Rhinoplasty—Do Patients and Surgeons See the Same? A Double-Blind Study with 100 Randomized Patients

Abstract

One of the key points of a successful rhinoplasty is communication between the patient and surgeon. The surgeon needs to get a clear understanding of the patient's motivation for surgery and expectations of the procedure. This information is mandatory in formulating an optimal surgical plan and managing realistic expectations of the procedures. Ideally, surgeons and patients see, discuss, and quantify the same nasal defects. In reality, the subjective nature of perceiving aesthetics can cause variability of inter-rating nasal appearance. Therefore, one might question how well surgeons understand their patients. Do they see what patients see? The aim of this study is to assess the level of agreement on the evaluation of nasal appearance between patients, surgeons, and nonphysicians observers, and try to find predictive factors that cause high interobserver variability. This prospective, observational, and cross-sectional study was performed on a total of 100 randomized patients undergoing rhinoplasty. All patients were photographed before surgery and asked to rate the appearance of their nose on a 10 cm visual analogue scale (VAS) with 0 indicating very ugly and 10 indicating very nice. Subsequently, the photographs of each patient were, independently, rated by two panels: one constituted by two rhinoplasty surgeons and the other by four nonmedical raters. Both panels included European raters from the north (The Netherlands) and south (Portugal). Data regarding age, gender, skin type, and major nasal deformity were also collected. The authors found that there is no statistical agreement between the aesthetical evaluation of the nose between patients and surgeons or patients and nonmedical raters. Based exclusively on the VAS for subjective evaluation of nasal appearance, the authors' findings show that surgeons and patients do not "see the same" and generally, the score attributed by the surgeon is more favorable (almost 1 point higher) than the auto-assessment's score. This is important to realize when communicating about nasal appearance before rhinoplasty.

Modified Dorsal Split Preservation Hybrid Rhinoplasty for Cartilaginous Pushdown and Full Letdown Applications: A PROM-Based Review of 100 Consecutive Cases

“…30,31 PROMs are indeed used with increasing frequency in assessing rhinoplasty result and have been shown to be of comparable importance to photo documentation. 34,35 In our cohort of patients, the data we derived regarding aesthetic results are encouraging and confirm our impression that the dorsal split preservation technique is versatile and effective. This was clearly demonstrated by a constant and significant reduction in the SCHNOS-C score.…”

Unveiling the Impact of Three-Dimensional Technology on Rhinoplasty: A Systematic Review and Meta-analysis

“…[5][6][7] This satisfaction is a key factor in the success of rhinoplasty surgeries. 8,9 Despite significant advancements in surgical technique, the results that do not meet the patient satisfaction could lead to a number of revisions and secondary rhinoplasty surgeries. [10][11][12][13][14] Patient satisfaction includes the visible result of the procedure, the degree to which the expectations are met, communication between the patient and the surgeon, understanding of the procedure prior to surgery, and the overall experience of the surgical process.…”

“…[10][11][12][13][14] Patient satisfaction includes the visible result of the procedure, the degree to which the expectations are met, communication between the patient and the surgeon, understanding of the procedure prior to surgery, and the overall experience of the surgical process. 8,15 Preoperative evaluation is a crucial process for successful rhinoplasty procedures.…”

Outcome-based Comparative Study to Examine the Correction of Columella Deformities following Rhinoplasty

“…In current practice, this is a challenge that presents itself routinely in the office or clinic when talking to patients who are about to embark on this complex operation or who have undergone rhinoplasty. 2 There is no doubt that across the United States, Europe, Middle East, and South America, there is a huge variability in the tolerance of patients toward a poor outcome. It has become a fad to share rhinoplasty outcome images widely on social media.…”