I read about this several years ago, a particular case struck where a young man had his legs amputated! He was never required to seek counseling, I really found that disgusting. Like cosmetic surgery without any attention to the psychological state of the patient... check out Amanda Lapore.
I would argue that we dye our hair, whiten our teeth, tan, lose weight, gain weight, get tattoos, get hair cuts, style our hair, wear contacts, paint our nails, shave, and then even cosmetic surgery like you mentioned. We get breast implants, liposuction, nose jobs, botox and on and on all without getting counseling before hand.
Why is it disgusting if this guy didn't have to get counseling before having his leg removed? I mean, isn't it all really the same thing?
I should edit to add that I have a lot of problems with the way I look. I don't mean mentally, but actually physically wrong. Certain aspects of me are awful, and it's not something I am imagining. (mostly from doctors and what not) I would give anything, anything.... to know that the things I see in the mirror were only in my head instead of being reality. People don't realize how lucky they are that it's just BDD (even though I understand it must be difficult to think you are ugly even though you aren't) and not reality.