A Multidisciplinary Approach to Rhinoplasty: The Facial Plastic Surgeon and the Psychologist

Abstract

Introduction

Rhinoplasty is one of the most frequently requested aesthetic procedures. However, a subset of patients presents with complex psychological profiles that can adversely impact surgical outcomes. Early psychological assessment is crucial to optimizing patient safety and satisfaction.

Objectives and Hypotheses

This narrative review aims to explore the role of integrated psychological assessment within multidisciplinary facial plastic surgery services. It hypothesizes that early psychological input improves patient selection, manages expectations, and reduces revision rates.

Study Design

Narrative review.

Methods

We conducted a structured narrative review of PubMed/MEDLINE, PsycINFO, Embase, and Scopus (from inception to June 2025), supplemented by clinical experience from a high-volume United Kingdom rhinoplasty center. Search terms included rhinoplasty, psychology, BDD, screening, and multidisciplinary care. Eligible sources comprised peer-reviewed studies, reviews, and guidelines on psychological assessment or outcomes in aesthetic rhinoplasty.

Results

Integrated psychological assessment can identify patients at risk of dissatisfaction, enhance patient selection, reduce revision surgeries, and improve overall outcomes.

Conclusion

Multidisciplinary collaboration between surgeons and psychologists improves rhinoplasty outcomes, enhances patient safety, and supports the ethical principle of nonmaleficence.

Keywords

rhinoplasty - plastic surgery - psychology - body dysmorphic disorders - multidisciplinary team

Publikationsverlauf

Eingereicht: 02. Mai 2025

Angenommen nach Revision: 05. November 2025

Artikel online veröffentlicht:
17. November 2025

• References

• 1 Hashemi M, Sakhi N, Ghazavi H. et al. Effects of aesthetic rhinoplasty on quality of life, anxiety/depression, and self-esteem of the patients. Eur J Plast Surg 2020; 43: 153-158
• 2 Sözen TS, Tahir E, Cabbarzade C, Kuşçu O. Factors determining patient satisfaction in rhinoplasty: analysis of 506 cases with rhinoplasty outcome evaluation. Acta Medica (Cordoba) 2017; 48: 1-5
• 3 Unadkat SN, Saleh HA. Restoring balance and symmetry to the aging nose. Facial Plast Surg 2021; 37 (02) 205-210
• 4 Auer D. The experience of female patients seeking elective rhinoplasty surgery: a narrative inquiry [DProf thesis]. London: Middlesex University and Metanoia Institute; 2018
• 5 Smith TW, Nicassio PM. Psychological practice: Clinical application of the biopsychosocial model. Managing chronic illness: A biopsychosocial perspective. Washington, DC, US: American Psychological Association; 1995: 1-31
• 6 Tardy Jr ME, Dayan S, Hecht D. Preoperative rhinoplasty: evaluation and analysis. Otolaryngol Clin North Am 2002; 35 (01) 1-27 , v
• 7 Wahass SH. The role of psychologists in health care delivery. J Family Community Med 2005; 12 (02) 63-70
• 8 Naraghi M, Atari M, Asadollahi H. When aesthetics, surgery, and psychology meet: aesthetic nasal proportions in patients having rhinoplasty and normal adults. Surg J (NY) 2016; 2 (01) e44-e48
• 9 Litner JA, Rotenberg BW, Dennis M, Adamson PA. Impact of cosmetic facial surgery on satisfaction with appearance and quality of life. Arch Facial Plast Surg 2008; 10 (02) 79-83
• 10 Reilly MJ, Tomsic JA, Fernandez SJ, Davison SP. Effect of facial rejuvenation surgery on perceived attractiveness, femininity, and personality. JAMA Facial Plast Surg 2015; 17 (03) 202-207
• 11 Chauhan N, Warner JP, Adamson PA. Perceived age change after aesthetic facial surgical procedures quantifying outcomes of aging face surgery. Arch Facial Plast Surg 2012; 14 (04) 258-262
• 12 Payne H, Brooks S. Different strokes for different folks: the BodyMind approach as a learning tool for patients with medically unexplained symptoms to self-manage. Front Psychol 2018; 9: 2222
• 13 Economic and social costs of mental health problems. Accessed November 10, 2025 at: https://www.centreformentalhealth.org.uk/sites/default/files/2018-10/Economic_and_social_costs_2010.pdf
• 14 East C, Kwame I, Hannan SA. Revision rhinoplasty: what can we learn from error patterns? An analysis of revision surgery. Facial Plast Surg 2016; 32 (04) 409-415
• 15 Cassidy T. Stress, Cognition and Health. 1st ed.. Routledge; 1999.
• 16 Beauchamp TL, Childress JF. Principles of biomedical ethics. New York: Oxford University Press; 1979
• 17 Parker R. Women, Doctors and Cosmetic Surgery: Negotiating the ‘Normal’ Body. Basingstoke: Palgrave Macmillan; 2009
• 18 Constantian MB. Childhood Abuse, Body Shame, and Addictive Plastic Surgery: The Face of Trauma. New York and London: Routledge; 2019
• 19 Naraghi M, Atari M. Self-esteem and rhinoplasty: a case-control study. Plast Aesthet Res 2016; 3: 111
• 20 Borah G, Rankin M, Wey P. Psychological complications in 281 plastic surgery practices. Plast Reconstr Surg 1999; 104 (05) 1241-1246
• 21 van der Kolk BA. The body keeps the score: Brain, mind, and body in the healing of trauma. Viking; 2014
• 22 Levine PA. In an unspoken voice: how the body releases trauma and restores goodness. Berkeley, CA: North Atlantic Books; 2010
• 23 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, ed 5. Washington, DC: American Psychiatric Association; 2013
• 24 Veale D, De Haro L, Lambrou C. Cosmetic rhinoplasty in body dysmorphic disorder. Br J Plast Surg 2003; 56 (06) 546-551
• 25 Woolley AJ, Perry JD. Body dysmorphic disorder: prevalence and outcomes in an oculofacial plastic surgery practice. Am J Ophthalmol 2015; 159 (06) 1058-1064.e1
• 26 Anderson RC. Body dysmorphic disorder: recognition and treatment. Plast Surg Nurs 2003; 23 (03) 125-128 , quiz 129
• 27 Andretto Amodeo C. The central role of the nose in the face and the psyche: review of the nose and the psyche. Aesthetic Plast Surg 2007; 31 (04) 406-410
• 28 Crerand CE, Phillips KA, Menard W, Fay C. Nonpsychiatric medical treatment of body dysmorphic disorder. Psychosomatics 2005; 46 (06) 549-555
• 29 Greenberg JL, Limoncelli KE, Wilhelm S. Body Dysmorphic Disorder by Proxy. In: Philips KA. ed. Body Dysmporphic Disorder: Advances in Clinical Practice. New York: Oxford University Press; 2017: 95-102
• 30 Wilhelm S, Phillips KA, Steketee G. Cognitive-behavioral therapy for body dysmorphic disorder: A treatment manual. Guilford Press; 2013
• 31 Sarwer DB, Wadden TA, Pertschuk MJ, Whitaker LA. The psychology of cosmetic surgery: a review and reconceptualization. Clin Psychol Rev 1998; 18 (01) 1-22
• 32 Royal College of Surgeons of England. Professional standards for cosmetic surgery. London: Royal College of Surgeons; 2016
• 33 American Society of Plastic Surgeons. Evidence-based clinical practice guidelines [Internet]. Arlington Heights (IL): ASPS; ; [cited 2025 Mar 28]. Accessed November 10, 2025 at: https://www.plasticsurgery.org/for-medical-professionals/quality/evidence-based-clinical-practice-guidelines
• 34 Royal College of Physicians and Surgeons of Canada. Entrustable professional activities for plastic surgery. Ottawa (ON): RCPSC; 2020. . Accessed November 10, 2025 at: https://www.royalcollege.ca
• 35 Medical Board of Australia. Guidelines for registered medical practitioners who perform cosmetic surgery and procedures. Canberra (AU): Australian Health Practitioner Regulation Agency; 2023. [cited 2025 Apr 9]. Accessed November 10, 2025 at: https://www.medicalboard.gov.au/Codes-Guidelines-Policies/Cosmetic-surgery-guidelines.aspx
• 36 Phillips KA, Atala KD, Pope HG. Diagnostic Instruments for Body Dysmorphic Disorder. Miami, FL: New Research, Programs and Abstracts; 1995
• 37 Alsarraf R. Outcomes research in facial plastic surgery: a review and new directions. Aesthetic Plast Surg 2020; 44 (04) 1210-1215
• 38 Lohuis PJFM, Hakim S, Duivesteijn W, Knobbe A, Tasman AJ. Benefits of a short, practical questionnaire to measure subjective perception of nasal appearance after aesthetic rhinoplasty. Plast Reconstr Surg 2013; 132 (06) 913e-923e
• 39 Moubayed SP, Ioannidis JPA, Saltychev M, Most SP. The 10-item standardized cosmesis and health nasal outcomes survey (SCHNOS) for functional and cosmetic rhinoplasty. JAMA Facial Plast Surg 2018; 20 (01) 37-42