Objectives: Careful patient selection in septorhinoplasty is critical to good patient outcomes. Body Dysmorphic Disorder (BDD) is a known risk factor for poor postoperative satisfaction. Our aim was to refine factors influencing patient satisfaction following septorhinoplasty and identifying relative risk of BDD. Design: A prospective cohort study was conducted. All participants completed SCHNOS and BDDQ (Body Dysmorphic Disorder Questionnaire) pre- and post-operatively; both validated tools in septorhinoplasty assessment. Setting: ENT clinic, district general hospital, UK Participants: 16 patients undergoing septorhinoplasty by a single surgeon, and 32 controls. Main outcome measures: Incidence of BDD in septorhinoplasty patients compared to control group. Identifying patient groups at high risk of BDD at presentation Results and Conclusions: Mean obstructive SCHNOS score improved from 79.7 to 35.9 following septorhinoplasty (22.5 in controls), p<0.01, 95%CI [28.6-58.9] and mean cosmetic SSCHNOS from 71.9 to 29.2 (1.7 in controls), p<0.001, 95%CI [27.2-58.2]. 38% (five female and one male) screened positively preoperatively on BDDQ and 31% (four male and one female) were borderline (0% in controls). Postoperatively 19% screened positively on BDDQ; one male identified preoperatively, and two males converting from borderline to BDD. All female patients positive on BDDQ preoperatively were non-BDD postoperatively. BDDQ is a useful screening tool for patients who may be dissatisfied with septorhinoplasty outcome. Satisfaction is high in female patients overall, although they are more likely to screen positive for BDD preoperatively. Particular caution should be exercised in male patients scoring borderline or positive on BDDQ.