Benefits of a short, practical questionnaire to measure subjective perception of nasal appearance after aesthetic rhinoplasty

Lohuis PJFM, Hakim S, Duivesteijn W, Knobbe A, Tasman AJ.

What this paper says

In 121 cosmetic rhinoplasty patients of one surgeon, a five-question form plus a 0 to 10 scale showed every patient rated their nose as improved, by a mean 4.36 points, and two built-in trick questions predicted how much each patient's score would rise.

Overview

Long outcome questionnaires are rarely used in busy practices. The authors designed a two-minute form with five Likert-scale questions and a visual analogue scale, including two trick questions intended to flag signs of body dysmorphic disorder, and tested it before and after surgery.

Sections of note

Prospective cohort of 121 patients, one surgeon.
Five questions (E1 to E5) on a five-point Likert scale, plus a 0 to 10 visual analogue scale; two questions designed as trick questions.
All patients rated appearance improved; mean VAS improvement 4.36 points (p = 0.018), normally distributed, range 0.5 to 10.
E1, E2 and the E1 to E5 sum improved significantly after surgery.
Linear relationship between preoperative trick-question score and postoperative VAS gain.
Test-retest in 74 of 121 (61%): positive correlation between responses at 1 year and at 2 to 4 years.
Level of evidence IV.

What it means for a patient

A two-minute questionnaire can record how you see your nose before and after surgery and track whether the view holds years later.
The trick questions are meant to spot patients whose expectations may not be met; the abstract does not say how they are worded or scored.
Single surgeon; no validation against established instruments or against a psychiatric diagnosis.

Why this paper matters

It offers a practical patient-reported outcome tool with an embedded screening element, at a time when outcome measurement was becoming expected. Formal validation of the trick questions against a BDD diagnosis is not reported.

Terms

Likert scale: a rating scale with fixed points, here five.
Visual analogue scale (VAS): a line on which a patient marks a rating, here 0 to 10.
Body dysmorphic disorder: preoccupation with a slight or imagined appearance flaw.
Test-retest reliability: whether a questionnaire gives consistent answers when repeated.
Prospective cohort: a group enrolled before treatment and followed forward.
Gaussian distribution: a bell-shaped spread of values around a mean.

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

From the abstract

“The authors tested a short, practically designed questionnaire to assess changes in subjective perception of nasal appearance in patients before and after aesthetic rhinoplasty. Methods: A prospective cohort study was conducted in a group of 121 patients who desired aesthetic rhinoplasty and were operated on by one…”

Excerpt; the full abstract is on PubMed.