Difference in Perception of Nasal Aesthetic Appearance Between Surgeons and Rhinoplasty Patients: A Single-Center Perspective

Overview

Patient satisfaction is an essential outcome after rhinoplasty, but whether patients and surgeons see nasal appearance the same way was unknown. The study examined a retrospective group of 300 patients seen in consultation for cosmetic, functional or combined rhinoplasty at one tertiary centre between June 2017 and June 2020, comparing surgeon ratings of their preoperative photographs against the patients' own scores.

Sections of note

• Retrospective cohort of 300 patients; 100 each in the cosmetic, functional and combined subgroups.
• Mean age was 35.4 plus or minus 13.7 years; 64 percent were women.
• Six surgeons of varying experience rated nasal appearance from preoperative images using a modified SCHNOS appearance survey.
• Those scores were compared with the patients' own SCHNOS appearance scores.
• Surgeon scores correlated well with each other.
• Correlations between patient scores and surgeon scores were weak, from 0.07 to 0.20.
• Cosmetic subgroup patients rated their appearance problems as more severe than the surgeons did.
• Functional subgroup patients rated their appearance problems as milder than the surgeons did.

What it means for a patient

• Surgeons agreed closely with each other and with the patients hardly at all.
• Patients seeking cosmetic surgery saw their nose as worse than surgeons did; patients seeking breathing surgery saw it as better.
• The mismatch concerns how the nose looks before surgery, which is the starting point for any discussion of goals.
• This was one centre and surgeons rated only photographs, not the patients in person.

Why this paper matters

Rhinoplasty outcomes are increasingly judged by patient reported scores, and this study shows those scores measure something different from what surgeons see. That gap affects both planning and how results are assessed. Whether narrowing it would improve satisfaction is unaddressed.

Terms

• SCHNOS-C: the appearance section of the Standardized Cosmesis and Health Nasal Outcomes Survey.
• Cosmetic rhinoplasty: surgery aimed at the appearance of the nose.
• Functional rhinoplasty: surgery aimed at nasal breathing.
• Correlation: a measure of how closely two sets of scores move together, from 0 to 1.
• Retrospective cohort: a group identified and analysed from existing records.