Azabache Protocol®: An Integrated Psychological and Ethical Evaluation Framework for Rhinoplasty Candidates

Díaz RA, Robles J.

PubMed 41361150 Publisher (DOI)Free full text (PMC)

What this paper says

The authors present a trademarked pre-rhinoplasty screening framework combining emotional typology, standard scales and ethical criteria, and state that its use has reduced emotional dissatisfaction and complaints in their practice.

Overview

Dissatisfaction after rhinoplasty is often unrelated to the technical result. Based on more than a decade of clinical observation, Diaz and Robles describe the Azabache Protocol, an algorithm for surgeons that combines an emotional typology of patients, subjective evaluation tools, standardised aesthetic and emotional scales, and ethical decision criteria. No patient numbers or comparative data are reported; Level of Evidence V.

Sections of note

Components: emotional typology, subjective evaluation tools, standardised aesthetic and emotional scales, ethical criteria.
Purpose: identify risk profiles, guide communication, support ethical surgical decisions.
Reported effect: fewer emotional dissatisfaction complaints and postoperative conflicts, "even in technically successful cases."
Presented as surgeon-friendly and structured.

What it means for a patient

Some surgeons now use formal psychological screening before agreeing to operate; this is one such system.
The claimed benefits are the authors' experience, not measured outcomes.
The protocol name is trademarked, which readers should weigh when judging the evidence.

Why this paper matters

It adds to a growing set of structured pre-surgical psychological assessments for aesthetic surgery. Limits: expert opinion, no data, proprietary.

Terms

Patient selection: deciding which candidates are suitable for surgery.
Emotional typology: classifying patients by emotional style and motivation.
Ethical criteria: principles such as not operating when harm is likely to exceed benefit.
Level of Evidence V: expert opinion.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

Background: Patient dissatisfaction after rhinoplasty is often unrelated to surgical outcomes but rather to unrecognized psychological and ethical variables. Despite advances in technique, instruments, and aesthetic analysis, the emotional dimension of patient selection remains underexplored. The Azabache Protocol® was conceived as an integrated framework for psychological and ethical evaluation prior to rhinoplasty, aiming to improve preoperative decision-making and reduce postoperative conflicts.

Methods: Based on more than a decade of clinical observation, the protocol combines emotional typology, subjective evaluation tools, standardized aesthetic and emotional scales, and ethical criteria. It provides surgeons with a structured, surgeon-friendly algorithm to identify risk profiles, guide communication, and support ethical surgical decisions.

Results: Clinical application of the Azabache Protocol® has demonstrated a decrease in emotional dissatisfaction and postoperative complaints, even in technically successful cases. The framework enhances patient-surgeon understanding and reinforces the ethical dimension of aesthetic surgery by transforming preoperative evaluation into a multidimensional process.

Conclusions: The Azabache Protocol® introduces a pragmatic, structured, and ethically grounded approach to psychological assessment in rhinoplasty. By systematizing preoperative emotional analysis, it complements traditional aesthetic planning and contributes to a more responsible, human-centered practice of facial surgery.

Level Of Evidence V: 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).