An Audit of Outcomes in Cosmetic Rhinoplasty with the Mandatory Psychiatric Evaluation Protocol

Overview

This is the third article in the authors' series on the psychology of rhinoplasty. They set out to answer two questions: what the success rate in cosmetic rhinoplasty is, and how to identify candidates likely to do well. Patients with any functional concern or other factor that could influence satisfaction with cosmetic surgery were excluded, leaving a group selected through mandatory psychiatric evaluation.

Sections of note

• Design: outcome audit of a selected practice cohort.
• 184 patients met inclusion criteria: 144 women and 40 men, aged 16 to 63, mean 31.09 years. Follow up ranged from 3 to 122 months, mean 70.18 months.
• Outcomes measured with a visual analog scale and a 5-point Likert scale.
• Mean visual analog score rose from 4.26 before surgery to 8.47 after, an improvement of 4.23.
• 95.1 percent were happy or very happy: 77.2 percent very happy scoring 8 to 10, and 21.2 percent happy scoring 6 to 7.9. 3.3 percent were neutral and 1.6 percent unhappy.
• The authors state that a proportion of unhappy outcomes persists despite the protocol.

What it means for a patient

• Satisfaction was high and held over a mean of nearly six years, which is longer follow up than most rhinoplasty series report.
• Roughly one patient in twenty was still not satisfied even after psychiatric screening and exclusion of complicating factors.
• The cohort was heavily filtered: purely cosmetic cases, no functional concerns, and psychiatric clearance, so the figure describes a selected group rather than all rhinoplasty patients.
• Limits: single practice, no comparison group operated without the protocol, and satisfaction scored on scales administered by the treating practice.

Why this paper matters

Reported rhinoplasty satisfaction rates vary widely, partly because practices define and select their patients differently. Reporting a rate alongside an explicit selection protocol and long follow up makes the number interpretable. Whether the protocol itself raises satisfaction cannot be judged without a comparison group.

Terms

• Mandatory psychiatric evaluation: a required assessment by a psychiatrist before surgery is offered.
• Visual analog scale: a line on which severity or satisfaction is marked.
• Likert scale: a response format where a rater chooses along a graded range.
• Audit: a systematic review of the results of a defined clinical practice.
• Inclusion criteria: the rules determining which patients enter a study.