Generic Health-Related Quality-of-Life Changes after Rhinoplasty: A Prospective Study with Long-Term Results

Overview

The study investigated which general health related quality of life domains change after rhinoplasty, whether the changes differ between patients motivated by breathing and those motivated by appearance, and whether the changes relate to functional or aesthetic improvement. Fifty four consecutive Caucasian patients were assessed prospectively with two general quality of life questionnaires plus nose specific measures.

Sections of note

• Prospective study with 1 year follow up; 54 patients; level of evidence IV.
• Instruments were the SF-36 and the EQ-5D for general quality of life.
• Nose specific assessment used peak nasal inspiratory flow, the NOSE scale, a visual analogue scale for obstruction, and the Rhinoplasty Outcome Evaluation.
• Significant improvement was found in EQ-5D, P less than 0.001, and its visual analogue scale, P equals 0.002.
• SF-36 domains improving significantly were general health, energy, physical functioning, physical limitation, pain and wellbeing.
• Improvement was significant in patients with nasal obstruction and in those who had a septoplasty.
• The improvement was associated with patient reported functional improvement.
• Emotional limitation and social functioning were not significantly changed by rhinoplasty.

What it means for a patient

• General wellbeing improved, but the gain tracked better breathing rather than a better looking nose.
• Emotional and social functioning, which cosmetic surgery is often expected to improve, did not change significantly.
• The improvements included physical domains such as energy and pain, consistent with relief of nasal obstruction.
• Fifty four Caucasian patients at one centre with no control group limits how far this generalizes.

Why this paper matters

Rhinoplasty is often justified by improved wellbeing, and this study separates which part of the operation drives that. It attributes the gain to function rather than appearance. Why social and emotional domains did not change is unexplained.

Terms

• Health related quality of life: how health affects daily functioning and wellbeing.
• SF-36: a 36 item general health survey covering multiple domains.
• EQ-5D: a general quality of life questionnaire covering five dimensions.
• Peak nasal inspiratory flow: the maximum airflow during a forced sniff.
• NOSE scale: the Nasal Obstruction Symptom Evaluation questionnaire.
• Septoplasty: surgery to straighten the central partition of the nose.