Psychosocial Factors Surrounding Aesthetic Rhinoplasty: A Systematic Review

Nagy KK, Cushman CJ, Selby M, Salter WZ, Hernandez EJ, Daniele E, MacKay BJ, Demke JC.

PubMed 41541245 Publisher (DOI)Free full text (PMC)

What this paper says

A systematic review of studies from 2000 to 2024 finds that patients with pre-existing body dysmorphic disorder, anxiety or depression consistently report lower satisfaction after aesthetic rhinoplasty even when the surgery is technically successful.

Overview

A patient's psychological state before surgery shapes how they judge the result. Following PRISMA, the authors searched PubMed, Cochrane and Embase for studies from January 2000 to August 2024 linking psychosocial characteristics, preoperative mental health and postoperative satisfaction in aesthetic rhinoplasty. The number of included studies is not stated in the abstract.

Sections of note

Body dysmorphic disorder, anxiety and depression were consistently associated with lower satisfaction despite good technical outcomes.
Patient-reported outcomes showed that psychological readiness, social context and expectation setting influenced perceived results.
Reduced psychosocial functioning predicted reduced satisfaction.
The authors recommend thorough preoperative mental health assessment to identify modifiable factors.

What it means for a patient

If you are depressed, anxious or preoccupied with a perceived flaw, a technically excellent rhinoplasty is less likely to make you happy with your nose.
Addressing these before surgery, or postponing surgery, may improve the eventual result.
A mental health question in the consultation is evidence-based, not a formality.

Why this paper matters

It consolidates two decades of evidence on the psychology of satisfaction. Limits: number and quality of included studies not given in the abstract; heterogeneous measures.

Terms

Body dysmorphic disorder (BDD): preoccupation with a perceived flaw that others see as minor.
Psychosocial: relating to psychological state and social circumstances together.
Patient-reported outcome measure: a validated questionnaire completed by the patient.
Expectation management: aligning what a patient hopes for with what surgery can achieve.

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

Abstract

Background: Rhinoplasty, widely known to improve form and function, is growing in popularity for both cosmetic and functional purposes. The preexisting psychosocial state of a patient significantly affects the perceived outcome of aesthetic rhinoplasty, even when surgery is technically successful. Given the elevated rates of distress, depression, social dysfunction, and body dysmorphic disorder among candidates, psychosocial optimization is essential.

Methods: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies published from January 2000 to August 2024 examining associations between aesthetic rhinoplasty outcomes and psychological factors were identified through PubMed, Cochrane Library, and Embase. Eligible studies evaluated psychosocial characteristics, preoperative mental health status, and postoperative satisfaction.

Results: Patients with preexisting mental health conditions, including body dysmorphic disorder, anxiety, and depression, consistently reported lower postoperative satisfaction despite technically successful results. Patient-reported outcome measures demonstrated that psychological readiness, social context, and expectation setting significantly influenced perceived outcomes. Individuals with diminished psychosocial functioning were more likely to experience reduced postoperative satisfaction, underscoring the interplay between psychological pathology and subjective assessment of surgical success.

Conclusions: Evaluating patient motivations, expectations, and psychosocial readiness allows physicians to better predict satisfaction and improve expectation management. Incorporating a thorough preoperative mental health assessment can help identify modifiable psychosocial factors and optimize outcomes for patients pursuing aesthetic rhinoplasty.

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