Using Nasal Self-Esteem to Predict Revision in Cosmetic Rhinoplasty

Okland TS, Patel P, Liu GS, Most SP.

What this paper says

Among 148 cosmetic rhinoplasty patients, those who rated their nose as most damaging to their mood and self esteem before surgery had revision rates of 16.7 and 18.8 percent, while those with lower ratings had a revision rate of zero.

Overview

The authors asked whether a single existing questionnaire item could identify patients at higher risk of needing revision surgery. They reviewed charts of 148 patients who had cosmetic rhinoplasty, collecting SCHNOS questionnaire results before and after surgery along with rates of actual revision and of patient initiated discussions about revision. Patients were sorted by their answer to question 5, which asks about decreased mood and self esteem due to the nose.

Sections of note

Retrospective chart review of 148 cosmetic rhinoplasty patients.
Women made up 72.9 percent; mean age 30.9 years, range 15 to 59, standard deviation 10.3.
Patients answering 4 on question 5 had a 16.7 percent revision rate and a 27.8 percent revision discussion rate.
Patients answering 5 had an 18.8 percent revision rate and a 31.25 percent revision discussion rate.
Patients answering 0 through 3 had a 0 percent revision rate and a 10.4 percent revision discussion rate.
On logistic regression with Bonferroni correction, only question 5 predicted revision, P equals 0.0484, and revision discussion, P equals 0.0257.
The authors conclude the question is a useful adjunct in guiding surgical management.

What it means for a patient

How much distress a nose causes before surgery, not just how it looks, was associated with wanting further surgery afterward.
No patient scoring 3 or below on that question underwent revision in this series.
This is a retrospective review at one centre with no independent validation.
The finding is an association. It does not show that low nasal self esteem causes dissatisfaction, or that anyone should be refused surgery.

Why this paper matters

Predicting who will be unhappy after rhinoplasty is a long standing problem tied to body dysmorphic concerns and consultation practice. This study finds a signal in a single question already asked routinely. Whether the threshold holds in other populations, and what should be done with a high score, is unresolved.

Terms

Revision rhinoplasty: a further operation to change the result of previous nasal surgery.
SCHNOS: the Standardized Cosmesis and Health Nasal Outcomes Survey, covering appearance and breathing.
Logistic regression: a statistical method for predicting a yes or no outcome.
Bonferroni correction: a statistical adjustment that guards against false findings when many items are tested.

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

From the abstract

“It would be useful if existing tools or outcomes measures could predict which patients are at greater risk of revision surgery following rhinoplasty. Objectives: The authors sought to determine if a single question assessing nasal self-esteem could be utilized to predict which patients are at greatest risk of revision…”

Excerpt; the full abstract is on PubMed.