JAMA FPS JAMA Facial Plastic Surgery · 2018

Association of Rhinoplasty With Perceived Attractiveness, Success, and Overall Health

Nellis JC, Ishii M, Bater KL, Papel ID, Kontis TC, Byrne PJ, Boahene KDO, Ishii LE.

PubMed 29049490 Publisher (DOI)Free full text (PMC)

What this paper says

473 blinded observers rating 13 patients' faces before or after rhinoplasty judged the postoperative faces significantly more attractive, more successful, and healthier, with attractiveness shifting an average of 14 rank positions out of 100.

Overview

Whether rhinoplasty changes how other people perceive a patient had not been measured. In this web-based survey, casual observers who did not know which images were before or after rated faces on three social dimensions. Statistical modeling accounted for differences between observers.

Sections of note

Blinded observers viewed independent images of 13 unique patient faces, either before or after rhinoplasty.
The Delphi method was used to select standardized images and confirm patient candidacy and surgical effect.
Ratings covered attractiveness, perceived success, and perceived overall health, on a visual analogue scale from 0 to 100.
473 observers completed the survey; mean age 29 years, range 18 to 73; 305 (70.8%) female.
Postoperative faces were rated significantly more attractive, effect 6.26, 95% CI 5.10 to 7.41.
More successful, effect 3.24, 95% CI 2.32 to 4.17; healthier, effect 3.78, 95% CI 2.79 to 4.81.
Estimated ordinal rank change for an average individual: 14, 9, and 10 positions out of 100 for attractiveness, success, and health.

What it means for a patient

Observers who knew nothing about the surgery judged the postoperative faces more favorably on all three measures.
The effect sizes are modest, roughly 3 to 6 points on a 100-point scale.
The authors note these results represent optimal outcomes, since images were selected as good surgical candidates with confirmed surgical effect.
Limits: only 13 patient faces, still images rather than people in motion, and observers rating strangers rather than acquaintances.

Why this paper matters

Claims that rhinoplasty changes how one is treated socially have been anecdotal, and this measures them under blinded conditions. The reported shift extends beyond attractiveness to inferred success and health. Whether the effect translates into real-life social or work outcomes is untested.

Terms

Blinded observer: A rater who does not know which condition an image represents.
Delphi method: A structured process for reaching expert consensus through rounds of review.
Visual analogue scale: A 0 to 100 line on which a rater marks a judgment.
Ordinal rank change: How many places a person would move in a ranked list of 100.
Multivariate mixed-effects regression: A statistical model separating the treatment effect from differences between raters.

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

Abstract

Importance: To date, the impact of rhinoplasty surgery on social perceptions has not been quantified.

Objective: To measure the association of rhinoplasty with observer-graded perceived attractiveness, success, and overall health.

Design, Setting, And Participants: In a web-based survey, blinded casual observers viewed independent images of 13 unique patient faces before or after rhinoplasty. Delphi method was used to select standardized patient images, confirming appropriate patient candidacy and overall surgical effect. Observers rated the attractiveness, perceived success, and perceived overall health for each patient image. Facial perception questions were answered on a visual analog scale from 0 to 100, where higher scores corresponded to more positive responses. A multivariate mixed-effects regression model was used to determine the effect of rhinoplasty while accounting for observer biases. To further characterize the effect of rhinoplasty, estimated ordinal rank change was calculated for each domain.

Main Outcomes And Measures: The primary objective was to measure the effect of rhinoplasty on observer-graded perceived attractiveness, success, and overall health.

Results: A total of 473 observers (mean age, 29 years [range, 18-73 years]; 305 [70.8%] were female) successfully completed the survey. On multivariate regression, patients after rhinoplasty were rated as significantly more attractive (rhinoplasty effect, 6.26; 95% CI, 5.10-7.41), more successful (rhinoplasty effect, 3.24; 95% CI, 2.32-4.17), and overall healthier (rhinoplasty effect, 3.78; 95% CI, 2.79-4.81). The ordinal rank change for an average individual's perceived attractiveness, success, and overall health was a positive shift of 14, 9, and 10 out of 100 rank positions, respectively.

Conclusions And Relevance: As perceived by casual observers, rhinoplasty surgery was associatedwith perceptions that in patients appeared significantly more attractive, more successful, and healthier. These results suggest patients undergoing rhinoplasty may derive a multifaceted benefit when partaking in social interactions. Furthermore, these results facilitate improved patient discussions aiming to provide more precise surgical expectations with an understanding that these results represent optimal outcomes.

Level Of Evidence: NA.

Abstract as indexed by PubMed; the article is open access (PubMed Central).