APS Aesthetic Plastic Surgery · 2024

Rhinoplasty Preferences: Can the Public Detect Prior Surgery on Social Media?

Valentine L, Weidman AA, Stearns SA, Dennis D, Alvarez AH, Foppiani J, Lin SJ.

PubMed 38286896 Publisher (DOI)Free full text (PMC)

What this paper says

Among 456 survey respondents shown rhinoplasty photographs, people could tell surgery had been done only when a visible defect remained, and believing a nose had been operated on lowered their rating of it.

Overview

A rhinoplasty result that looks natural and proportional matters for satisfaction. The authors tested whether members of the public can spot a nose that has been operated on, and how that belief affects their judgment. A survey distributed through the Amazon Mechanical Turk platform showed nine rhinoplasty patients before and after surgery, and asked respondents to rate appearance, identify abnormalities and say whether they thought surgery had occurred.

Sections of note

Design: online public survey, 456 responses included. Level of evidence IV.
Nine patients were shown, each before and after surgery.
Ratings ran 1 to 5, with 5 most aesthetically pleasing.
Highest rated: a postoperative patient with no visible deformity, 3.95, then a postoperative patient with a bulbous tip, 3.48.
Lowest rated: a prior rhinoplasty with saddle nose deformity, 3.02, and one with nasal trapezoid deformity, 2.95.
Respondents correctly identified prior surgery only when a resulting defect was present.
When respondents believed surgery had occurred, their average rating was lower than when they did not, 3.74 versus 4.15, p less than 0.0001.

What it means for a patient

A well healed rhinoplasty was not detectable to lay observers in this survey.
The belief that a nose had been operated on lowered its rating even when no defect was present, so the perception itself carries a penalty.
Visible defects listed as giveaways include a remaining hump, an over-rotated tip and collapse of the middle of the nose.
Limits: nine patients, an online crowdworker panel that may not represent the general public, and static photographs rather than faces in motion.

Why this paper matters

Whether a nose reads as operated on is a stated goal of most rhinoplasty patients, and it has rarely been measured on the public rather than on surgeons. The finding that the assumption of surgery lowers ratings independently of the result supports the widely stated aim of an unoperated look. Which specific features trigger that perception is only partly identified.

Terms

Saddle nose deformity: a collapsed bridge that dips in the middle.
Bulbous tip: a rounded, poorly defined nasal tip.
Over-rotated tip: a tip turned up more than intended.
Mid-vault collapse: inward collapse of the middle third of the nose.
Amazon Mechanical Turk: an online platform where people are paid to complete short tasks such as surveys.

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

Abstract

Background: The creation of postoperative rhinoplasty results that appear natural and proportional to the face are crucial for patient satisfaction. The purpose of this study was to assess the public's ability to detect a post-rhinoplasty result and preference of preoperative and postoperative rhinoplasty outcomes.

Methods: A survey was distributed using the Amazon Mechanical Turk online platform showing nine preoperative and postoperative rhinoplasty patients. Participants rated aesthetic appearance, identified areas of abnormality, and stated whether they believed the patient had undergone prior rhinoplasty.

Results: A total of 456 responses were included. On a scale of 1-5 with 5 being the most aesthetically pleasing, the highest rated nose was a postoperative patient without visible deformities (3.95, SD 1.07) followed by the postoperative patient with a resultant bulbous tip (3.48, SD 0.96). The lowest ranking noses were the prior rhinoplasty with resultant saddle nose deformity (3.02, SD 1.19) and the prior rhinoplasty with nasal trapezoid deformity (2.95, SD 1.04). The public was able to correctly determine if patients had prior rhinoplasty surgery only if there were resultant defects. When respondents believed that the patient had undergone prior rhinoplasty, their average rating was lower than those who believed they had not undergone surgery (3.74/5 vs. 4.15/5, p < 0.0001).

Conclusions: The belief that someone had previously undergone rhinoplasty led the public to rate the aesthetic appearance of the nose lower. To provide optimal results following rhinoplasty, surgeons may therefore seek to provide a natural, "un-operated" look.

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 . Differences for nasal aesthetic preferences exist and vary based on geographic region The public is unable to discern if a patient previously underwent rhinoplasty if the result does not show a postoperative defect, such as a dorsal hump, over-rotated tip, or mid-vault collapse Oppositely, the public can generally tell if patients have undergone rhinoplasty surgery if a postoperative deformity is present The belief that someone had rhinoplasty surgery negatively impacts the attractiveness ranking of the nose, even without any postoperative defects present.

Abstract as indexed by PubMed; the article is open access (PubMed Central).