Association Between Psychiatric Diagnoses and Revision Cosmetic Rhinoplasty

Overview

Little evidence exists on how often patients with psychiatric diagnoses undergo revision cosmetic rhinoplasty. The authors queried adult patients at a single institution operated on between December 1979 and June 2024, excluding non-cosmetic cases and anyone with nasal trauma, tumour, cleft lip or palate, or a congenital nasal deformity. Patients were split by whether they carried a psychiatric diagnosis.

Sections of note

• Design: retrospective single institution cohort study spanning about 45 years.
• The initial query found 1110 patients; 961 remained after exclusions, 135 with a psychiatric diagnosis and 826 without.
• The cohort was 75 percent female, 724 of 961, with a mean age of 48 years, standard deviation 15.
• Patients with at least one revision: 24 of 135, 18 percent, in the psychiatric group versus 95 of 826, 12 percent, in controls, p equal to 0.04.
• Age 46 or over and female gender were found to predict revision cosmetic rhinoplasty.
• Other stated outcomes were mean revisions per patient, satisfaction after secondary rhinoplasty, and a breakdown by specific psychiatric diagnosis, none of which are reported in the abstract.
• Stated conclusion: patients with psychiatric diagnoses had higher revision rates.

What it means for a patient

• The difference is real but modest: roughly 1 in 5.5 versus 1 in 8 patients returning for a further operation.
• Age and sex also predicted revision, so a psychiatric diagnosis is one factor among several rather than the dominant one.
• Psychiatric diagnosis here is a broad category recorded in charts, not a specific condition such as body dysmorphic disorder.
• Limits: retrospective, one institution, records spanning 45 years during which practice changed substantially, and revisions performed elsewhere would not be captured.

Why this paper matters

Whether mental health history should influence candidacy for cosmetic surgery is contested, and most evidence concerns body dysmorphic disorder specifically. Measuring revision rates across all psychiatric diagnoses gives a broader picture. It cannot say whether the extra revisions were driven by the diagnosis or by other differences between the groups.

Terms

• Revision cosmetic rhinoplasty: a further operation to change the result of an earlier cosmetic one.
• Psychiatric diagnosis: any recorded mental health condition.
• Cohort study: research following defined groups and comparing their outcomes.
• Exclusion criteria: the rules determining which patients are left out of a study.
• Congenital nasal deformity: an abnormality of nasal shape present from birth.