But science has to nail things down to the bricks and mortar of what must be identifiably different in a person with BDD. They have found abnormally active circuits. That is the facts. A person with BDD generally doesn't have any abnormality in looks. Of course there is probably strong genetics behind this phenomena.
So
I have a strong bias for aesthetics and I care immensely about the ways things look
,
is the reason your doubting fired up to create BDD. If you hadn't cared then you would have been able to accept the doubt. But surgery hasn't removed the doubt even though you have a more acceptable look. The doubt will always connect to something you might fear or care about the most.
Accepting that you doubt your looks doesn't mean you accept that you are ugly. You don't have to give the doubt any meaning other than it is a thought coming from your anxious brain. Turning doubt into a negative fear is the follow on that you try to avoid but most likely will feel intensely.
Better understanding of how you create the feelings of danger from the doubting is a rational step to take. It is the story that is missing in the jigsaw. Marg