Aesthetic Science of Rhinoplasty: Three Principles

Gruber RP, Holland M, Rochlin D, Sue G, Moshrefi S.

PubMed 35441238 Publisher (DOI)Free full text (PMC)

What this paper says

An opinion article proposing three principles for aesthetic rhinoplasty, symmetry, continuity and persistence, drawn from research on how the brain responds to visual information.

Overview

The authors describe aesthetic science as a growing discipline concerned with how and why the human brain responds to the visual world. They argue plastic surgery is part of that movement because it applies aesthetic principles directly. Surgeons should therefore be familiar with those principles in order to define and reach the aesthetic goal alongside any functional goal.

Sections of note

Opinion article; the journal assigns level of evidence V, the lowest tier.
The abstract reports no patient numbers, no outcomes and no follow up.
Three principles are proposed for rhinoplasty: symmetry, continuity and persistence.
The article gives examples of how each applies before, during and after surgery.
The authors state a firm understanding of these principles guides decision making, operative planning and surgical execution.
Aesthetic rhinoplasty is described by the authors as arguably the most difficult aesthetic operation in plastic surgery.

What it means for a patient

The three principles concern how a nose is perceived rather than what technique is used.
Continuity refers to unbroken lines and surfaces; persistence to a result that holds over time.
This is expert opinion with no data supporting the principles or their effect on results.
The article offers a framework for surgical judgment rather than any measurable standard.

Why this paper matters

Rhinoplasty decisions rest heavily on individual aesthetic judgment, which is difficult to teach or examine. This article attempts to ground that judgment in visual perception research. Whether applying these principles produces better rated results has not been tested.

Terms

Aesthetic science: the study of how people perceive and judge visual appearance.
Symmetry: correspondence between the two sides of a structure.
Continuity: unbroken lines and smooth transitions across a surface.
Persistence: a result that holds its form over time.
Level of evidence V: expert opinion, the weakest evidence category.

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

Abstract

Aesthetic science is a rapidly growing discipline that involves plastic surgery as much or more than other disciplines of science. Fortunately, how and why the human brain responds to the visual world is better understood now than ever before. Of necessity plastic surgery is a part of that aesthetic science movement because it deals directly with the application of aesthetic principles. Therefore, it behooves the surgeon to be familiar with the principles of aesthetic science so as to both delineate and attain the aesthetic goal at the same time any functional goal is part of the operation. There are three important principles for rhinoplasty: (1) symmetry, (2) continuity and (3) persistence. This study provides examples of how they apply in the preop, intraop and postop phase of performing aesthetic rhinoplasty. A firm understanding of these principles can then guide the surgeon through the difficult maze of decision making, operative planning and surgical execution that arguably makes aesthetic rhinoplasty the most difficult aesthetic operation in plastic surgery. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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