ABSTRACT
Shame is the biblical mustard seed. Body dysmorphic disorder is primarily a disease of emotions, particularly toxic shame—not appearance. The odds of making a patient happy in one operation were almost four times higher if the patient had no trauma history. Childhood trauma appeared to influence surgical motivation. A trauma history impacts perceived surgical success. A history of trauma is common among revision rhinoplasty patients. Human resilience accounts for the fact that most people exposed to trauma do not develop psychiatric disorders. A trauma history impacts behavior and therefore the surgical experience. Trauma can produce a chronic state of physiologic hyperarousal, driving some patients to relive their experiences in thoughts, actions, and images. Childhood trauma creates messages of shame, inadequacy, or superiority in children that mercilessly lurch forward into adulthood.
