Every person pursuing a nose job comes to their doctor with a different rationale. Some have real difficulty breathing through their nose, whether they were born with a wonky nasal passage or those passages were made wonky by a baseball that collided with their sniffer on the playground years ago. Others are straightforward that their goal is to make themselves more attractive.

But a study published Wednesday in JAMA Facial Plastic Surgery, says there’s a third category of patients pursuing rhinoplasty, the surgical name for a nose job. People in this group may be struggling with mental health issues and, it seems, have body dysmorphia about their noses.

In the new study, Erika Stradzins of the University of New South Wales in Australia looked at 495 Australians pursuing cosmetic surgery. The majority were women, but a substantial portion — 193 — were men. The patients underwent various tests of their nose’s function, like a measurement of their nasal peak inspiratory flow, which involves this fun-looking device:

nasal inspiratory flow monitor rhinoplasty nose job body dysmorphia new research
A peak nasal inspiratory flow monitor in action.

See also: What Azealia Banks Is Talking About When She’s Defending Skin Lightening

Then, the patients rated their perception of their nose’s functioning. It was between these two numbers — the empirical observation and the internal assessment — that researchers found a stark divide.

Among patients with good mental health, real and perceived nose functioning were relatively similar. But in patients with poor mental health, many thought that their noses weren’t functioning well — even though, by external measures, they were. The researchers argue this is a form of body dysmorphia, where people become occupied with what they see as their malformed physique.

This new data probably isn’t a total shocker, especially if you live in the United States. According to Pew, 58 percent of Americans say they’re skeptical that plastic surgery is an appropriate use of modern medicine. In an environment like that, it’s easy to think that the 4 percent of Americans who have elected to undergo cosmetic surgery are doing so out of fear, self-loathing, or other negative reasons. Meanwhile in Seoul, South Korea, where more than half of young women have gone under the knife, conversation around cosmetic surgery has a slightly more positive — or at least pragmatic — spin.

Instead of just being a source of confirmation bias, however, Stradzins’s research on the relationship between mental health and rhinoplasty could have clinical value. While many people can obtain cosmetic surgery for purely cosmetic reasons, many doctors — and insurance companies — treat patients who self-report functional issues from the shape of their nose, like breathing difficulty. Stradzins’s study suggests those reports aren’t all correct. While patient-doctor trust is important, in some cases doctors might need to engage potential nose job recipients in more serious conversations about their mental health.

See also: Doctor Discovers Unexpected Role of Fake Breasts in Gun Defense


You've read that, now watch this: "4 Stem Cell Breakthroughs Happening Right Now"