Feeling more distressed after a cosmetic or medical procedure can be confusing and isolating. A person may be concerned about healing, pain, scarring, a change in appearance, uncertainty about the result, other people’s reactions or a fear that they have made a mistake. A blog cannot determine why this is happening, diagnose body dysmorphic disorder, judge the quality of a procedure or advise on an individual medical outcome. New, severe, worsening or worrying physical symptoms after a procedure should be discussed with the relevant medical professional, urgent care service or other appropriate provider. Mental health support is not a substitute for post procedure medical advice, follow up or emergency care. Appearance concerns can occur with or without BDD. BDD is a diagnosable mental health condition that requires appropriate assessment. It should not be assumed from dissatisfaction with a result, from checking a mirror, or from seeking another opinion. An assessment can consider the history of the concern, its impact on daily life, health information, safety, current support and the person’s priorities. CBT may be considered after assessment where appropriate. It is not a self directed instruction to stop checking, deliberately confront distressing images, avoid medical follow up or decide against future treatment. If behavioural work is clinically suitable, it is planned collaboratively with a qualified clinician and takes account of medical advice, consent, safety and the person’s wider circumstances. Support may also involve the treating clinician, a GP, a specialist medical service, a trusted person, practical aftercare information or other mental health support. Therapy cannot promise that appearance concerns will disappear or determine what decision should be made about another procedure. For related information, see support for body dysmorphic disorder at lyceumclinic.co.uk/therapy/body dysmorphic disorder/, the BDD and CBT guide at lyceumclinic.co.uk/guides/body dysmorphic disorder cbt west london/ and the guide to body image, weight, diet and movement at lyceumclinic.co.uk/guides/mental health weight diet movement/. If distress includes crisis, thoughts of self harm or an inability to keep safe, urgent appropriate help is needed.