Relevance of Self-Consciousness of Appearance on Patient Satisfaction in Primary Rhinoplasty: a 12-Month Follow-up Prospective Study

Marangi GF, Faiola A, Cimmino AA, Savani L, Mirra C, Gratteri M, Giuffrè MT, Segreto F, Cogliandro A, Persichetti P.

PubMed 38200126 Publisher (DOI)Free full text (PMC)

What this paper says

Among 50 primary rhinoplasty patients followed for a year, those who ended up satisfied had significantly lower appearance related distress scores than those who did not.

Overview

Rhinoplasty affects quality of life, and patients seeking it show more appearance related distress than the general population. The authors investigated how that distress relates to satisfaction after surgery, adding an independent surgeon assessment. Fifty consecutive patients had primary cosmetofunctional rhinoseptoplasty and completed questionnaires before surgery and over 12 months of follow up.

Sections of note

Design: prospective study, 50 consecutive patients, 12 month follow up. Level of evidence IV.
Instruments: the Derriford Appearance Scale 59 for appearance related distress, and SCHNOS for nasal appearance and blockage.
Three plastic surgeons independently rated outcome on a scale from 1, poor, to 5, excellent.
Patients were divided into a satisfied group and an unsatisfied group.
Mean Derriford score in the satisfied group was significantly lower than in the unsatisfied group, p less than 0.05.
Strong positive correlation between change in Derriford score and change in the SCHNOS cosmesis score over 12 months, r equal to 0.7514, p less than 0.001.
Also correlated: Derriford with SCHNOS obstruction, r equal to 0.5117, both p less than 0.001. Stated conclusion: unrealistic expectations can lead to dissatisfaction even after a properly performed operation.

What it means for a patient

How distressed a person is about their appearance in general, beyond the nose, tracked with how satisfied they were after surgery.
Appearance distress and satisfaction moved together, which the authors read as surgery affecting self consciousness in both directions.
The authors place weight on the first consultation as the point to assess and address expectations.
Limits: 50 patients, one centre, no control group, and correlation between two questionnaires does not establish that distress causes dissatisfaction.

Why this paper matters

Dissatisfaction after technically successful rhinoplasty is a persistent problem, and psychological factors are the usual explanation without much measurement behind it. Using a validated appearance distress scale alongside outcome scores puts numbers on that link. Whether screening with such a scale improves patient selection is untested.

Terms

Self-consciousness of appearance: how much a person's awareness of their looks affects daily life.
Derriford Appearance Scale 59: a validated questionnaire measuring appearance related distress.
SCHNOS: a validated questionnaire scoring both nasal appearance and nasal blockage.
Rhinoseptoplasty: nose surgery that reshapes the outside and straightens the septum.
Correlation coefficient: a number from minus 1 to 1 describing how strongly two measures move together.

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

Abstract

Background: Rhinoplasty procedure has a strong impact on patient quality of life. Plastic surgery patients show a degree of appearance-related distress higher than general population, especially patients undergoing rhinoplasty. Relationship between patient-reported outcome after rhinoplasty and self-consciousness of appearance needs further studies. The aim of this study is to investigate this correlation, considering the surgeon external evaluation as well.

Materials And Methods: A total of 50 consecutive patients underwent primary cosmetofunctional rhinoseptoplasty. Appearance-related distress and surgical outcome were assessed by DAS59 (Derriford Appearance Scale 59) and SCHNOS (Standardised Cosmesis and Health Nasal Outcomes Survey), administered before and after surgery. Follow-up period was 12 months. Third-party clinical outcome was evaluated by three plastic surgeons by a scale ranging from 1 (poor outcome) to 5 (excellent outcome).

Results: A first division in Group 1 (satisfied) and Group 2 (unsatisfied) was done. DAS59 mean score in Group 1 showed to be statistically lower than Group 2 (p value < 0.05). Spearman's test showed a large strong positive correlation between preoperative and postoperative DAS59 and SCHNOS-C score variations (Delta 0-12 months) (r = 0.7514, p<0.001), as well as between DAS59 and SCHNOS-O (r = 0.5117, p<0.001) and between SCHNOS-C and SCHNOS-O (r = 0.6928, p<0.001).

Conclusion: Rhinoseptoplasty has a significant impact on the patient self-consciousness of appearance, in both negative and positive terms. We emphasize the surgeon's burden, who need to carefully assess and address the patient's expectations during the first evaluation. This distinction is crucial since unrealistic expectations may lead to dissatisfaction even after a properly performed procedure.

Level Of Evidence Iv: 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).