JAMA FPS JAMA Facial Plastic Surgery · 2019

Assessment of Casual Observers' Willingness to Pay for Increased Attractiveness Through Rhinoplasty

Chen D, Ishii M, Nellis J, Bater K, Darrach H, Liao D, Joseph A, Byrne P, Boahene K, Papel I, Kontis T, Ishii LE.

PubMed 30543344 Publisher (DOI)Free full text (PMC)

What this paper says

Surveying 228 observers, the baseline value placed on a rhinoplasty with no change in attractiveness was $3,769.98, rising by $2,353.77 for each standard deviation gained in attractiveness.

Overview

Willingness to pay is an established economic method for valuing a benefit. This cross-sectional survey applied it to rhinoplasty, asking members of the public to rate the change in attractiveness in before and after photographs and to attach a dollar value to that change.

Sections of note

Cross-sectional survey administered through public online forums to 228 casual observers.
Participants viewed preoperative and postoperative photographs of 12 patients who had cosmetic rhinoplasty and 4 who had no surgery.
They rated the change in overall attractiveness and the monetary value they associated with it.
144 of 228 respondents were female (63.2%); median age 25 years, median income bracket $50,000 to $75,000.
Analysis used multilevel mixed-effects linear regression.
Baseline value of a rhinoplasty with no change in attractiveness: $3,769.98, 95% CI $3,541.59 to $4,007.10, P below .001.
One standard deviation gain in attractiveness was worth an additional $2,353.77, 95% CI $2,197.57 to $2,512.81; two standard deviations an additional $5,453.07, 95% CI $5,052.57 to $5,865.51, both P below .001.

What it means for a patient

The public attached a floor value of roughly $3,770 to the operation even when they saw no change in attractiveness.
Each further step in perceived attractiveness added roughly $2,350 of perceived value.
The authors note the average valuation approximates the actual average cost of cosmetic rhinoplasty.
Limits: 12 patients, 228 online respondents skewing young, still photographs, and hypothetical rather than actual spending.

Why this paper matters

It applies a standard health economics method to a self-funded cosmetic procedure, where price is set by market rather than by evidence. Finding that public valuation tracks actual price is the notable result. Hypothetical willingness to pay is known to differ from real purchasing behavior.

Terms

Willingness to pay: An economic method valuing a benefit by what people say they would pay for it.
Contingent valuation: A survey technique estimating value for something not directly bought and sold.
Standard deviation: A measure of how spread out values are; here, a step in attractiveness rating.
Cross-sectional survey: A survey taken at one point in time.
Casual observer: A member of the public with no professional connection to the field.

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

Abstract

Importance: Contingent valuation, or willingness to pay, is an established economic concept that has been applied in other areas of medicine and may be useful for understanding the economic forces that determine the cost of cosmetic procedures.

Objective: To determine the monetary value of changes in attractiveness achieved through rhinoplasty, as perceived by society.

Design, Setting, And Participants: Cross-sectional survey administered via public online forums to 228 casual observers.

Main Outcomes And Measures: Participants were shown preoperative and postoperative photographs of 12 patients who underwent cosmetic rhinoplasty and 4 patients who did not undergo any surgery. They were asked to rate (1) the change in overall attractiveness of the patients, and (2) the monetary value they would associate with these changes.

Results: Completed surveys were obtained from 228 casual observers; 144 were female (63.2%); median age, 25 years (median income bracket, $50 000-$75 000). Multilevel, mixed-effects, linear regression was used to characterize the association between monetary value and change in attractiveness. There was a significant association between the change in attractiveness from a rhinoplasty and its monetary value as perceived by society. The baseline value of a rhinoplasty without any change in attractiveness was $3769.98 (95% CI, $3541.59-$4007.10; P < .001). To increase 1 standard deviation in attractiveness was worth an additional $2353.77 (95% CI, $2197.57-$2512.81; P < .001), while increasing 2 standard deviations in attractiveness was worth an additional $5453.07 (95% CI, $5052.57-$5865.51; P < .001).

Conclusions And Relevance: There is a significant association between the societally perceived value of cosmetic rhinoplasty and the change in attractiveness after surgery. The average value of a rhinoplasty in our study approximates the actual average cost of cosmetic rhinoplasty, suggesting that willingness to pay may be a useful concept for studying the value of cosmetic procedures.

Level Of Evidence: NA.

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