Ethical considerations in aesthetic rhinoplasty: a survey, critical analysis, and review

Karimi K, McKneally MF, Adamson PA.

What this paper says

Surveyed on 15 ethical dilemmas in cosmetic rhinoplasty, fellowship directors and fellows of the American Academy of Facial Plastic and Reconstructive Surgery disagreed significantly on 5 scenarios, and no scenario drew unanimous agreement in either group.

Overview

Cosmetic surgery raises ethical questions that general medical ethics does not settle: whom to operate on, what to promise, how to handle money and marketing. The authors wrote 15 short case scenarios from the senior author's nearly 30 years of practice and teaching and asked experienced and trainee facial plastic surgeons how they would act.

Sections of note

Anonymous survey of fellowship directors and facial plastic surgery fellows of the AAFPRS; the abstract gives no response counts.
15 clinical vignettes on ethical quandaries in aesthetic rhinoplasty, based on the senior author's (P.A.A.) experience.
5 of 15 vignettes showed significant differences between directors and fellows.
No vignette reached unanimous consensus in either group.
The paper offers a practical approach to ethical issues in clinical practice and proposes the survey as a teaching tool.
The specific vignettes and the direction of disagreement are not described in the abstract.

What it means for a patient

Surgeons do not all agree on when to decline an operation or how to handle difficult situations, even within one specialty.
Experience changes surgeons' answers on some questions.
The abstract does not say which dilemmas divided them, so no specific guidance can be drawn from it.

Why this paper matters

Ethics in aesthetic surgery is rarely studied with data. This survey documents real disagreement between generations of surgeons and argues for teaching ethics before trainees meet the situations. Which answers are right, and whether teaching changes practice, are not tested.

Terms

Vignette: a short written case scenario used to prompt a decision.
Fellowship: a year of subspecialty training after residency; here in facial plastic surgery.
Fellowship director: the senior surgeon who runs a fellowship program.
AAFPRS: the American Academy of Facial Plastic and Reconstructive Surgery.
Aesthetic rhinoplasty: nose surgery done for appearance rather than breathing or reconstruction.
Consensus: agreement across all respondents.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

From the abstract

“Although the practice of medicine is built on a foundation of ethics, science, and common sense, the increasing complexity of medical interventions, social interactions, and societal norms of behavior challenges the ethical practice of aesthetic surgeons. We report a survey of the opinions, practices, and attitudes of…”

Excerpt; the full abstract is on PubMed.