A Systematic Review of Randomized Control Trials on Patient-Reported Outcome Measures in Rhinoplasty

Overview

Patient reported outcome measures are central to judging rhinoplasty results, yet no standardized validated instrument exists that is tailored to the operation. The authors examined which measures are actually used in randomized trials and where they fall short. The review followed PRISMA reporting standards with the protocol registered in advance, and assessed bias with the Cochrane tool and study quality with GRADE.

Sections of note

• Design: systematic review of randomized controlled trials, protocol registered a priori.
• 12 randomized trials covering 743 patients were analyzed.
• Mean follow up 9.1 months; mean patient age 35.35 years; male to female ratio 1 to 1.91.
• Ten distinct patient reported outcome measures were identified across the trials.
• FACE-Q was the most robust instrument, meeting 19 of 21 development standards.
• FACE-Q lacks the ability to assess functional outcomes critical to rhinoplasty, including airway function and breathing.
• Stated conclusion: current tools do not address both appearance and function, so refinement or a dedicated instrument is needed.

What it means for a patient

• Ten different questionnaires across twelve trials means results cannot be compared between studies.
• The best validated instrument measures only how the nose looks, while most rhinoplasty patients also care how it breathes.
• Mean follow up of about nine months is short for judging a result that continues changing for a year or more.
• The review assesses the measuring tools rather than the operations, so it says nothing about which technique works better.

Why this paper matters

Rhinoplasty outcome research cannot be pooled while every study uses a different questionnaire, and this review quantifies that fragmentation within the strongest study designs available. Identifying that even the best instrument omits breathing explains why appearance and function are so rarely reported together. No replacement instrument is proposed here.

Terms

• Patient-reported outcome measure: a questionnaire completed by the patient rather than the clinician.
• FACE-Q: a validated questionnaire measuring satisfaction with facial appearance.
• PRISMA: a checklist governing how systematic reviews are searched and reported.
• GRADE: a system for rating the certainty of evidence.
• Risk of bias: the extent to which a study's design could distort its results.
• Validated instrument: a questionnaire tested to confirm it measures what it claims consistently.