Body dysmorphic disorder is a psychiatric disease that can be frequently encountered in an aesthetic practice. Body dysmorphic disorder is characterized by a preoccupation with a minimal or nonexistent appearance defect and causes significant distress and interferes with the social life of the patient. The perceived physical anomaly may involve the shape and size of the whole body or may be centered around single units. Body dysmorphic disorder patients are known to request multiple aesthetic procedures that leave them unsatisfied. Only a timely diagnosis will enable the surgeon and staff to adequately address the patient's needs. Body dysmorphic disorder patients cannot be cured with surgery. Diagnostic techniques such as patient interview and observation are presented in this article. With this, the plastic surgeon should be able to diagnose body dysmorphic disorder preoperatively. Using the presented algorithm to approach body dysmorphic disorder patients will avoid disappointment for patients and surgeons alike.