An Overview of Rhinoplasty Practices: European Academy of Facial Plastic Surgery, Collaborative Cross-Sectional Study

Overview

The European Academy of Facial Plastic Surgery ran a multicenter cross sectional study to describe how rhinoplasty is actually practiced. Members were emailed and invited to anonymously complete a questionnaire covering the operations they performed as first or supervising surgeon between 1 January 2019 and 1 January 2022. Reporting followed the STROBE guidelines for observational studies.

Sections of note

• 115 surgeons submitted data on 41,259 rhinoplasties from 33 countries. The authors state this is the largest published rhinoplasty dataset.
• 80 percent were primary operations and 20 percent secondary.
• Primary cases: 35 percent closed and 65 percent open. Indications were 31 percent cosmetic, 11 percent functional and 58 percent both.
• Of 8147 secondary cases: 44 percent closed and 56 percent open, with indications 30 percent cosmetic, 11 percent functional, 59 percent both.
• Surgeon specialty: 91 percent ENT, 5 percent maxillofacial, 3 percent plastic surgery, 1 percent dual trained.
• Revision surgery followed 1730 primary rhinoplasties, 5 percent, and 102 secondary rhinoplasties, 1 percent.
• Most common indications for revision: dorsal asymmetry, nasal blockage and dissatisfaction with the tip.
• Only 3 percent of patients had a preoperative psychological assessment.

What it means for a patient

• Most rhinoplasties in this sample were done for both appearance and breathing rather than for either alone.
• The reported revision rate after first time surgery was about 1 in 20, though revisions performed elsewhere would not be captured in a surgeon's own returns.
• Psychological screening before surgery is rare, and the authors state higher levels are needed to reduce unsuccessful outcomes.
• Limits: self reported questionnaire data, voluntary participation, and a membership heavily weighted toward ENT surgeons in Europe.

Why this paper matters

Rhinoplasty practice has been described mostly through single surgeon series, leaving basic questions about how common each approach is unanswered. This dataset provides benchmarks for approach, indication and revision. It cannot verify the self reported figures or link them to outcomes.

Terms

• Primary rhinoplasty: a first nose operation, with no previous nasal surgery.
• Secondary rhinoplasty: surgery on a nose that has already been operated on.
• Open and closed approach: with or without an external incision on the columella.
• Cross-sectional study: a study measuring a population at one point in time.
• STROBE: a checklist governing how observational studies are reported.