Morphing as a Selection Tool in the Rhinoplasty Consult: A Cross-Sectional Study

Overview

Simulation is used to show patients a predicted result, but its value as a screening tool had not been studied. This cross-sectional study used the presence or absence of agreement during simulation to decide who was a suitable candidate, then tracked what happened to those accepted.

Sections of note

• 334 consecutive patients seeking rhinoplasty underwent two-dimensional computer imaging and completed a 14-question survey about morphing.
• Patients were divided into accepted or rejected candidates based on whether patient and physician agreed on the expected outcome during simulation.
• 44 patients (13.2%) were rejected because consensus was not achieved.
• Of 290 accepted patients: 178 (53.3%) underwent surgery, 74 (22.1%) postponed, and 38 (11.4%) cancelled.
• 57 percent of rejected patients and 42 percent of those who postponed were not satisfied with the proposed morphing results, versus 16 percent of the operated group.
• 64 percent of rejected patients and 47 percent of those who postponed were not reassured after morphing, versus 26 percent of the operated group.
• The authors conclude satisfaction and reassurance with morphed images predict who will proceed to surgery.

What it means for a patient

• Disagreement about what the simulation shows is treated here as a reason not to operate.
• Roughly 1 in 8 patients was declined on that basis.
• Of those accepted, only just over half went ahead within the study period.
• Limits: single center, cross-sectional, two-dimensional imaging only, and no follow-up on whether rejected patients were correctly identified.

Why this paper matters

Patient selection is the recognized determinant of satisfaction, and this converts a communication tool into a screening one. Using agreement rather than the surgeon's impression makes the decision explicit. Whether declining these patients avoided dissatisfaction is not testable from this design.

Terms

• Morphing: Digitally altering a photograph to show a predicted surgical result.
• Consensus: Agreement between patient and surgeon on the expected outcome.
• Attrition rate: The proportion of patients who do not proceed from consultation to surgery.
• Cross-sectional study: A study measuring a group at one point in time.
• Patient selection: Deciding which patients are appropriate candidates for surgery.