The decision to change something about your appearance is rarely uncomplicated.
This is not a statement about whether such decisions are right or wrong. Many people approach cosmetic surgery from a grounded, considered place. They have thought clearly about what they want, they have realistic expectations about outcomes, and their sense of self is not contingent on the result in ways that would concern a psychologist. For these people, the assessment is a conversation and, in the vast majority of cases, an approval.
For others, the picture is more complex. Not because they are deluded or disturbed. Because the feature they want changed has become organised around something else: a belief about the self, a long history of particular responses from others, a conviction that if this one thing were different, something larger would shift. These are psychologically real experiences. They deserve psychological attention. And they are experiences that surgery, by itself, generally cannot resolve.
The psychological assessment required before major cosmetic procedures under AHPRA guidelines is designed to make this distinction. Not to advise on whether the surgery is wise. Not to approve or reject based on aesthetics or the psychologist's preferences about what a person should or should not want. To understand what a specific person is actually asking for, and whether what they are asking for is something the procedure can reasonably provide.
Body dysmorphic disorder sits at one end of this spectrum. Most people who come through the assessment process are not there. They sit somewhere in the middle of a very human experience: aware of the body in ways that sometimes take up more space than they would like, hopeful that a change on the outside will quiet something on the inside. The assessment is designed to meet that honestly. Not with reassurance and not with refusal, but with genuine psychological attention to what the decision is carrying.
The approval rate for assessments at this practice is high. The process is not adversarial. What it provides, for everyone who goes through it, is the space to be honest about what the decision means and what it is being asked to do. That is useful regardless of what happens in the operating theatre.
The procedure can change the feature. The psychological work addresses what the feature has come to mean.