Feeling Normal? Long-Term Follow-up of Patients with a Cleft Lip-Palate after Rhinoplasty with the Derriford Appearance Scale (DAS-59)

Overview

A nasal deformity from a cleft lip and palate carries a lasting stigma. The authors asked whether rhinoplasty, single or repeated, brings self-perception closer to that of the general population. They scored patients before and after surgery with the Derriford Appearance Scale and compared results against published datasets.

Sections of note

• 61 patients had at least one rhinoplasty. 26 answered all questions and were analysed.
• Mean age of responders was approximately 30 years, male to female ratio 1 to 1.2.
• The full scale and every subscale improved significantly after surgery.
• After surgery, facial self-consciousness showed no difference from either a population concerned or unconcerned about appearance.
• General self-consciousness and social self-consciousness after surgery showed no difference from the population concerned about appearance.
• Sexual and bodily self-consciousness improved beyond the level of the concerned control population. The negative self-concept subscale improved only slightly and remained significantly different from the concerned population.

What it means for a patient

• Rhinoplasty improved how these patients saw their own appearance across every measured area.
• On facial self-consciousness they became indistinguishable from people without a cleft, which is the central finding.
• One area, described as negative self-concept, barely shifted, and the authors suggest treatment beyond surgery may be needed for it.
• Only 26 of 61 patients answered fully, scoring was retrospective, and comparison groups came from published datasets rather than a matched control group recruited for the study.

Why this paper matters

Cleft rhinoplasty is usually judged on shape and airway, and this study measures whether it changes how the patient experiences their own appearance. Finding one dimension that surgery did not touch is the more useful result, since it identifies where psychological support would add something surgery cannot. How lasting these gains are is not addressed.

Terms

• Cleft lip and palate: a gap in the lip and roof of the mouth present at birth, which also distorts the nose.
• Derriford Appearance Scale: a validated questionnaire measuring distress and self-consciousness about appearance.
• Subscale: a section of a questionnaire measuring one specific aspect.
• Self-consciousness: awareness of and discomfort about how one appears to others.
• Negative self-concept: a persistently poor view of oneself, beyond appearance alone.
• Psychosocial wellbeing: emotional and social functioning in everyday life.