerns.
• Thoughts: Thought processes were coherent and goal-directed. Content focused on realistic expectations and understanding of risks/benefits of the procedure. Some preoccupation with nose appearance evident but without delusional beliefs about appearance.
• Perceptions: No hallucinations or perceptual disturbances were reported or observed.
• Cognition: Ms. Taylor was alert and oriented. She demonstrated good attention, concentration, and memory throughout the assessment.
• Insight: She showed good insight into her motivation for the procedure with realistic self-assessment of appearance. Her perception of her nose appears consistent with objective observation though she may focus on this feature more than others might notice. Family and friends acknowledge her concerns as understandable rather than completely exaggerated.
• Judgment: Ms. Taylor demonstrates good judgment regarding risks, benefits, and recovery planning. She has researched the procedure thoroughly and approached decision-making thoughtfully.

Summary:

Ms. Taylor is a 37-year-old woman seeking rhinoplasty to address a longstanding, specific concern regarding nasal appearance. The assessment reveals realistic expectations, appropriate motivation, good understanding of risks/benefits, though moderate appearance anxiety as evidenced by AAI scores and some functional impairment. There is no evidence of severe body dysmorphic disorder, significant depression, anxiety, or other mental health conditions that might complicate treatment. She demonstrates good insight and judgment with thorough preparation for recovery. Strong support systems and stable life circumstances provide protective factors. Based on this psychological assessment, Ms. Taylor appears to be an appropriate candidate for the requested cosmetic procedure with no identified psychological contraindications.