APS Aesthetic Plastic Surgery · 2021

The Role of Age and Gender on Perception of Women After Cosmetic Rhinoplasty

Parsa KM, Charipova K, Coerdt K, Clark CM, Wang H, Chu E, Reilly MJ.

PubMed 33123780 Publisher (DOI)Free full text (PMC)

What this paper says

Across 174 blinded observers rating photographs of 20 women before and after cosmetic rhinoplasty, postoperative photographs were rated significantly more sociable, attractive, feminine and confident.

Overview

Rhinoplasty is known to increase rated attractiveness, but whether the observer's own age and gender change that judgment was undetermined. This retrospective cross sectional study used photographs of 20 women operated on between January 2012 and December 2019. Four surveys were built, each with 10 sets of photographs, five preoperative and five postoperative, arranged so no patient appeared twice in one survey.

Sections of note

Twenty women, mean age 28.2 years; 174 respondents completed the surveys, 62 percent female, largest age band 25 to 34 at 41 percent.
Each survey went to at least 30 lay people through a web based tool; respondents were anonymous and blinded.
Ratings used a 7 point scale for aggressiveness, likeability, sociability, trustworthiness, attractiveness, femininity, intelligence and confidence.
Overall, postoperative photographs scored higher for sociability 0.13, attractiveness 0.21, femininity 0.18 and confidence 0.15.
Male respondents rated the women less aggressive by 0.42 and higher on likeability, sociability, trustworthiness, attractiveness, femininity and intelligence.
Female respondents recorded increases only in attractiveness, 0.16, and femininity, 0.18.
Raters aged 25 to 34 showed improvement across all traits; respondents over 55 showed only increased trustworthiness, 0.51.

What it means for a patient

Strangers judged the same women differently after surgery, including on traits unrelated to appearance such as trustworthiness and intelligence.
Male observers and those aged 25 to 34 showed the largest shifts.
The effect sizes are small on a 7 point scale, typically a fifth of a point.
Twenty patients and photographs alone cannot represent real life interaction, and the study says nothing about the patients' own satisfaction.

Why this paper matters

Social perception is one of the stated motivations for cosmetic nasal surgery, and this study measures whether observers actually respond differently. It shows the response varies with who is looking. Whether these rating shifts translate into any real world difference is unknown.

Terms

Cross sectional study: one measuring a group at a single point in time.
Blinded respondent: a rater who does not know which photographs are before or after surgery.
Likert scale: an ordered rating scale, here with seven points.
Confidence interval: the range in which the true value is likely to lie.
Recall bias: distortion caused by a rater remembering an earlier image.

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

Abstract

Background: Rhinoplasty is known to increase attractiveness; however, the influence of observer age and gender are largely undetermined.

Methods: This retrospective cross-sectional study included 20 women who underwent cosmetic rhinoplasty between January 1st, 2012, and December 31st, 2019. A total of 4 surveys were constructed with 10 sets of photographs each (5 preoperative and 5 postoperative). Surveys were designed such that photographs of the same patient were not placed in the same survey to avoid recall bias. Each of these surveys were then sent to at least 30 lay people via a web-based survey tool. Anonymous blinded respondents used a 7-point Likert scale to rate their perception of each patient's aggressiveness, likeability, sociability, trustworthiness, attractiveness, femininity, intelligence and confidence. A multivariate linear mixed effect model was applied to analyze the overall patient trait data as well as to assess age and gender differences.

Results: This survey study included photographs of 20 women (mean age, 28.2 years) before and after cosmetic rhinoplasty. A total of 174 respondents (mean age range, 25-34 years [41%]; 108 [62%] were female) completed the survey. Overall, postoperative photographs were perceived as significantly more sociable (0.13; 95% CI, 0.01-0.25), attractive (0.21; 95% CI, 0.09-0.34), feminine (0.18; 95% CI, 0.05-0.30), and confident (0.15; 95% CI, 0.02-0.27). When analyzed by sex, men rated women as less aggressive (-0.42, 95% CI, -0.65,-0.17) and more likeable (+0.45, 95% CI, 0.21-0.69), sociable (+0.38, 95% CI, 0.14-0.62), trustworthy (+0.37, 95% CI, 0.13-0.61), attractive (+0.60, 95% CI, 0.35-0.84), feminine (+0.23, 95% CI, 0.07-0.41) and intelligent (+0.29, 95% CI, 0.04-0.53). In contrast, female respondents indicated an increase in perceived attractiveness (+0.16, 95% CI, 0.06-0.22) and femininity (+0.18, 95% CI, 0.03-0.32) for women after rhinoplasty. Raters aged 25-34 indicated improvements across all traits analyzed. Almost all age ranges rated post-operative photographs as more attractive (18-24: +0.32, 95% CI, 0.19-0.46; 25-34: +0.52, 95% CI, 0.33-0.72; 35-44: +0.29, 95% CI, 0.12-0.51; 45-54: +0.50, 95% CI, 0.11-0.89) while individuals over age 55 only indicated increased trustworthiness (+0.51, 95% CI, 0.03-0.99).

Conclusions: These findings suggest that cosmetic rhinoplasty improves perceptions of personality and physical traits of women with males and individuals aged 25-34 indicating the greatest benefit.

Level Of Evidence: Level IV.

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