Recent regulatory changes in Australian cosmetic surgery necessitate preoperative screening for body dysmorphic disorder (BDD). This study, which focuses on patient outcomes, evaluates the COPs tool's efficacy and examines its implications on patients undergoing cosmetic procedures. A total of 189 patients were included: 78 underwent Medicare-classified "cosmetic" surgeries, and 111 underwent "medically necessary" procedures. Patients completed the COPs assessment pre- and post-operatively, with a score >40 indicating BDD susceptibility. Results show no significant pre- to post-operative change in COPs scores across different surgical procedures (body, breast, facial, and mixed) in both "cosmetic" (p = 0.2-0.4) and "itemised" groups (p = 0.15-0.33). However, overall, there was a marked reduction in COPs scores post-operatively (p < 0.001), indicating improved self-perception. Specifically, 91% of patients initially BDD-prone showed scores < 40 post-operatively. Conversely, 3.8% of initially low-scoring patients developed BDD-prone scores post-operatively. Comparison between cosmetic and itemised groups revealed higher preoperative COPs scores in the itemised group (p = 0.006), though post-operative scores did not differ significantly (p = 0.33). Incidences of post-operative BDD-prone scores or scores < 40 did not differ between groups (p = 0.61). Complication rates and the need for revision surgery were similar between groups. These findings suggest two plausible interpretations: First, preoperative screening with the COPs tool may positively influence self-perception related to BDD among cosmetic surgery patients, potentially serving as a therapeutic adjunct for those at risk. Second, while screening tools are beneficial, they may have limitations in predicting post-operative outcomes related to BDD development. Further research should explore these dynamics to refine screening practices and optimise patient outcomes in cosmetic surgery contexts. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
