Comparison Between Patient and Plastic Surgeon Aesthetic Analysis in Rhinoplasty Consultation

Overview

A surgeon analyzes a nose by measured proportions, while a patient judges it by self image, and rhinoplasty aims at the patient's satisfaction. The authors tested how far the two views coincide. They ran a cross sectional study on 57 primary rhinoplasty consultations at the Plastic Surgery Clinic in King Fahad Hospital, Hofuf, between June and September 2017. Surgeon and patient each completed the same 27 item questionnaire about nasal appearance before the consultation.

Sections of note

• Design: cross sectional study, 57 primary rhinoplasty consultations, single clinic.
• Instrument: identical 27 component questionnaires completed separately by surgeon and patient, with agreement measured by Cohen's Kappa and Pearson's correlation coefficient.
• Overall appearance of the nose showed moderate agreement, kappa 0.2 to 0.39.
• Best agreement: dorsal hump, kappa 0.6, p equal to 0.001, and tip drops down, kappa 0.41, p equal to 0.002.
• Worst agreement: the columella, kappa minus 0.06, and the suitability of the front part of the nose, kappa minus 0.09. Negative values mean agreement below chance.
• Across most questionnaire components agreement was slight or absent, kappa 0.004 to 0.39.

What it means for a patient

• You and your surgeon are likely to agree that you have a hump or a drooping tip, and unlikely to agree about most other features.
• Features seen mainly from the front or from below, such as the columella, are where the two views diverge most.
• The practical consequence is that naming what specifically bothers you, feature by feature, matters more than assuming the surgeon sees the same nose you do.
• Limits: 57 consultations, one clinic, data collected in 2017, and agreement measured before surgery only.

Why this paper matters

Dissatisfaction after rhinoplasty often traces to a mismatch between what the patient wanted changed and what the surgeon set out to change. This study quantifies that gap at the consultation itself. It does not follow patients forward, so whether low agreement predicts unhappiness is unanswered.

Terms

• Dorsal hump: the bump of bone and cartilage on the bridge of the nose.
• Columella: the strip of tissue between the nostrils.
• Cohen's Kappa: a statistic measuring rater agreement beyond chance, where 1 is perfect and 0 is chance.
• Cross-sectional study: a study measuring a group at one point in time.