Abstract
The stigma of nasal deformity due to a congenital cleft lip–palate has an undeniable
influence on the affected patient's life. It is therefore of interest to investigate
if efforts to reduce esthetic and functional impairments by rhinoplasty (single or
multiple) can result in an increased satisfaction with appearance and a self-perception
similar to the noncleft population. Retrospective scoring before and after rhinoplasty
using the validated Derriford Appearance Scale (DAS-59) and subsequent statistical
evaluation and comparison to datasets available in the literature for further classification
was used. Of the 61 patients who underwent at least one rhinoplasty, 26 responded
to all questions. The mean age of responders was approximately 30 years of age and
the male:female ratio was 1:1.2. The scale showed a significant overall improvement
after surgery. The full scale and all subscale scores of the DAS-59 were significantly
reduced after surgery demonstrating an improvement in the respective categories. Most
importantly, if postoperative results were compared with a population concerned and
unconcerned about appearance, no difference “facial self-consciousness” of appearance
was apparent. Also postoperative subscores for “general self-consciousness” (GSC)
and “social self-consciousness” of appearance (SSC) showed no difference from those
obtained from the population concerned about appearance. The postoperative subscore
for “sexual and bodily self-consciousness” of appearance (SBSC) indicated improvement
beyond the level found in the concerned control population. Due to only a low improvement
in the difference compared with the subscore representing a “negative self-concept,”
a statistically significant difference to the concerned population remained, possibly
indicating that therapy beyond surgery is needed for improvement. After rhinoplasty,
the investigated group of cleft lip–palate patients with nasal deformities showed
an improvement in their self-conceived appearance as measured by the DAS-59. Their
assessment of self-appearance was comparable to that of a group of noncleft persons
with concern about their appearance. Taken together, rhinoplasties, primary and revision,
add to the psychosocial well-being and an improved self-perception enhancing quality
of life and enabling a more normal life. Further research is needed to clarify how
the low reduction found in the “negative self-concept” may be addressed successfully.
Keywords
revision rhinoplasty - outcome evaluation - cleft lip - cleft palate - self-perception
