FPS Facial Plastic Surgery · 2018

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

Ferreira MG, Santos M, Carmo DOE, Neves JC, Sousa CAE, Datema FR.

What this paper says

Across 100 patients rating their own noses against ratings by two surgeons and four lay observers, there was no statistical agreement, and surgeons scored the noses almost 1 point higher out of 10 than patients did themselves.

Overview

A successful rhinoplasty depends on the surgeon and patient agreeing on what is wrong. This prospective cross-sectional study tested whether they actually do, comparing a patient's own rating of their nose against independent ratings by surgeons and by non-medical observers.

Sections of note

Prospective, observational, cross-sectional study of 100 randomized patients undergoing rhinoplasty.
All patients were photographed before surgery and rated their own nose on a 10 cm visual analogue scale, 0 being very ugly and 10 very nice.
Photographs were rated independently by two panels: two rhinoplasty surgeons, and four non-medical raters.
Both panels included European raters from the north, the Netherlands, and the south, Portugal.
Age, gender, skin type, and major nasal deformity were also recorded.
No statistical agreement was found between patients and surgeons, or between patients and non-medical raters.
Surgeons' scores were on average almost 1 point higher than patients' self-assessments.

What it means for a patient

Surgeons rated these noses better looking than the patients themselves did, by nearly a full point out of ten.
Lay observers also failed to agree with patients, so the mismatch is not specific to surgical training.
The practical implication is that a consultation must establish what the patient sees rather than assume it is shared.
Limits: preoperative ratings only, a single overall score rather than feature-by-feature, two surgeons and four lay raters, and no linkage to postoperative satisfaction.

Why this paper matters

Mismatched perception is a plausible root of dissatisfaction after technically sound surgery, and this measures the gap directly. The consistent direction, surgeons rating higher, is the notable finding. Whether the gap predicts postoperative dissatisfaction is not tested here.

Terms

Visual analogue scale: A line on which a rater marks a judgment, here from 0 to 10.
Interobserver variability: How much different observers disagree when rating the same thing.
Cross-sectional study: A study measuring a group at one point in time.
Self-assessment: A rating a person gives of their own feature.
Double-blind: Neither raters nor patients knew each other's scores.

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

From the 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…”

Excerpt; the full abstract is on PubMed.